IN THE MATTER OF S.M., Alleged to be Seriously Mentally Impaired, S.M., Respondent-Appellant.
from the Iowa District Court for Johnson County, Chad A.
inmate diagnosed with schizophrenia appeals the district
court order finding him to be seriously mentally impaired
under Iowa Code chapter 229 (2017).
R. Hart of Hart Law, North Liberty, for appellant.
J. Miller, Attorney General, and Gretchen W. Kraemer,
Assistant Attorney General, for appellee State.
Considered by Doyle, P.J., and Tabor and McDonald, JJ.
of first-degree murder nearly forty years ago, S.M. is
serving a life sentence in the custody of the Iowa Department
of Corrections (DOC). S.M. has been treated for schizophrenia
during his prison stay. From 2000 until 2016 he was subject
to a civil commitment order as a means to enforce medication
compliance. Without that enforcement, S.M. resisted taking
his prescribed anti-psychotic drug and grew increasingly
delusional. When S.M.'s conspiracy theories progressed to
include prison staff and other inmates, and he discussed
"retaliation" against them, his treating
psychiatrist sought to renew the civil commitment. The
district court ordered S.M. to receive treatment within the
DOC at the outpatient level of care. S.M. appeals that order,
contending the State did not prove he posed a danger. In
light of his past actions, S.M.'s current threats and
physical posturing signaled the probable commission of a
harmful act upon himself or others likely to result in
physical injury; we find the dangerousness element satisfied.
Facts and Prior Proceedings
diagnosis of schizophrenia dates back to 1977 when he was
discharged from the military. S.M. admitted killing his
mother in 1978 by striking her head with a large concrete
lawn ornament. At his trial, S.M. claimed he suffered from a
psychosis aggravated by drug and alcohol use. He nevertheless
received a sentence of life without parole. Early in his
prison term, around 1984, S.M. engaged in self-mutilation,
cutting his testicles with a razor. He also got into two
fights with fellow inmates during the 1980s. He attempted
suicide in the late 1990s. The DOC records indicate S.M. has
exhibited ongoing delusions and fixations involving
"biker gang wars" and "rock and roll wars,
" as well as conspiracy theories about murders across
the country. At times, his delusions have been categorized as
hyper-sexual and hyper-religious, including his declaration
of a "holy war" in which he was the leader of his
psychiatrist Gary Keller noted S.M. had "a long history
of not complying with medications and treatment, so had been
on a long acting injectable medication, haloperidol, for many
years." Because of his non-compliance, from 2000 until
2016, S.M. was under a mental health civil commitment at the
Clarinda Correctional Facility, where he was incarcerated. In
May 2017, the DOC transferred S.M. back to the Iowa Medical
and Classification Center (IMCC) so that his mental illness
could be better monitored and managed. According to Dr.
Keller, since the commitment ended, S.M. "has refused
his medication for treatment of his schizophrenia" and
"has deteriorated in regard to his delusional
system." Dr. Keller found S.M.'s illness has grown
"much more prominent in his interactions."
early August 2017, S.M. became convinced a corrections
officer on his unit, as well as other inmates, were involved
in a conspiracy involving the death of S.M.'s father.
While on the prison yard, staff overheard S.M. discussing the
conspiracy and bringing up "retaliation." S.M. also
spoke of a "genocide scenario." In the same time
period, S.M. wrote a note discussing his father's death
which, according to Dr. Keller's recollection, stated
"quote, they should pay for what they've done."
S.M. named a particular offender in the note and also
"incorporated" officers in S.M.'s living unit
and acute mental health unit into his conspiratorial
thinking. In a follow-up discussion with Dr. Keller, S.M.
engaged in "even more delusional talk." Meanwhile,
fellow inmates expressed unease about S.M.'s compulsive
pacing and his aggressive demeanor. Dr. Keller also received
reports S.M. displayed "increased irritability" and
intimidated other inmates when he "often flexes and
tenses up in mannerisms as if he is ready to strike
out." Dr. Keller opined S.M. was "starting to act
on his delusional thinking."
Keller feared not only for the inmates and staff who came in
contact with S.M. at the prison but also was concerned that
S.M.'s manifestations of his schizophrenia were
threatening S.M.'s own health. S.M. would exercise to the
point of developing sores on his hands and feet and allowed
his personal hygiene to decline. S.M. also was reluctant to
rehydrate because he believed the water at the prison was
contaminated. According to Dr. Keller, S.M. was not only
refusing his anti-psychotic medication, but S.M.'s
compliance with taking other prescribed medications for
physical maladies had waned.
August 7, 2017, a social worker at the IMCC filed an
application for an order of involuntary hospitalization with
S.M. as the respondent. Dr. Keller filed a physician's
report outlining his concerns about S.M.'s mental health
and increasing threats toward staff and fellow inmates. After
a hearing, a judicial hospital referee found S.M. to be
seriously mentally impaired within the meaning of Iowa Code
chapter 229 (2017). S.M. appealed and the district court held
a hearing on September 12, 2017. Dr. Keller testified that
the point of the mental-health commitment was to enable staff
to administer medication notwithstanding S.M.'s
objection. Dr. Keller said S.M. had "incorporated"
different officers on the living unit and on the acute
mental-health unit into his conspiracy theories. Plus, peers
indicated they were concerned about S.M.'s demeanor and
avoided interactions with him. S.M. also testified, telling
the court he "doesn't believe [he] is
schizophrenic." S.M. testified he dislikes the side
effects of the anti-psychotic medication, which makes him
lethargic, shaky, and restless.
district court affirmed the finding of the judicial
hospitalization referee, noting that during S.M.'s
testimony "he quickly reverted to the delusional and
conspiratorial thinking that Dr. Keller had described in his
testimony. The Court agrees with Dr. Keller that [S.M.]
represents a danger to himself and others at this ...