IN THE COURT OF APPEALS OF IOWA

No. 15-1823

Filed June 15, 2016

IN THE INTEREST OF THE MATTER OF K.R.A.,

Alleged to be seriously mentally impaired,

K.R.A., 

Respondent-Appellant.

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Appeal from the Iowa District Court for Polk County, Robert B. Hanson, 

Judge.

K.R.A. appeals from the hospitalization order placing him in a facility for 

inpatient psychiatric care. AFFIRMED.

Michael A. Horn of Kuntz, Laughlin & Horn, Des Moines, for appellant.

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

Attorney General, for appellee.

Considered by Potterfield, P.J., and Mullins and McDonald, JJ.
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MCDONALD, Judge.

This case arises out of a civil commitment proceeding under Iowa Code 

chapter 229 (2015). K.R.A. appeals from a hospitalization order finding him to be 

“seriously mentally impaired” within the meaning of Iowa Code section 229.1(20) 

and a placement order continuing inpatient psychiatric treatment. On appeal,

K.R.A. challenges the sufficiency of the evidence supporting the hospitalization 

and placement orders. We review the challenged orders for the correction of 

legal error. See Iowa R. App. P. 6.907; In re J.P., 574 N.W.2d 340, 342 (Iowa 

1998). 

We conclude there is substantial evidence supporting the challenged 

orders. Involuntary hospitalization requires the applicant to prove by clear and 

convincing evidence the following: (1) the person must be afflicted with a mental 

illness; (2) the person lacks sufficient judgment to make responsible decisions 

with respect to the person’s hospitalization or treatment because of the illness; 

and (3) the person is likely, if allowed to remain at liberty, to inflict physical injury 

on the “person’s self or others,” to inflict emotional injury on certain others, or to 

suffer physical debilitation or death due to the inability of the person to satisfy the 

person’s needs. See Iowa Code § 229.1(20); In re Foster, 426 N.W.2d 374, 377 

(Iowa 1988). The third element is commonly referred to as the endangerment 

element. See J.P., 574 N.W.2d at 343-44. Our courts require the endangerment 

element to be established by a recent overt act, attempt, or threat. See Matter of 

Mohr, 383 N.W.2d 539, 542 (Iowa 1986). In this case, the examining physician 

testified K.R.A. suffered from mental illness, specifically, post-traumatic stress 

disorder, anxiety disorder, depression, and neurocognitive disorder (dementia). 
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The physician testified K.R.A. lacked sufficient judgment, because of his illness, 

to make rational decisions regarding his treatment, as evidenced by his repeated 

noncompliance with prescribed medications. Finally, K.R.A. is a danger to others

and himself if allowed to remain at liberty as evidenced by recent overt acts. The 

testimony showed K.R.A. was verbally and physically aggressive against his 

spouse and hospital staff, including throwing his walker on one occasion. On 

another occasion, he overdosed on his medication because he could not 

remember whether he had taken his medication. The orders of the district court 

are affirmed without further opinion. See Iowa Ct. R. 21.26(1)(a), (b), (e). 

AFFIRMED.