Court of Appeals of Texas, Twelfth District, Tyler
THE STATE OF TEXAS FOR THE BEST INTEREST AND PROTECTION OF C.C.
from the County Court at Law of Cherokee County, Texas (Tr.
Ct. No. 42230)
consisted of Worthen, C.J., Hoyle, J., and Neeley, J.
appeals from an order authorizing the Texas Department of
State Health Services (the Department) to administer
psychoactive medication-forensic. In three issues, C.C.
asserts the evidence is legally and factually insufficient to
support the trial court's finding that administration of
psychoactive medications is in her best interest, that the
State does not have an important governmental interest in
administering psychoactive medications to her, and that the
evidence is legally and factually insufficient to support the
trial court's finding that the patient presents a danger.
We reverse and render.
October 12, 2017, Stephen Poplar, M.D. signed an application
for an order to administer psychoactive medication-forensic
to C.C. In the application, Poplar stated that C.C. was
subject to an order for inpatient mental health services
issued under Chapter 46B (incompetency to stand trial) of the
Texas Code of Criminal Procedure. He stated further that C.C.
had been diagnosed with bipolar I disorder, most recent
episode manic, severe with psychotic features, and requested
the trial court to compel C.C. to take psychoactive
medications including antidepressants,
anxoilytic/sedative/hypnotics, antipsychotics, and mood
stabilizers. According to Poplar, C.C. verbally refused to
take the medications and, in his opinion, C.C. lacked the
capacity to make a decision regarding administration of
psychoactive medications because she did not believe that she
has a mental illness and thus, cannot rationally weigh the
risks and benefits of treatment.
concluded that these medications were the proper course of
treatment for C.C. and that, if she were treated with the
medications, her prognosis would be fair. He believed that,
if C.C. were not administered these medications, the
consequences would be an increased risk of harm to others,
prolonged hospitalization, and poor quality of life. Poplar
considered other medical alternatives to psychoactive
medication, but determined that those alternatives would not
be as effective. He believed the benefits of the psychoactive
medications outweighed the risks in relation to present
medical treatment and C.C.'s best interest. Poplar also
considered less intrusive treatments likely to secure
C.C.'s agreement to take psychoactive medication.
trial court held a hearing on the application. Poplar
testified that he was C.C.'s treating physician, that
C.C. was currently under court ordered mental health services
under Chapter 46B of the Texas Code of Criminal Procedure,
and that he completed the application for an order to
administer psychoactive medications-forensic. He reiterated
the statements that he made in his application, and testified
that C.C. was suffering from bipolar I disorder, most recent
episode manic, severe with psychotic features. Poplar stated
C.C.'s behaviors suggest that she needs medications
because she has had several episodes of aggression such as
throwing a plastic chair at a psychiatric nursing assistant
before walking away, verbally threatening the staff's
children, and slamming a bathroom stall door on a staff
member's hand. According to Poplar, C.C. was charged with
a false report, a Class B misdemeanor. He stated that C.C.
filed approximately thirty complaints of neglect and abuse.
Poplar said the medications would not interfere with
C.C.'s ability to confer with her attorney in the
underlying criminal charge.
cross examination, Poplar testified that C.C. did not make
any statements regarding side effects or potential side
effects of the medications. Nor did she make any statements
regarding religious beliefs that would prevent her from
taking these medications or any general legal objections to
her right not to take medications. C.C. testified that she
was worried about the side effects of psychoactive
medications because she was diagnosed with Hepatitis B when
she was young. Consequently, she said, her liver function is
"bad" and one medication previously prescribed by a
psychologist would make her liver function worse. A second
medication that she was prescribed would make her hands,
head, and neck shake, and worsen her speech and social
ability. One other medication that C.C. had been prescribed
made her "pass out much earlier."
also disputed her mental illness and that she needed to take
medication for it. She stated that in her Taiwanese culture,
she was taught to not use drugs or take caffeine because it
would cause bone deficiency. C.C. denied threatening to kill
staff members' children, stating that a nurse assistant
used to threaten C.C., telling her that she, the nurse,
wanted C.C. to die earlier. C.C. told the nurse assistant
that parents "have the misdemeanor and it will impact
the children." She also denied slamming a bathroom door
on a staff member's hand, stating that she was being
attacked and sworn at by the staff. C.C. stated that the
staff member pulled the door open, put their arm inside the
bathroom, and would not leave her in privacy or let her shut
the bathroom door.
close of the evidence, the trial court granted the
application. After considering all the evidence, including
the application and the expert testimony, the trial court
found that the allegations in the application were true and
correct and supported by clear and convincing evidence.
Further, the trial court found that treatment with the
proposed medication was in C.C.'s best interest and that
C.C. lacked the capacity to make a decision regarding
administration of the medication. The trial court authorized
the Department to administer psychoactive medications to
C.C., including anxiolytics/sedatives/hypnotics,
antidepressants, antipsychotics, and mood stabilizers. This
Administration of Psychoactive Medications
second issue, C.C. argues that administration of psychoactive
medication unconstitutionally deprives her of the liberty to
reject medical treatment because the government's
interest in bringing her to trial is not an important
governmental interest, citing In re F.H., 214 S.W.3d
780 (Tex. App.-Tyler 2007, no pet.). In In re F.H.,
the patient argued that the trial court erred in granting the
order based upon the United States Supreme Court's
opinion in Sell v. United States, 539 U.S. 166, 123
S.Ct. 2174, 156 L.Ed.2d 197 (2003). In re F.H., 214
S.W.3d at 782.