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In re T.K.

Court of Appeals of Iowa

November 7, 2018

IN THE MATTER OF T.K., Alleged to be Seriously Mentally Impaired, T.K., Respondent-Appellant.

          Appeal from the Iowa District Court for Johnson County, Christopher L. Bruns, Judge.

         T.K. appeals a district court order finding her seriously mentally impaired.

          Sandra R. Hart of Hart Law, North Liberty, for appellant.

          Thomas 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.

          TABOR, JUDGE.

         T.K.'s 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.

         I. Facts and Prior Proceedings

         In late 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.

         On 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.

         At a January 5 hearing before the judicial hospitalization referee, T.K. stipulated she met the elements necessary for a finding of serious mental impairment:[1] 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.

         T.K. 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.

         On 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. herself.

         Dr. 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 ...

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