Opinion
No. 5-592 / 05-0117
Filed August 31, 2005
Appeal from the Iowa District Court for Scott County, James E. Kelley, Judge.
J.K. appeals from an order for hospitalization. AFFIRMED.
Jack E. Dusthimer of Jack E. Dusthimer, P.C., Davenport, for appellant.
William E. Davis, County Attorney, and Theodore J. Priester, Assistant County Attorney, for appellee.
Considered by Zimmer, P.J., and Hecht and Vaitheswaran, JJ.
J.K. has had paranoid schizophrenia for more than fifteen years. In September 2004, the district court ordered him transferred from the Mental Health Institute in Independence to an outpatient treatment program. Within weeks, J.K. voluntarily reduced his medication regimen. According to a treating psychiatrist who saw him after the reduction, he appeared "labile," and "stormy," and expressed "homicidal fantasies" toward the psychiatrist.
Proceedings were initiated to have J.K. re-hospitalized. A hospital referee found J.K. was "non-compliant with taking his medication on an outpatient basis." The referee also found J.K. lacked "sufficient judgment to make responsible decisions with respect to his hospitalization or treatment" and was "likely to injure himself if allowed to remain at liberty without treatment."
J.K. appealed this order to the district court. Pursuant to statute, the court held an evidentiary hearing. See Iowa Code § 229.21(3), (5) (2003). The court then ruled that J.K. should again be placed at the Mental Health Institute. This appeal followed.
J.K. contends (1) the record lacks clear and convincing evidence to establish that he was a danger to himself or others, and (2) his condition had improved by the time the district court entered its ruling. Our review of these issues is for errors of law. In re J.P., 574 N.W.2d 340, 342 (Iowa 1998). We will set aside a district court's findings only if, as a matter of law, the findings are not supported by clear and convincing evidence. Id. 1. Dangerousness.
A person may not be involuntarily committed to an institution unless there is clear and convincing evidence that the person (1) has a mental illness, (2) lacks sufficient judgment to make responsible decisions regarding hospitalization or treatment, and (3) is unable to satisfy personal needs for essential medical care or meets other criteria not at issue here. Iowa Code § 229.1(15). The third element embodies the constitutionally required element of dangerousness. In re J.P., 574 N.W.2d at 344; In re Foster, 476 N.W.2d 374, 377 (Iowa 1988).
The district court found that J.K. exhibited all three elements. The court stated:
[W]hen [J.K.] reduces his medications he becomes easily irritated, upset and argumentative. Thus he is unable because of that illness to satisfy his needs for essential medical care, which includes monitoring of his medications. . . . The court finds from clear and convincing evidence that the Respondent suffers from a mental illness: schizophrenia, chronic paranoid type. This mental illness prevents him from making responsible decisions with respect to his treatment, especially his need for medications and to continue medications at the prescribed levels.
The record contains clear and convincing evidence to support these findings. A psychiatrist who treated J.K. for several years confirmed that J.K. has had paranoid schizophrenia that required treatment with medication. He stated, "I don't believe without a structured setting and monitoring that he would take his medication and then his condition can deteriorate or he becomes more disorganized and can be more not functional in the community and be a danger towards himself and others." In addition, the psychiatrist who examined J.K. after he reduced his medication reported that J.K. "continued to deny his need for medication." In light of this evidence, we affirm the district court.
2. Improved Condition.
J.K. next contends the district court could not re-hospitalize him because he did not have the "same degree of impairment" as he had when he was first institutionalized. Cf. In re M.A.A., 421 N.W.2d 118, 124-25 (Iowa 1988) (holding requirements for original commitment, including dangerousness and lack of judgment regarding treatment decisions must also be established in habeas corpus proceedings). Specifically, he suggests "he no longer had any risk of dangerousness." Having found clear and convincing evidence of dangerousness at the time of the district court re-hospitalization order, we reject this contention.