In the Matter of F.T.

IN THE COURT OF APPEALS OF IOWA

No. 23-1612
Filed August 21, 2024

IN THE MATTER OF F.T.,
Alleged to Have a Substance-Use Disorder,

F.T.,
Respondent-Appellant.
________________________________________________________________

Appeal from the Iowa District Court for Woodbury County, Jessica Noll,

Judge.

A person found to have a substance-use disorder appeals from a civil

commitment order. AFFIRMED.

Debra S. De Jong of De Jong Law Firm, P.C., Orange City, for appellant.

Brenna Bird, Attorney General, and Sarah Jennings, Assistant Attorney

General, for appellee State.

Considered by Ahlers, P.J., and Chicchelly and Buller, JJ.
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BULLER, Judge.

F.T. appeals from a court order committing her as a person with a

substance-use disorder pursuant to Iowa Code chapter 125 (2023). We affirm,

finding sufficient evidence to support commitment and that—assuming without

deciding there is a right to effective counsel under chapter 125—F.T.’s attorney

was not ineffective.

A court-ordered physician’s report documented F.T. was diagnosed with a

substance-use disorder as defined by the American Psychiatric Association—

cannabis use disorder. The reporting physician concluded F.T.’s cannabis use

was “exacerbating” her mental illness by causing her to be “manic, delusional,

verbally aggressive, and threatening on unit.” The physician also noted supporting

facts, including that F.T. was “actively using cannabis,” had a recent positive

urinalysis test, and had a prior hospitalization. And the physician concluded F.T.

was a danger to herself or others and would benefit from treatment to stabilize her

and manage her medications.

In her affidavit seeking commitment, F.T.’s grandmother explained that

F.T.’s cannabis use caused her to show symptoms of schizoaffective disorder.

The grandmother wrote that cannabis caused F.T. to “engage[ ] in behaviors that

put her safety at risk,” such as halting her psychiatric medications and living on the

street.

F.T.’s grandmother testified at the commitment hearing that F.T. has

“extreme side effects” when she uses marijuana: “[s]he becomes paranoid, she

gets delusions, she says things that aren’t true, makes accusations, [and] she

disappears and goes off on her own and we can’t find her.” The grandmother
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described some of the side effects F.T. experienced as “mania” or a “mania state”

that endangered F.T., as evidenced by her “jumping out of cars because she

thought they were going to blow up.” F.T.’s grandmother said she was “very

frightened and very worried” about F.T.’s safety.

F.T. testified that she used marijuana but was not addicted. She claimed

her marijuana use did not affect her daily life or cause side effects. And she

admitted she had been previously committed for mental-health reasons. But she

disputed her grandmother’s testimony that she had discontinued mental-health

treatment. During the hearing, F.T. told the court she recently saw a dead body

on the street that was “scalped”; at one point she said it was her boyfriend but then

she suggested it was someone else. She also indicated she believed she was in

Wayne, Nebraska, rather than Sioux City, Iowa, and told the court she needed to

be at a “pop up” art show rather than in treatment.

The district court found by clear and convincing evidence that F.T. had a

substance-use disorder and ordered her commitment for inpatient treatment.

Inherent in this resolution of contested facts, the district court credited the

testimony of F.T.’s grandmother and the physician’s report and rejected F.T.’s

testimony.

F.T. appeals, asserting insufficient evidence supported her commitment

and that her attorney rendered ineffective assistance. Our review of the sufficiency

of the evidence is for correction of errors at law. In re B.B., 826 N.W.2d 425, 428

(Iowa 2013). And we review ineffective-assistance claims de novo. In re B.T.G.,

784 N.W.2d 792, 798 (Iowa Ct. App. 2010).
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Sufficiency of the evidence. Commitment of a person with a substance-

use disorder under Iowa Code chapter 125 requires clear and convincing evidence

the person: (1) has a qualifying, diagnosed substance-use disorder; (2) lacks

sufficient judgment to make responsible decisions with respect to hospitalization

or treatment because of the condition; and (3) presents a danger to self or others

because of the condition. See Iowa Code §§ 125.2(16), .75, .82(4), .83; Iowa Ct.

R. 13.14.

F.T. first contests the evidence of her substance-use disorder. That term is

defined by statute as “a diagnosable substance use disorder of sufficient duration

to meet diagnostic criteria specified within the most current diagnostic and

statistical manual of mental disorders published by the American psychiatric

association that results in a functional impairment.” Iowa Code § 125.2(16). In the

context of commitments under chapter 229, we have found physician reports

containing a diagnosis sufficient to meet that statute’s requirements. See In re

S.S., No. 15-0494, 2015 WL 6508809, at *4 (Iowa Ct. App. Oct. 28, 2015). We

think the same is true under chapter 125, and thus the physician’s report here—

which was necessarily credited by the district court—was sufficient to meet the first

element. And even if the physician’s report was insufficient on its own, the

grandmother’s testimony established at least a year of issues with F.T. using

cannabis and not taking her psychiatric medications. This is not a case where, as

F.T. alleges, the physician’s report contained “no facts.” While it may be sparse,

there is enough in the report for our review, and we discern no legal error on the

first element.
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It’s a little unclear whether F.T. challenges the second element concerning

lack of judgment, but we briefly explore it. The physician’s report concluded F.T.

lacked sufficient judgment to make decisions about hospitalization or treatment,

and we note again the district court necessarily credited this report. We also

recognize F.T.’s statements at the hearing—where she did not recognize where

she was, denied substance use in the past month despite a positive test, and

expressed that she wanted to attend a “pop up” art show rather than seek

treatment—tend to support that conclusion. As does her recent history of

noncompliance with mental-health medication and treatment. Cf. B.T.G., 784

N.W.2d at 797.

F.T. specifically challenges evidence of present dangerousness. On

appeal, the State concedes that commitments under chapter 125, like their

chapter 229 counterparts, require a recent overt act in addition to evidence that

suggests future dangerousness. Here, the physician’s report and testimony from

the grandmother established that F.T.’s substance use led her to discontinue her

psychiatric medications and begin experiencing symptoms of schizoaffective

disorder. The grandmother described F.T.’s manic state—including jumping out

of a car because of a hallucination or delusion it was about to blow up. And the

physician opined that she was a danger to herself or others. This evidence is

sufficient to predict future dangerousness and the incident with the car is a recent

overt act. Cf. In re Mohr, 383 N.W.2d 539, 542 (Iowa 1986). We discern no error

on the third element and find sufficient evidence supported F.T.’s commitment.

Ineffective assistance. F.T.’s final contention is that her appointed

attorney was ineffective. To succeed on such a challenge, F.T. must prove that
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her counsel breached an essential duty and that she was prejudiced to the extent

she was denied a fair trial. See B.T.G., 784 N.W.2d at 798. As we have in the

past for commitments under chapter 229, we assume without deciding there is a

right to effective counsel in civil commitment proceedings under chapter 125. See

In re C.J., No. 24-0244, 2024 WL 3518284, at *2 (Iowa Ct. App. July 24, 2024); In

re J.H., No. 12-1133, 2013 WL 1760183, at *3 (Iowa Ct. App. Apr. 24, 2013); see

also Iowa Code § 125.78(1) (providing the respondent a right to a court-appointed

attorney). Most of F.T.’s complaints are essentially procedural in nature, focused

on the timing of events below or that the court file does not contain certain returns

of service. She cites no case law establishing that she would be owed any remedy

other than a continuance if these issues had been raised in the district court. We

also observe that any information contained in filings F.T. did not receive before

the hearing was communicated to her at the hearing, which undermines any

claimed prejudice. On our de novo review, we do not find any of these alleged

procedural deficiencies prejudiced F.T. to the extent she was denied a fair trial.

The most substantive ineffective-assistance complaint F.T. alleges is that

her trial attorney did not require the physician authoring the report to personally

appear for cross-examination. But there could be legitimate tactical considerations

supporting that choice, including a reasonable fear that the physician’s live

testimony would be more damning and detailed than the sparse handwritten report.

See C.J., 2024 WL 3518284, at *2; cf. State v. Yaw, 398 N.W.2d 803, 807

(Iowa 1987) (finding trial counsel not ineffective for permitting child-sexual-abuse

victims’ testimony to be admitted by deposition rather than live testimony). On this

record, F.T. has not overcome the presumption of counsel’s competence. See
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State v. Majors, 940 N.W.2d 372, 391 (Iowa 2020) (noting in criminal and

postconviction cases “our presumption is that counsel performed competently

unless the claimant proves otherwise by a preponderance of the evidence” and

“[m]ore is required than a showing that counsel’s trial strategy backfired or the case

would have been tried differently by another attorney”).

Last, to the extent F.T. advances a claim of cumulative error, and assuming

without deciding such a claim exists in civil-commitment cases, we reject it. See

State v. Clay, 824 N.W.2d 488, 501–02 (Iowa 2012) (performing a cumulative-error

analysis in a criminal case). We discern no prejudice, independently or in the

aggregate, that would warrant relief.

AFFIRMED.