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In re S.M.

Court of Appeals of Iowa

March 7, 2018

IN THE MATTER OF S.M., Alleged to be Seriously Mentally Impaired, S.M., Respondent-Appellant.

         Appeal from the Iowa District Court for Johnson County, Chad A. Kepros, Judge.

         An inmate diagnosed with schizophrenia appeals the district court order finding him to be seriously mentally impaired under Iowa Code chapter 229 (2017).

          Sandra R. Hart of Hart Law, North Liberty, for appellant.

          Thomas J. Miller, Attorney General, and Gretchen W. Kraemer, Assistant Attorney General, for appellee State.

          Considered by Doyle, P.J., and Tabor and McDonald, JJ.

          TABOR, Judge.

         Convicted 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.

         I. Facts and Prior Proceedings

         S.M.'s 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 own church.

         DOC 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."

         In 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."

         Dr. 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.

         On 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.

         The 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 ...


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