NO. 12-06-00286-CV
IN THE COURT OF APPEALS
TWELFTH COURT OF APPEALS DISTRICT
TYLER, TEXAS
THE STATE OF TEXAS § APPEAL FROM THE
FOR THE BEST INTEREST § COUNTY COURT AT LAW
AND PROTECTION OF S.A. § CHEROKEE COUNTY, TEXAS
MEMORANDUM OPINION
S.A. appeals from an order to administer psychoactive medication. After a hearing without a jury, the trial court entered an order authorizing the Texas Department of State Health Services to administer psychoactive medication to S.A. In his sole issue, S.A. asserts the trial court’s order violates his constitutionally protected liberty interest in avoiding the involuntary administration of antipsychotic medication. We reverse and render.
Background
On July 26, 2006, the trial court entered an order for mental health services pursuant to Chapter 46B of the Texas Code of Criminal Procedure, finding S.A. incompetent to stand trial. On July 27, 2006, Dr. William Todd filed an application for court ordered authorization for the administration of psychoactive medication. Dr. Todd diagnosed S.A. as suffering from psychotic disorder not otherwise specified. S.A. refuses to take the medication voluntarily. Dr. Todd explained that S.A. is electively mute, but shook his head “no” when the doctor offered the medication. The doctor indicated that he believes S.A. lacks the capacity to make a decision regarding administration of psychoactive medication because of his psychosis.
Dr. Larry Hawkins testified at the hearing on the application. He explained that S.A. is receiving court ordered inpatient mental health services under Chapter 46B, suffers from psychotic disorder not otherwise specified, and refuses to accept medication voluntarily. S.A. will not talk and refuses to give any information at all. Dr. Hawkins testified that S.A. lacks the capacity to make a decision regarding the administration of psychoactive medication. The doctor testified that the requested medications are in the proper course of treatment for S.A. and in his best interest. S.A. will likely benefit from using these medications. Those benefits will outweigh any risks and S.A.’s hospital stay will likely be shortened if he takes the medications. Dr. Hawkins testified that there are no less intrusive means which would obtain the same or similar results as psychoactive medication.
On cross examination, Dr. Hawkins testified that S.A. is charged with theft of property valued at $50.00 or more, but not more than $500.00, a Class B misdemeanor. He was arrested April 13, 2006 and had been incarcerated for approximately 111 days. The doctor named potential side effects of the requested medications, but could not say for sure how they would affect S.A. Some might interfere with his ability to communicate with legal counsel. He estimated that S.A. might need to stay at the hospital, taking medication, for eight weeks. After hearing Dr. Hawkins’s testimony, the court entered an order to administer psychoactive medication.
Liberty Interest
In his sole issue, S.A. asserts the trial court violated his constitutionally protected liberty interest in avoiding involuntary administration of antipsychotic drugs by ordering the administration of psychoactive medication. He contends that there is no evidence that he is a dangerous person or that refusal to take the medication puts his health at risk. Further, because he was not charged with committing a serious crime, there are no important governmental interests at stake justifying curtailment of his liberty. Additionally, he argues, there is no showing that administration of the drugs is substantially likely to render S.A. competent to stand trial and substantially unlikely to have side effects that will interfere significantly with his ability to assist legal counsel with his defense. He contends the record does not support findings that alternative, less intrusive treatments are unlikely to achieve the same results or that antipsychotic medications are medically appropriate. Therefore, he argues, the evidence does not support the conclusion that involuntary medication is necessary to further the State’s important interests.
Applicable Law
An individual has a significant liberty interest in avoiding the unwanted administration of antipsychotic drugs. Sell v. United States, 539 U.S. 166, 178, 123 S. Ct. 2174, 2183, 156 L. Ed. 2d 197 (2003). However, courts may order involuntary medication in certain instances where the individual’s interest is overcome by an “essential” or “overriding” state interest. Id., 539 U.S. at 179, 123 S. Ct. at 2183. An order for involuntary medication may be entered if it is shown that treatment with antipsychotic medication is medically appropriate and, considering less intrusive alternatives, essential for the sake of the patient’s own safety or the safety of others. Id. Thus, forced medication may be warranted to address an individual’s dangerousness or where refusal to take drugs puts the individual’s health gravely at risk. Id., 539 U.S. at 182, 123 S. Ct. at 2185. Further, involuntary administration of drugs may be allowed to render a defendant charged with a serious criminal offense “competent to stand trial, but only if the treatment is medically appropriate, is substantially unlikely to have side effects that may undermine the fairness of the trial, and, taking account of less intrusive alternatives, is necessary significantly to further important governmental trial-related interests.” Id., 539 U.S. at 180, 123 S. Ct. at 2184-85. This requires consideration of four factors: 1) whether important governmental interests are at stake, 2) whether involuntary medication will significantly further those interests, 3) whether involuntary medication is necessary to further those interests, and 4) whether the administration of the drugs is medically appropriate. Id., 539 U.S. at 180-81, 123 S. Ct. at 2185.
Discussion
Dr. Hawkins testified that S.A. was, at the time of the hearing, under an order for mental health services and suffers from psychotic disorder not otherwise specified. He said S.A. has refused to accept medications voluntarily and lacks the capacity to make a decision regarding administration of psychoactive medication. The requested medications are in the proper course of treatment and are in S.A.’s best interests. The benefits outweigh the risks, and his hospital stay would be shortened if medications are used. This testimony does not speak to the constitutional requirements for overcoming an individual’s liberty interest in avoiding the unwanted administration of antipsychotic drugs.
In another constitutional context, the Supreme Court has regarded offenses for which a term of imprisonment exceeding six months may be imposed as being serious. See Baldwin v. New York, 399 U.S. 66, 69, 90 S. Ct. 1886, 1888, 26 L. Ed. 2d 437 (1970) (For purposes of determining the right to trial by jury, offense is serious if imprisonment for more than six months is authorized.). This logic has been followed in cases considering whether an offense is serious for the purpose of forcible administration of medication to restore competency. See United States v. Evans, 404 F.3d 227, 237 (4th Cir. 2005); United States v. Algere, 396 F. Supp. 2d 734, 740 (E.D. La. 2005). The record reflects that S.A. is charged with a Class B misdemeanor, which is punishable by a fine of up to $2,000.00 and confinement in jail for a term not to exceed 180 days. Tex. Pen. Code Ann. § 12.22 (Vernon 2003). Therefore, the crime S.A. is charged with is not a “serious” crime that the State has an important interest in prosecuting.
Dr. Hawkins indicated that he did not have a good “understanding of what’s going on with the patient” and never testified that administration of the drugs was substantially likely to render S.A. competent to stand trial. Dr. Hawkins stated without explanation that there are no less intrusive means which would obtain the same or similar results as psychoactive medication. While he acknowledged potential side effects, the doctor was unable to say how or to what extent the medications could interfere with S.A.’s ability to communicate with legal counsel. He acknowledged the possibility of drowsiness in some cases. There was no evidence that S.A. is dangerous or that his failure to take the drugs would put his health at risk. Considering all the factors concerned, we conclude that the record does not support a conclusion that administration of antipsychotic medication was necessary to further an important state interest. See Sell, 539 U.S. at 179, 123 S. Ct. at 2184-85. Accordingly, the trial court erred in granting the State’s application for court ordered authorization for the administration of psychoactive medication. We sustain S.A.’s sole issue.
Disposition
We reverse the trial court’s order for the administration of psychoactive medication. We render judgment denying the State’s application.
SAM GRIFFITH
Justice
Opinion delivered January 31, 2007.
Panel consisted of Worthen, C.J., Griffith, J., and Hoyle, J.
(PUBLISH)