DUBUQUE COUNTY, Plaintiff, vs. IOWA DISTRICT COURT FOR DUBUQUE COUNTY, Defendant.
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IN THE COURT OF APPEALS OF IOWA
No. 8-306 / 07-0473
Filed August 13, 2008
DUBUQUE COUNTY,
Plaintiff,
vs.
IOWA DISTRICT COURT
FOR DUBUQUE COUNTY,
Defendant.
_______________________________________________________________
Appeal from the Iowa District Court for Dubuque County, John
Bauercamper, Judge.
Dubuque County filed a petition for writ of certiorari claiming the district
court erred by finding it in contempt under an order for the involuntary
hospitalization of J.B. WRIT SUSTAINED.
Ralph R. Potter, County Attorney, for plaintiff.
Sarah E. Stork-Meyer of Clemens, Walters, Conlon & Meyer, L.L.P.,
Dubuque, for J.B.
Considered by Vogel, P.J., and Zimmer, J., and Beeghly, S.J.*
*Senior judge assigned by order pursuant to Iowa Code section 602.9206 (2007).
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PER CURIAM
I.
Background Facts & Proceedings
J.B. has a history of mental health problems and has been adjudicated to
be seriously mentally impaired under Iowa Code chapter 229 (2005). She has
been involuntarily committed to a mental health institute (MHI) in Iowa.1 The MHI
did not recommend continued placement at that facility, however, due to the level
of care required for J.B. The MHI staff physician recommended that J.B. be
placed at Brookhaven Hospital in Tulsa, Oklahoma, because it was believed she
could receive more appropriate treatment there.
A judicial hospitalization referee entered an order on April 20, 2005, which
provided J.B. should be placed at Brookhaven Hospital. The order provided,
“[p]ursuant to Iowa Code section 229.42, the cost of hospitalization shall be paid
by the county of legal settlement, and therefore, the Court Orders that Dubuque
County fund the court-ordered placement pursuant to Iowa Code chapter 229.”2
In addition, the order stated, “MHI, DHS, and CPC shall arrange for transfer,
transport and funding pursuant to their respective statutory and legal duties . . .
.”3
1
She was most recently ordered to be placed at MHI-Independence on August 12,
2004. J.B. had previous placements at MHI, and other facilities within Iowa.
2
The referee refers to section 229.42. This section, however, applies to voluntary
admissions to a mental hospital. Section 230.1(1)(a) provides that the county in which a
person has legal settlement is liable for the costs and expenses for the “support of a
person with mental illness admitted or committed to a state hospital . . . .” See Emmet
County Bd. of Super’s v. Ridout, 692 N.W.2d 821, 828 (Iowa 2005).
3
DHS refers to the Iowa Department of Human Services. CPC refers to Central Point
Coordination, which is a process used for “the delivery of mental health, mental
retardation, and developmental disabilities services which are paid for in whole or in part
by county funds.” Iowa Code § 331.440(1)(a).
3
On May 19, 2005, J.B. filed an application for rule to show cause against
Dubuque County. The referee entered an order stating that the contempt matter
should be heard before another judge, but also stating “there are considerable
funding issues involved in the case that respective funding for the Respondent
shall be made consistent with statutory and legal duties only and consistent with
the required court-ordered involuntary hospitalization proceedings under Chapter
229.”4
In March 2006, Brookhaven Hospital contacted Dubuque County and
advised that it was necessary for the County to enter into a contract for individual
medical services for J.B., and that a legal guardianship should be established for
her. Dubuque County informed Brookhaven it was responsible for funding only,
and that Brookhaven should contact the court or MHI concerning the contract or
a legal guardianship. There was no further response by Brookhaven.
On September 20, 2006, J.B. filed another application for rule to show
cause against Dubuque County stating she remained in Iowa and no
arrangements had been made for transfer, transport, or funding for her
placement at Brookhaven Hospital in Oklahoma. The district court entered an
order on February 12, 2007, finding Dubuque County in contempt of court. The
court found, “[t]he county and the various agencies cannot agree on which
agency is required to do which things needed to negotiate with Brookhaven over
its requirements to accomplish [J.B.’s] admission and comply with the Order.”
4
The County filed a separate application for rule to show cause, and matters in this
case were continued during the proceedings in that case. Delays also arose because
DHS denied a request to fund J.B.’s placement at Brookhaven for the reason it was not
psychosocially necessary.
4
The court concluded, “Dubuque County’s conduct in not fully participating in and
cooperating with the efforts needed to comply with the placement order was
willful, and constitutes contempt.” The court then ordered that J.B.’s attorney
should negotiate, on behalf of Dubuque County, with Brookhaven over the terms
of admission for J.B. This contract would be submitted to the court for approval,
and if approved the court would require the County to sign it.
Dubuque County filed a petition for writ of certiorari and a request for an
immediate stay.
The Iowa Supreme Court granted the petition for writ of
certiorari and granted the stay. The case was transferred to the Iowa Court of
Appeals for consideration.
II.
Standard of Review
When a district court has made a finding of contempt, we review the
evidence to determine that the court’s factual findings are supported by
substantial evidence. Gimzo v. Iowa Dist. Court, 561 N.W.2d 833, 834-35 (Iowa
Ct. App. 1997). We review the court’s legal conclusions for the correction of
errors at law. Id. at 835. A person should not be punished for contempt unless
the alleged contumacious actions have been established by proof beyond a
reasonable doubt.
Phillips v. Iowa Dist. Court, 380 N.W.2d 706, 709 (Iowa
1986).
III.
Merits
Dubuque County claims the district court erred by finding it in contempt for
failure to fulfill duties that were not clearly imposed on the County by the court’s
order of April 20, 2005. A party seeking a finding of contempt has the burden to
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prove the alleged contemnor (1) had a duty to obey a court order, and (2) willfully
failed to perform that duty. Christensen v. Iowa Dist. Court, 578 N.W.2d 675, 678
(Iowa 1998). “Before a person may be held in contempt for violating a court
order, the order should inform him in definite terms as to the duties thereby
imposed upon him, and the command must therefore be express rather than
implied.” City of Dubuque v. Iowa Dist. Court, 725 N.W.2d 449, 453 (Iowa 2006).
A party cannot be found in contempt if a court order has not directed the party to
perform or not perform an act. Id.
The court’s order of April 20, 2005, directed that “MHI, DHS, and CPC
shall arrange for transfer, transport and funding pursuant to their respective
statutory and legal duties and reports shall be filed every 15 days regarding
treatment.” (Emphasis added.) The order also directed “Dubuque County [to]
fund the court-ordered placement pursuant to Iowa Code chapter 229.” The
order limits Dubuque County’s responsibility to its statutory responsibility to fund
the placement.5
A judicial hospitalization referee has the ability, under chapter 229, to
place a person adjudicated to be seriously mentally impaired in a suitable facility
outside the state of Iowa. Jasper County v. McCall, 420 N.W.2d 801, 803 (Iowa
1988). Such a placement should be made only when adequate treatment is not
available within Iowa. Id. The Iowa Supreme Court stated, “[w]e think it follows
that the placement can be ordered at public expense under the same terms and
conditions as would be appropriate for placements in Iowa.” Id. Thus, the fact
The procedures for a county’s payment of the expenses of a person having legal
settlement in that county and who has been committed to a mental health institute within
Iowa are found in sections 230.20 and 230.21.
5
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that a person has been placed in a facility outside the state of Iowa should not
place a greater duty on a county than that required for a person placed within
Iowa.
The order in this case directed only that “Dubuque County fund the courtordered placement pursuant to Iowa Code chapter 299.” In a case involving the
City of Dubuque, the supreme court stated:
In the case at hand, Dubuque’s actions did not violate any
terms of the district court’s original order unless we read them in by
implication.
“We cannot, however, supply by interpretation
constraints which are not expressed in [the order], especially when
the result is to apply powers of the court as formidable as
contempt.”
City of Dubuque, 725 N.W.2d at 453 (citation omitted). Dubuque County was not
found to be in contempt for failure to provide funding.
The district court’s order found the County in contempt for “not fully
participating in and cooperating with the efforts needed to comply with the
placement order . . . .” The court’s order of April 20, 2005, however, did not
make the County responsible for making arrangements for J.B.’s placement,
such as signing a contract with Brookhaven. Under the court’s order, MHI, DHS,
and CPC are to make the arrangements for funding, as well as the arrangements
for transfer and transport.
The County’s responsibility is to fund J.B.’s
placement, as required by statute, once those arrangements are made.
We conclude the County was not in contempt of the court’s order of April
20, 2005. We sustain the writ of certiorari.
WRIT SUSTAINED.
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BEEGHLY, S.J., (specially concurring)
The April 20, 2005 order required “that Dubuque County fund the courtordered placement” at Brookhaven. The order was entered pursuant to Iowa
Code section 229.42, which provides that “[t]he mental health institute and the
county shall work together to locate appropriate alternative placements . . . .”
Section 229.42 also provides, “All the provisions of chapter 230 shall apply to
such voluntary patients so far as is applicable.” Even though section 229.42
refers only to voluntary patients, it applies as well to committed patients under
placement order. See Iowa Code § 229.14A(9).
The Dubuque County Board of Supervisors received a letter from
Brookhaven along with a proposed contract for services. The proposed contract
required that a guardianship be established before admission into the hospital.
Under the proposed contract basic services were to be provided at the base rate
of $769.81 per day.
The base rate would provide room and board on the
Neurorestorative Unit at Brookhaven Hospital, therapy services, recreational and
psycho-social rehabilitation, laboratory management of medication for admitting
mental health or neurological conditions, pharmacy for such conditions and
physician services for neurology and internal medicine. The base rate would not
cover psychiatric services, physician services other than neurology and internal
medicine, medical treatment outside of Brookhaven Hospital, spending allowance
or transportation for admission or discharge. It was anticipated that one-on-one
staffing might be clinically necessary due to behavioral or safety concerns. In
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that event additional staffing would be charged at $15.00 per hour, not to exceed
$360.00 per day.
The Board of Supervisors responded:
The Dubuque County Board of Supervisors and its
employees are not the appropriate parties to contract for individual
medical services or to establish guardianships for patients. The
County’s responsibility is solely to provide funding. The placement
was ordered by the Hospitalization Referee at the request of MHI Independence. Those agencies should be approached about the
contract and guardianship issues.
Brookhaven’s proposal of having a written contract was reasonable. It is
good practice for the parties to clarify their respective responsibilities, especially
where the financial obligation is substantial. While the county may not have had
a duty to provide a guardianship, the CPC process contemplates coordination of
efforts with other agencies or individuals to make such arrangements.
The
record in this case shows no attempt by Dubuque County to utilize the CPC
process to arrange a guardianship.
Iowa Code section 331.381(5) specifically requires the county to “comply
with chapters 227, 229 and 230, including but not limited to sections 227.11,
227.14, 229.42, 230.25, 230.27, and 230.35, in regard to the care of persons with
mental illness.”
Section 230.1(1)(a) provides that “[t]he necessary and legal costs and
expenses attending . . . admission, commitment, and support of a person with
mental illness admitted or committed to a state hospital shall be paid by a county”
where legal settlement is in that county and the committed person is over
eighteen years of age. If the person is under eighteen or legal settlement is
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undetermined the State of Iowa is responsible. See Iowa Code § 230.1(1)(b).
Section 230.1(3) provides that a county of legal settlement is not liable for costs
and expenses associated with a person with mental illness unless the costs and
expenses are for services and other support authorized for the person through
the CPC process. For purposes of this chapter, “central point of coordination
process” means the same as defined in section 331.440.
Section 331.440 defines the CPC process as a process established by a
county for the delivery of mental health and other services which are paid for in
whole or in part by county funds.
Section 331.440 provides that the CPC
process may include, but is not limited to, reviewing a person’s eligibility for
services, determining the appropriateness of the type, level, and duration of
services, and performing periodic review of the person’s continuing eligibility and
need for services.
Dubuque County is liable for the cost of placement for this patient. There
was no legal ground to avoid responsibility. The patient was over eighteen years
of age. Legal settlement was not in dispute. The placement was court-ordered
under section 229.14A. The county received notice of the placement hearing
and was provided an opportunity to present evidence under section 229.14A(7).
The placement at Brookhaven was authorized through the CPC process as a
matter of law under section 229.14A(9).
The county had a duty to “work
together” with MHI to provide services under section 229.42.
Rather than put its efforts into arranging appropriate placement, the
county chose to put its efforts into avoiding court-ordered placement. There is
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clear and convincing evidence that Dubuque County, through its Board of
Supervisors, stone-walled to avoid funding this placement. It has taken no action
to comply with reasonable requirements for placement at Brookhaven. However,
contempt must be proven beyond a reasonable doubt.
I concur in the majority’s determination that the evidence does not show
beyond a reasonable doubt that Dubuque County was in contempt of the April
20, 2005 order of the judicial hospitalization referee.
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