NO. 12-06-00055-CV
IN THE COURT OF APPEALS
TWELFTH COURT OF APPEALS DISTRICT
TYLER, TEXAS
§ APPEAL FROM THE
THE STATE OF TEXAS
FOR THE BEST INTEREST § COUNTY COURT AT LAW OF
AND PROTECTION OF J.L.G.
§ CHEROKEE COUNTY, TEXAS
MEMORANDUM OPINION
Appellant J.L.G. appeals from an order for temporary inpatient mental health services and an order to administer psychoactive medications. In two issues, J.L.G. asserts the evidence is legally and factually insufficient to support the commitment order and that the order to administer psychoactive medications is invalid. We affirm.
Background
On February 13, 2006, Dr. C.B. Cuellar signed an application for an order to administer psychoactive medication to J.L.G. Cuellar stated that J.L.G. had been diagnosed with schizophreniform disorder and requested the trial court to compel J.L.G. to take four psychoactive medications: an antidepressant, an anxoilytic/sedative/hypnotic, an antipsychotic, and a mood stabilizer. Cuellar stated that J.L.G. refused to take the medications voluntarily and that, in his opinion, J.L.G. lacked the capacity to make a decision regarding administration of psychoactive medications because he exhibited marked delusional denial of his illness. Cuellar concluded that these medications were the proper course of treatment for J.L.G. and that, if he were treated with the medications, his prognosis was better with a good probability of improving. However, Cuellar believed that, if J.L.G. were not administered the medications, his mental health would deteriorate further, with violence and harm to himself and others. Cuellar considered other medical alternatives to psychoactive medication, but determined that those alternatives would not be as effective. Moreover, Cuellar believed the benefits of the psychoactive medications outweighed the risks in relation to present medical treatment and J.L.G.’s best interest.
On February 14, 2006, an application for court ordered temporary mental health services was filed requesting the court to commit J.L.G. to the Rusk State Hospital (the “Hospital”) for a period not to exceed ninety days. At the time the application was filed, J.L.G. was a patient at the Hospital. The application was supported by two physician’s certificates of medical examination for mental illness. The first certificate stated that, on February 13, 2006, Cuellar evaluated and examined J.L.G. and diagnosed him with schizophreniform disorder. According to Cuellar, J.L.G. was mentally ill and was likely to cause serious harm to himself or others. As the basis for his opinion, Cuellar stated that J.L.G. denied his illness and admitted hating his father. Cuellar reported that J.L.G. was paranoid and threatened suicide and harm to family members. Cuellar was further of the opinion that J.L.G. presented a substantial risk of serious harm to himself or others if not immediately restrained, demonstrated by his behavior or by evidence of severe emotional distress and deterioration in his mental condition to the extent that he could not remain at liberty. As the basis for this opinion, Cuellar stated that J.L.G. denied his illness, admitted hating his father, was paranoid and very angry, and threatened suicide and harm to family members.
On February 14, 2006, Dr. Jon A. Guidry evaluated and examined J.L.G. and diagnosed him with schizophreniform disorder or bipolar disorder manic. Guidry noted that J.L.G. refused treatment and refused to allow him to talk with J.L.G.’s parents. According to Guidry, J.L.G. was mentally ill and was likely to cause serious harm to others. As the basis for his opinion, Guidry stated that J.L.G. denied traveling recently, contrary to his records. According to Guidry, J.L.G. stated he had been hospitalized in Palestine. Further, Guidry reported that J.L.G. denied allegations that he threatened to kill his father when he was discharged from the psychiatric hospital in Palestine. Guidry was of the opinion that J.L.G. presented a substantial risk of serious harm to himself or others if not immediately restrained, demonstrated by his behavior. As the basis for this opinion, Guidry reported that J.L.G. denied allegations that he threatened homicide or suicide, but stated that “they are bad people.” According to Guidry, J.L.G. exhibited paranoia, stating that his family was trying to do something bad to him, and refused to allow Guidry to talk with his parents.
The hearing on the application for court ordered temporary mental health services was held on February 21, 2006. After a hearing, the trial court found, by clear and convincing evidence, that J.L.G. was mentally ill and was likely to cause serious harm to himself and others. On February 21, the trial court entered an order for temporary inpatient mental health services, committing J.L.G. to the Hospital for a period not to exceed ninety days. After ordering J.L.G. committed to the Hospital, the trial court heard the application for an order to administer psychoactive medication. The trial court found, by clear and convincing evidence, that treatment with the proposed medication was in J.L.G.’s best interest and that he lacked the capacity to make a decision regarding administration of the medication. The trial court authorized the Texas Department of Mental Health and Mental Retardation (the “Department”) to administer to J.L.G. psychoactive medications, including antidepressants, antipsychotics, mood stabilizers, and anxiolytics/sedatives/hypnotics. This appeal followed.
Sufficiency of the Evidence
In his first and second issues, J.L.G. argues that the evidence is neither legally nor factually sufficient to support the order of commitment and that the order to administer psychoactive medications is invalid.
Standard of Review
In a legal sufficiency review where the burden of proof is clear and convincing evidence, we must 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 findings were true. In re J.F.C., 96 S.W.3d 256, 266 (Tex. 2002). We must assume that the fact finder settled disputed facts in favor of its finding if a reasonable fact finder could do so and disregard all evidence that a reasonable fact finder could have disbelieved or found incredible. Id. This does not mean that we are required to ignore all evidence not supporting the finding because that might bias a clear and convincing analysis. Id.
The appropriate standard for reviewing a factual sufficiency challenge is whether the evidence is such that a fact finder could reasonably form a firm belief or conviction about the truth of the petitioner’s allegations. In re C.H., 89 S.W.3d 17, 25 (Tex. 2002). In determining whether the fact finder has met this standard, we consider all the evidence in the record, both that in support of and contrary to the trial court’s findings. Id. at 27-29. Further, we must consider whether disputed evidence is such that a reasonable fact finder could not have reconciled that disputed evidence in favor of its finding. In re J.F.C., 96 S.W.3d at 266. If the disputed evidence is so significant that a fact finder could not reasonably have formed a firm belief or conviction, then the evidence is factually insufficient. Id.
Involuntary Commitment Order
The trial judge may order a proposed patient to receive court ordered temporary inpatient mental health services if the judge or jury finds, from clear and convincing evidence, that the proposed patient is mentally ill and, as a result of the mental illness, he is likely to cause serious harm to himself, is likely to cause serious harm to others, or is (i) suffering severe and abnormal mental, emotional, or physical distress, (ii) experiencing substantial mental or physical deterioration of his ability to function independently, which is exhibited by his inability, except for reasons of indigence, to provide for his basic needs, including food, clothing, health, or safety, and (iii) unable to make a rational and informed decision as to whether or not to submit to treatment. Tex. Health & Safety Code Ann. § 574.034(a) (Vernon 2003).
To be clear and convincing under this statute, the evidence must include expert testimony and, unless waived, evidence of a recent overt act or a continuing pattern of behavior that tends to confirm either the likelihood of serious harm to the proposed patient or others or the proposed patient’s distress and the deterioration of his ability to function. Tex. Health & Safety Code Ann. § 574.034(d) (Vernon 2003). Clear and convincing evidence means the measure or degree of proof that will produce in the mind of the trier of fact a firm belief or conviction as to the truth of the allegations sought to be established. State v. Addington, 588 S.W.2d 569, 570 (Tex. 1979). The statutory requirements for an involuntary commitment are strict because it is a drastic measure. In re C.O., 65 S.W.3d 175, 182 (Tex. App.–Tyler 2001, no pet.).
The State provided expert testimony from Cuellar and Guidry who examined J.L.G. and diagnosed him with schizophreniform disorder. However, expert testimony confirming mental illness, standing alone, will not support an involuntary commitment. T.G. v. State, 7 S.W.3d 248, 252 (Tex. App.–Dallas 1999, no pet.). Both doctors provided evidence showing that J.L.G. was mentally ill. Cuellar reported that J.L.G. denied his illness, admitted hating his father, and was paranoid and very angry. Guidry stated that J.L.G. refused treatment, denied recent travel, contrary to his records, and was paranoid, stating that his family was trying to do something bad to him. At the hearing, Guidry testified that J.L.G. continued to self-converse and show some irritability. Guidry stated that his observations at the Hospital along with J.L.G.’s paranoia and lack of insight suggested that J.L.G. remained psychotic and paranoid. Evidence of continuing delusional or paranoid behavior merely reflects that an individual is mentally ill and in need of hospitalization, but does not provide the continuing pattern of behavior necessary to support a commitment. See In re C.O., 65 S.W.3d at 182; Broussard v. State, 827 S.W.2d 619, 622 (Tex. App.–Corpus Christi 1992, no writ).
An expert opinion recommending commitment must be supported by the factual bases on which it is grounded and not simply recite the statutory criteria. See J.M. v. State, 178 S.W.3d 185, 193 (Tex. App.–Houston [1st Dist.] 2005, no pet.). What is necessary is the expert’s description of the patient’s specific behaviors on which his or her opinion is based. See id. We must examine the record to determine where there is clear and convincing evidence showing an overt act or a continuing pattern of behavior that tended to confirm the likelihood of serious harm to others or his distress and the deterioration of his ability to function. See Tex. Health & Safety Code Ann. § 574.034(d).
Regarding J.L.G.’s threats or threatening actions, Cuellar reported that J.L.G. threatened suicide and harm to family members. Guidry noted that J.L.G. denied allegations that he threatened to kill his father, but refused to let Guidry speak with his father. At the hearing, Guidry testified that J.L.G. believed that his family was trying to harm him even though the family showed no malevolence and J.L.G. could not clarify why his family was bad or evil or would attempt to do something bad to him. Guidry was concerned that J.L.G.’s condition would deteriorate to the point where he could be dangerous to others. Guidry stated that J.L.G.’s further deterioration could lead to rehospitalization or jail. Although J.L.G. denied allegations that he threatened himself or others, Guidry stated that he was worried about J.L.G.’s family’s safety. Guidry admitted that J.L.G. had not made any recent overt act of harm to himself, but stated that, according to earlier testimony, he had pushed a hand out in front of him against his half sister, Sandra Isget.
Jimmy Lee Griffin, J.L.G.’s father, testified that J.L.G.’s behavior had changed recently. He stated that J.L.G. made threats to him and Griffin’s parents and stated that he was going to kill himself. J.L.G. told Griffin that he believed his whole family would kill him “if they thought they could do it and get away with it.” According to Griffin, J.L.G. said that there was nothing wrong with him, that he was tired of his “whole family” hating him, and that he was going to do something about it. Griffin stated that J.L.G. went from conversing with him to hating him and Griffin’s parents and stating that “there was no telling what he might do.” About a month ago, J.L.G. told Griffin that he “may take care of himself.” Griffin believed that J.L.G.’s statements indicated that he was going to harm himself, Griffin, or Griffin’s parents.
Isget testified that J.L.G. made threats on his life to her. J.L.G. stated to Isget that he would not be in her wedding because he would not be “here then.” J.L.G. told her that he did not want to be “here,” and that he was tired of being “here.” Isget believed J.L.G. was in danger. Isget alleged that J.L.G. physically pushed her arm away when she reached to touch him in the hallway before the hearing. Regarding the incident with Isget, J.L.G. stated that Isget grabbed him and was getting in his way, so he shoved her hand away and walked off.
Regarding J.L.G.’s deterioration of his ability to function, Griffin also testified that J.L.G. began disappearing, failed to show up for one of their regular Friday night dinners, and failed to show up at work, all without notice. Griffin noted that, prior to this incident, J.L.G. had not missed work in three years. Moreover, J.L.G. became angry and confrontational when Griffin attempted to check up on him. Directly afterwards, J.L.G. disappeared for three days. J.L.G. had not been paying his rent regularly or his utilities at all in four months. Although J.L.G. believed that his family disowned him, Griffin denied the allegation. About a week before J.L.G.’s hospitalization, Griffin and J.L.G. had dinner. During dinner, Griffin stated that J.L.G. stared off into space about fifteen or twenty times during the meal, a tendency that had started a few months ago. During those times, Griffin stated, he could not get J.L.G.’s attention. According to Griffin, J.L.G. was fascinated with movie stars. At one point, J.L.G. wanted to discuss movie actors and directors. Instead of responding, Griffin asked J.L.G. to consider visiting a doctor. According to Griffin, J.L.G. reacted violently, yelled at Griffin, cursed, ran from the restaurant, and hid in his vehicle.
Isget noted that J.L.G. had delusions regarding a relationship with a girl and that his perception of reality was “skewed.” He was obsessed with celebrities and religion. Isget testified that J.L.G. was paranoid about financial institutions and that, after withdrawing his money from the bank, he failed to pay for essentials, such as housing and food. J.L.G. testified that his family disowned him and no longer cared about him. He equated not caring about him with disowning him. He denied that Griffin was his father. In J.L.G.’s opinion, his family disowned him because they were not good people and he was. J.L.G. admitted that he was a movie buff and that, just because he wanted to talk about movies, Griffin thought it was “weird” and uninteresting. J.L.G. denied becoming angry and storming out during dinner, although he admitted not finishing the meal. He believed that his father had dinner with him in order to put him in the Hospital and to do something bad to him. According to J.L.G., his father lied and made up “stuff” to put him in the Hospital.
We consider J.L.G.’s threats to his family and alleged threatening actions, his delusions regarding his family and his view that his family was going to do something bad to him, his deteriorating ability or inclination to take care of his basic needs, and his inability to recognize his mental illness to be a continuing pattern of behavior that tended to confirm the likelihood of serious harm to himself or others. See Tex. Health & Safety Code Ann. § 574.034(d). Viewing all the evidence in the light most favorable to the findings, we conclude a reasonable trier of fact could have formed a firm belief or conviction that J.L.G. was likely to cause serious harm to himself or others. See Tex. Health & Safety Code Ann. § 574.034(a), (d); In re J.F.C., 96 S.W.3d at 266. Therefore, the evidence is legally sufficient to support the trial court’s order. See In re J.F.C., 96 S.W.3d at 266.
Having determined that the evidence is legally sufficient to support the order, we address factual sufficiency and consider all of the evidence, both that in support of and contrary to the trial court’s findings. See In re C.H., 89 S.W.3d at 27-29. Griffin admitted that J.L.G. never stated he was going to kill him nor had he committed any overt act in an attempt to harm himself or others. Isget admitted that J.L.G.’s comments to her could have meant that he was not going to be a part of her wedding, that he did not like her, or that he was moving. She admitted that J.L.G. never told her he was going to kill himself or hurt her or others. Isget also denied that J.L.G. assaulted her. Guidry admitted that his working chart did not document an assault on another patient or the staff at the Hospital. Guidry also stated that J.L.G. never said he would harm himself or others. Griffin admitted that J.L.G. was “semi” able to shop for food and clothing.
J.L.G. denied ever stating that he wanted to harm himself or others and denied wanting to do so. He also denied stating that he would harm his parents or grandparents. He denied any assaultive behavior at the Hospital or having a criminal record. J.L.G. also denied being a paranoid schizophrenic and stated that Guidry misdiagnosed him, could not prove his illness, and was making it up. Although J.L.G. denied having any interaction with his family, he admitted that he had a birthday party with them before Christmas. He admitted that his family never told him that they disowned him or that they did not like or care about him. J.L.G. stated that he paid rent and had a job for three years, missing only one day of work. He denied telling Isget that he wanted to harm himself and stated that he meant he was moving.
The trial court was entitled to disbelieve J.L.G. and disregard the evidence contrary to the State’s position. See id. Based upon our review of the record as a whole, we conclude that, although there is some disputed evidence, this evidence is not so significant that a reasonable trier of fact could not have reconciled this evidence in favor of its finding and formed a firm belief or conviction that J.L.G. was likely to cause serious harm to himself or others. See Tex. Health & Safety Code Ann. § 574.034(a)(d); In re J.F.C., 96 S.W.3d at 266. Therefore, the evidence is factually sufficient to support the trial court’s order. See In re J.F.C., 96 S.W.3d at 266. Accordingly, we conclude that the trial court met the obligations imposed by Section 574.034 of the Texas Health and Safety Code and overrule J.L.G.’s first issue.
Order to Administer Psychoactive Medication
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) (Vernon Supp. 2006). The court may issue an order if 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). “Capacity” means a patient’s ability to (1) understand the nature and consequence 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. Tex. Health & Safety Code Ann. § 574.101(1) (Vernon 2003). In making its findings, 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 the patient is treated with psychoactive medication, and (6) alternatives, less intrusive treatments. See Tex. Health & Safety Code Ann. § 574.106(b) (Vernon Supp. 2006).
In his brief, J.L.G. contends that the order authorizing the administration of psychoactive medications is invalid because the order of commitment is invalid. Because we have concluded that the order for temporary inpatient mental health services was valid, we must determine whether the evidence is legally and factually sufficient to support a finding that J.L.G. lacked the capacity to make a decision regarding administration of psychoactive medication and that it was in his best interest. Cuellar and Guidry believed that J.L.G. lacked the capacity to make a decision regarding administration of psychoactive medications. Cuellar based his opinion on J.L.G.’s marked delusional denial of his illness. Cuellar believed that if J.L.G. were not administered these medications, his mental health would deteriorate further, resulting in violence and harm to himself and others. Guidry based his opinion on J.L.G.’s lack of insight into his illness, denial of his illness, and statements that he did not need medication because he was not mentally ill. Guidry stated that, if J.L.G. were not administered these medications, his condition would deteriorate and his psychosis would worsen.
Both doctors stated that there were no less intrusive means of achieving the same results other than psychoactive medications. Moreover, both doctors stated that the benefits of the psychoactive medications outweighed the risks and that these medications were in J.L.G.’s best interest. J.L.G. discussed these medications with Guidry, but refused to take them, stating that he did not need them. Guidry stated that, without medication, it was unlikely J.L.G. would improve. Guidry testified that the longer J.L.G. was in a psychotic episode without medication, the more damage he was doing. Considering all the evidence in the light most favorable to the findings, we conclude a reasonable trier of fact could have formed a firm belief or conviction that J.L.G. lacked the capacity to make a decision regarding administration of the proposed medications and that treatment with the proposed medications was in his best interest. See Tex. Health & Safety Code Ann. § 574.106(a-1); In re J.F.C., 96 S.W.3d at 266. Therefore, the evidence is legally sufficient to support the trial court’s order. See In re J.F.C., 96 S.W.3d at 266.
Having determined that the evidence is legally sufficient to support the finding, we address factual sufficiency and consider all of the evidence, both that in support of and contrary to the trial court’s findings. See In re C.H., 89 S.W.3d at 27-29. Guidry admitted that he and J.L.G. discussed taking these psychoative medications and their possible side effects. J.L.G. testified that he did not want these medications and believed that they “mess[ed] with the serotonin and the transmitters in the brain.” He denied being depressed, psychotic, or schizophrenic, and said to “prove it.” J.L.G. wanted vitamins and exercise. The trial court was entitled to disbelieve J.L.G. and disregard the evidence contrary to the State’s position. See id. Further, the trial court was not required to defer to J.L.G.’s preferences and beliefs, but must have considered them. See Tex. Health & Safety Code Ann. § 574.106(b).
Because J.L.G. presented evidence to the trial court of his preference not to take psychoactive medications, it is presumed that the trial court gave his preferences and beliefs due consideration. Based upon our review of the record as a whole, we conclude that, although there is some disputed evidence, this evidence is not so significant that a reasonable trier of fact could not have reconciled this evidence in favor of its finding and formed a firm belief or conviction that J.L.G. lacked the capacity to make a decision regarding administration of the proposed medications, and that treatment with the proposed medications was in his best interest. See Tex. Health & Safety Code Ann. § 574.106(a-1), (b); In re J.F.C., 96 S.W.3d at 266. Therefore, the evidence is factually sufficient to support the trial court’s order. See In re J.F.C., 96 S.W.3d at 266. Accordingly, we conclude that the trial court met the obligations imposed by Section 574.106 of the Texas Health and Safety Code and overrule J.L.G.’s second issue.
Disposition
The judgment of the trial court is affirmed.
JAMES T. WORTHEN
Chief Justice
Opinion delivered August 25, 2006.
Panel consisted of Worthen, C.J. and Griffith, J.
(PUBLISH)