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In re S.J.

Court of Appeals of Iowa

October 24, 2018

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

          Appeal from the Iowa District Court for Woodbury County, Jeffrey L. Poulson, Judge.

         S.J. appeals involuntary-commitment orders under Iowa Code chapters 125 and 229 (2018).

          Zachary S. Hindman of Mayne, Hindman, & Daane, Sioux City, until withdrawal, and then Jason B. Gann of Moore, Heffernan, Moeller, Johnson & Meis, LLP, Sioux City, for appellant.

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

          Considered by Vaitheswaran, P.J., and Doyle and Mullins, JJ.

          MULLINS, Judge.

         S.J. appeals involuntary-commitment orders under Iowa Code chapters 125 and 229 (2018). She argues the district court's findings that she suffers from a substance-related disorder, as provided in Iowa Code sections 125.2(14) and 125.75(2)(a), and a serious mental impairment, as defined in section 229.1(20), are not supported by sufficient evidence.[1]

         I. Background Facts and Proceedings

         In February 2018, hospital staff filed applications in the district court alleging S.J. to be a person with a serious mental impairment and substance-related disorder. The applications and supporting affidavits noted S.J. was brought to the hospital due to hallucinations and, over the previous several days, she was unable to communicate and was walking around her house naked. At the hospital, S.J. tested positive for marijuana and PCP and exhibited "delusional and psychotic" behavior. When hospital staff asked S.J. about her children, she responded her kids "are in the hospital being born." S.J. also advised staff she takes her insulin by having sex. S.J. additionally stated to staff that she is "a judge or God" and at times believed she was dead or in heaven. The applications also alleged S.J. was assaultive and sexually inappropriate with others and required seclusion.

         The district court entered orders for immediate custody pursuant to Iowa Code sections 125.81 and 229.11 and ordered a personal examination of S.J. A psychiatrist examined S.J. on February 27 and authored reports reflecting his findings. As to the chapter 229 matter, the psychiatrist diagnosed S.J. with substance-induced psychosis and concluded that, because of the mental illness, S.J. lacks sufficient judgment to make responsible decisions with respect to her hospitalization or treatment. The psychiatrist opined S.J.'s mental impairment resulted from "recent delirium" and the impairment was treatable and could be "resolved when not using illicit drugs." The psychiatrist concluded that, as a result of her mental illness, S.J., if allowed to remain at liberty without treatment, was likely to physically injure herself or others, inflict serious emotional injury upon her family members, and be unable to satisfy her own personal needs.

         As to the chapter 125 matter, the psychiatrist diagnosed S.J. with the substance-related disorder of "cannabis use disorder with frequent episodes of usage, psychosis, delirium, and agitation" and concluded the disorder functionally impaired her in relation to "school and academic failure, as well as family, social, and medical problems." The doctor opined the disorder is treatable and S.J. would improve "when not using marijuana." The psychiatrist further opined that, without inpatient treatment, S.J. would likely injure herself or others, noting she was under the influence of marijuana when she overdosed on cold medicine.

         An evidentiary hearing on both applications was held on March 1. At the hearing, the psychiatrist testified what he learned of S.J. during his examination of her-she had overdosed on cold medicine prior to being brought to the hospital; she uses marijuana on a "fairly regular basis"; she uses cold medicine less often; and the use of cold medicine, either by itself or mixed with marijuana, "caused a state of delirium." As to the state of S.J.'s mental health, the psychiatrist testified:

As I recall, she really initially wasn't able to make any sort of decisions about herself. She, however, was able to recuperate very, very well. I actually chatted with her for a brief period of time this morning and she's doing exceedingly well from a medical standpoint. She was able to have a reasonable, logical conversation with me. [A]nd this was a young girl who was very, very sick.

         The psychiatrist went on to testify that, as a result of her substance-induced psychosis, S.J., if allowed to remain at liberty without treatment, was likely to physically injure herself or others, inflict serious emotional injury upon her family members, and be unable to satisfy her own personal needs. The psychiatrist based these conclusions on the fact that S.J. voluntarily took an excessive amount of cold medicine, which resulted in her "psychotic delirium" and could have resulted in death. Although the psychiatrist believed S.J. was doing "a lot better" at the time of the hearing than she was previously, he concluded she needed to be committed to inpatient treatment because if her desire for outpatient treatment was allowed, "she is at risk of going back and using some substance that has the potential of creating significant harm for her." The psychiatrist further testified S.J.'s cannabis use disorder functionally impairs her home and school life and her use of cannabis, together with cold medicine, resulted in a "life threatening event." The psychiatrist testified there is a "significant risk" S.J. will use ...


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