Polk County Sheriff v. Iowa Dist. Court for Polk County

• Decision Date: 28 April 1999
• Docket Number: No. 99-219,99-219
• Citation: 594 N.W.2d 421
• Parties: POLK COUNTY SHERIFF, Plaintiff, v. IOWA DISTRICT COURT FOR POLK COUNTY, Defendant.
• Court: Iowa Supreme Court

Page 421

594 N.W.2d 421

POLK COUNTY SHERIFF, Plaintiff, v. IOWA DISTRICT COURT FOR POLK COUNTY, Defendant.

No. 99-219.

Supreme Court of Iowa.

April 28, 1999.

John P. Sarcone, County Attorney, and Eliza Ovrom and Michael B. O'Meara, Assistant County Attorneys, for plaintiff.

Thomas J. Berg of Elverson, Vasey & Peterson, L.L.P., Des Moines, for defendant.

David Vestal, Des Moines, for amicus curiae Iowa State Sheriffs and Deputies Association.

Considered en banc.

LAVORATO, Justice.

This is a certiorari action to our court brought by the sheriff of Polk County seeking to reverse a district court decision denying the sheriff's application to compel jail inmate Jerrell Brown to submit to kidney dialysis treatment. We must decide whether the district court correctly found that Brown's liberty interest to refuse such treatment outweighs the State's countervailing interests to preserve life, prevent suicide, protect the interests of innocent third parties, maintain the ethical integrity of the medical profession, and maintain prison security, order, and discipline. We find that the State's interests must prevail. We therefore sustain the writ.

I. Scope of Review.

The nature of the issues in this certiorari proceeding determines our review. See Hancock v. City Council, 392 N.W.2d 472, 473 (Iowa 1986). Certiorari is a law action to determine whether a tribunal--here, the district court--has exceeded its jurisdiction or otherwise acted illegally. Medina v. Iowa Dist. Ct., 552 N.W.2d 140, 141 (Iowa 1996). Apart from constitutional issues, our review is therefore for correction of errors at law. Hancock, 392 N.W.2d at 473. Because Brown has raised constitutional issues in the proceedings before the district court, we make an evaluation of the facts from the totality of the circumstances. Id. Our review of the facts is therefore de novo.

II. Facts and Proceedings.

The police arrested Brown on December 16, 1998, on charges of possession of a controlled substance with intent to deliver and failure to possess a drug tax stamp. At the time material to these proceedings, Brown was a Polk County jail inmate.

On February 24, 1999, the Polk County Sheriff filed an application in the district court asking the court to issue an order regarding emergency treatment for Brown. Apparently, Brown was refusing to continue with kidney dialysis treatment, which he had been receiving for about a year. The district court immediately ordered an evaluation of Brown's mental competency.

The next day, the district court held a hearing on the sheriff's petition. Iowa Lutheran Hospital intervened. Apparently, Brown had been receiving kidney dialysis treatments at this hospital.

The following facts were developed during the hearing. Brown is thirty-four years old. He has a medical condition known as nephrotic syndrome arising from hypertension. This condition has rendered his kidneys minimally functional.

Brown has been receiving kidney dialysis (hemodialysis) treatments three days a week. As mentioned, he has been receiving such treatments for about a year. Each treatment lasts about three and one-half hours. An arterial venous fistula has been permanently inserted in his arm. Needles are inserted into this device each time Brown receives the kidney treatment. While receiving the treatment, Brown must sit for the three and one-half hours while the dialysis machine cleans his blood of toxins. Medical testimony revealed that the procedure is not painful and presents no serious side effects. Medical testimony also revealed that unless Brown receives the treatment, he would die within one week. Cardiac arrest would most likely cause his death. Continuing the treatment would allow Brown to live as long as twenty years.

According to the jail medical director, Dr. Roy Overton III, in the event Brown went into cardiac arrest, jail personnel would transport him to an emergency room at a local hospital. Without a do-not-resuscitate order or a living will, hospital personnel would take whatever measures necessary to save Brown's life. These measures would include intubating Brown, placing him on a respirator, inserting a catheter, and performing emergency dialysis. These medical procedures are more invasive than the regular dialysis treatment Brown has been receiving.

The jail medical director testified that he would honor a do-not-resuscitate order. He also testified that there are no Polk County jail inmates who have such orders in place. There was no evidence suggesting Brown has a do-not-resuscitate order or a living will in place.

Marvin Wilson is the chief jailer. He testified that in his twenty-three years at the jail, he has never known an inmate to have a do-not-resuscitate order. Wilson also testified that, even were there such an order, sheriff's deputies would still transport Brown to a hospital in case of a serious medical condition. Wilson pointed out that the jail is not a health care facility and sheriff's deputies would not honor do-not-resuscitate orders. According to Wilson, he would leave that decision to medical personnel.

Wilson testified that the sheriff has a duty to care for the safety, security, custody, and control of jail inmates and a duty to provide medical treatment to them, including Brown. Wilson had several concerns were the district court to allow Brown to refuse medical treatment. First, the other 600 inmates would be encouraged to refuse medical treatment as an excuse to get out of jail. Second, such an order would require jail personnel to exert more eyes-on supervision. This additional supervision would be required even if Brown were to execute a do-not-resuscitate order. Wilson indicated this level of supervision would be more than would be required for an inmate with a contagious medical condition or with a psychotic disorder.

Although Brown did not testify, he did state that he was refusing medical treatment "at this time." This was in response to a question from the judge conducting the hearing.

Dr. Michael Taylor, a psychiatrist, evaluated Brown the day before the hearing. Taylor testified Brown was competent, appeared to be of at least average intelligence, and understood the risks of his discontinuing the treatment. Taylor offered that Brown "knew more about the risks of stopping hemodialysis than some physicians in this state." According to Taylor, Brown said that spending any further time in any correctional facility was unacceptable and that he was going to stop his dialysis treatment "whether he was looking at another month, or another year, or another five years" in incarceration.

Taylor's report concerning the evaluation is in evidence. From it we learn that Brown expressed no particular concern about the potential impact his refusal of treatment and certain death would have on his children. According to the report, Brown stated that he was tired of the routine of being taken to the hospital in jail garb and in manacles only to have to return to jail. The report quotes Brown as stating that "he has decided to refuse any future dialysis until March 4, 1999," which according to Brown was his pretrial conference date. When Taylor expressed doubt that Brown could live until March 4, Brown responded that he really did not care: "I'd be dead, so there would be nothing to worry about."

At the end of the evidence, the district court ruled from the bench. After making detailed findings of fact, the court, in a very thoughtful and thorough ruling, concluded that Brown's liberty interests under the Fourteenth Amendment were superior to the State's claim of reasonable governmental interests in compelling the dialysis treatment. The court overruled the sheriff's application for an order compelling the medical treatment.

The sheriff filed a petition for writ of certiorari with this court and requested an order requiring Brown to immediately undergo kidney dialysis treatment until we could hear the matter. Additionally, the sheriff requested that following the hearing we make the order permanent.

We granted the petition. In addition, we authorized the sheriff to compel Brown to submit to kidney dialysis treatment and, if ordered by a physician, forcibly administer such treatment to maintain Brown's life until we could address the merits of his case.

Following oral arguments, the sheriff notified us that the district court had released Brown from jail. The court had released Brown based on the State's motion to dismiss the charges against Brown prompted by a district court ruling sustaining Brown's motion to suppress. In a written motion, the sheriff has asked us to decide this case, even though the case is now moot.

III. Mootness.

Ordinarily, we do not consider cases that are moot. Shannon v. Hansen, 469 N.W.2d 412, 414 (Iowa 1991). Nevertheless, we may decide to consider moot cases on grounds of public policy. Id. Generally, we consider three factors in making this determination: (1) the public or private nature of the question, (2) the desirability of authoritative adjudication for the future guidance of public officials, and (3) the likelihood of future recurrence. Id. Given the circumstances of this case, we think one additional factor is important: the likelihood that the issue may arise repeatedly, yet evade appellate review. See Commissioner of Correction v. Myers, 379 Mass. 255, 399 N.E.2d 452, 455 (1979) (holding that question of inmate's right to refuse lifesaving treatment in an emergency situation is one of public importance, capable of repetition, yet evading appellate review; court considered issue even though moot, reasoning that other instances of inmate refusal could become factually moot by the mere passage of time before appeal, either because untreated inmate has died or has voluntarily submitted to treatment).

Having considered all four factors, we agree with the sheriff that we should decide this case. Clearly, the issue is one of public importance, and our...