## Facts

- Timothy Floyd Clites, diagnosed with intellectual disability, was admitted in 1963 as a child to a state-operated residential hospital-school.
- Around 1970, facility physicians began prescribing major tranquilizers to control aggressive behavior.
- From 1970 to 1975, he received multiple major tranquilizers in varying combinations under several physicians.
- In 1975, he was diagnosed with tardive dyskinesia, associated with long-term use of major tranquilizers, with symptoms including involuntary facial and limb movements.
- Timothy’s father and guardian alleged Timothy’s condition deteriorated from the drug regimen and use of physical restraints.
- In July 1976, claimants submitted an administrative tort claim to the state appeal board; the board took no action for six months.
- In March 1977, claimants filed suit under the state tort claims statute against the State and related agencies and officials.
- After a bench trial, the district court found defendants failed to provide reasonable medical treatment (including drug use, monitoring, restraints, and consent practices), that negligence proximately caused Timothy’s injuries, and awarded damages for future medical expenses and pain and suffering.

## Issues

1. Whether the district court had subject-matter jurisdiction when the administrative board did not act for six months and claimants did not file a formal written withdrawal before filing suit.
2. Whether the trial court applied the correct standard of care regarding physical restraints, prescribing and monitoring major tranquilizers, and obtaining informed consent from the guardian.
3. Whether the damages for future medical expenses and pain and suffering were excessive or unsupported by the evidence.

## Decision

- The appellate court affirmed the judgment in full.
- The district court had subject-matter jurisdiction because claimants substantially complied with the tort-claims procedures after the board’s six-month inaction.
- The trial court applied the proper professional standard of care, and substantial evidence supported findings of negligent medication practices, inadequate monitoring, improper restraint-related care, and failures in informed consent.
- The evidence supported proximate cause between the negligent course of treatment and tardive dyskinesia and related deterioration.
- The damages award was supported by the record and was not excessive under the applicable appellate review standard.

## Legal Principles

- Under Iowa’s state tort-claims procedures, a claimant may commence suit after filing an administrative claim and waiting six months without action; substantial compliance can satisfy procedural prerequisites when the board has had a reasonable opportunity to act.
- State-operated residential facilities must provide medical care consistent with professional standards when administering major tranquilizers and using restraints; negligent prescribing, inadequate monitoring for serious side effects, and failure to consider less restrictive alternatives may support liability.
- The duty to obtain informed consent can apply to long-term administration of high-risk psychotropic medications in an institutional setting; guardians must be informed of material risks and reasonable alternatives.
- Damages for severe, permanent injury will be upheld when supported by substantial evidence and not shown to result from passion or prejudice.

## Conclusion

The court upheld a bench-trial judgment imposing tort liability on state defendants for negligent long-term use of major tranquilizers and related failures in monitoring, restraint-related care, and informed consent, and it held that six months of administrative inaction satisfied the statutory pre-suit process.


Clites v. State, 322 N.W.2d 917 (Iowa Ct. App. 1982)