Court of Appeals of Texas, Twelfth District, Tyler
THE STATE OF TEXAS FOR THE BEST INTEREST AND PROTECTION OF B. D.
FROM THE COUNTY COURT AT LAW CHEROKEE COUNTY, TEXAS
consisted of Worthen, C.J., Hoyle, J., and Neeley, J.
T. WORTHEN CHIEF JUSTICE.
patient committed to a mental health facility pursuant to
Chapter 46B of the Texas Code of Criminal Procedure, appeals
from an order authorizing the administration of psychoactive
medication. Appellant contends that the evidence is legally
and factually insufficient to support the trial court's
finding that the administration of psychoactive medication is
in the best interest of the patient. We reverse and render.
was found incompetent to stand trial for a criminal charge
and was committed to Rusk State Hospital for the purposes of
regaining competency pursuant to Chapter 46 of the Texas Code
of Criminal Procedure. Appellant refused to take the
medications prescribed for his illness. The State petitioned
the court for an order to administer psychoactive medications
to Appellant. At the hearing, Appellant's treating
physician, Dr. Stephen Poplar, testified that Appellant
suffered from psychosis marked by disorganized and illogical
thinking, coupled with delusions and paranoia. Dr. Poplar
further indicated that Appellant believed the medication
prescribed for his illness was heroin and that Dr. Poplar was
trying to drug him. After the hearing, the trial court
granted the order to administer the psychoactive medication.
This appeal followed.
of the Evidence
sole issue, Appellant challenges the legal and factual
sufficiency of the evidence to support the trial court's
order authorizing the administration of psychoactive
medication. Specifically, Appellant argues that the evidence
is legally and factually insufficient to support the trial
court's finding that the administration of psychoactive
medication is in Appellant's best interest.
law requires that orders authorizing administration of
psychoactive medication be supported by clear and convincing
evidence. See Tex. Health & Safety Code Ann.
§ 574.106(a-1) (West 2017). Clear and convincing
evidence is that degree of proof which will produce in the
mind of the trier of fact a firm belief or conviction as to
the truth of the allegations to be established. State v.
Addington, 588 S.W.2d 569, 570 (Tex. 1979) (per curiam).
This intermediate standard falls between the preponderance
standard of civil proceedings and the reasonable doubt
standard of criminal proceedings. Id.; In re G.M.,
596 S.W.2d 846, 847 (Tex. 1980). While the proof must weigh
heavier than merely the greater weight of the credible
evidence, there is no requirement that the evidence be
unequivocal or undisputed. Addington, 588 S.W.2d at
570. This higher burden of proof elevates the appellate
standard of legal sufficiency review. Diamond Shamrock
Ref. Co. v. Hall, 168 S.W.3d 164, 170 (Tex. 2005);
Sw. Bell Tel. Co. v. Garza, 164 S.W.3d 607, 622, 625
reviewing a legal sufficiency claim, we look at all the
evidence in the light most favorable to the finding to
determine whether a reasonable trier of fact could have
formed a firm belief or conviction that its finding was true.
In re J.F.C., 96 S.W.3d 256, 266 (Tex. 2002). When
reviewing factual sufficiency, we must give due consideration
to evidence that the fact finder could reasonably have found
to be clear and convincing and then determine whether, based
on the entire record, a fact finder could reasonably form a
firm conviction or belief that the allegations in the
application were proven. Id. The reviewing court
must consider whether the disputed evidence is such that a
reasonable fact finder could not have reconciled that
disputed evidence in favor of its finding. Id. If
the disputed evidence is so significant that a fact finder
could not reasonably have formed a firm belief in the
finding, the evidence is factually insufficient. Id.
court may issue an order authorizing the administration of
one or more classes of psychoactive medications to a patient
who is under a court order to receive inpatient mental health
services. Tex. Health & Safety Code Ann. §
574.106(a)(1). The court may issue an order under this
section only if, after a hearing, it finds by clear and
convincing evidence that (1) the patient lacks the capacity
to make a decision regarding the administration of the
proposed medication, and (2) treatment with the proposed
medication is in the best interest of the patient.
Id. § 574.106(a-1)(1).
refers to a patient's ability to (1) understand the
nature and consequences of a proposed treatment, including
the benefits, risks, and alternatives to the proposed
treatment, and (2) make a decision whether to undergo the
proposed treatment. Id. § 574.101(1) (West
2017). A patient does not have the capacity to make a
decision regarding the administration of medications if the
patient does not understand the nature of his mental illness
or the necessity of the medications. See A.S. v.
State, 286 S.W.3d 69, 73 (Tex. App.-Dallas 2009, no
pet.). In making its finding that treatment with the proposed
medication is in the best interest of the patient, the trial
court shall consider (1) the patient's expressed
preferences regarding treatment with psychoactive medication,
(2) the patient's religious beliefs, (3) the risks and
benefits, from the perspective of the patient, of taking
psychoactive medication, (4) the consequences to the patient
if the psychoactive medication is not administered, (5) the
prognosis for the patient if treated with psychoactive
medication, (6) alternative, ...