Court of Appeals of Texas, Second District, Fort Worth
Appeal from County Court at Law No. 2 Wichita County, Texas
Trial Court No. 50572-LR-D
Sudderth, C.J.; Gabriel and Bassel, JJ.
SUDDERTH, CHIEF JUSTICE
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
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.
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."
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. 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."
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.
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
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 - -
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.
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.
trial court granted the application for medication
administration. In its written order, the trial court found
by clear and convincing evidence that ...