In the Matter of T.B., Alleged to be Seriously Mentally Impaired

IN THE COURT OF APPEALS OF IOWA

No. 22-1061
Filed January 25, 2023

IN THE MATTER OF T.B., ALLEGED TO BE SERIOUSLY MENTALLY
IMPAIRED,

T.B.,
Respondent-Appellant.
________________________________________________________________

Appeal from the Iowa District Court for Woodbury County,

Brian E. Buckmeier, Magistrate.

The respondent appeals from a court order requiring he receive inpatient

treatment and submit to injectable medications. AFFIRMED.

Debra S. De Jong, Orange City, for appellant.

Brenna Bird, Attorney General, and Chandlor Collins (until withdrawal) and

Sarah A. Jennings, Assistant Attorneys General, for appellee State.

Considered by Vaitheswaran, P.J., and Ahlers and Buller, JJ.
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PER CURIAM.

The respondent, who has a lengthy history of court involvement related to

schizoaffective disorder and schizophrenia, appeals from a court order requiring

he receive inpatient treatment and submit to injectable medications pursuant to

Iowa Code Chapter 229 (2022). The respondent experiences paranoid delusions

and has shown some escalating aggressive behaviors. Based largely on evidence

contained in reports from two physicians, one of which was commissioned at the

respondent’s request, we affirm.

I. Background Facts and Course of Proceedings

The court file detailing the respondent’s mental-health struggles is lengthy

and we need not detail it here, except to note that he has been subject to continuing

commitment in two Iowa counties.

This appeal concerns a June 9, 2022 order requiring the respondent to

submit to injectable medications. The basis of the court’s order was evidence from

two physicians and a report from the facility where the respondent previously

received treatment.

The first physician’s report opined that the respondent was mentally ill with

diagnoses of schizoaffective disorder, bipolar type with paranoia and delusions,

and post-traumatic stress disorder. The first-opinion physician opined that the

respondent lacked sufficient judgment to make responsible decisions because he

“has no insight into his mental illness and need for treatment.” This physician also

opined the respondent was a danger to himself or others due to his paranoid

delusions, refusal to take medication, and belief “he is being poisoned . . . [and]

has been shot in the head,” when that was confirmed to be false.
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The second physician’s report was a “second opinion” requested by the

respondent. The second-opinion physician opined that the respondent was

mentally ill and experienced acute psychosis with fixed delusions, “consistent with

prior diagnoses of schizoaffective disorder and schizophrenia.” This physician

further opined that the respondent lacked sufficient judgment to make responsible

decisions and that the risk of violence against “multiple people in his environment,”

such as “family, healthcare workers, and an unspecified judge,” is “high.” Last, the

second-opinion physician opined that the respondent was a danger to himself or

others and identified the respondent’s “belief he is being poisoned and under threat

by multiple people in his environment” as evidence of present dangerousness.

The facility’s periodic report indicated the respondent continued to

demonstrate psychotic behaviors and refused to take prescribed medications. The

facility reported that the respondent’s mental health was deteriorating as a result,

manifesting in part through delusions about his identity, being shot in the head,

and government surveillance. The facility also reported escalating aggressive

behavior, including following staff out to their vehicles, threatening to send staff “to

jail for murder,” and likely destroying property (kicking in a door).

At the hearing, the respondent denied that his legal name belonged to him

and claimed he did not know his name. He reported being kidnapped by the

persons who were in fact his biological parents. He also testified that the facility

filed a report indicating he was being aggressive because “they drugged [his]

coffee” and he had been “irritated with them for lying to [him] about [his] name.”

He testified that he was “not willing to take medicine.”
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The district court ordered that the respondent submit to injectable

medication if he did not comply voluntarily. This appeal followed.

II. Standard of Review

A commitment under Chapter 229 must be supported by clear and

convincing evidence. In re J.P., 574 N.W.2d 340, 342 (Iowa 1998). Our review on

appeal is for correction of errors at law, and findings of fact are binding on us if

they are supported by substantial evidence. Id.

III. Discussion

A person may be civilly committed under Chapter 229 when the person is

“seriously mentally impaired” or has “serious mental impairment.” Iowa Code

§§ 229.1(20), .6. “Seriously mentally impaired” is a term of art with three elements:

(1) mental illness; (2) that causes a lack of sufficient judgment to make responsible

decisions regarding the person’s hospitalization; and (3) the person shows any of

multiple additional criteria. Id. § 229.1(20). This third element can be met by

establishing the person is likely to “physically injure the person’s self or others” or

“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

such person remains at liberty and untreated. Id. § 229.1(20)(a), (b).

There is no real debate between the State and the respondent, or any real

question on this record, that the respondent is mentally ill as to satisfy the first

element. Both physicians opined as to schizoaffective disorder or schizophrenia.

These conditions are a “mental disease” or “mental disorder.” See id. § 229.1(11)

(with exceptions not applicable here, defining “mental illness” to include “every type

of mental disease or mental disorder”).
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The record also clearly demonstrates the second element: a lack of

sufficient judgment to make decisions about hospitalizations. Again, both

physicians agree on this point, and the respondent has not offered any evidence

to the contrary. We also note that the first physician’s observation that the

respondent “has no insight into his mental illness and need for treatment” is

consistent with the balance of the record evidence and is, in our view, an apt

summary.

The fighting issue in this appeal is over the third element, dangerousness

to self or others. The respondent argues that he has yet to threaten to kill or

physically harm anyone, only yelled at them and threatened to sue them. The

State replies that the respondent is engaged in escalating behavior and that the

statute requires less than a “specific incident of violence,” only a “likelihood he may

inflict [such an] injury.” We agree with the State on the particular facts of this case.

The dangerousness inquiry requires us to “make a predictive judgment

about whether the respondent poses a danger to himself or others.” In re Foster,

426 N.W.2d 374, 377 (Iowa 1988). Under supreme court case law, this judgment

must be based at least in part on “a ‘recent overt act, attempt or threat.’” In re

Mohr, 383 N.W.2d 539, 542 (Iowa 1986) (quoting Stamus v. Leonhardt, 414 F.

Supp. 439, 451 (S.D. Iowa 1976)). Paranoia and delusions are relevant

considerations to this analysis. See In re B.B., 826 N.W.2d 425, 433 (Iowa 2013);

Mohr, 383 N.W.2d at 542.

We find the record contains substantial evidence of dangerousness. While

we encourage physicians to include more supporting facts in their reports than

what we find in this record, this is not a case where the physicians’ reports lack
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any facts or discussion to support their opinions as to dangerousness. See In re

L.E.B., No. 14–0989, 2015 WL 7575399, at *4 (Iowa Ct. App. Nov. 25, 2015)

(finding the evidence insufficient to support commitment when the physician

checked the “yes” box for dangerousness but offered no supporting information).

The second-opinion physician specifically opined as to a “high” risk of danger to

persons in the respondent’s environment, such as “family, healthcare workers, and

an unspecified judge.” The second-opinion physician also specifically linked this

danger to the respondent’s “well elaborated, fixed delusions involving multiple

people in his environment” and “perceived threats” from these people, such as the

belief that he was “being poisoned and under threat.” The first-opinion physician

similarly cited delusions to support his opinion as to dangerousness. These

opinions give context to the respondent’s most recent overt act, one week before

the June 9, 2022 order was entered: the respondent approached the vehicle of a

facility employee, accused her of malfeasance in a raised voice, walked away, and

then approached the vehicle again. The employee felt so threatened by the

respondent’s conduct and demeanor that she called 911. This behavior,

contextualized by the physician’s reports, is sufficient to sustain the district court’s

order. The order for commitment is supported by substantial evidence.

AFFIRMED.