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In re N.N.

Court of Appeals of Texas, Second District, Fort Worth

August 28, 2019

In the Matter of N.N.

          On Appeal from County Court at Law No. 2 Wichita County, Texas Trial Court No. 50572-LR-D

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



         Appellant N.N. appeals the trial court's order requiring the administration of psychoactive medication. See Tex. Health & Safety Code Ann. § 574.106(a)(2). We affirm.


         While awaiting trial on charges of stalking and harassment, Appellant was found incompetent to stand trial and ordered committed to inpatient mental-health treatment in May 2019. See Tex. Code Crim. Proc. Ann. art. 46B.073. Psychiatrist Dr. Peter Fadow, who had begun treating Appellant on July 2, sought an order for the administration of psychoactive medication for N.N. See id. art. 46B.086; Tex. Health & Safety Code Ann. §§ 574.104, .106. At the July 10 hearing on the application for such an order, Dr. Fadow testified that Appellant suffers from schizophrenia, which manifests in Appellant through delusional thoughts and delusional fixations on female professionals. According to Dr. Fadow,

[Appellant] reports that he has - - a group or a military group is pumping gas into his residence at his home and that he has had these attacks going on since 2013 up until the date of his arrest. He also forms these delusional fixations on female professionals, including a Dallas newscaster and an attorney in the Dallas area. [Appellant] has hallucinations. He says this gas that's pumped into his home caused a stinging sensation on his head and also his - - his stomach and that he can smell it. So, he's got olfactory and tactile hallucinations. He has acted on these delusional thoughts, and he's been engaged allegedly in stalking these females and harassing. I also note that from reviewing records of a previous hospitalization at Rusk State Hospital that he has also retaliated in the past as well.

         Dr. Fadow testified that Appellant presents a danger to others at the hospital, specifically to female professionals working there. Although Dr. Fadow admitted that it had yet to happen, he explained, "[Appellant's] pattern is to think that he has romantic relationships with these women, and I think that could occur here as well."

         Appellant refused to voluntarily take medication because he did not believe he suffered from a mental illness. Appellant also refused psychoactive medication because of prior side effects he suffered related to heart conditions when he had taken antipsychotic medications in the past.[1] But according to Dr. Fadow, "the internist on [Appellant's] heart condition" had verified that Appellant could be safely treated with antipsychotic medications and "cleared him for medication," without any need to follow up with a cardiologist. Consequently, Dr. Fadow recommended Appellant take Abilify, a "very effective antipsychotic" that would also cause the least side effects. And while Appellant had complained that Abilify made him feel hungry, Dr. Fadow expressed confidence that weight gain caused by increased hunger could be controlled through diet. Because weight gain could cause other medical problems, such as high blood pressure, Dr. Fadow testified that the medical team keeps a close eye on the situation: "[W]e monitor it very closely here, and we do have a dietitian to prevent the excessive weight gain from occurring."

         In Dr. Fadow's opinion, Appellant would continue to be psychotic without medication, "and his paranoid delusions are such that he will form a fixation, probably on one of our female staff, a physician or a social worker, and he might become aggressive as he has previously." Dr. Fadow testified that there were no available alternatives or less intrusive treatments available that would likely produce the same results as treatment with medication.

         According to Dr. Fadow, when he had attempted to explain the benefits and side effects of Abilify to Appellant, Appellant did not appear to fully understand them. Dr. Fadow attributed Appellant's lack of understanding to Appellant's mistaken belief that he did not suffer from delusional thoughts or hallucinations. Based upon his observations and interactions with Appellant, Dr. Fadow concluded that medication was in Appellant's best interests and that Appellant lacked the capacity to make decisions about its administration.

         Appellant also testified at the hearing. He confirmed that he suspected that toxic gas was being pumped into his home and causing his high blood pressure. And he testified that although he had taken Abilify in the past, it was ineffective:

A. ... [T]he key issue is what benefits you're going to have. And these thoughts that Dr. Fadow refers to as delusions, which may or may not be true, didn't change - -
Q. Okay.
A. - - so that's the core issue of taking the medication is they're going to change your thought process. And did it change? No.

         Appellant reiterated his concern that medication could cause him to gain weight and that, in turn, his blood pressure would again rise to unhealthy levels. Appellant also complained that Abilify gave him an "icky feeling," causing him to feel anxious, to suffer from dry mouth, and to experience difficulty in sleeping, concentrating, and exercising.

         The trial court granted the application for medication administration. In its written order, the trial court found by clear and convincing evidence that ...

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