Court of Appeals of Texas, Twelfth District, Tyler
THE STATE OF TEXAS FOR THE BEST INTEREST AND PROTECTION OF T.M.
FROM THE COUNTY COURT AT LAW CHEROKEE COUNTY, TEXAS
consisted of Worthen, C.J., Hoyle, J., and Neeley, J.
T. WORTHEN CHIEF JUSTICE.
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.
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
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.
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.
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).
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.
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).
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.
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.
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