IN THE MATTER OF T.K., Alleged to be Seriously Mentally Impaired, T.K., Respondent-Appellant.
from the Iowa District Court for Johnson County, Christopher
L. Bruns, Judge.
appeals a district court order finding her seriously mentally
R. Hart of Hart Law, North Liberty, for appellant.
J. Miller, Attorney General, and Gretchen Witte Kraemer,
Special Assistant Attorney General, for appellee State.
Considered by Danilson, C.J., and Vogel and Tabor, JJ.
unsafe behavior during the "frigid weather" last
winter prompted her brother and her neighbor to seek mental
health treatment on her behalf. In response to their
affidavits and a psychiatric evaluation at the University of
Iowa Hospitals and Clinics (UIHC) in Iowa City, a judicial
hospital referee committed T.K. on an outpatient basis. The
district court affirmed the involuntary commitment, finding
T.K. suffered from a serious mental impairment and was likely
to physically injure herself if she remained at liberty
without treatment. On appeal, T.K. disputes the district
court's finding she poses a threat to herself if allowed
to remain at liberty without treatment. Because we find
substantial evidence supports the district court's
findings, we affirm.
Facts and Prior Proceedings
November 2017, T.K. made her monthly call to her brother
Mark, who lives out of state. During the call, T.K. made
comments that worried her brother. For example, she described
being followed and having her communications intercepted. She
also disbelieved and misremembered recent and more distant
past events. In December, T.K. performed demolition in her
home and left significant debris in her yard. In
"bitterly cold" temperatures, T.K. walked to her
neighbor's house barefoot and without a coat to apologize
for yelling the day before. The neighbor contacted Mark with
concerns about T.K.'s well-being. Another neighbor
contacted police, alleging T.K. had caused property damage.
T.K.'s long-time boyfriend, Michael, entered T.K.'s
home to find the thermostat removed and the heat left on
high. T.K.'s dogs were not doing well, and Michael was
concerned the house had elevated levels of carbon monoxide.
December 28, Mark filed an application alleging T.K. suffered
from serious mental impairment. His application asserted T.K.
posed a danger to herself or others and lacked judgmental
capacity. In support, he provided an affidavit detailing his
observations, in addition to an affidavit from T.K.'s
neighbor. Under court order, UIHC admitted T.K. to its
psychiatric ward. While there, T.K. displayed symptoms of
paranoia. She also refused to allow UIHC access to medical
records from institutions where she previously received
mental-health and substance-abuse treatment. Before
T.K.'s admission, she was prescribed a high dose of
stimulants and a "modest prescription" for
benzodiazepines. Doctors evaluated T.K. twice during the
in-patient commitment, seeing improvement in her symptoms
when she took her medication.
January 5 hearing before the judicial hospitalization
referee, T.K. stipulated she met the elements necessary for a
finding of serious mental impairment: judgmental capacity,
treatability, dangerousness, and mental illness. The hearing
was not reported, nor did the parties enter a written
stipulation into the record. The referee ordered a complete
psychiatric evaluation on an outpatient basis and discharged
T.K. to outpatient treatment.
filed a handwritten notice of appeal on January 9 challenging
the finding of mental impairment. After filing the appeal,
she filled one prescription on January 11 but did not pursue
refilling another prescription despite her primary care
physician's direction she follow up with a psychiatrist.
She also failed to appear at her outpatient evaluation
appointment scheduled for February 7.
February 8, the district court held a de novo hearing on
T.K.'s appeal. In its review, the district court
considered Mark's application and accompanying
affidavits, as well as three reports from the hospital's
chief medical officer summarizing T.K.'s psychiatric
examinations. The court also heard testimony from T.K.'s
attending psychiatrist, Dr. Judith Crossett, and T.K.
Crossett testified to gathering T.K.'s history from the
"escalating report of bizarre and dangerous
behavior" from her brother. Dr. Crossett likewise
incorporated the neighbor's concerns about T.K.
"yelling and screaming late into the night" and
"showing up at the neighbor's door" with
"no coat, no shoes" in late December. The
psychiatrist also considered information she received from
T.K.'s boyfriend that the house was in disarray and T.K.
removed the thermostat from the wall because "it was
spying on her." Michael found T.K. left the furnace
"just full on." "The house was 90 degrees
inside," leaving Michael concerned about carbon monoxide
poisoning. Dr. Crossett ...