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In re T.C.

Court of Appeals of Texas, Second District, Fort Worth

July 3, 2017






         Appellant T.C. appeals the trial court's order authorizing forced administration of psychoactive medication. In two issues, he contends that the evidence is insufficient to support the requirements for such an order under section 574.106 of the Texas Health and Safety Code. See Tex. Health & Safety Code Ann. § 574.106 (West 2017). We affirm.

         Background Facts

         On May 24, 2017, Dr. Charlene Shero filed an application in which she asked the trial court to authorize the forced administration of psychoactive medication to appellant. In her application, Dr. Shero, who is appellant's attending physician, alleged that he was subject to a March 2017 order for court-ordered inpatient mental health services because he was adjudged incompetent to stand trial for a criminal offense. The clerk's record contains a March 20, 2017 "Agreed Judgment of Incompetency." That document recites that appellant's counsel in his criminal case filed a motion asking for a competency examination for appellant, that an expert examined appellant and found him to be incompetent, that both parties in the criminal proceeding agreed that he was incompetent, that the court found him incompetent, and that the court ordered his confinement to the North Texas State Hospital for "treatment toward the specific objective of attaining competency to stand trial."

         Dr. Shero also alleged in her application that appellant is bipolar, exhibits psychosis, and prefers "mania despite intense negative consequences to the mania." She stated that appellant had refused to voluntarily take the proposed medication. She opined that without the medication, appellant would exhibit repeated aggression, episodes of self-harm, and an inability to regain competency to stand trial, but she stated that if he took the medication, he would have less "aggression, less head banging, more organized thought[, ] and [the] ability to be restored to competency." The trial court appointed counsel to represent appellant and set Dr. Shero's application for trial.

         The trial occurred on May 30, 2017. The trial court heard testimony from Dr. Shero and from appellant. Dr. Shero testified that appellant was under an order to receive inpatient mental health services because he was adjudged incompetent to stand trial for a felony assault charge. She explained that appellant has bipolar disorder and exhibits mania, narcissism, and antisocial traits. Dr. Shero described the symptoms of appellant's mental illness as a "push of speech, a psychomotor elevation, intrusiveness, grandiosity, dismissing of his need for treatment, blaming others, demanding benzodiazepines, poor insight and judgment, [and] efforts to harm himself."

         More specifically, Dr. Shero testified that five days before the trial, appellant had required mechanical restraints after "repeatedly stating that he wanted to harm himself." On that day, appellant had wrapped linens around his neck while "stating that he wanted to hurt himself and that his intent was to strangle peers as well." The day before that, appellant had to be restrained because he was beating his head against a window. Despite these acts, according to Dr. Shero, appellant did not see the need for treatment; instead, he stated that "all he need[ed] [was] cannabis and that's what makes his life perfect."

         Dr. Shero asked the trial court to allow her to prescribe mood stabilizers, antipsychotics, and anxiolytics, and she expressed that appellant was not taking most of those medications voluntarily. When asked why appellant would not take the medications voluntarily, Dr. Shero stated,

Sometimes he'll engage in a meaningful discussion of that. Sometimes he won't. Often, he is dismissive or stands up and says that we don't understand that cannabis is all he needs. We're all fools. I don't know why they didn't teach you that in med school. Or he says he doesn't really need it; he's fine; we're all idiots. . . . So I've never even gotten to the other steps of what's available. Basically, he disregards the need for treatment despite repeated problems with behavior.

         According to Dr. Shero, once medicated, appellant could stop harming himself, could stop aggression toward others, could be restored to competency, and could "play a meaningful role in his defense." Dr. Shero testified that there were no alternative treatments that were less intrusive. She also stated that appellant lacked capacity to make a decision concerning the administration of the medications because he was "crippled by his narcissism and . . . his bipolar mania."

         On cross-examination, Dr. Shero acknowledged that appellant fears needles and that some of her proposed medication would require the use of needles, but she testified that the benefits of the medication would "far outweigh a bit of anxiety." Dr. Shero also acknowledged that the medication may have side effects, and she stated that she would "definitely review [the side effects] with [appellant] if he [was] willing to engage in a meaningful discussion."

         Appellant testified that medication he had already taken at the state hospital had given him side effects of clogged sinuses, a bloody nose, restless feet, and unclear thinking. Explaining his resistance to the medication, he stated, "I don't want to go to court . . . and have my head all messed up to where I can't defend myself in trial. You know, I want to be able to remember the facts and not just sit there and drool on the table . . . ."

         Appellant expressed that he was willing to discuss medications with Dr. Shero if the trial court did not force him to take them, and he expressed that he was willing to listen to Dr. Shero's advice. When appellant's counsel asked whether he had anything else to say, he stated (apparently to Dr. Shero),

I'm really sorry, ma'am, for our shortness of discussions, but . . . I just felt like that it wasn't going anywhere either which way. I couldn't put in my two cents at first. I'm sorry. I know y'all gotta speak first and then me second, but, you know, if we can work on a good way to take just the pills on there, and that they're not allergic to me, I have no problem with that. But I believe that, you know, any time that I've ever healed myself in any ...

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