Limits of Constitutional Protections in Civil Commitment Proceedings

Facts of the Case

V.H., identified as a 22-year-old male, was incarcerated at the Iowa Medical and Classification Center (IMCC) in Coralville, Iowa in May 2019 following convictions on two counts of assault causing injury to peace officers and three counts of first-degree harassment. He began serving consecutive prison sentences amounting to eight years for his convictions when prison staff began recording instances of his impulsive and aggressive conduct, such as banging his head, damaging property, harassing female staff, and attempting to ingest metal objects. On certain occasions, he was placed in restraints after threatening self-harm and physically resisting officers. An IMCC psychiatrist diagnosed V.H. with bipolar I disorder, impulse control disorder, and antisocial personality disorder, submitting reports supporting continued commitment over the next two years.

In March 2022, V.H. submitted a handwritten letter moving to terminate his commitment and demanding the opportunity to independently cross-examine his treating psychiatrist after his continued commitment was confirmed by the district court. On April 4, the judicial hospitalization referee held a hearing in which V.H. was represented by a court-appointed attorney. The referee ordered that V.H. remain committed to IMCC, based on the report and testimony from the psychiatrist who noted that V.H. had multiple recent instances of headbanging, fighting with staff, suicidal ideation, and at times he required placement in physical restraints for his own safety. V.H.’s appointed counsel then filed a notice of appeal on behalf of V.H. to the district court as well as a motion to allow him to proceed pro se, citing his right to self-representation under the Sixth and Fourteenth Amendments of the U.S. Constitution. The district court set a hearing for the following month, and V.H.’s behavior worsened. Subsequent reports from his psychiatrist noted that V.H. repeatedly refused medications, continued to strike his head resulting in bleeding, and fought another inmate. Each such instance prompted injected medications.

In May 2022, the district court heard V.H.’s appeal and denied his motion to proceed pro se, citing Iowa Code section 229.9, which requires representation by counsel at all proceedings related to a civil commitment. Further, the court stated the Sixth Amendment did not apply to civil commitment proceedings and the requirement for legal representation did not offend Fourteenth Amendment due process rights. The psychiatrist testified that V.H.’s civil commitment remained necessary based on danger to himself and others. V.H., through his attorney, was allowed to make a statement and cross-examine the psychiatrist. Despite argument that Iowa failed to establish dangerousness in his case, the district court found that V.H.’s recent headbanging, which resulted in bleeding, was sufficient evidence of dangerousness, and affirmed his continued commitment.

V.H. subsequently appealed the district court’s decision, contending the court erred in denying his fundamental right to self-representation under the Sixth and Fourteenth Amendments. He also argued the court’s decision to support his involuntary hospitalization based on his recent headbanging behavior as evidence of dangerousness was flawed. The state responded that V.H.’s headbanging had resulted in injuries in the past, which caused him to bleed, and that “even in the criminal process, the right to represent oneself is not absolute and a Judge has the ability to determine if a defendant is capable of conducting their own defense” (Matter of V.H, p 536). In an appellate reply brief, V.H. reasserted his right to self-representation, adding a novel reference to Article I, Section 10 of the Iowa Constitution.

Ruling and Reasoning

The Supreme Court of Iowa determined that V.H. failed to preserve the matter of a right to self-representation under the Iowa Constitution. Next, the court affirmed both the denial of V.H.’s Sixth and Fourteenth Amendment claims to self-representation at Chapter 229 proceedings and his continued commitment.

Prior to an appellate reply brief, V.H. had only claimed a federal right to self-representation, without mentioning Iowa’s state constitution. The court reiterated its holding in Meier v. Senecaut III, 641 N.W.2d 532 (Iowa 2002), that appellate matters should have generally been raised and decided by a district court. Thus, V.H.’s failure to assert error under the Iowa Constitution in district court forfeited this matter.

The court reviewed Iowa §229.9 (2022), stating in part, “The respondent’s attorney shall represent the respondent at all stages of the proceedings, and shall attend the hospital hearing.” The court noted there is no provision that would permit V.H. to waive his right to counsel. Additionally, the court recognized a circularity problem in which the validity of a committed person’s waiver of the right to counsel could later be challenged and require a rehearing if a court believes a “respondent so severely impaired as to necessitate an involuntary mental health commitment” (Matter of V.H, p 533).

The court was not persuaded by V.H.’s reliance on federal case law recognizing a right to self-representation under the Sixth Amendment in criminal cases, specifically Faretta v. California, 422 U.S. 806 (1975). Writing for the court, Judge Waterman noted that this right of the criminally accused had never been extended to individuals in civil commitment proceedings. In United States v. O’Laughlin, 934 F.3d 840 (8th Cir. 2019), the U.S. Court of Appeals for the Eighth Circuit affirmed the rejection of the respondent’s motion to proceed pro se while contesting civil commitment, citing Addington v. Texas, 441 U.S. 418 (1979): “Civil commitment involves a loss of liberty, to be sure. But rather than imposing a punitive sentence upon criminal conviction, the civil commitment process provides for release once the individual is no longer a danger to others” (p 428). Rejecting a Fourteenth Amendment claim, the court cited Iowa Code Section 229’s explicit mandate of counsel representation in civil commitment hearings as satisfying substantive due process.

The Iowa Supreme Court similarly parried other state courts’ upholding self-representation in commitment proceedings (see, e.g., In re Det. of J.S., 159 P.3d 435 (Wash. Ct. App. 2007); In re Jesse M., 170 P.3d 683 (Ariz. 2007)), as those rulings turned on distinct state constitutions and explicit statutory construction.

Given that V.H.’s headbanging and suicidal ideation presented a danger to himself and met civil commitment requirements as evidenced by a “recent overt act, attempt, or threat” (In re Mohr, 383 N.W.2d 539, 542 (Iowa 1986)), the court affirmed the district court’s ruling, satisfied that Iowa had met its burden to commit the respondent.