IN THE COURT OF APPEALS OF IOWA

No. 24-0218

Filed June 5, 2024

IN THE INTEREST OF W.T., L.T., and L.T.,

Minor Children,

L.T., Minor Child,

Appellant,

H.T., Mother,

Appellant.

________________________________________________________________

Appeal from the Iowa District Court for Washington County, Daniel Kitchen, 

Judge.

A mother and one child separately appeal the termination of the mother’s 

parental rights. AFFIRMED ON BOTH APPEALS.

Katie Mitchell of Mitchell Law Office, PLC, Washington, for appellant minor 

child L.T.

Jeannette Keller of Bowman, DePree and Murphy, West Liberty, for 

appellant mother.

Brenna Bird, Attorney General, and Tamara Knight, Assistant Attorney 

General, for appellee State.

Sara Strain Linder of Linn County Advocate, Inc., Cedar Rapids, guardian 

ad litem for minor children and attorney for W.T. and L.T.
2

Considered by Bower, C.J., Greer, J., and Gamble, S.J.*

*Senior judge assigned by order pursuant to Iowa Code section 602.9206 

(2024).
3

GAMBLE, Senior Judge.

A mother and one child appeal the termination of the mother’s parental 

rights to three of her children. After careful consideration, we conclude the child’s 

opposition to termination does not overcome the danger posed by the mother, and 

termination of the mother’s rights was in the best interests of the children.

I. Background Facts & Proceedings

The mother (H.T.) and R.T. are the parents of three children: W.T., born in 

2006, L.T., born in 2006, and L.T., born in 2007. The elder L.T. prefers to go by 

N.T., and the youngest child prefers O.T. We will use the children’s preferred 

initials and pronouns. The mother and children moved to Iowa around 2012; the 

father remained in Kentucky. At the time of the termination hearing, the mother 

had moved to Vermont, but her parents still live in Iowa and she receives mail here. 

The Iowa Department of Health and Human Services (HHS) became 

involved with the family in August 2021 due to the state of the home, unsecured 

prescription medications, and giving the children unprescribed medications. The 

children had been moved among several schools in the area; the mother took the 

children out frequently for medical appointments and would not provide releases 

so the school could coordinate with medical providers for the children’s education 

plans. O.T. was only attending school around forty-five minutes a day at the time 

of removal. Due to the large number of medical diagnoses and medications each 

child was taking, HHS arranged for a medical record review. A medical team 

reviewed the records and determined the children were victims of medical child 

abuse perpetrated by the mother in the form of factitious disorder imposed by 

another person; the lead doctor opined it was not safe to leave the children in the 
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home at the time. The children were then removed from the mother’s care. In the 

order adjudicating them children in need of assistance (CINA), the court found all 

three children “have experienced mental injury as victims of medical child abuse, 

and do not function within their expected range for performance and behavior as 

a result.” 

All three children have been given incorrect diagnoses over the years based 

on the mother’s false reporting; the afflictions attributed to one or more child at 

various times include cerebral palsy, autism, developmental delays, intellectual 

disability, seizure disorders, incontinence, recurring respiratory infections, 

gastrointestinal problems, diabetes, premature birth, choking spells, apnea, 

deafness, and walking and leg problems. The records review compared the 

clinical findings in the voluminous medical records with the afflictions reported by 

the mother; most had little to no evidence of actually affecting the children. The 

false reporting dated back to the birth of the oldest child and continued throughout 

the children’s lives. The children also reported having a variety psychological 

disorders.

In July 2022, W.T. and N.T. moved to the father’s home in Kentucky, were 

formally placed there the next month, and custody transferred that fall. They have 

thrived in his care. They attend school regularly and have part-time jobs—they are 

“just normal teenagers.” They have improved significantly academically, and W.T. 

grew several inches and no longer uses a wheelchair or leg braces. The children 

were weaned off their prescriptions, and now only take one or two medications for 

common issues. 
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O.T. resisted contact with the father and did not transfer to his care with the 

older siblings. Instead, O.T. has moved among foster families, shelter care, and a 

qualified residential treatment provider. O.T. did not receive regular mental-health 

therapy throughout the case for a variety of reasons—including the mother’s

resistance to switching the child’s therapists, moves, and insurance issues—which 

made it harder for O.T. to process what was going on. O.T. has recently been 

reducing and weaning off some of his medications based on reduced or eliminated 

mental-health, neurological, diabetes, and seizure diagnoses. In June 2023, the 

mother met with O.T.’s school (without including O.T., HHS, foster parents, the 

guardian ad litem (GAL), or the child’s attorney in the meeting) and tried to update

O.T.’s educational plan to place the child at a residential school, which would have 

removed the child from his foster placement. Although HHS attempted to limit the 

mother’s contact with O.T. after the permanency order changing the goal to 

termination, a worker acknowledged O.T. had a phone and it appeared they were 

having unsupervised phone calls. After O.T. ran from a placement and sheltered 

with the mother and grandmother, without any of them informing HHS or law 

enforcement of his location, HHS cut off contact between the mother and O.T. The 

mother did continue to attend O.T.’s medical appointments, finding out about them 

from the online portal; HHS did not tell her she could not attend. 

In October 2022, the mother underwent a psychological evaluation. The 

psychologist affirmatively diagnosed the mother with factitious disorder imposed 

on another. The mother denied her actions caused any harm to the children and 

denied any need for change or treatment. The psychologist concluded “until [the 

mother] makes significant therapeutic change, her children remain at-risk for 
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continued emotional and physical harm.” The psychologist also noted the mother’s 

long-term vilification of the father to the children would be damaging to the children 

and would be the source of O.T.’s feelings towards the father, given the child’s 

young age at the time they split. “[I]ntensive and extensive” therapy was 

recommended for the mother. This last point is also supported by observations 

from service providers; for example, the mother “has made it very clear that [the 

father] is dangerous and [O.T.] should not want to speak to him.” The mother went 

to some therapy in the first half of 2023 but could not remember if she provided 

her therapist with a copy of the evaluation, and had not had any appointments for 

several months at the time of the termination hearing. 

The mother exhibited a preference in favor of O.T. over the other children 

during visitations, particularly by criticizing and ignoring the older children. The 

mother’s behavior documented in the monthly progress reports showed significant 

levels of manipulation, encouraging the children to speak and act like young 

children, but also placing O.T. in an inappropriate decision-making role. The 

mother appeared to sabotage any other familial relationships which might support 

the children—with not only their own father but also the mother’s siblings and other

family members. 

An HHS worker explained the petitions to terminate the mother’s rights were 

filed to protect the children’s medical care and education and “because there had 

been no progress forward to be able to reunite them, really, with their mother.” 

The juvenile court terminated the mother’s rights as to all three children 

under Iowa Code section 232.116(1)(f) (2023), finding clear and convincing 

evidence the children could not be returned to the mother’s custody. After 
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observing the mother throughout the case, including her testimony at the 

termination hearing, the court found “it was clear . . . that [the mother] was utterly 

convinced that all her actions were correct, and she remains devoid of any insight 

into the harm she has continued to cause her children, especially [O.T.].” More, 

even after some counseling, “credible evidence indicates that [the mother] 

continued to be an active danger to the children” and she had “no intention of 

seeking help.” The court then noted O.T.’s “aggressive loyalty” to the mother and 

her narrative, and the effect on O.T.’s relationships with her siblings and the father. 

While finding the mother loves the children, the court held “[c]lear and convincing 

evidence shows that [the mother] is tragically not able to provide the children with 

the care they need.” The court opined O.T.’s objection to the termination “is a 

symptom of the trauma that [O.T.] has experienced” and likened the mother-child 

bond “like the bond between a boa constrictor and its prey.” 

The mother and O.T. appeal.

II. Analysis

We review the record in termination cases de novo and accord weight to 

the juvenile court’s findings of fact. In re J.H., 952 N.W.2d 157, 166 (Iowa 2020). 

Our review normally follows a three-step analysis found in Iowa Code 

section 232.116—evaluating the grounds for termination, determining the best 

interests of the children, and weighing possible exceptions to termination. In re 

A.R., 932 N.W.2d 588, 591 (Iowa Ct. App. 2019). Because the mother does not 

challenge the grounds for termination, we will not address that step. 

1. W.T. and N.T. The mother argues that termination of her rights to her 

older two children “was unnecessary and is not required to achieve the best 
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interests of these children.” She urges that since the father has sole legal custody 

and care of both children, and the court has restricted her contact with the children, 

the court should just let the children determine what contact they want with her 

instead of terminating her rights. We interpret this as a best-interests challenge 

under step two and a possible application of the first listed permissive exception 

under Iowa Code section 232.116(3)(a)—“a relative has legal custody of the child.”

Both N.T. and W.T. told their father and the GAL they wanted the mother’s 

parental rights to them terminated. The father wanted the mother’s rights to W.T. 

and N.T. terminated to “prevent her from contacting schools, doctors, work places, 

and creating further issues for them.” The GAL expressed concern the mother 

would interfere with the children without monitoring from HHS. And the mother 

agreed she still had access to W.T. and N.T.’s medical records “because I still have 

parental rights.” She stated she objected to the termination as to W.T. and N.T. 

because “I don’t want them to think I gave up on them or I abandoned them” and 

she wanted to make sure O.T. could maintain a sibling relationship with them. 

Both N.T. and W.T. have resisted any contact with the mother for more than 

a year before the termination hearing. The mother acknowledges W.T. has turned 

eighteen since the termination order, and she no longer has any authority over any 

facet of his life.

1

 And she recognizes that N.T. is nearly eighteen and will soon 

exercise a similar control over their life.

1 Although now an adult, W.T. was not yet eighteen when the court’s ruling was 

made. Because the juvenile court had jurisdiction at the time of its ruling, we retain 

jurisdiction of this appeal. See In re M.A., No. 24-0092, 2024 WL 1548812, at *2 

n.6 (Iowa Ct. App. Apr. 10, 2024) (considering mootness of a CINA appeal when 

the child had turned eighteen after the appealed order was filed).
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Given the mother’s long history of inflicting unnecessary medical care for 

manipulated diagnoses as well as the mental and emotional harm she has caused, 

we find termination is the best option to ensure W.T. and N.T.’s safety, long-term 

nurturing and growth, and the children’s physical, mental, and emotional condition 

and needs. See Iowa Code § 232.116(2). Nor does the fact that the father has 

legal custody provide reason in this case to not terminate the mother’s rights. We 

affirm the termination of the mother’s parental rights as to W.T. and N.T.

2. O.T. The mother does not contest the grounds for termination. See Iowa 

Code § 232.116(1)(f). Rather, she argues termination of her parental rights to O.T. 

is not in the child’s best interests, the child does not want her rights terminated, 

that the child would be harmed by termination because she is “the only constant in 

[O.T.]’s life” since the removal. 

O.T. also contests the termination of the mother’s parental rights, noting 

termination would make no difference as to the child’s permanency or long-term 

placement. O.T. asserts he is closely bonded to the mother and his only 

meaningful family relationships are with her and the maternal grandmother. A 

long-term placement has not been found for O.T., and he has moved in and out of 

foster homes and shelter placements. He told the court “being away from home 

has not helped anything.” The moves have further disrupted O.T.’s schooling and 

made arranging therapy difficult. 

The father admitted he was not a good alternative for O.T.’s placement at 

the time of the hearing. He stated O.T. did not want to live with him, he was not 

comfortable with the idea given some of O.T.’s past behaviors, and the influence 

the mother still had on O.T would be detrimental to W.T. and N.T. O.T. agreed he 
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did not want to go to the father’s home because the father is not accepting of O.T.’s 

gender identity. 

In a 2022 permanency order, the juvenile court found the mother “has not 

recognized the harm she has done to her children, is not interested in change of 

any kind, and remains resistant to any effort to prevent her condition from harming 

her children.” The court moved custody of O.T. to the father, but it was then 

returned to HHS after O.T. ran away and the father refused to take custody. In 

early 2023, the court waived the requirement to make reasonable efforts to reunite 

O.T. with the mother. 

Even at the termination trial, the mother did not seem able to accept that 

the children did not have many of the diagnoses she arranged over the years, 

including cerebral palsy, autism, or seizure disorders. The mother’s inability to 

distinguish between the child’s actual medical needs and her perception of what 

the child needs have resulted in unnecessary medical appointments, physical and 

mental diagnoses, and medications, and served to make the children as 

dependent on her as possible. She does not accept her own diagnosis of factitious 

disorder imposed by another person or that she harmed the children through years 

of unnecessary and harmful medical care, and she has not pursued any related 

mental-health treatment for herself. In short, the mother has not demonstrated an 

ability to recognize the child’s true needs or put the child’s well-being above her 

own needs. See In re D.D., 955 N.W.2d 186, 193 (Iowa 2021) (“It’s folly to think 

the mother will stand sentinel to protect against a foe she doesn’t acknowledge 

exists.”); see also In re E.R., No. 20-1076, 2020 WL 7021681, at *3 (Iowa Ct. App. 

Nov. 30, 2020) (finding termination in the children’s best interests despite
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placement instability due to the mother’s inability to prioritize their needs and wellbeing). Terminating the mother’s rights would prevent her from access to, 

manipulation of, and authority over O.T.’s medical decisions and schooling, which 

would be best for the child’s current and long-term safety, growth, and well-being. 

Termination is in the child’s best interests.

But the court need not terminate the relationship between parent and child 

where, as here, the child is over ten years of age and objects to the termination. 

See Iowa Code § 232.116(3)(b). O.T.’s objection is an important consideration as 

a possible reason not to terminate the mother’s parental rights. See A.R., 932 

N.W.2d at 592. And the child’s objection is intertwined with the parent-child bond. 

See Iowa Code § 232.116(3)(c). O.T. claims termination of his mother’s parental 

rights would leave him in limbo. The father is not a proper placement. O.T. does 

not want to go to another foster family and will not be adopted. He cannot stay in 

residential treatment indefinitely. H.T. is the only parent who remains in contact 

with O.T. and the child wants to remain in contact with her. 

But we recognize “[t]he best interests of a child is not always what ‘the child 

wants.’” A.R., 932 N.W.2d at 592 (citation omitted) (noting several factors to 

consider2). Here, the mother’s behavior throughout the case convinces us she 

cannot safely have the right to be part of any decisions in O.T.’s life. Her negative 

2 Factors considered include, but are not limited to: 

(1) [the child’s] age and education level; (2) the strength of their 

preference; (3) their intellectual and emotional make-up; (4) their 

relationship with family members; (5) the reason for their decision; 

(6) the advisability of honoring the children’s desire; and (7) the 

court’s recognition it is not aware of all the factors influencing the 

children’s view.

A.R., 932 N.W.2d at 592.
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behavior includes interjecting herself into, disbelieving, and objecting to medical 

decisions; attempting to change O.T.’s school without consulting O.T. or HHS; 

influencing O.T.’s reactions to foster families and support structures; helping O.T. 

run from placement; manipulating O.T.’s relationship with his siblings; and making 

accusations against family members that might otherwise provide a support 

system for O.T. While we understand O.T.’s desire to maintain contact with his 

mother, she had not demonstrated an ability to safely care for his needs. See In 

re B.W., No. 23-0583, 2023 WL 3861979, at *4 (Iowa Ct. App. June 7, 2023) 

(affirming termination where a close parent-child bond existed but the juvenile 

court ongoing contact between parent and child would be detrimental to the child’s 

physical and emotional well-being). Because our paramount concern must be the 

long-term best interests of the child, see Iowa Code § 232.116(2), we affirm the 

termination of the mother’s parental rights.

AFFIRMED ON BOTH APPEALS.

Bower, C.J., concurs; Greer, J., concurs specially.
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GREER, Judge (concurring specially). 

I concur with the well-written opinion in this case but write separately to 

emphasize the cracks in the safety system afforded to children like O.T., who find 

themselves in the child-in-need-of-assistance world. Here, the guardian ad litem 

opined that O.T. is at risk of being “institutionalized” and had not received any 

meaningful mental-health treatment over the course of these proceedings. While 

much of the discussion in our decision focuses on the mental health of the mother, 

the stated goal of reunification of families is not realistic if the mental health of a 

child diagnosed with serious mental-health conditions is not addressed. And the 

treatment is not just for reunification purposes but also for dealing with the impact 

of the breakup of the family. See In re K.N., 625 N.W.2d 731, 734 (Iowa 2001) 

(“The purpose of the juvenile process in general has always been to care for, 

educate, and train the children adjudged in need of assistance . . . .”); Iowa Code 

§ 232.1 (2023) (“This chapter shall be liberally construed to the end that each child 

under the jurisdiction of the court shall receive . . . the care, guidance and control 

that will best serve the child’s welfare and the best interest of the state.”). I can 

only wonder if O.T. would have been in a better position to face the traumatic steps 

toward termination of the mother’s parental rights if mental-health therapy had 

been ongoing rather than what actually happened here—where the child received 

“no treatment services for the past two years.” 

We can do better, and we should do better. See K.N., 625 N.W.2d at 734–

35 (recognizing “the underlying policy of chapter 232 to be ‘[t]he welfare and best 

interests of the children’” (citation omitted)).