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In re R.W.

Court of Appeals of Texas, Second District, Fort Worth

June 27, 2019

In the Matter of R.W.

          On Appeal from County Court at Law No. 2 Wichita County, Texas Trial Court No. 50468-L-D

          Before Sudderth, C.J.; Gabriel and Bassel, JJ.


          Lee Gabriel, Justice

         Appellant R.W. appeals from the county court's order authorizing the Texas Department of Mental Health and Mental Retardation to administer, regardless of R.W.'s refusal, psychoactive medication to restore him to competency. RW. challenges the sufficiency of the evidence to support the order. We conclude that the evidence was legally and factually sufficient to support the county court's findings, authorizing the involuntary administration of medication.

         I. BACKGROUND

         A. Incompetency Determinations

         R.W. was charged with two criminal offenses.[1] On September 24, 2018, R.W.'s attorney filed a motion for the appointment of an expert to examine RW. for his competency to stand trial. See Tex. Code Crim. Proc. Ann. arts. 46B.004-.005, .021. The district court appointed a disinterested expert to examine R.W., and the expert reported to the court that RW. was incompetent to stand trial. See id. art. 46B.025. On November 14, 2018, the district court found R.W. incompetent to stand trial because of mental illness and ordered him committed to a state hospital for 120 days. See id. art. 46B.073(a).

         The Texas Department of State Health Services later informed the district court that R.W. had not attained competency and filed two certificates of R.W.'s recent psychiatric examinations, affirming that R.W. was not competent. See id. arts. 46B.077(b), .079, .083. Both the State and R.W.'s counsel reviewed the certificates and agreed that R.W. was not competent to stand trial on the pending criminal charges. See id. art. 46B.083. The district court found by clear and convincing evidence that RW. suffered from a mental illness and as a result of that illness, he was

suffering severe and abnormal mental, emotional or physical distress; [was] experiencing substantial mental or physical deterioration of his ability to function independently, which [was] exhibited by the defendant's inability, except for reasons of indigence, to provide for his basic needs, including food, clothing, health, [or] safety; and, [was] unable to make a rational and informed decision as to submit to treatment.

See Tex. Health & Safety Code Ann. § 574.035(a)(1), (2)(C); Tex. Code Cnm. Proc.

         Ann. arts. 46B.083(a), .084(e). On March 22, 2019, the district court concluded that R.W. met the criteria for court-ordered, extended mental-health services and ordered R.W. committed to a state hospital for a period not to exceed twelve months "for further examination and treatment toward the specific objective of attaining competency to stand trial." See Tex. Health & Safety Code Ann. § 574.035(h); Tex. Code Crim. Proc. Ann. art. 46B.102. R.W. does not challenge this order on appeal. See id. § 574.070(a).

         B. Order to Administer Psychoactive Medications

         On April 15, RW.'s treating physician filed, on the State's behalf and in a county court at law with probate jurisdiction, an application for an order authorizing psychoactive medications for R.W. See id. § 574.104, .106(c); Tex. Gov't Code Ann. § 25.2452. In the application, the physician, Zahida X. Syed, stated that she had diagnosed R.W. with "Schizophrenia, Non-compliance with treatment" and that the administration of four classes of psychoactive medications would be appropriate and in R.W.'s best interest.[2] Syed averred that R.W. verbally and by other indication refused to voluntarily take the recommended medications and that he lacked the capacity to make a medication decision:

The patient is paranoid, delusional and entitled. He is getting agitated by getting loud, having verbal altercation with staff and using profanity towards his provider. He believes and states that the State [owes] 2, 960, 00 [0] dollars for 37 years of false imprisonment on him. He is refusing to take any psychotropics because of poor insight and judgment.

         Syed concluded that with the appropriate medication, RW. could be restored to competence but could not be if the medications are not administered. The county court appointed an attorney to represent RW. and set a hearing on the application for April 17. See Tex. Health & Safety Code Ann. § 574.105(1)-(4).

         At the hearing, Dr. Charlene Shero, a consulting physician, testified as a qualified expert regarding the State's application.[3] She reviewed R.W.'s medical records and concluded that he was diagnosed with schizoaffective disorder bipolar type, "leaning more towards" schizophrenia, which caused disordered thinking, unstable moods, and an unstable affect. R.W. presented a risk of harm to others, was "extremely explosively angry," and could not reason logically. R.W. refused to take his medications and would only yell and curse if hospital staff tried to discuss it with him. On April 4 when a nurse tried to raise the issue and explain the risks and benefits of the medications, he threatened her "yelling out lewd, sexual, assaultive comments for nearly ten minutes," which "terrified" her. Between March 26 and April 17, R.W. "threatened repeatedly to [anally] rape" a nurse when she asked him to wear appropriate clothing to class; physically threatened another nurse; asked for female staff members' home addresses and cursed when the request was refused; wore a shirt to class on which he had drawn a sexually explicit picture of the teacher; and threatened Shero when she tried to interview him. Shero testified that the recommended medications, with the exception of antidepressants, would decrease R.W.'s ...

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