IN THE COURT OF APPEALS OF IOWA

No. 15-1416

Filed March 23, 2016

IN RE THE MATTER OF C.J.,

Alleged to be Seriously Mentally Impaired,

C.J.,

Respondent-Appellant.

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Appeal from the Iowa District Court for Woodbury County, Duane 

Hoffmeyer, Judge.

Respondent appeals the district court order finding he was seriously 

mentally impaired. REVERSED AND REMANDED.

Zachary S. Hindman of Bikakis, Mayne, Arneson, Hindman & Hisey, Sioux 

City, for appellant.

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

Assistant Attorney General, for appellee State.

Considered by Tabor, P.J., and Bower and McDonald, JJ.
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BOWER, Judge.

Respondent C.J. appeals the district court order finding he was seriously 

mentally impaired. We find there is not clear and convincing evidence to show 

C.J. was a danger to himself or others due to insufficient evidence of a recent 

overt act. We also find there is insufficient evidence to show he was likely to 

inflict serious emotional injury on members of his family or others who lacked a 

reasonable opportunity to avoid contact with him if he was allowed to remain at 

liberty without treatment. We reverse the decision of the district court and

remand for dismissal of the application.

I. Background Facts & Proceedings

On July 14, 2015, C.J. was taken to the emergency room at Mercy 

Medical Center in Sioux City, Iowa, by police officers. Dr. Brian Paugh, a 

physician, requested a forty-eight-hour hold, pursuant to Iowa Code section 

229.22 (2015). Dr. Paugh stated:

[Patient] has been exhibiting paranoid schizophrenia today. 

He has been exhibiting aggressive behavior toward SCPD [Sioux 

City Police Department] officers. I would like hold for evaluation & 

treatment.

The district court ordered C.J. should be immediately detained due to serious 

mental impairment.

On July 16, 2015, an application was filed alleging C.J. was seriously 

mentally impaired. An affidavit in support of the application was signed by 

Marlene Sorensen, a member of the hospital staff, who stated:

[C.J.] was admitted to Mercy Behavioral Health on 7/14/15 

from the ER. He had been hearing voices due to an implanted 2-

way radio. He remains paranoid. States wants a full body scan to 

see the chips in his [right] ear and [left] eye. States this is the doing 
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of the FBI. States chips make him hear voices that know exactly 

what he is thinking.

An affidavit by Christine Strand, another member of the hospital staff, stated:

[C.J.] was admitted to Mercy Behavioral through the 

Emergency Department due to delusional & paranoid behavior. He 

believes that he has had microchips put into parts of his body & is 

wanting body scans. He has been at Mercy before with similar 

delusions. He is refusing psychiatric medications. His delusions 

impact his decision-making resulting in him being in imminent 

danger to self & possibly others.

Dr. Josette Lindahl completed the physician’s report, pursuant to section 

229.10(2), and found C.J. was mentally ill and lacked sufficient judgment to make 

responsible decisions with respect to his hospitalization or treatment. Dr. Lindahl 

gave the opinion C.J. was likely to physically injure himself or others; inflict 

serious emotional injury on members of his family or others who lacked a 

reasonable opportunity to avoid contact with him; and was unable to satisfy his 

needs for nourishment, clothing, essential medical care, or shelter, if he was 

allowed to remain at liberty without treatment.

A commitment hearing was held on July 21, 2015. C.J. waived the 

presence of Dr. Lindahl and the applicants. He agreed the court could consider 

the request for the forty-eight-hour hold. The only witness at the hearing was 

C.J., who stated he just needed a CAT scan to find the wires implanted in him, 

because, “As far as mental, there wasn’t nothing, you know, wrong with me 

mentally.” He also stated, “I don’t need any mental health treatment.”

The district court entered an order finding C.J. was seriously mentally 

impaired. The court found C.J. was afflicted with a mental illness and lacked 

sufficient judgment to make responsible decisions with respect to his treatment or 
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hospitalization. The court found if C.J. was allowed to remain at liberty he was 

likely to inflict serious injury on himself or others and was likely to inflict serious 

emotional injury on members of his family or others who lacked a reasonable 

opportunity to avoid contact with him. The court gave the following factual basis 

for its ruling:

Dr. report mental illness; believes wire placed by 2 females 

with connections to law enforcement & wanted to press charges 

against and got CAT scan to prove illegal wiretap. Allows FBI to 

track & speak with him. He says he has cooperated with whoever 

is speaking with him. Prior medical care with Dr. Brink until 

retirement; treatment in Mississippi. Aggressive behavior towards 

police officers (ER-Doctor) & C. Strand application immediate 

danger.

The court ordered C.J. should be immediately hospitalized for treatment. He 

appeals the decision of the district court.

II. Standard of Review

Challenges to the sufficiency of the evidence in involuntary commitment 

proceedings are reviewed for the correction of errors at law. In re B.B., 826 

N.W.2d 425, 428 (Iowa 2013). An allegation of serious mental impairment must 

be proven by clear and convincing evidence. Iowa Code § 229.13(1). “Clear and 

convincing evidence is less burdensome than evidence establishing proof 

beyond a reasonable doubt, but more burdensome than a preponderance of the 

evidence.” B.B., 826 N.W.2d at 428. “It means that there must be no serious or 

substantial doubt about the correctness of a particular conclusion drawn from the 

evidence.” Id.

While the elements of serious mental impairment must be established by 

clear and convincing evidence, the district court’s factual findings are binding on 
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appeal if they are supported by substantial evidence. In re J.P., 574 N.W.2d 340, 

342 (Iowa 1998). “Evidence is substantial if a reasonable trier of fact could 

conclude the findings were established by clear and convincing evidence.” Id.

III. Merits

Iowa Code section 229.1(20) (Supp. 2015) defines “seriously mentally 

impaired” in the following way:

“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.

The definition of serious mental impairment has three elements. The 

respondent must be found to have (1) a mental illness, (2) to lack “sufficient 

judgment to make responsible decisions with respect to the person's 

hospitalization or treatment,” and (3) to be likely, if allowed to remain at liberty, to 

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

injury on those close to the person, or to be unable to satisfy the person’s 

physical needs. J.P., 574 N.W.2d at 343 (quoting In re Foster, 426 N.W.2d 374, 

376–77 (Iowa 1988)).

A. C.J. claims the evidence does not show he was likely to physically 

injure himself or others if allowed to remain at liberty without treatment. He 
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claims there is no evidence of a recent overt act, attempt, or threat to support a 

finding of dangerousness.

We have said the element of dangerousness “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) (citations omitted). The term “likely” means “probable or reasonably to be 

expected.” Id. The danger the person poses to himself or others must be 

evidenced by a “recent overt act, attempt or threat.” J.P., 574 N.W.2d at 344. “In 

the context of civil commitment we hold that an ‘overt act’ connotes past 

aggressive behavior or threats by the respondent manifesting the probable 

commission of a dangerous act upon himself or others that is likely to result in 

physical injury.” Foster, 426 N.W.2d at 378 (citation omitted).

The only evidence of a recent overt act is the request by Dr. Paugh for a 

forty-eight-hour hold, stating C.J. had been exhibiting aggressive behavior toward 

police officers. There is no evidence in the record as to whether this was verbal 

or physical aggression. The record does not show a threat or an act of 

unprovoked physical aggression. See id. at 378–79. We conclude the evidence 

does not show a recent overt act by C.J. “manifesting the probable commission 

of a dangerous act upon himself or others that is likely to result in physical injury.” 

See id. at 378. Strand’s statement C.J.’s “delusions impact his decision-making 

resulting in him being in imminent danger to self & possibly others,” did not 

include evidence of a recent overt act “likely to result in physical injury.” See id.

Due to the lack of evidence of a recent overt act, we conclude there is not 

clear and convincing evidence in the record to show C.J. was likely to injure 
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himself or others if allowed to remain at liberty without treatment. See Iowa Code 

§ 229.1(20)(a).

B. C.J. also claims there is not sufficient evidence in the record to 

show he was likely to inflict serious emotional injury on members of his family or 

others who lacked a reasonable opportunity to avoid contact with him if he was 

allowed to remain at liberty without treatment. See Iowa Code § 229.1(20)(b).

The district court found this ground had been proven by clear and 

convincing evidence, but did not cite any specific evidence to support its 

conclusion. On our review of the record we find there is no evidence to support 

the court’s finding on this ground.

We reverse the district court’s order finding C.J. was seriously mentally 

impaired and remand for dismissal of the application.

REVERSED AND REMANDED.