Court of Appeals of Texas, Second District, Fort Worth
Appeal from County Court at Law No. 1 Wichita County, Texas
Trial Court No. 50576-LR-D
Sudderth, C.J.; Kerr and Birdwell, JJ. Memorandum Opinion by
N.S. appeals from the trial court's order authorizing the
administration of psychoactive medications. See Tex.
Health & Safety Code Ann. § 574.106(a)(2). We
13, 2019, while awaiting trial on a charge of misdemeanor
assault, N.S. was found incompetent to stand trial. The trial
court ordered her committed to a mental-health facility for
inpatient mental-health treatment under code of criminal
procedure chapter 46B with the specific objective of
achieving competency. See Tex. Code Crim. Proc. Ann.
art. 46B.073. On July 12, 2019, Dr. Charlene Shero,
N.S.'s attending physician at the facility, filed an
application under health and safety code section 574.104 for
an order to authorize the involuntary administration of
psychoactive medication to N.S. In the application, Dr. Shero
stated that if N.S. were treated with the psychoactive
medicine specified in the application, N.S.'s prognosis
would be "[m]uch improved," the "[r]isk of
further aggression w[ould] decline," "[c]ompetency
m[ight] be restored, [and N.S. would] no longer suffer
trial court held a hearing on the application on July 15,
2019. Dr. Shero testified that N.S. has schizophrenia,
paranoid type. The doctor stated that a team at the facility
had met with N.S. that morning and the previous week, and
"[o]n each occasion, she [was] very disorganized. She
denie[d] mental illness. She ha[d] odd and illogical speech.
. . . [S]he[ was] quite guarded to the point of
paranoia." Dr. Shero characterized N.S. as "quite
disorganized" and stated that N.S. had expressed that
she wanted to "visit various places in the world and get
'chava, '" which N.S. said was "a
psychostimulant of some importance." Dr. Shero further
Initially, [N.S.] would not speak to us for a protracted
period of time, stating she was busy with Homeland Security
business. She was, prior to admission here, arrested for
assault on a security officer and when they became aware of
her mental status, they dropped that down to a misdemeanor,
realizing at that time that it may be due to other reasons.
But she was originally assaultive on a security officer.
Shero testified that N.S. was a danger to others, as
evidenced by the fact that she had assaulted a security
officer. N.S. had not, however, acted aggressively toward any
staff or other patients at the hospital. Dr. Shero did not
know if N.S. was aggressive while at the jail, although she
was "blanketly uncooperative and defensive." Dr.
Shero further "argue[d] very strongly that [N.S.'s]
pattern of traveling about the country without any means of
support or other people and then breaking into cars for
shelter place[d] her at a tremendous risk of assault by
others, of unsafe housing, [and demonstrated] just very, very
Shero stated that N.S. had refused medications other than
agreeing to "a completely ineffective dose of Haldol
that . . . would not even be enough for a pediatric case, to
help organize her thoughts." The basis of N.S.'s
refusal was that she "d[id]n't do meds." Dr.
Shero stated that N.S. needed antipsychotics and possibly a
mood stabilizer and anxiolytics. Dr. Shero believed that on
the proper medications, N.S. would improve; "she is
natively quite intelligent, and . . . with even a week of
treatment, . . . she would be found competent." Without
the medications, on the other hand, Dr. Shero "could not
at any time call [N.S.] competent with her delusions and her
inability to cooperate with people that disagree with
about N.S.'s capacity to make a decision about taking
medication, Dr. Shero stated that N.S. "[was] crippled
by her paranoia to allow that intrusion" and "[was]
hyper-aware of every possible [medication] side effect that
could possibly happen, but not in a realistic
perspective." Dr. Shero testified that taking medication
was "absolutely" in N.S.'s best interest. The
alternative to medications for N.S.'s condition is
electroconvulsive therapy, which Dr. Shero characterized as
"impractical, nonsustainable[, ] and frightening."
testified about why she wanted to negotiate her own
treatment. She explained, "I'm an individual human
being and that's my right to be able to do that, the
right to refuse, to negotiate, to not agree with the course
of care." When asked if she wanted the trial court to
deny the application, she initially responded that she was
"not necessarily asking for that" and that she
"feel[s] anxious sometimes due to large amounts of work
and burnout, uh, tons of work." But she testified that
it would upset her if she were administered medication that
she had not consented to take.
disputed Dr. Shero's diagnosis of her. Asked if she
understood that she had been diagnosed with schizophrenia,
paranoid type, N.S. explained that her understanding was that
that diagnosis was put on there in question because of all
the different medications from before and it had never been
substantiated and it still [wasn't] to [her] knowledge.
So that would be one of the problematic- the diagnosis was
depression and that was due to severe psychological abuse and
not understanding the medications during that time and side
effects and any and all of that and working way too much.
if she heard Dr. Shero testify about her diagnosis, N.S.
Yeah, and then that's where then that separate piece, you
can provide me medicine for that, and as you do so, then
I'll take that further to state and federal court,
because that was not my diagnosis.
I'll accept that you're going to provide me medicine
for something that I do not have. But, unfortunately, large
amounts of different people were provided medicine for
different diagnoses that were not present and can be created
by different abuse.
closing arguments, N.S.'s attorney stated that for an
order for the administration of medication under health and
safety code section 574.106, the State was required to show
that N.S. presented a danger to herself or to others in the
inpatient mental-health facility or that she had remained
confined in a correctional facility for seventy-two hours and
presented a danger there, but it had failed to do so. In
response, the State's attorney argued that section
574.106 "give[s] an either/or option"; the trial
court may also issue an order under the section if the
patient "lacks the capacity to make a decision regarding
the administration of the proposed medication and . . . the
treatment with the proposed medication is in the best
interest of the patient."
trial court signed a "Notification of Court's
Determination-Forensic" stating that it had determined
that N.S. did not have the capacity to make a proper
determination regarding the administration of the proposed
medications and that treatment with antipsychotics, mood
stabilizers, and anxiolytics was in her best interest. The
notice stated that "[t]he reasons for the court's
determination are that the Court believes the benefits to be
obtained by treatment are greater than any risks that may be
encountered by treatment with the proposed medication(s), and
there is no suitable alternative at this time."
separate order, the trial court granted the application for
medication administration. In this order, the trial court
found by clear and convincing evidence that
1. [N.S.] lack[ed] the capacity to make a decision regarding
the administration of the ...