January 11, 2017
IN THE MATTER OF T.J., Alleged to Be Seriously Mentally Impaired, T.J., Respondent-Appellant.
from the Iowa District Court for Lucas County, Martha L.
appeals from the district court's order finding him to be
seriously mentally impaired. REVERSED.
C. Audlehelm of Audlehelm Law Office, Des Moines, for
J. Miller, Attorney General, and Gretchen W. Kraemer,
Assistant Attorney General, for appellee State.
Considered by Vogel, P.J., and Vaitheswaran and McDonald, JJ.
magistrate found T.J. seriously mentally impaired and ordered
him committed for inpatient treatment and, subsequently, for
outpatient treatment. T.J. appealed the order to the district
court, which affirmed the magistrate's decision following
an evidentiary hearing. The court ordered T.J. to
"remain under an out-patient commitment until further
order." On appeal, T.J. challenges the sufficiency of
the evidence supporting the district court's finding of a
"serious mental impairment."
Code section 229.1 (2016) defines "seriously mentally
impaired" as follows:
"Seriously mentally impaired" or "serious
mental impairment" describes the condition of a person
with mental illness and because of that illness lacks
sufficient judgment to make responsible decisions with
respect to the person's hospitalization or treatment, and
who because of that illness meets any of the following
a. Is likely to physically injure the person's self or
others if allowed to remain at liberty without treatment.
b. Is likely to inflict serious emotional injury on members
of the person's family or others who lack reasonable
opportunity to avoid contact with the person with mental
illness if the person with mental illness is allowed to
remain at liberty without treatment.
c. Is unable to satisfy the person's needs for
nourishment, clothing, essential medical care, or shelter so
that it is likely that the person will suffer physical
injury, physical debilitation, or death.
Iowa Code § 229.1(20). This definition contains three
elements: (1) mental illness, (2) lack of sufficient
judgment, and (3) the criteria labeled (a), (b), and (c),
which encompass the threshold requirement of dangerousness.
See In re Oseing, 296 N.W.2d 797, 800-01
(Iowa 1980) (analyzing predecessor statute). "[T]he
elements of serious mental impairment must be established by
clear and convincing evidence and the district court's
findings of fact are binding on us if supported by
substantial evidence." In re J.P., 574 N.W.2d
340, 342 (Iowa 1998); accord In re B.B., 826 N.W.2d
425, 428, 432 (Iowa 2013).
argues the record lacks substantial evidence to support a
finding of a mental illness. He notes that the psychiatrist
who testified at the district court hearing failed to include
a formal diagnosis in his report. The report, completed on a
form titled "Physician's Report of Examination
pursuant to 229.10(2), " was left blank under the
question "state diagnosis and support observations or
psychiatrist acknowledged he forgot to specify the diagnosis
under this particular question. But he listed the diagnosis
in the next question as "delusional [disorder]
persecutory type." At the district court hearing, he
testified to independently diagnosing T.J. with this
condition after observing him for several days. He characterized
the disorder as "similar to schizophrenia" but
without all the symptoms. The report constitutes substantial
evidence in support of a finding of mental illness.
to the question of whether T.J. had sufficient judgment to
make responsible decisions. The psychiatrist answered
"no" to this question, citing T.J.'s "poor
compliance and limited insight." He stated,
"[T]here is a big chance for him to stop his meds and
not follow up." At the hearing, the psychiatrist
affirmed this answer. The report constitutes substantial
evidence in support of a finding that T.J. lacked sufficient
judgment to make responsible decisions.
left with the element of dangerousness. As noted, this
element implicates the three statutory criteria set forth in
Iowa Code section 229.1 (20)(a), (b) and (c). The threat the
patient poses must be evidenced by a "recent overt act,
attempt or threat." In re Mohr, 383 N.W.2d 539,
542 (Iowa 1986).
psychiatrist reported that, in his judgment, it was
"hard to determine" whether T.J. was likely to
physically injure himself or others. He stated T.J. could be
released to the custody of a relative or friend without
danger to himself or others and, indeed, would "most
likely" be discharged the following day. In response to
the question whether T.J. was likely to inflict severe
emotional injury on those who could not avoid contact with
him, he responded "this is still possible but [on] his
medication, he has shown better behavior and social
interactions." Finally, he reported T.J. could be
treated on an outpatient basis because there was "no
suicidality or homicidality at this point" and he was
"able to take care of his [activities of daily
psychiatrist reaffirmed these opinions at the district court
hearing. He stated, T.J. "is not a danger to himself. He
is not suicidal or homicidal, but . . . it doesn't mean
that he will take his medications or go to his
appointments." This evidence does not amount to
substantial evidence in support of a finding of
State asks us to consider family affidavits proffered at the
time of the initial commitment. Those affidavits and the acts
attested to in them were not recent enough to establish that
T.J. was a danger to himself or others at the time of his
commitment hearing. See In re Foster, 426 N.W.2d
374, 378 (Iowa 1988) ("In the context of civil
commitment, . . . an 'overt act' connotes past
aggressive behavior or threats by the respondent manifesting
the probable commission of a dangerous act upon himself or
others that is likely to result in physical injury.");
In re S.S., No. 15-0494, 2015 WL 6508809, at *5
(Iowa Ct. App. Oct. 28, 2015) ("Although the doctor
noted S.S. got 'into arguments with family members'
and 'seem[ed] to be having significant difficulties with
family members, ' there is nothing to connote the
arguments to be evidence of aggressive behavior or threats
manifesting the probable commission of a dangerous act upon
others that is likely to result in physical injury.");
In re S.A.M., No. 04-0763, 2005 WL 292217, at *3
(Iowa Ct. App. Feb. 9, 2005) ("S.A.M.'s weight in
December of 2003 cannot reasonably be considered to be a
recent overt act showing that she was a danger to herself at
the time her commitment hearing was held in April
only other evidence that arguably could reflect dangerousness
is a reference to pending charges against T.J. on which he
was jailed. However, the record does not tell us why he was
jailed and whether violence was involved.
dangerousness was not proved, we reverse the civil commitment
 The original commitment order was
based on a report filed by another physician. The physician
who testified at the district court hearing and the earlier
commitment hearing worked with the other physician.