NO. 12-05-00193-CV
IN THE COURT OF APPEALS
TWELFTH COURT OF APPEALS DISTRICT
TYLER, TEXAS
THE STATE OF TEXAS FOR § APPEAL FROM THE
THE BEST INTEREST AND § COUNTY COURT OF
PROTECTION OF R.J.M. § CHEROKEE COUNTY, TEXAS
MEMORANDUM OPINION
Appellant R.J.M. appeals from an order of commitment for temporary inpatient mental health services. After a hearing without a jury, the trial court ordered R.J.M. committed to Rusk State Hospital for a period not to exceed ninety days. In one issue, R.J.M. asserts the evidence is legally and factually insufficient to support that order. We affirm.
Background
On June 6, 2005, an application for court ordered temporary mental health services was filed requesting the court commit R.J.M. to Rusk State Hospital for a period not to exceed ninety days. The application was supported by a certificate of medical examination for mental illness, prepared by a physician, Dr. Vasantha Orocoesky, who had examined R.J.M. on June 5. Dr. Orocoesky diagnosed R.J.M. as suffering from Bipolar Disorder. He found that R.J.M. is mentally ill and likely to cause serious harm to herself. He also found that she is suffering severe and abnormal mental, emotional, or physical distress; is experiencing substantial mental or physical deterioration of her ability to function independently; and is unable to make a rational and informed decision as to whether or not to submit to treatment.
Dr. Orocoesky reached these conclusions because, on or about June 5, R.J.M. admitted to running naked to make a point for the world because we are going to be blown up soon. She said, “If that is not true, I am crazy.” The doctor explained that she was disheveled and fearful, and she refused to speak to people at Sabine Valley Center. Dr. Orocoesky found that R.J.M. presents a substantial risk of serious harm to herself or others if not immediately restrained, an opinion he based on R.J.M.’s behavior and on evidence of severe emotional distress and deterioration in her mental condition to the extent that she cannot remain at liberty. Dr. Orocoesky formed this opinion because of what R.J.M. had said and done as set out above.
On June 7, 2005, R.J.M. was examined by Dr. Laurence Taylor who then also prepared a certificate of medical examination for mental illness. Dr. Taylor diagnosed R.J.M. with Bipolar I Disorder, mixed, with psychosis and indicated that R.J.M. is mentally ill and likely to cause serious harm to herself. The doctor also found that R.J.M. is suffering severe and abnormal mental, emotional, or physical distress; is experiencing substantial mental or physical deterioration of her ability to function independently; and is unable to make a rational and informed decision as to whether or not to submit to treatment. He based his opinion on R.J.M.’s statements that “the world is going to be blown up by nuclear war” and “the U.S.A. cabinet will not reconsider their bullshit” along with the fact that she was discharged from this facility by the court approximately one month ago. The patient repeatedly used curse words, including the “F” word, throughout the interview and thought the doctor was the chaplain. R.J.M. exhibited extremely poor insight and judgment as well as manic-like behavior.
Dr. Taylor testified at the hearing, explaining that R.J.M. is mentally ill, suffering from Bipolar I Disorder, mixed, with psychosis, and likely to cause harm to herself. He also testified that R.J.M. is suffering severe and abnormal mental, emotional, or physical distress, experiencing substantial mental or physical deterioration of her ability to function independently, and is unable to make a rational and informed decision whether or not to submit to treatment. Dr. Taylor based his opinion on R.J.M.’s condition at the time of her admission. He explained that, when she was admitted, R.J.M. told him the world was going to be blown up by nuclear war. She cursed frequently, primarily by using the “F” word throughout the interview. The doctor explained that R.J.M. has extremely poor insight and judgment and since her stay she has required a multitude of injections of emergency medications for such things as loud, agitated, aggressive, and assaultive behavior. Dr. Taylor said R.J.M. is threatening and delusional, will not redirect, and directs racial slurs at other patients. The doctor testified that R.J.M.’s threatening behavior and language toward other people is a continuing pattern of behavior. She argues about the medication and dosage and is at times very loud and threatening. Dr. Taylor said the delusions about the world coming to an end were a problem where she lived and interfere with her ability to care for herself appropriately. He also explained that her manic behavior would affect her ability to take care of herself or cause serious harm to her. She “gets to carrying on” verbally and physically and will not stop to listen to reason. Having no insight into her illness, she makes terrible decisions. Dr. Taylor stated that Rusk State Hospital is the least restrictive available option for R.J.M. at this time.
On cross examination, Dr. Taylor agreed that R.J.M. does not want to be at the hospital and is angry about being kept there against her will, which could be the basis for irritability, loud behavior, and racial slurs. The doctor stated that, while all who use vulgar language and racial slurs are not mentally ill, that sort of language can be a symptom of mental illness. The doctor agreed that there are those in the world who are seriously worried about the future of the world and some in the field of religion who prophesy that we are in the end times. He did not recall that R.J.M. had attempted suicide. Dr. Taylor testified that R.J.M. is able to feed herself and dress herself without assistance or prompting. Dr. Taylor testified that R.J.M. would know enough of the dangers of a burning building to get out of the building, but she does not know the basic fundamentals of personal safety. R.J.M. can purchase food at a grocery store and obtain housing.
Upon questioning by the court, Dr. Taylor clarified that R.J.M. had assaulted patients and/or staff and that she has delusions of grandeur. She believes she knows more than anyone and tells the doctor what medications she should take, what color the pills should be, and the dose she should take. As an example of her poor decision making, the doctor stated that she becomes aggressive and has assaulted other patients. He said this assaultive behavior is caused by her mental illness and is not provoked in any way.
On continued cross examination, Dr. Taylor clarified that there were eight assaults and the most recent occurred the day before the hearing. The doctor explained that the assaults were physical and initiated by R.J.M.
R.J.M. testified in her own behalf. She said she does not want to remain in Rusk State Hospital. She explained that she wants to go home to Lake of the Pines where she lives with her dog. She said she does not wish to harm herself or anything else. She explained that she had a cut on her head but she did not cut herself. She and her daughter had a “scrap.” She said that was a long time back and her head has been hit four times since then. When she is living alone, she does her own shopping and cooking if she wants to. She said she feeds herself and there are people at her church who will not let her do without. She did not consent to coming to the hospital but she is not angry because they are helping her in a lot of ways.
R.J.M. explained that what the doctor referred to as aggressive behavior was probably when she was telling the devil to get behind her. She said she is a loud person and she is getting out of a twenty-two year relationship. When asked about getting into fights at the hospital, R.J.M. said she did not fight “him” and described an incident when a nurse and others came into her room to give her two shots. Counsel asked if she threw a punch and she responded, “He grabbed me.” Counsel asked if she was fighting for her defense and she said she was just trying to stay in her bed. When asked if she had been in other physical altercations at the hospital, she said, “Not that I know of, not intentionally. If I did, I’m sorry.” She said she had not been in a fight outside the hospital since about February and that was with her ex-husband.
R.J.M. explained that she talks to God all the time in a prayerful manner, begging for mercy. She meant what she had said about nuclear wars. She said if we do not pull together, there will not be a 2006. She explained that if she were in a burning building she would do her best to get out, if she had a broken arm, she would see a medical doctor, and she would not sit on a fire ant hill. She explained that she believes in knowing your body and not abusing drugs or yourself. Dr. Taylor would not listen to her about knowing her body. She continued, “But he gave me Seraquel at 300 milligrams, and I ran out of Lithium, and if I walked outside naked, Dr. Taylor, I apologize. When I take 300 Seraquels, I am dead, so I take a quarter of one of those when I get ready to rest.”
On cross examination, R.J.M. said she is not sure if she ran naked. The medication messes her up but she did not think she did. Her neighbors will tell her when she gets home.
The court then asked Dr. Taylor if he had both a written record and verbal record indicating the incidents of aggression. The doctor explained that each morning the nurse brings him a written record from the past twenty four hours and he gets additional information from verbal reports.
The trial court entered an order for temporary inpatient mental health services after determining that the evidence supports the allegations that R.J.M. is mentally ill and that she is likely to cause serious harm to herself. The court also found that R.J.M. is suffering severe and abnormal mental, emotional, or physical distress, experiencing substantial mental or physical deterioration of her ability to function independently, and unable to make a rational and informed decision as to whether to submit to treatment. The court ordered R.J.M. committed to Rusk State Hospital for a period not to exceed ninety days.
Sufficiency of the Evidence
In her sole issue, R.J.M. asserts the evidence is neither legally nor factually sufficient to support the order of commitment. She asserts that the evidence merely shows, if anything, that she is mentally ill and may be in need of hospitalization. She argues that the doctor’s testimony does not support the imposition of a commitment under the clear and convincing standard.
Standard of Review
In a legal sufficiency review where the burden of proof is clear and convincing evidence, the reviewing court must consider all of 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). The reviewing court must assume that the factfinder resolved disputed facts in favor of its finding if a reasonable factfinder could do so. Id. A court should disregard all evidence that a reasonable factfinder could have disbelieved or found to have been incredible. Id.
In addressing a factual sufficiency of the evidence challenge, we must consider all the evidence in the record, both that in support of and contrary to the trial court’s findings. In re C.H., 89 S.W.3d 17, 27-29 (Tex. 2002). This court must give due consideration to evidence that the factfinder could reasonably have found to be clear and convincing. Id. at 25. We must determine
whether the evidence is such that a factfinder could reasonably form a firm belief or conviction about the truth of the State’s allegations. Id. We must consider whether disputed evidence is such that a reasonable trier of fact could not have reconciled that disputed evidence in favor of its finding. In re J.F.C., 96 S.W.3d at 266. Appellate courts retain deference for the constitutional roles of the factfinder. In re C.H., 89 S.W.3d at 26. The trier of fact is the exclusive judge of the credibility of the witnesses and the weight to be given their testimony. See id. at 27; In re J.J.O., 131 S.W.3d 618, 632 (Tex. App.–Fort Worth 2004, no pet.).
Applicable Law
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 the 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).
Analysis
The State provided expert testimony explaining that R.J.M. is mentally ill and describing her behavior and statements. In his certificate of medical examination, Dr. Orocoesky explained that R.J.M. was disheveled and fearful. She had been running naked because she felt the world was going to be blown up soon. Dr. Taylor’s certificate of medical examination indicated that R.J.M. was delusional and exhibited poor insight and judgment. At the hearing, Dr. Taylor testified that R.J.M. was likely to cause harm to herself, a conclusion he came to based on R.J.M.’s condition at admission. She has exhibited loud, agitated, aggressive, and assaultive behavior while at the hospital. Having no insight into her illness, she makes terrible decisions, which led to the eight assaults she committed while in the hospital. This is expert testimony of a pattern of behavior that tends to confirm the likelihood of R.J.M.’s causing serious harm to herself by inviting attack. 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 R.J.M. is likely to cause serious harm to herself. See In re J.F.C., 96 S.W.3d at 266. The evidence is legally sufficient to support the trial court’s order. See id.
In addressing R.J.M.’s factual sufficiency complaint, we consider the evidence, giving due consideration to evidence the factfinder could reasonably have found to be clear and convincing. In re C.H., 89 S.W.3d at 25. R.J.M. testified that she did not want to harm herself. She explained away the aggressive behavior, saying she was a loud person and was addressing the devil. She denied intentionally participating in altercations at the hospital. The trial court was entitled to disbelieve R.J.M.’s testimony and disregard evidence contrary to the State’s position. See id. at 27. Accordingly, in light of the entire record, the evidence that the trial court could not have credited in favor of its findings is not so significant that it could not reasonably form a firm belief or conviction that R.J.M. is mentally ill and is likely to cause serious harm to herself. See id. Thus, the evidence is factually sufficient to support the trial court’s findings. Because we hold the evidence is both legally and factually sufficient to support the trial court’s order, we overrule R.J.M.’s sole issue.
Disposition
We affirm the trial court’s order of commitment for temporary inpatient mental health services.
DIANE DEVASTO
Justice
Opinion delivered February 28, 2006.
Panel consisted of Worthen, C.J., Griffith, J., and DeVasto, J.
(PUBLISH)