In the Matter of the Civil Commitment of: Nathaniel Lee Betzler.

This opinion is nonprecedential except as provided by
Minn. R. Civ. App. P. 136.01, subd. 1(c).

STATE OF MINNESOTA
IN COURT OF APPEALS
A24-0102

In the Matter of the Civil Commitment of: Nathaniel Lee Betzler.

Filed July 1, 2024
Affirmed
Smith, Tracy M., Judge

Stearns County District Court
File No. 73-PR-19-7551

Tucker L. Isaacson, Bradshaw & Bryant, PLLC, Waite Park, Minnesota (for appellant
Nathaniel Lee Betzler)

Janelle P. Kendall, Stearns County Attorney, Nathan S. Crowe, Assistant County Attorney,
St. Cloud, Minnesota (for respondent Stearns County Human Services)

Considered and decided by Bjorkman, Presiding Judge; Smith, Tracy M., Judge;
and Slieter, Judge.
NONPRECEDENTIAL OPINION
SMITH, TRACY M., Judge
On appeal from his commitment as a sexually dangerous person (SDP) and as a
sexual psychopathic personality (SPP), appellant Nathaniel Lee Betzler argues that the
district court erred by determining that (1) Betzler meets the definitions of an SDP and an
SPP and (2) no less restrictive alternative to commitment exists. We affirm.
FACTS
In August 2022, respondent Stearns County Human Services petitioned for civil
commitment of Betzler as an SDP and an SPP . Following a commitment hearing , the
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district court granted the county’s petition and indeterminately committed Betzler to the
care of the Minnesota Commissioner of Human Services for treatment in the Minnesota
Sex Offender Program (MSOP) as an SDP and an SPP.
Betzler’s history of criminal-sexual-conduct offenses began when he was a juvenile.
In 1990, when he was 13 years old, Betzler committed fourth-degree criminal sexual
conduct against a seven-year-old relative. Betzler put Vaseline on his penis and placed his
penis on his relative’s upper leg. His relative stated that it hurt. Betzler also asked his
relative to “do the wild thing” and asked if she would let him put his penis in her “butt,”
but she did not let him. The district court adjudicated Betzler delinquent, placed him on
probation, and ordered him to participate in sexual-offender treatment.
In 1997, Betzler committed fifth-degree criminal sexual conduct and pleaded guilty
to a gross misdemeanor. At a party, after an intoxicated guest went to sleep, Betzler
removed her pants and underwear and sexually assaulted her. He was convicted, sentenced
to one year in jail with all but 45 days stayed, and required to complete sexual-offender
treatment. Betzler later violated his probation requirements, including by failing to
complete sexual-offender treatment, and the district court revoked the stay and ordered the
remaining 320 days of jail time executed.
Between 1998 and 2002, Betzler was not in compliance with his requirement to
register as a sex offender, although he was not prosecuted for his noncompliance.
In 2005, Betzler committed third-degree criminal sexual conduct and pleaded guilty
to the charged conduct . After a wedding, Betzler and his friends offered a woman a ride
home in a van. The van traveled through a remote area that the woman was unfamiliar with,
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and Betzler told the woman that he had a gun. Betzler sexually assaulted the woman in the
van. The district court sentenced him to 96 months in prison but stayed the execution of
his sentence and placed him on probation. Betzler’s conditions of probation included that
he complete sexual-offender treatment, that he have no contact with women under age 18,
and that he not use pornography.
In 2010, Betzler violated his conditions of probation by failing to complete sexual -
offender treatment after he was terminated from the program he was attending. He served
180 days in jail for this violation.
That same year, after being released from jail, Betzler again violated his conditions
of probation. He had a 16-year -old girl staying with him at his apartment and had
pornographic photos of her on his cell phone. Based on these violations, his stay was
revoked and the district court executed his 96-month sentence. Betzler was also criminally
charged for that conduct, and he was convicted of possession of child pornography and
sentenced to 50 months in prison. He was ordered to be on conditional release for ten years
following his incarceration and was required to register as a predatory offender for life.
This offense is Betzler’s most recent conviction.
In 2011, while serving his prison sentence, Betzler was admitted to MSOP at the
Minnesota Department of Corrections (DOC) location. Although he made progress in the
treatment program, he was discharged from the program in 2013 for fighting with his
roommate. He was readmitted to MSOP at the DOC location in 2014. He once again made
progress in treatment. In 2016, he was released from prison on probation, and therefore
discharged from MSOP.
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Betzler was placed on intensive supervised release (ISR). His conditions of
supervised release included that he complete sexual-offender treatment, that he inform his
ISR supervisor of his activities, and that he not possess dangerous weapons. In 2017,
Betzler took a day of sick leave without notifying his probation agents. A coworker alleged
that Betzler sexually assaulted her on that day, although she later stated that their
interaction had been consensual. Betzler was arrested based on the alleged assault and was
discharged from his sexual-offender treatment program based on his unavailability. Betzler
was returned to incarceration for 100 days for violating his conditions of release, based on
his failure to notify his agents of his sick leave, his failure to complete sexual-offender
treatment, and his possession of a pocketknife in his residence.
Betzler resumed sexual-offender treatment when he was released on ISR. In 2019,
the sexual-offender treatment program discharged Betzler for lack of progress, causing
Betzler to fail to complete sexual-offender treatment. He also had alcohol in his residence,
which was prohibited under his conditions of release. Based on these violations of his
conditions of release, Betzler was returned to incarceration.
Betzler was released to the Alpha Emergence sexual-offender treatment program
(Alpha) on January 25, 2021. One condition of his release was that he submit to GPS
monitoring. Also, Alpha had directed Betzler to have no visitors. On January 30, Betzler
persuaded Alpha staff into letting him go to a last-minute medical appointment, at which
he persuaded the medical staff to remove his GPS bracelet and at which a visitor, his wife,
was present. Betzler met with ISR agents to discuss this infraction of his conditions of ISR.
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In December 2021, ISR agents searched Betzler’s residence and found pornographic
DVDs that he admitted he used for masturbation purposes. Betzler was disciplined for this
infraction of his conditions of ISR.
For two weeks in January 2022, Betzler disabled the monitoring software on his
cellphone. In February 2022, after the monitoring software had been re-enabled, Betzler
engaged in online searches for sexually explicit videos and admitted to viewing sexually
explicit videos that he had found. He was arrested for this violation of his conditions of
ISR but was released on ISR to the Alpha program. In June 2022, Betzler again accessed
sexually explicit photos on his cellphone and was disciplined for his violation of his terms
of release.
Betzler also reported unadjudicated sexual misconduct, including committing
sexual assaults when he was a juvenile, coercing multiple women into engaging in sexual
intercourse with him, having sexual thoughts about minors, and having fantasies of forcing
sex on another person.
Prior to the commitment hearing, three experts evaluated Betzler, and each authored
a report of their opinion. Before the county filed its petition to commit Betzler, it engaged
Amber Lindeman, Psy.D., to review Betzler’s records and determine whether he meets the
statutory criteria for commitment as an SDP or SPP . Dr. Lindeman reviewed police
records, psychosexual evaluations, actuarial risk assessment scores, and records from the
DOC. She opined that Betzler meets the criteria for commitment as an SDP and an SPP.
Linda Marshall, Ph.D., was appointed as an examiner by the district court and
completed a psychological evaluation of Betzler. Dr. Marshall reviewed Betzler’s records
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and interviewed him. She opined that Betzler meets the criteria for commitment as an SDP
and an SPP. She wrote that Betzler “needs continued sex offender specific treatment and
the structure and support of a secure treatment facility that offers cognitive behavioral
therapy and relapse prevention with phases leading to community reintegration and
eventual release.”
Upon Betzler’s request, Tyler Dority , Ph.D., a licensed psychologist, was also
appointed as an examiner by the district court and completed a psychological evaluation of
Betzler. Dr. Dority reviewed Betzler’s records and interviewed him. He opined that Betzler
meets the criteria for commitment as an SDP and an SPP.
At the commitment hearing, Dr. Marshall and Dr. Dority testified, as did Betzler,
Betzler’s wife, two of Betzler’s ISR supervisors, and the executive director of Alpha. The
executive director of Alpha testified that Alpha was transitioning from providing inpatient
services to providing outpatient services only. She testified that Betzler would be welcome
back into the Alpha program, that the level of services provided in their intensive outpatient
program was the same as the level of services formerly provided in their inpatient program,
and that Alpha would help Betzler locate 24-hour supervised housing at a partner facility.
She testified that the partner facilities were supervised but were not secure and that a patient
could leave the facility.
In her testimony, Dr. Marshall opined that Betzler needed treatment in a secure
setting. She also stated that she did not belie ve that the Alpha program had the level of
security and structure necessary to treat Betzler. In his testimony, Dr. Dority opined that
Betzler needed treatment in a setting “that has a significant amount of external controls”
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and that that setting could be found at MSOP. In Betzler’s testimony, he acknowledged
that viewing pornography was part of his “offending cycle ” and that his offending cycle
culminates in him “acting out or offending.”
The district court determined that Betzler was an SDP and an SPP and committed
him indefinitely to the Minnesota Commissioner of Human Services for treatment in
MSOP. Betzler filed a posttrial motion for a new trial, judgment notwithstanding the
verdict, and new findings. He argued that Alpha was an appropriate less restrictive
alternative than MSOP. The district court denied his motion.
Betzler appeals.
DECISION
I. The district court did not err by determining that Betzler meets the definitions
of an SDP and an SPP.

Betzler argues that the district court erred by determining that he meets the
definitions of an SDP and an SPP. To commit a person as an SDP or SPP, the petitioner
must prove by clear and convincing evidence that the person meets the statutory definition
of the term. Minn. Stat. § 253D.07, subd. 3 (2022). An appellate court reviewing a district
court’s commitment decision examines the factual findings for clear error. In re Civ.
Commitment of Stone, 711 N.W.2d 831, 836 (Minn. App. 2006), rev. denied (Minn.
June 20, 2006). When applying the clear -error standard of review, an appellate court
(1) views the evidence in the light most favorable to the district court ’s findings, (2) does
not reweigh the evidence, (3) does not engage in fact-finding, (4) does not reconcile
conflicting evidence, and (5) “need not go into an extended discussion of the evidence to
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prove or demonstrate the correctness of the findings of the [district] court.” In re Civ.
Commitment of Kenney, 963 N.W.2d 214, 221-22 (Minn. 2021) (quotation omitted).
Appellate courts review de novo whether the record contains clear and convincing evidence
to support the district court’s conclusion that the person meets the standard for civil
commitment. In re Civ. Commitment of Crosby, 824 N.W.2d 351, 356 (Minn. App. 2013)
(affirming commitment as SDP and SPP), rev. denied (Minn. Mar. 27, 2013).
A. SDP
Minnesota Statutes section 253D.02 (2022 & Supp. 2023) defines an SDP as “a
person who: (1) has engaged in a course of harmful sexual conduct as defined in
subdivision 8; (2) has manifested a sexual, personality, or other mental disorder or
dysfunction; and (3) as a result, is likely to engage in acts of harmful sexual conduct as
defined in subdivision 8.” Minn. Stat. § 253D.02, subd. 16(a). “Harmful sexual conduct”
is “sexual conduct that creates a substantial likelihood of serious physical or emotional
harm to another.” Id., subd. 8(a). Betzler challenges the district court’s determinations with
respect to the first and third prongs.
In arguing that he has not engaged in a course of harmful sexual conduct under the
first prong, Betzler focuses on the 12-year span between his most recent adjudicated sexual
offense in 2010 and the county’s petition for his commitment. While he acknowledges a
20-year history of offending up until 2010, he argues that, since that time, his conduct has
not constituted harmful sexual conduct. Instead, he contends, he has only engaged in
technical violations of ISR.
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The incidents that establish a course of harmful sexual conduct can occur “over a
period of time and need not be recent.” Stone, 711 N.W.2d at 837. In addition, “the
existence of a period in which a person has not committed sex offenses does not preclude
a determination that he engaged in a course of sexual misconduct.” Id. at 838. A “course
of harmful sexual conduct takes into account both conduct for which the offender was
convicted and conduct that did not result in a conviction.” Id. at 837.
With these principles in mind, and following Kenney’s guidance on the standard for
reviewing a district court’s findings of fact, we conclude that the record supports the
finding that Betzler engaged in a course of harmful sexual conduct. The record includes
adjudicated and unadjudicated sexual conduct that spanned at least 20 years. It is true that,
as of the time of the petition, Betzler had not committed a sexual offense generating a
conviction for 12 years. But, as Betzler acknowledges, about half of that time was spent in
incarceration. During the other half, he was living in the community. But, during that time,
Betzler engaged in conduct including possessing sexually explicit materials and searching
for pornographic materials on his cellphone, even though he acknowledges that
pornography use is part of his offending cycle . In her testimony, Dr. Marshall explained
that Betzler’s use of pornography is “ the start of a cycle and as it goes along the more
pornography he looks at it leads to eventually some type of assault usually.” Betzler also
engaged in attempts to avoid supervision, including disabling monitoring software to
obtain unsupervised access to the internet. Considering Betzler’s entire history, we discern
no clear error in the district court’s finding of a course of harmful sexual conduct.
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Turning to the third prong, caselaw has established a multi-factor test to determine
whether an individual is likely to engage in acts of harmful sexual conduct in the future. In
re Linehan, 518 N.W.2d 609, 614 (Minn. 1994). These factors are: (a) the individual’s
demographics, (b) the individual’s history of violent behavior, (c) the base rate statistics
for violent behavior among other people of the individual’s background, (d) the sources of
stress in the individual’s environment, (e) the similarity of the present or future context to
the contexts in which the individual has used violence in the past, and (f) the individual’s
record in sex-therapy programs. Id.
Betzler argues that the district court erred by finding that he is likely to reoffend
because his recent history includes only technical violations and not sexual offenses and
because continued ISR will preclude any reoffense. We are not persuaded. The district
court made findings specific to each of the Linehan factors outlined above. Regarding
demographics, the district court considered Betzler’s age of 46, his family history, and his
“long history of sexual offenses as both a juvenile and an adult.” Regarding history of
violent behavior, the district court considered the fact that Betzler’s offenses have involved
manipulation and threatening behavior and that he continued to engage in sexual
misconduct while under supervision. Regarding base rate statistics, the district court
considered Betzler’s scores on actuarial assessments that placed him at an above average
risk of committing another sexual or violent sex offense. Regarding stress in the
environment, the district court considered Betzler’s history of noncompliance with rules
and family conflict. Regarding present or future context, the district court considered
Betzler’s reoffenses while under supervision and in the community. Regarding record with
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sex-therapy programs, the district court considered Betzler’s failure to successfully
complete a sex-treatment program. The district court also relied on the examiners’
opinions, which it found credible, that, based on their assessments and the Linehan factors,
Betzler is highly likely to engage in future acts of harmful sexual conduct. We discern no
error in these findings.
The district court specifically addressed Betzler ’s argument that the evidence does
not establish a likelihood of future harmful sexual conduct because he has not committed
any adjudicated offenses since 2010. The district court recognized that Betzler has not had
a conviction since that time, but it concluded that Betzler’s 20-year history of violent
behavior and his violations of treatment and supervision rules, including around
pornography, support the conclusion that Betzler is likely to engage in additional harmful
sexual conduct absent intervention. We are not persuaded that this conclusion was error.
Regarding Betzler’s argument that IS R would prevent any future harmful sexual
conduct, we are not persuaded. Betzler was not compliant with IS R rules. Among other
things, he continued to view pornography in the past while on ISR, even though he admits
that viewing pornography is part of his offense cycle. We are not persuaded that continued
ISR compels the determination that Betzler is not likely to engage in acts of harmful sexual
conduct.
Because the record supports the district court’s factual findings and contains clear
and convincing evidence to support the district court’s conclusions on the first and third
prongs, the district court did not err by concluding that Betzler meets the definition of an
SDP.
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B. SPP
Minnesota Statutes section 253D.02 defines an SPP as
the existence in any person of such conditions of emotional
instability, or impulsiveness of behavior, or lack of customary
standards of good judgment, or failure to appreciate the
consequences of personal acts, or a combination of any of these
conditions, which render the person irresponsible for personal
conduct with respect to sexual matters, if the person has
evidenced, by a habitual course of misconduct in sexual
matters, an utter lack of power to control the person’s sexual
impulses and, as a result, is dangerous to other persons.

Minn. Stat. § 253D.02, subd. 15. “A person may be committed as [an SPP] on clear and
convincing proof that [they] (1) ha[ve] engaged in a habitual course of misconduct in
sexual matters; (2) ha[ve] an utter lack of power to control [their] sexual impulses; and
(3) [are], therefore, dangerous to others.” In re Kindschy, 634 N.W.2d 723, 732 (Minn.
App. 2001) (citing Minn. Stat. § 253B.02, subd. 18b (2000), now located at Minn.
Stat.§ 253D.02, subd. 15), rev. denied (Minn. Dec. 19, 2001). Betzler challenges the
district court’s determinations with respect to all three prongs.
Betzler argues that the prongs are not met because he has not committed a sex
offense since 2010, has been on ISR since 2010, understands that he needs more treatment,
and did not reach the level of psychopathy on one test score. He contends that he could not
have gone 13 years without committing a new offense if he had an utter lack of power to
control his sexual impulses. We are not persuaded that the district court erred.
The district court addressed each of the three prongs identified by caselaw.
Regarding the first prong, habitual course of misconduct in sexual matters requires
“evidence of a pattern of similar conduct.” Stone, 711 N.W.2d at 837. The district court
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relied on Betzler’s 20-year history of adjudicated and unadjudicated offenses during which
he followed a pattern of coercing and manipulating vulnerable children and adults in order
to sexually assault them.
Regarding the second prong, an utter lack of power to control sexual impulses is
determined using a multi-factor test. The factors are
[1] the nature and frequency of the sexual assaults, [2] the
degree of violence involved, [3] the relationship (or lack
thereof) between the offender and the victims, [4] the
offender’s attitude and mood, [5] the offender’s medical and
family history, [6] the results of psychological and psychiatric
testing and evaluation, and [7] such other factors that bear on
the predatory sex impulse and the lack of power to control it.

In re Blodgett, 510 N.W.2d 910, 915 (Minn. 1994).
The district court evaluated the evidence with respect to each of these factors.
Summarizing its detailed findings, the district court concluded that the record established
an utter lack of power to control sexual impulses. The district court cited Betzler’s
“sexually offending behavior” from “childhood through adulthood with victims of different
ages and relationships ,” expert opinions , and Betzler’s continuing to offend despite
supervision and multiple treatment programs.
We are not persuaded by Betzler’s argument that the district court erred. With
respect to the first factor, as Betzler points out, he has not had a sex offense since 2010.
But that factor weighs not just the frequency of sexual assaults but also their nature, and
the record supports the district court’s determination that Betzler’s sexual assaults were of
a severe nature in which he took advantage of victims in vulnerable positions. With respect
to the sixth factor, although Betzler argues that he did not fall into the category of
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“psychopath” based on part of Dr. Marshall’s testing, we are not persuaded that that fact
undermines the district court’s determination that Dr. Marshall’s opinion, based on her full
assessment, was credible and reliable. We discern no error in the district court’s
determination that the second prong of the definition of an SPP is met.
The record also supports the district court’s determination that the third prong is met
because Betzler is a danger to the public based on his risk of reoffending. Betzler testified
that viewing pornography was part of his cycle of offending. Despite committing his first
offense in 1990, Betzler admitted that he has never completed sex-offender treatment. In
addition, Dr. Dority noted that Betzler has a “tendency to say what he believes assessors
want to hear and to verbalize treatment language while the behavioral evidence is
incongruent with his narrative.”
Because the record supports the district court’s factual findings and contains clear
and convincing evidence to support the district court’s conclusions on all three prongs, the
district court did not err by concluding that Betzler meets the definition of an SPP.
II. The district court did not err by determining that Alpha would meet neither
Betzler’s needs nor the needs of public safety.

Betzler argues that Alpha is a less restrictive alternative that would meet his needs
and the public’s need for safety. We review a district court’s determination of the least
restrictive alternative for clear error. In re Thulin, 660 N.W.2d 140, 144 (Minn. App. 2003).
Again, we apply the standard articulated in Kenney when reviewing for clear error. 963
N.W.2d at 221-22.
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If the district court determines that a person is an SDP or SPP, Minnesota law
requires the district court to commit the person to a secure treatment facility “unless the
person establishes by clear and convincing evidence that a less restrictive treatment
program is available, is willing to accept the respondent under commitment, and is
consistent with the person’s treatment needs and the requirements of public safety.” Minn.
Stat. § 253D.07, subd. 3.
The district court determined that Alpha would meet neither Betzler’s needs nor the
needs of public safety. Appellant argues that this determination was error for two reasons:
first, he contends that continued ISR will preclude future violations because ISR has a high
success rate and, second, he asserts that the testimony from the executive director of Alpha
establishes that Alpha would be immediately available and would meet his treatment needs
and the needs of public safety.
We discern no error in the district court’s determination that Betzler failed to
establish the existence of a less restrictive alternative. The district court based its
conclusion on several findings. It found that Betzler “has violated conditions of release and
program rules while in Alpha, the very program to which he seeks to return.” It also found
that Alpha was restructuring to provide only outpatient services and that “there was no
definitive information available about where Mr. Betzler would be housed and how his
security would be monitored.” And the district court credited the testimony of Dr. Marshall
and Dr. Dority that Betzler required treatment in a secure facility. All of these findings
have support in the record. Viewing the record in the light most favorable to the district
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court’s findings, the district court did not clearly err by determining that Betzler requires
treatment at MSOP, both for his needs and the needs of public safety.1
Affirmed.

1 Betzler also argues that commitment to MSOP violates his constitutional rights. Betzler
did not raise this argument to the district court. Generally, appellate courts will not consider
matters not argued to and considered by the district court. Thiele v. Stich, 425 N.W.2d 580,
582 (Minn. 1988). This general rule applies to constitutional questions. In re Welfare of
C.L.L., 310 N.W.2d 555, 557 (Minn. 1981). Because Betzler did not raise this argument to
the district court, we do not address it.