Opinion
No. 4-853 / 04-0763
Filed February 9, 2005
Appeal from the Iowa District Court for Johnson County, Thomas M. Horan, Judge.
S.A.M. appeals from a district court order involuntarily committing her to inpatient treatment. REVERSED.
Chad Thomas, Iowa City, for appellant.
J. Patrick White, County Attorney, and Anne Lahey, Assistant County Attorney, for appellee.
Considered by Huitink, P.J., and Zimmer and Vaitheswaran, JJ.
Respondent S.A.M. appeals from a district court order committing her to inpatient treatment. She contends insufficient evidence was presented at her civil commitment hearing to show she was likely to physically injure herself. As a result, she argues the statutory grounds for commitment were not met. We reverse.
I. Background Facts Proceedings
S.A.M. is a twenty-one year old woman. She has struggled with a serious eating disorder, anorexia nervosa, since she was twelve years old. Due to her illness, S.A.M. has had over twenty inpatient admissions for treatment. Before S.A.M. turned eighteen, her parents initiated her admissions for inpatient treatment. From the time S.A.M. turned eighteen and until she was involuntarily committed to inpatient treatment on April 12, 2004, all of her admissions for inpatient treatment were voluntary.
S.A.M.'s most recent period of voluntary inpatient treatment was from December 15, 2003, to March 22, 2004, at the University of Iowa Hospitals and Clinics. At the time S.A.M. checked in for treatment in December 2003, she weighed eighty-one pounds. By March 2004, S.A.M.'s weight was up to about 120 pounds and her doctors discharged her from the hospital. Following her discharge, S.A.M. continued with treatment on an outpatient basis. Her outpatient treatment program consisted primarily of daily meetings and group sessions.
After S.A.M. missed four of eleven days of her scheduled out-patient treatment over a three week period, her doctors at the University of Iowa Hospitals and Clinics filed an application on April 7, 2004, seeking to involuntarily commit her for inpatient care. On April 12, 2004, an involuntary commitment hearing was held before the district court. At that hearing, Dr. Stan Giudici testified in support of S.A.M.'s involuntary commitment to in-patient treatment. He stated that S.A.M. was seriously mentally impaired as defined in Iowa Code section 229.1(15) (2003) because she was diagnosed with anorexia nervosa; lacked the ability to make responsible decisions with respect to her treatment; and was likely to physically injure herself if not committed.
S.A.M. testified she contacted the staff of her program on the four days she did not attend her outpatient treatment.
In discussing his factual basis for believing S.A.M. was likely to physically injure herself, Dr. Giudici identified the following three concerns: (1) S.A.M. was at only seventy percent of her ideal body weight, (2) she suffered from osteoporosis, and (3) a dramatic weight loss could result in serious metabolic abnormalities. In elaborating on these concerns, Dr. Giudici testified S.A.M.'s ideal body weight was 133 pounds and that her current weight was 120.4 pounds. He further testified that osteoporosis was an ailment that would have developed over a prolonged period of time, and not just during recent months. He also stated that S.A.M. was not currently facing any metabolic abnormalities, was not in immediate danger of developing metabolic abnormalities, and during the last nine years had no history of metabolic abnormalities despite weighing as little as eighty-one pounds within the past year.
We note that if S.A.M.'s ideal body weight was 133 pounds then at 120.4 pounds she was at ninety-one percent of her ideal body weight, not seventy percent as Dr. Giudici testified.
Following the involuntary commitment hearing, the district court found that S.A.M. was seriously mentally impaired and was a danger to herself and others. The court entered an Order for Hospitalization committing S.A.M. to inpatient treatment at the University of Iowa Hospitals and Clinics. This appeal followed.
II. Scope of Review
An involuntary hospitalization proceeding is triable as an ordinary action at law. In re Melodie L., 591 N.W.2d 4, 6 (Iowa 1999). Our review is for errors at law. Id. The allegations made in the application for involuntary commitment must be supported by clear and convincing evidence. See Iowa Code § 229.12(3) (2003); In re J.P., 574 N.W.2d 340, 342 (Iowa 1998). There must be no serious or substantial doubt about the correctness of a particular conclusion drawn from the evidence. J.P., 574 N.W.2d at 342. The district court's findings of fact are binding on us if supported by substantial evidence. Id. III. Finding of Serious Mental Impairment
A person found to have a serious mental impairment may be committed involuntarily. See Iowa Code § 229.13. Serious mental impairment is defined as 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 the person with mental illness is 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.
Only subsection (a) of Iowa Code section 229.1(15) applies here. The State does not contend that subsection (b) or (c) is applicable.
Our supreme court has made clear that the definition of serious mental impairment has three elements. The respondent must be found to be (1) "afflicted with a mental illness," consequently (2) to lack "sufficient judgment to make responsible decisions with respect to his or her hospitalization or treatment," and (3) to be likely, if allowed to remain at liberty, to inflict physical injury on h[er]self or others. . . . In re Oseing, 296 N.W.2d 797, 799 (Iowa 1980). S.A.M. does not challenge the first two elements. She acknowledges she has a mental illness and concedes that a sufficient factual basis exists in the record under a review for errors at law to support the finding that she lacks sufficient judgment to make responsible decisions regarding her hospitalization or treatment. However, S.A.M. does argue that there was not substantial evidence presented at the involuntary commitment hearing upon which a reasonable trier of fact could find that she was likely to physically injure herself if she was not committed. We believe S.A.M.'s argument has merit.
The danger a person poses to self or others must be evidenced by a "recent overt act, attempt or threat." J.P., 574 N.W.2d at 344. In assessing whether or not a person is likely to physically injure herself, "likely" has been construed to mean, "probable or reasonably to be expected." Oseing, 296 N.W.2d at 801. The endangerment element of serious mental impairment "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).
In its brief on appeal, the State argues the "recent overt act" requirement of physical injury necessary to establish the dangerousness element of serious mental impairment is met by S.A.M.'s weight in December 2003, her lack of weight gain and failure to attend four of eleven sessions during outpatient treatment, and her history of prior inpatient admissions. We do not agree that this evidence is sufficient to establish an overt act or dangerousness.
S.A.M.'s weight in December of 2003 cannot reasonably be considered to be a recent overt act showing that she was a danger to herself at the time her commitment hearing was held in April of 2004. S.A.M. had four months of voluntary inpatient treatment after her admission to the hospital in mid-December of 2003. This treatment resulted in her discharge from the hospital on March 22, 2004, at a weight of 120 pounds. Additionally, the record shows S.A.M. was able to maintain her weight of 120 pounds during the approximately three-week period during which she was participating in treatment on an outpatient basis following her discharge.
We further find that Dr. Giudici's concerns regarding osteoporosis and metabolic abnormalities do not qualify as recent overt acts of physical injury. As we have mentioned, S.A.M.'s osteoporosis developed over a prolonged period of time. Moreover, her diagnosis of osteoporosis did not prevent her from being discharged from the hospital in March 2004. In addition, despite S.A.M.'s lengthy struggle with anorexia nervosa, her history shows that she has never suffered from metabolic abnormalities even though her weight had been as low as eighty-one pounds as recently as December 2003.
While we are sympathetic to the fact that S.A.M. might benefit from inpatient treatment, she cannot be involuntarily committed unless our statutory standards are met. Because our current statutory scheme forbids involuntary treatment unless S.A.M. is currently dangerous to herself, we reverse.