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State Best Interest and Protection of T.M.

Court of Appeals of Texas, Twelfth District, Tyler

September 18, 2019

THE STATE OF TEXAS FOR THE BEST INTEREST AND PROTECTION OF T.M.

          APPEAL FROM THE COUNTY COURT AT LAW CHEROKEE COUNTY, TEXAS (Tr.Ct.No. 42.650)

          Panel consisted of Worthen, C.J., Hoyle, J., and Neeley, J.

          MEMORANDUM OPINION

          JAMES T. WORTHEN CHIEF JUSTICE.

         T.M. appeals from an order authorizing the administration of psychoactive medication. In three issues, he challenges the denial of his motion for continuance, the denial of his request for a jury trial, and the legal and factual sufficiency of the evidence. We affirm.

         Background

         T.M. was committed to Rusk State Hospital pursuant to an order for in patient mental health services under Chapter 46C of the code of criminal procedure, not guilty by reason of insanity. When T.M. refused to voluntarily take psychoactive medication, the State petitioned the court for an order to administer psychoactive medications to T.M. On April 12, 2019, Dr. Jill Pontius, T.M.'s treating physician, signed an application to order the administration of psychoactive medications.

         After a hearing, the trial court signed an order authorizing the administration of psychoactive medication – forensic, which found (1) the allegations in the application are true and correct and supported by clear and convincing evidence, and (2) T.M. lacks the capacity to make a decision regarding the administration of said medication and treatment with the proposed medication is in T.M.'s best interest. The trial court authorized the Texas Department of State Health Services to administer antidepressants, antipsychotics, mood stabilizers, anxiolytics/sedative/hypnotics, and miscellaneous drugs. This appeal followed.

         Sufficiency

         In his third issue, T.M. challenges the legal and factual sufficiency of the evidence to support the trial court's order to administer psychoactive medication. Specifically, he contends that the State failed to prove, by clear and convincing evidence, that he lacked the capacity to make a decision regarding administration of medication, and treatment with the proposed medications was in his best interest. We address this issue first because, if granted, it would afford the greatest relief.

         Standard of Review

         Texas law requires that orders authorizing administration of psychoactive medication be supported by clear and convincing evidence. See Tex. Health & Safety Code Ann. § 574.106(a–1) (West 2017). Clear and convincing evidence is that degree of proof which will produce in the mind of the trier of fact a firm belief or conviction as to the truth of the allegations to be established. State v. Addington, 588 S.W.2d 569, 570 (Tex. 1979) (per curiam). This intermediate standard falls between the preponderance standard of civil proceedings and the reasonable doubt standard of criminal proceedings. Id.; In re G.M., 596 S.W.2d 846, 847 (Tex. 1980). While the proof must weigh heavier than merely the greater weight of the credible evidence, there is no requirement that the evidence be unequivocal or undisputed. Addington, 588 S.W.2d at 570. This higher burden of proof elevates the appellate standard of legal sufficiency review. Diamond Shamrock Ref. Co., L.P. v. Hall, 168 S.W.3d 164, 170 (Tex. 2005); Sw. Bell Tel. Co. v. Garza, 164 S.W.3d 607, 622, 625 (Tex. 2004).

         In reviewing a legal sufficiency claim, we look at all the evidence in the light most favorable to the finding to determine whether a reasonable trier of fact could have formed a firm belief or conviction that its finding was true. In re J.F.C., 96 S.W.3d 256, 266 (Tex. 2002). When reviewing factual sufficiency, we must give due consideration to evidence that the fact finder could reasonably have found to be clear and convincing and then determine whether, based on the entire record, a fact finder could reasonably form a firm conviction or belief that the allegations in the application were proven. Id. The reviewing court must consider whether the disputed evidence is such that a reasonable fact finder could not have reconciled that disputed evidence in favor of its finding. Id. If the disputed evidence is so significant that a fact finder could not reasonably have formed a firm belief in the finding, the evidence is factually insufficient. Id.

         Applicable Law

         A trial court may issue an order authorizing the administration of one or more classes of psychoactive medications to a patient who is under a court order to receive inpatient mental health services. Tex. Health & Safety Code Ann. § 574.106(a)(1). The court may issue an order under this section only if, after a hearing, it finds by clear and convincing evidence that (1) the patient lacks the capacity to make a decision regarding the administration of the proposed medication, and (2) treatment with the proposed medication is in the best interest of the patient. Id. § 574.106(a– 1)(1).

         "Capacity" refers to a patient's ability to (1) understand the nature and consequences of a proposed treatment, including the benefits, risks, and alternatives to the proposed treatment, and (2) make a decision whether to undergo the proposed treatment. Id. § 574.101(1) (West 2017). A patient does not have the capacity to make a decision regarding the administration of medications if the patient does not understand the nature of his mental illness or the necessity of the medications. See A.S. v. State, 286 S.W.3d 69, 73 (Tex.App.–Dallas 2009, no pet.). In making its finding that treatment with the proposed medication is in the best interest of the patient, the trial court shall consider (1) the patient's expressed preferences regarding treatment with psychoactive medication, (2) the patient's religious beliefs, (3) the risks and benefits, from the perspective of the patient, of taking psychoactive medication, (4) the consequences to the patient if the psychoactive medication is not administered, (5) the prognosis for the patient if treated with psychoactive medication, (6) alternative, less intrusive treatments that are likely to produce the same results as treatment with psychoactive medication, and (7) less intrusive treatments likely to secure the patient's agreement to take the psychoactive medication. Tex. Health & Safety Code Ann. § 574.106(b).

         Hearing on Application

         Pontius testified that she is T.M.'s treating physician and that he is under a court order pursuant to Chapter 46C of the code of criminal procedure, having been found not guilty, by reason of insanity, of murdering his stepfather. She confirmed that T.M. suffers from Bipolar I disorder, the most recent episode manic with psychotic symptoms. She discussed the need for psychoactive medications with T.M., but he verbally refused to accept the medication. He accepted other medications, but not antipsychotic medications. She believed that T.M. understands the medications, side effects, and indications, but does not have insight into his need for the medication. She explained that he denies having a mental illness and does not want any medication or medical interventions. He complained of various side effects to certain medications, such as emotional numbing, a physical sensation in his nervous system, slow thinking, hair loss, weight gain, motor restlessness sensation, as well as long term risks. He expressed no religious objections. Regarding constitutional objections, he wanted freedom to control what substances enter his body.

         She testified that T.M. has been previously hospitalized and has a history of aggression toward others, "infrequent but highly lethal violence." She identified an instance on April 5, 2019, when he experienced escalating anger and frightened the hospital staff to the extent they called for back-up. T.M. had been shadowboxing, kicking an upright support, and making threats toward another patient. The staff recognized the potential for harm and escorted the patient inside the building, but T.M. followed and told a nurse that he was not "going to be stopped." The nurse described T.M. as having a rage-filled tone and an intense look. The staff were so concerned for the patient's safety that they placed him in the nurse's station until he could receive one-to-one observation for his safety. During debriefing, the staff expressed concern and an ongoing threat to the patient. They indicated never having seen the ...


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