In thе Matter of B.B., Alleged to be Seriously Mentally Impaired, B.B., Appellant.
No. 12-0158.
Supreme Court of Iowa.
Jan. 4, 2013.
Rehearing Denied Feb. 22, 2013.
826 N.W.2d 425
Thomas J. Miller, Attorney General, Gretchen Witte Kraemer, Assistant Attorney General, Patrick A. Jennings, County Attorney, and Joshua D. Widman, Assistant County Attorney, for appellee.
APPEL, Justice.
In this case, we must determine whether an appeal from a finding of “serious mental impairment” resulting in an involuntary commitment under
I. Factual and Procedural Background.
On December 14, 2011, police brought B.B. to the emergency room at Mercy Medical Center in Sioux City after he entered a restricted area at an Iowa Air National Guard base. A judge then ordered B.B.‘s emergency hospitalization pursuant to
Shortly after B.B.‘s emergency hospitalization, an application alleging serious mental impairment pursuant to
A physician‘s report was also attached to the application. The report, authored by Dr. Ejiro Idahosa, a psychiatrist, diagnosed B.B. with psychosis, not otherwise specified, and noted symptoms of paranoia. Dr. Idahosa concluded B.B. lacked sufficient judgment to make responsible decisions with respect to his hospitalization or treatment because оf the mental illness. The report further stated that, because of his mental illness, if left at liberty without treatment B.B. was more likely to physically injure himself or others, to inflict serious emotional injury on members of his family or others who lacked a reasonable opportunity to avoid contact with him, and to be unable to satisfy his need for nourishment, clothing, essential medical care, or shelter such that it made it likely he would suffer physical injury, debilitation, or death. Dr. Idahosa also noted B.B. had a history of mental illness, recommended B.B. return to inpatient treatment for further stabilization, and opined B.B. would need outpatient treatment upon rеlease for medication management and therapy.
A hearing was held on the application on December 20. The Sorensen and Hoffman affidavits and Dr. Idahosa‘s report were admitted into evidence. Dr. Idahosa testified that B.B. met the statutory requirements as one who is seriously mentally impaired. She explained B.B. was a danger to himself or others based on B.B.‘s irritability, arguments with his wife, and symptoms of paranoia. Elaborating, she stated that B.B. “feels people are trying to do something to him,” that he believes people are trying to remove his brain or other organs from his body, and that his wife “is afraid for him to come home.” Dr. Idahosa further stated that “[B.B.‘s wife] has a restraining order and he has nowhere to go.” Dr. Idahosa noted the observations made in the two affidavits in the application. She testified that B.B.‘s wife advised her B.B. had a history of paranoia that had been ongoing for twelve years and that recently the symptoms were “the worst [B.B.‘s wife] has seen.” Dr. Idahosa also opined B.B. did not have sufficient judgment to make responsible decisions with regard to his hospitalization or treatment. In Dr. Idahosa‘s opinion, hospitalization was the least restrictive form of treatment available for B.B. at that time.
B.B. also testified. B.B. denied attempting to board a flight with a fake passport. B.B. asserted it was all a misunderstanding because he found some boarding passes that did not belong to him and he was simply attempting to give them to an airline employee. He then left the Omaha airport and drove to the air base in Sergeant Bluff because he was emotional due to marital problems and “was considering getting into the National Guard.” B.B. testified that he accidentally drove into a secured area. He further stated he did not believe he suffered from a mental illness or was a danger to himself or others.
The district court concluded the record established by clear and convinсing evidence that B.B. was seriously mentally
During the pendency of the appeal, B.B. was released to outpatient treatment at the University of Nebraska Medical Center (UNMC) in Omaha. Because an entry in the court file indicated B.B. was no longer a patient at UNMC as of January 28, 2012, and because B.B. did not have family or employment connections in Woodbury County, the State filed a motion to discharge and terminate the proceedings. The district court granted the motion, terminated the proceedings, dischаrged B.B. from court-ordered treatment and placement, and stated interested parties could reinitiate court proceedings if B.B. returned to Iowa and was believed to be seriously mentally impaired.
This proceeding is not B.B.‘s first involuntary commitment proceeding. He testified that he was involuntarily committed approximately fourteen years ago for depression with psychotic features.
II. Standard of Review.
We review challenges to the sufficiency of the evidence in involuntary commitment proceedings for errors at law. In re J.P., 574 N.W.2d 340, 342 (Iowa 1998). The allegations made in an application for involuntary commitment must be proven by clear and convincing evidence. Id. Clear and convincing evidence is less burdensome than evidence establishing proof beyond a reasonable doubt, but more burdensome than a preponderance of the evidence. Id. “It means that there must be no serious or substantial doubt about the correctness of a particular conclusion drawn from the evidence.” Id. (citation and internal quotation marks omitted).
III. Discussion.
We are confronted with two issues in this appeal. First, we must address whether an appeal from a finding that a person is seriously mentally impaired under chapter 229 becomes moot when the person is released from involuntary commitment and the proсeedings are terminated.1 Second, if the matter is not moot, we must determine whether the district court‘s finding that B.B. is seriously mentally impaired is supported by substantial evidence.
A. Mootness.
Ordinarily, an appeal is moot if the “issue becomes nonexistent or academic and, consequently, no longer involves a justiciable controversy.” State v. Hernandez-Lopez, 639 N.W.2d 226, 234 (Iowa 2002). We will generally not review moot issues, but our caselaw and that of other jurisdictions recognize exceptions. Relevant to this appeal, one exception permits appellate review of otherwise moot issues when the issue is one of
For example, in M.T. we stated that an appeal from an involuntary commitment was moot when the party had been released from inpatient treatment, the State no longer sought to have the party committed for inpatient treatment, and the party did not challenge his commitment to outpatient treatment. 625 N.W.2d at 705.2 Nonetheless, we reached the merits of whether the party‘s statutory right to be present at his involuntary commitment proceeding had been violated because it was an issuе of broad public importance capable of recurring, yet likely to evade appellate review. Id.
Similarly, B.B.‘s case is arguably moot because he was no longer subject to inpatient treatment and had been discharged from court-ordered treatment and placement. B.B., however, argues his case warrants our review because he will continue to suffer adverse collateral consequences.3 Although we have not yet adopted this exception to the mootness doctrine in this context, we now hold that a party who has been adjudicated seriously mentally impaired and involuntarily committed is presumed to suffer collateral consequences justifying appellate review.
A number of jurisdictions recognize the notion that one who is involuntarily committed due to a mental illness suffers collateral consequences. See, e.g., In re Ballay, 482 F.2d 648, 651-52 (D.C.Cir.1973); In re Joan K., 273 P.3d 594, 597-98 (Alaska 2012); In re Morris, 482 A.2d 369, 371-72 (D.C.1984); Bradshaw v. State, 120 Idaho 429, 816 P.2d 986, 989 (1991); In re McCaskill, 603 N.W.2d 326, 329 (Minn. 1999); In re Splett, 143 Ill.2d 225, 157 Ill.Dec. 419, 572 N.E.2d 883, 885 (1991); In re Walter R., 850 A.2d 346, 349-50 (Me.2004); In re Hatley, 291 N.C. 693, 231 S.E.2d 633, 634-35 (1977); In re D.B.W., 616 P.2d 1149, 1150-51 (Okla.1980); State v. Lodge, 608 S.W.2d 910, 912 (Tex.1980); In re Giles, 657 P.2d 285, 286-87 (Utah 1982); State v. J.S., 174 Vt. 619, 817 A.2d 53, 55-56 (2002). One commonly cited collateral consequence of involuntary commitment is the accompanying stigma. See, e.g., Joan K., 273 P.3d at 597-98; Bradshaw, 816 P.2d at 989; Splett, 572 N.E.2d at 885; D.B.W., 616 P.2d at 1150-51; Lodge, 608 S.W.2d at 912; J.S., 817 A.2d at 55-56. The United States Supreme Court relied in part on the stigmatization of being labeled mentally ill in holding that a child has a liberty interest in not being confined unnecessarily. See Parham v. J.R., 442 U.S. 584, 601, 99 S.Ct. 2493, 2503, 61 L.Ed.2d 101, 118 (1979). The Court has also observed,
[I]t is indisputable that involuntary commitment to a mental hospital after a finding of probable dangerousness to self or others can engender adverse social consequences to the individual. Whether we label this phenomena “stigma”
or choose to call it something else else is less important than that we recognize that it can occur and that it can have a very significant impact on the individual.
Addington v. Texas, 441 U.S. 418, 425-26, 99 S.Ct. 1804, 1809, 60 L.Ed.2d 323, 330-31 (1979).
In In re Guardianship of Hedin, 528 N.W.2d 567, 574 (Iowa 1995), we recognized the existence of stigma in observing that one has a protected liberty interest in not being labeled mentally ill. Many courts rely heavily on the stigma of mental illness in holding that a case involving an involuntary commitment is not moot simply because the person alleged to be mentally ill hаs been released from commitment. See, e.g., Joan K., 273 P.3d at 597-98; Bradshaw, 816 P.2d at 989; Splett, 572 N.E.2d at 885; D.B.W., 616 P.2d at 1150-51; Lodge, 608 S.W.2d at 912; J.S., 817 A.2d at 55-56. But see Westlake v. State, 440 So.2d 74, 75 (Fla.Dist.Ct.App.1983) (holding that an appeal is moot despite stigma because courts look to legal consequences, not social consequences).
Another collateral consequence stemming from a finding that one is mentally ill is the potential to use one‘s involuntary commitment as evidence in future proceedings. In Ballay, the District of Columbia Circuit explained it this way:
Indeed, such an adjudication, while not always crippling, is certainly always an ominous presence in any interaction between the individual and the legal system. Such evidence will frequently be revived to attack the capacity of a trial witness. Deрending upon the diagnosis, it may be admissible for impeachment purposes. Indeed, even in a criminal trial it may be available to attack the character of a defendant if he has put character in issue. Most significantly, records of commitments to a mental institution will certainly be used in any subsequent proceedings for civil commitment, a factor which may well have been influential in the present case.
482 F.2d at 652. Other courts have made similar observations. See, e.g., Joan K., 273 P.3d at 597; In re Amey, 40 A.3d 902, 909 (D.C.2012); In re Alfred H.H., 233 Ill.2d 345, 331 Ill.Dec. 1, 910 N.E.2d 74, 84 (2009); Hatley, 231 S.E.2d at 634-35; Giles, 657 P.2d at 287; see also Walter R., 850 A.2d at 349-50 (holding possibility of longer commitment period following adjudication of incompetence is a collateral consequence); In re Webber, 201 N.C.App. 212, 689 S.E.2d 468, 474 (2009) (discussing an analogous situation involving defendants placed on probаtion).
Although persons adjudicated seriously mentally impaired suffer the foregoing collateral consequences,4
Hospitalization of a person under this chapter, either voluntarily or involuntarily, does not constitute a finding of nor equate with nor raise a presumption of incompetency, nor cause the person so hospitalized to be deemed a person of unsound mind nor a person under legal disability for any purpose, including but not limited to any circumstances to which sections 6B.15, 447.7, section 488.603, subsection 6, paragraph “c“, sections 488.704, 597.6, 600B.21, 614.8,
We disagree with the South Dakota Supreme Court insofar as it suggests
Some courts have considered the impact of prior involuntary commitments on the right of a person to appeal subsequent involuntary commitment. In Joan K., the Alaska Supreme Court concluded that “there are sufficient general collateral consequences, without the need for a particularized showing, to aрply the doctrine in an otherwise-moot appeal from a person‘s first involuntary commitment order.” 273 P.3d at 598. Although the court agreed collateral consequences are presumed, it noted that “some number of prior involuntary commitment orders would likely eliminate the possibility of additional collateral consequences, precluding the doctrine‘s application.” Id.
The Illinois Supreme Court took the opposite approach in Alfred H.H. The court held that the determination of potential collateral consequences for the purposes of mootness must be made on a case-by-case basis. 331 Ill.Dec. 1, 910 N.E.2d at 84. Thus, in Illinois the person must present evidence sufficient to justify application of the collateral consequences exception.
We agree with the Alaska Supreme Court that the better approach is to presume that a person adjudicated seriously mentally impaired and involuntarily committed suffers adverse collateral consequences. Such an adjudication not only requires a finding that the person suffers a mental illness, but also that the person poses a danger to himself or others, is likely to inflict serious emotional injury upon another, or is unable to satisfy his own bodily needs for survival. The stigma arising from this adjudication is significant. In addition, the potential for the adjudication to be used in future proceedings is likely present in each case. Further, we recognize collateral consequences are mitigated if the person has previously been involuntarily committed under chapter 229. For example, under federal law he or she will not lose the right to possess firearms because the right was already lost following the first commitment. See
B. Sufficiency of the Evidence.
B.B. alleges the determination that he is seriously mentally impaired is not supported by substantial evidence.
17. “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 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.
B.B. agrees sufficient evidence supports the finding that he has a mental illness, but challenges the sufficiency of the evidence as to whether he is unable to make responsible decisions about his own treatment, whether he would have caused serious physical injury to himself or others, and whether he would have caused serious emotional injury to his family or others. We disagree with B.B.‘s contentions.
Dr. Idahosa testified that B.B. claimed the hospital staff was attempting to take away his brain and other organs up until at least one day prior to the hearing, that he was irritable and violent towards hospital staff when he arrived at the hospital and thereafter, and that he refused to swallow his medication while hospitalized, prompting Dr. Idahosa to change his prescription to a medication that would dissolve under his tongue. In addition, in finding the element was satisfied, the district court observed that B.B. “can‘t even make the recognition that he has a mental illness, and that is where his problems begin.” Thus, substantial evidence supрorts the district court‘s finding that B.B. lacked sufficient judgment to make responsible decisions about his medical treatment.
B.B. also argues substantial evidence does not support the finding that he would be likely to inflict serious physical injury on himself or others or that he would be likely to inflict serious emotional injury to members of his family or others lacking a reasonable opportunity to avoid him. In Oseing, we observed that the term “likely” means “probable or reasonably to be expected.” Oseing, 296 N.W.2d at 801. We also stated that it “requires a predictive judgment, ‘based on prior manifestations but nevertheless ultimately grounded on future rather than past danger.‘” Id. (citation omitted). In In re Mohr, 383 N.W.2d 539, 542 (Iowa 1986), we еxpanded on this definition by noting “[t]his element requires that the threat the patient poses to himself or others be evidenced by a ‘recent overt act, attempt, or threat.‘” (quoting Stamus v. Leonhardt, 414 F.Supp. 439, 451 (S.D.Iowa 1976)).
Dr. Idahosa opined B.B. was likely to cause physical injury to himself or others. She based her opinion in part on the ground that B.B. is “irritable, he is paranoid, he feels people are trying to do something to him.” Dr. Idahosa further stated, “He‘s always arguing with his wife, she has a restraining order and he has nowhere to go.” That Dr. Idahosa based her opinion on the fact that B.B. was paranoid is significant because the district court could have found the diagnosis of “psychosis, not otherwise specified” to be directly connected to the finding that B.B. posed a likely threat to cause physical injury. See
IV. Conclusion.
For the reasons expressed above, we hold that the matter is justiciable. On the merits, we conclude the district court‘s finding that B.B. was seriously mentally impaired is supported by substantial evidence.
AFFIRMED.
All justices concur except WATERMAN and MANSFIELD, JJ., who concur in part and dissent in part.
MANSFIELD, Justice (concurring in part and dissenting in part).
I agree that if we reach the merits, the district court‘s order should be affirmed. However, I would dismiss the appeal as moot.
The majority seemingly holds that an appeal from a civil commitment order, where the appellant has been released, should only be dismissed as moot if there have been “a seriеs of recent, successive involuntary commitments that were either not appealed or upheld on appeal.” I think this standard opens the door to too many future appeals of commitment orders where nothing tangible is at stake. I am not in favor of using our judiciary‘s limited resources in this fashion.
This particular case highlights the potential concerns. Here B.B., a Nebraskan with a history of mental illness who admitted he was “distraught,” crossed into Iowa on December 14, 2011, and tried to enter the restricted area of an Iowa Air National Guard base. He was brought to a hospital emergency room “in a very agitated and сonfused state.” He was “making wild threats to harm himself and others and ... requiring 3 police officers to keep him subdued.” Based on an emergency order, B.B. was hospitalized. He refused to take his medication. He denied he had any mental illness or needed any medication. He claimed the hospital staff were going to take his brain or his organs from his body.
In addition to getting medical treatment in a Sioux City hospital, B.B. received a full hearing on December 20. After the hearing, the district court concluded that B.B. should remain hospitalized for the reasons set forth in
Now B.B. seeks to bring an appeal challenging the sufficiency of the evidence to sustain his expired commitment order. The taxpayers of Iowa will pay for all aspects of this appeal, including the expense of B.B.‘s attorney, just as they bore the expense of all lower court proceedings.7
No one suggests that we are constitutionally required to hear this case. This is purely our call. As the majority notes, there is a grab bag of standards from other jurisdictions, under some of which this appeal would be moot. See also In re Involuntary Commitment of Skelton, 777 So.2d 148, 149 (Ala.Civ.App.2000) (dismissing
Furthermore, under our own precedent, this appeal is moot. In In re M.T., we indicated that an appeal from a civil commitment order ordinarily becomes moot when the party has been released, stating, “We think the present appeal is moot. M.T. is no longer subject to the inpatient treatment order that resulted from the challenged hearing.” 625 N.W.2d 702, 705 (Iowa 2001). True, what we said there was arguably dictum, because we later went on to hear the case under a separate exception to the ordinary rules of mootness. Id. But our court unanimously signed on to the foregoing general statement on mootness, and it has been repeatedly followed by the court of appeals in dismissing appeals from commitment orders on mootness grounds.8
If we are going to overrule what we said in In re M.T., then I would propose a different standard from the majority‘s. Thus, I would hold that a commitment appeal should automatically go forward if the appellant has not previously been adjudicated mentally ill (or the statutory equivalent) in any jurisdiction. If, however, the State can demonstrаte that the appellant has previously been adjudicated mentally ill, e.g., in papers filed with a motion to dismiss the appeal, then the presumption would arise that the appeal is moot if the appellant has been released. The burden then would shift to the appellant to show that he or she will suffer some specific collateral consequence from the judgment that he or she seeks to appeal (other than the stigma or potential future evidentiary value of one more finding that the appellant is mentally ill). Alternatively, the appellant may show that the appeal falls into the broad public interest exception (and here I would hold that sufficiency of the evidence appeals do not meet that exception).9 If the appellant fails to do either of these things, the appeal would be dismissed.
I believe this approach appropriately balances the interests of the appellant, the State, and the courts, and gives guidance for future cases. Under this approach, B.B.‘s appeal would be dismissed. He has a prior involuntary commitment, even though it is from a number of years ago, and he has not shown that he will be subject to any specific collateral conse
I recognize the potential exists for collateral consequences from any involuntary commitment order. I also acknowledge there can be stigma, although it bears emphasis that the proceedings are confidential. See
WATERMAN, J., joins this concurrence in part and dissent in part.