Iowa Upholds De Novo Standard for Review of Competence to Stand Trial Rulings and Clarifies That Parties May Not Hire Independent Expert at Dispositional Phase
In State v. Brown, 16 N.W.3d 288 (Iowa 2025), the Iowa Supreme Court unanimously held that the appropriate standard for appellate review of a competence to stand trial ruling remained, despite being an outlier, a de novo standard. The court further held, based on its review of the language and apparent intent of Chapter 812 of the Iowa Code, that neither party may retain an independent expert for a new psychiatric evaluation at the dispositional stage of competence to stand trial proceedings.
Facts of the Case
In February 2021, Lukouxs Brown allegedly cut the throat of a coworker at a pork-processing plant in Iowa, killing him. Mr. Brown was charged with first-degree murder. Defense counsel requested a competency hearing because of Mr. Brown’s responding to internal stimuli and reporting a diagnosis of schizophrenia. The court suspended proceedings and ordered a competence to stand trial evaluation at the Iowa Medical and Classification Center (IMCC), a forensic psychiatric hospital.
An IMCC psychiatrist diagnosed Mr. Brown with substance use disorders and a “schizophrenia-like disorder.” He opined that Mr. Brown lacked competence to stand trial because of Mr. Brown’s inability to “appreciate the charges against him, effectively assist in his defense, or understand the legal proceedings in a meaningful manner” (Brown, p 290). He further opined that there was a “good possibility” of restoration within a “reasonable period of time” (Brown, p 290). The trial court, after reviewing that report, adjudicated Mr. Brown incompetent to stand trial and committed him to the IMCC for restoration treatment.
Mr. Brown was admitted to the IMCC in May of 2021. During his initial treatment, Mr. Brown demonstrated positive and negative symptoms of schizophrenia. He reportedly heard voices from the Central Intelligence Agency (CIA) and engaged in assaultive behavior. Over the following months, reports indicated that Mr. Brown’s positive symptoms of schizophrenia were improving; by November, his hallucinations and delusions were significantly reduced. By December, his schizophrenia was regarded as “in substantial remission” and his legal knowledge had improved.
In December of 2021, Mr. Brown’s restoration team requested consultation from a University of Iowa neuropsychologist. The subsequent evaluation was approximately four hours long and resulted in a diagnosis of major neurocognitive disorder. Mr. Brown was noted to exhibit “impairments in nearly all aspects of …intellectual abilities,” with a verbal intelligence quotient (IQ) of 74 (Brown, p 290). The neuropsychologist opined that Mr. Brown remained incompetent to stand trial.
In February of 2022, a forensic psychiatrist from IMCC submitted a report opining that Mr. Brown remained incompetent to stand trial. He further opined that Mr. Brown “lack[ed] the capability of ever being restored to competency in any reasonable amount of time with any currently available or known treatment” (Brown, p 291). The court, in response, scheduled the statutorily mandated hearing (which must be held within 14 days). The state asked for time to retain an expert for an independent competence evaluation. Mr. Brown’s attorney objected, noting that Iowa Code did not allow such an evaluation. The court granted the state’s request and an indefinite continuance. One month later, Mr. Brown’s attorney filed a motion to dismiss the case given the lack of the required hearing. Simultaneously, the state submitted their expert’s report. The motion to dismiss was denied; another hearing was scheduled to review the state’s expert report.
In May of 2022, three months after the February IMCC report, the mandated competence hearing took place. The state’s expert was a clinical psychologist who had interviewed Mr. Brown for 90 minutes, reviewed his IMCC reports, and reviewed his criminal records. The court cited contradictions in her report, including that Mr. Brown understood legal roles, yet “can’t remember what the jury does …they might be like court jesters” (Brown, p 291). Although the state-retained psychologist testified to her opinion of competence, the IMCC forensic psychiatrist and consulting neuropsychologist also testified that Mr. Brown was incompetent and could not be restored within a reasonable period. Additional evidence was introduced, including a phone call recorded in April of 2022, wherein Mr. Brown told his sister about hearing the CIA talk to him in his head. The trial court ultimately sided with the state’s expert; they adjudicated Mr. Brown competent to stand trial and reinstated proceedings.
Mr. Brown applied for an interlocutory appeal to stop the reinstatement of proceedings. The appeal was granted and heard by the intermediate appellate court (the court of appeals). Mr. Brown alleged that the trial court (the district court) made three errors: permitting an independent psychiatric evaluation, failing to have a hearing within the required 14-day time period, and adjudicating him competent. The court of appeals rejected the first two claims, finding they were not errors. In accordance with Iowa case law, they then conducted a de novo review of Mr. Brown’s competence. Based on this review, the court of appeals, disagreeing with the trial court, adjudicated Mr. Brown incompetent but restorable. They noted that he was “making progress in regaining competency” and still had 10 months left for restoration (Brown, p 296). The court ordered Mr. Brown be returned to IMCC for additional treatment.
The state disagreed with the court of appeals’s use of a de novo standard and finding of incompetence. They requested, and were granted, further review by the Iowa Supreme Court.
Ruling and Reasoning
The Iowa Supreme Court held that the court of appeals’s use of a de novo standard to review the trial court’s finding of Mr. Brown’s competence was appropriate. They acknowledged that Iowa’s use of such a stringent standard, which had only been clearly set in Iowa law in 2010, made it an outlier. But the court declined to reverse course. They cited stare decisis and the ongoing utility of this standard to protect constitutional rights at risk.
The Iowa Supreme Court also reviewed the trial court’s decision to allow the state to hire an expert to conduct an independent competence evaluation subsequent to the IMCC’s opinion of incompetence (and unrestorability). The court held that neither party had the ability to seek a separate evaluation at that “dispositional phase” of Mr. Brown’s competence proceedings. They supported their holding with the text and apparent intent of the Iowa code, when read in totality. They cited the explicit statutory authorization for independent evaluations at the probable cause phase (the initial determination of competence) and the absence of such a provision at the dispositional phase (the “conclusion of the restoration process”) (Brown, p 296). The court also noted that, as such hearings are held after competence restoration treatment, there are already “neutral medical experts” available. The court further noted that the statutory requirement for a hearing within 14 days after a final competence report presents great logistical challenges if parties were allowed to obtain independent experts, citing the lengthy delays in Mr. Brown’s case as an example.
The court, noting its own “de novo review of the appropriate record”, concluded that there was “no substantial probability” of Mr. Brown becoming competent “within a reasonable amount of time” (Brown, p 298). The court thus vacated the court of appeals’s decision, reversed the district court’s order that had found Mr. Brown competent to stand trial, and remanded the case for further proceedings.
Discussion
In Brown, the Iowa Court of Appeals and Iowa Supreme Court reviewed the trial court’s ruling on competence to stand trial using a de novo standard. This is a stringent standard of review, permitting an appellate court to reassess findings anew rather than deferring to a trial court’s determinations and focusing on legal errors or the possibility of an abuse of discretion (LaFave W. et al. Criminal Procedure § 27.5. West Paul, MN: West Academic; 2024). As the court itself noted, Iowa’s use of this standard makes it an outlier, which it upheld in this case, citing the constitutional implications of allowing an incompetent defendant to proceed to trial.
Although the Iowa Supreme Court summarized the conflicting expert positions in its opinion, the reasoning of its holding focused on procedure and the requirements of the Iowa Code. In finding that the state expert had been improperly appointed, from a procedural perspective, that expert’s opinion was functionally excluded from consideration. That left the opinions of the IMCC forensic psychiatrist and consulting neuropsychologist, who had opined Mr. Brown incompetent and unable to be restored within a reasonable period. This is the opinion that the Iowa Supreme Court ultimately adopted.
This case highlights how we, as forensic psychiatrists, operate in a legal world. Jurisdictional-specific requirements, and standards of review, determine the outcome of our opinions. Iowa utilizes a de novo standard of review when assessing competence to stand trial adjudications. As a result, opposing expert opinions, provided in testimony in the trial court, were thoroughly reassessed and reweighed at the intermediate appellate court. Yet ultimately, the Iowa Supreme Court held that the state’s expert had, in fact, been appointed in error. Thus, it was not the merit of the state expert’s opinion, or credibility of her expertise, that became of primary relevance. Rather, the salient variable became the status of the proceedings when she was retained and the lack of statutory authority for her evaluation.
- © 2026 American Academy of Psychiatry and the Law
