Opinion
No. 3-547 / 02-2052
Filed August 13, 2003
Appeal from the Iowa District Court forStory County, William C. Ostlund, Judge.
P.D. appeals the denial of his petition for writ of habeas corpus seeking his release from involuntary commitment. AFFIRMED.
Jennifer Paullin of Paullin Law Office, Kelley, for appellant.
Stephen Holmes, County Attorney, and Richard Early, Assistant County Attorney, for appellee.
Considered by Vogel, P.J., and Mahan and Zimmer, JJ.
P.D. appeals the denial of his petition for writ of habeas corpus seeking his release from involuntary commitment. We affirm.
Background Facts and Proceedings.
Following an October 16, 2000, hearing, P.D. was placed at the Mary Greeley Medical Center in Ames due to serious mental impairment. The physician's report of examination at that time noted delusions, minimal personal hygiene, and bizarre behavior. A series of subsequent out-patient treatments and involuntary commitments ensued. Following a rapid deterioration in his mental status, P.D. was again hospitalized at the end of March 2002. On April, 16, 2002, pursuant to a recommendation by Dr. James Trahan, the district court placed P.D. at Cedar Lane Estates residential treatment facility.
On November 18, 2002, P.D. filed a "Writ of Habeas Corpus," pursuant to Iowa Code section 229.37 (2001), seeking to obtain his release from involuntary commitment. He alleged that his mental condition had improved such that he is no longer in need of in-patient treatment. Following a hearing, the district court ordered that P.D. should remain in placement at the Cedar Lane Estates. The court first noted P.D.'s extensive history of mental illness and court intervention. The court found evidence that P.D.'s condition had worsened in the past year and pointed to inappropriate behavior and responses as recently as November of 2002. P.D. seeks review of this ruling.
Standards of Review.
An involuntary commitment proceeding is a special action triable to the court as an ordinary action at law. In re Oseing, 296 N.W.2d 797, 800-01 (Iowa 1980). Accordingly, we review challenges to the sufficiency of the evidence for errors at law. Iowa R.App.P. 6.4. The 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. See In re Foster, 426 N.W.2d 374, 376 (Iowa 1988). Clear and convincing evidence is more than a preponderance of the evidence but less than evidence beyond a reasonable doubt . In re N.C., 551 N.W.2d 872, 873 (Iowa 1996). Evidence is substantial if a reasonable trier of fact could conclude the findings were established by clear and convincing evidence. In re J.P., 574 N.W.2d 340, 342 (Iowa 1998).
Analysis.
A person who is "seriously mentally impaired" may be the subject of an involuntary civil commitment. Iowa Code § 229.6. The Code defines "seriously mentally impaired" as:
" 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 criteria:
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 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.
That P.D. suffers from a serious mental impairment is not contested on appeal. In fact, in P.D's brief he stipulates to the finding of mental illness. However, despite this stipulation, he maintains he does not meet any of the remaining criteria for keeping him committed. In particular, P.D. contends the record does not contain substantial evidence that he lacks judgmental capacity regarding treatment and that he is likely to inflict serious emotional injury on others or is a danger to himself or others.
This stipulation comes on appeal despite P.D.'s claim at the hearing on this matter that he does not suffer from a mental illness.
As our supreme court discussed in B.A.A. v. Chief Med. Officer, Univ. of Iowa Hosp., 421 N.W.2d 118, 124 (Iowa 1988), the concept of "dangerousness" is a constitutionally necessary requisite for keeping a mentally ill individual confined. The court has also noted the endangerment element "requires a predictive judgment, based on prior manifestations but nevertheless ultimately grounded on future rather than past danger." In re Mohr, 383 N.W.2d 539, 542. (Iowa 1986). The danger the person poses to himself or others must be evidenced by a "recent overt act, attempt or threat." Id.
Our review of the record convinces us substantial evidence supports the district court's conclusion P.D. both lacks judgmental capacity regarding treatment and is likely to inflict serious emotional injury on members of his family or others who lack reasonable opportunity to avoid contact with him. First, because P.D. considers himself to not have a mental illness, we question whether he can effectively administer his treatment. One who does not acknowledge he has a problem is hardly in a position to treat himself. We find additional support in P.D.'s cycle of hospitalizations and improved functioning, followed by his repeated release and subsequent medical noncompliance.
Moreover, as the district court noted, P.D. possesses a long history of mental illness and troubling symptoms. The record includes three letters, written by P.D. while under the current commitment, that are stained by his own blood. At trial, he explained the blood was intended to represent "pain" or "self-sacrifices," but that the letters were not meant to be threatening. We find these letters, particularly the letter postmarked September 19, 2002, to be strongly indicative of P.D.'s state of mind and his dangerousness. We conclude the letters constitute a "recent overt act" as contemplated in involuntary commitment case law. See Mohr, 383 N.W.2d at 542. In addition to the blood, the letters contain threatening content. For example, he writes in one "Eat always the bread of suffering! Let my blood be testimony against you both and share this written hell with him." The manner in which the letters were sent is also indicative of an element of dangerousness. In one letter sent to his psychiatrist, Gabrielle Barloon, P.D. addressed the envelope to "Gabriel, the Angel of Death." A March 30, 2002, letter to Dr. Barloon is addressed as "Dr. Barloon, The devil's bitch by any other name" and "the Angelic Doctor."
At trial, Dr. Barloon testified that over the past year P.D. had multiple hospitalizations for worsening conditions including paranoia and delusional thought processing. She noted an incident in which he sent letters to other people in his condominium complex that also contained blood drops. She also testified that recently P.D. had become more upset and his volume and anger level had escalated. She expressed an opinion that because of his delusional thoughts and distorted thinking, P.D. was "dangerous" and "threatening." Accordingly, we conclude substantial evidence supports the district court's conclusions as to P.D.'s dangerousness, inability to administer his own treatment, and the likelihood he would cause serious emotional injury to others.
Finally, P.D. claims that when one has been involuntarily committed but improves to the point he is no longer a danger to himself or others, he must, under the guidance of B.A.A., 421 N.W.2d at 118, be released even if the State believes the improvement resulted from the involuntary placement itself. This argument presupposes the individual no longer constitutes a threat to himself or others. Because we have affirmed the district court's conclusions to the contrary, we need not address this contention.