IN THE COURT OF APPEALS OF IOWA

No. 19-0034

Filed August 21, 2019

IN THE MATTER OF J.E.,

Alleged to be Seriously Mentally Impaired,

J.E.,

Respondent-Appellant.

________________________________________________________________

Appeal from the Iowa District Court for Black Hawk County, Bradley J. 

Harris, Judge.

The respondent challenges the district court’s order of continued 

involuntary inpatient commitment. AFFIRMED.

Christina M. Shriver, Waterloo, for appellant.

Thomas J. Miller, Attorney General, and Gretchen Kraemer, Assistant 

Attorney General, for appellee State.

Considered by Potterfield, P.J., and Doyle and May, JJ. 
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POTTERFIELD, Presiding Judge.

J.E. challenges the district court’s order of continued involuntary inpatient 

commitment. J.E. maintains there is insufficient evidence to support the 

determination he is a present danger to himself or others and requires continued 

placement in an alternative care facility. “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. 

J.E. has been involuntarily committed to the same 24-hour-care facility 

since 2013. During that time, J.E. has asked for and received a number of 

placement hearings. 

Pursuant to Iowa Code section 229.15 (2018), the chief medical officer 

from the facility at which J.E. is committed completed a periodic report in October 

2018. The report indicated J.E. remained seriously mentally impaired and 

needed full-time custody and care (though not in a hospital setting). The 

hospitalization referee entered an order continuing J.E.’s placement at the 24-

hour-care facility. Pursuant to section 229.14A, J.E. requested a hearing for 

review of placement.

The hearing took place in November 2018.1 Afterward, the judicial 

hospitalization referee found by clear and convincing evidence that J.E. remained 

seriously mentally impaired and in need of treatment and full-time custody. The 

referee noted: 

[J.E.] last had a placement hearing on June 16, 2018. As a result 

of that hearing Country View staff placed [J.E.] on a Medication 

Education Program. The results of that program were reported in 

 

1 We do not have a transcript of the hearing; it is unclear whether it was reported.
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August, 2018. [J.E.] has serious medical issues including diabetes 

requiring daily shots and polydipsia which requires monitoring and 

restriction of fluid intake. [J.E.] clearly made efforts to be able to 

manage his medications during the time of the program. He 

learned to name his medications and to be able to state what they 

were prescribed for. However, despite his efforts he was only able 

to seek his medications without prompting fifty-three percent of the 

time. This is not sufficiently regular to keep him safe. He also 

continues to be irresponsible about his restricted fluid intake, 

stealing water and taking it to his room. Without supervision he is 

likely to consume too much liquid. His other behaviors which are 

barriers to [living] in a habilitation home include stealing things such 

as blankets and pillows from other patients and coming out of his 

room unclothed.

J.E. appealed the ruling to the district court, which affirmed the hospitalization 

referee’s order, stating:

It is the court’s determination that [J.E.] is unrealistic in his 

belief that he can continue to sell real estate and is able to live by 

himself. [J.E.] dresses inappropriately for the season and fails to 

follow a restricted diet as is necessary due to his diabetic condition.

Additionally, he picks at his scalp and has caused numerous sores. 

Without proper reminders, he would fail to take his required 

medication. Although not violent or abusive, the above conditions 

make [J.E.] a danger to himself if he were not in a structured 

setting.

Although [J.E.] seems to concede that he is need of 

assistance to see to his daily needs, he is requesting a less secure 

facility to allow him to live on his own. Testimony was presented 

that four separate treatment providers have been contacted as 

alternative placements for [J.E.]. All four providers have refused to 

accept respondent due to medication and elopement issues.

The court further determines that [J.E.’s] commitment to 

Country View is appropriate unless or until a less restrictive 

alternative becomes available.

Here, J.E. challenges the sufficiency of the evidence to support the 

determination he is a present danger to himself and requires continued 

placement in an alternative care facility. 
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As of July 1, 2018, Iowa Code section 229.1(20)2 provides:

“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.

d. Has a history of lack of compliance with treatment and any 

of the following apply:

(1) Lack of compliance has been a significant factor in the 

need for emergency hospitalization.

(2) Lack of compliance has resulted in one or more acts of 

serious physical injury to the person’s self or others or an attempt to 

physically injure the person's self or other.

In other words, to support a finding of serious mental impairment, the State must 

prove “that the individual: (1) has a mental illness, (2) lacks ‘sufficient judgment 

to make responsible decisions with respect to the person’s hospitalization or 

treatment’ because of the mental illness, and (3) is likely, if permitted to remain at 

liberty, to be a danger to self or others.” In re M.E., No. 16-1479, 2017 WL 

1278321, at *3 (Iowa Ct. App. Apr. 5, 2017) (citing Iowa Code § 229.1(20)). 

J.E. does not dispute he has a mental illness and lacks sufficient judgment 

to make responsible decisions with respect to his treatment. He focuses his 

argument on whether he presents a danger to himself or others and, as the State 

puts it, how that intersects with his placement given that J.E. is seeking a less 

 

2 See 2018 Iowa Acts ch. 1056, § 7 (adding paragraph (d) and subparagraphs (1) and 

(2)).
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restrictive level of care. See Iowa Code § 229.1(20)(a)-(d). At the hearing before 

the district court, J.E. indicated his goal was to move into a group home setting 

and then, ultimately, to live independently. 

J.E. is not able to satisfy his essential needs without assistance. See id. 

§ 229.1(20)(c). Following his June 2018 indication that he wished to live 

independently in the community, the care facility put in place a medication 

education program for J.E., who was instructed to request his medication without 

prompting. From June 18 through August 14, J.E. asked for his medication—

including insulin, on which J.E. is dependent—only 92 out of 174 times. 

Additionally, the director of behavioral health services at the facility where J.E. is 

committed testified J.E. “needs constant encouragement on dressing in the 

mornings so that he is appropriately dressed and areas covered.” The director

also discussed that J.E. is unaware when his blood sugar is low, so he fails to 

take corrective action; at its most severe, this could cause J.E. to go into a 

diabetic coma. J.E. also has issues with incontinence and requires staff 

intervention to clean himself and change his clothing. There is sufficient 

evidence to support the district court’s determination J.E. remains seriously 

mentally impaired.

Because J.E. is seriously mentally impaired, it is up to the court to 

determine the appropriate placement for him. See id. § 229.14A(8). While J.E. 

would like to reside in a group home, the evidence established the care facility 

had contacted four habilitative homes, each of which denied placement for J.E. 

due to his issues with medication management and elopement. We cannot say 

the court erred in continuing J.E.’s placement in the 24-hour-care facility when 
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there is no evidence a group home would accept J.E. Moreover, the court stated 

in its order that it determined J.E.’s commitment to the care facility “is appropriate 

unless or until a less restrictive alternative becomes available.” We understand 

this statement to mean that if a place in a group home becomes available for 

J.E., his placement could be modified.

Because sufficient evidence supports the district court’s order of continued 

involuntary inpatient commitment, we affirm.

AFFIRMED.