Reversed and Rendered and Majority and Dissenting Opinions filed February 20, 2007.
In The
Fourteenth Court of Appeals
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NO. 14-05-01273BCV
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MARLIN DEANDRE HOUSE, Appellant
V.
THE STATE OF TEXAS, Appellee
On Appeal from the 208th District Court
Harris County, Texas
Trial Court Cause No. 739,579
M A J O R I T Y O P I N I O N
Appellant, Marlin Deandre House, appeals an order extending inpatient mental health treatment for a period of one year. In three issues, appellant contends (1) the evidence is legally insufficient to support the order, (2) the evidence is factually insufficient to support the order, and (3) the recommitment order is void because it does not specify which statutory criteria formed the basis for recommitment. Because we find the evidence legally insufficient to support the order, we reverse and render.
I. Background
On December 6, 1996, appellant killed his mother by stabbing her with a kitchen knife ninety-three times. Appellant was indicted for her murder. In August 1997, a psychologist concluded that appellant was Asuffering from a mental illness which included paranoid ideation and auditory hallucinations@ and that appellant met the requirements for the insanity defense. After a bench trial on November 3, 1997, the trial court found appellant not guilty by reason of insanity. A month later, he was committed to Vernon State Hospital for inpatient treatment. In January 1999, following a physician=s recommendation, appellant was transferred to Rusk State Hospital. Since then, the trial court has annually found that appellant meets the requirements for inpatient recommitment. This is an appeal from the most recent recommitment order signed November 28, 2005.
II. Applicable Statutory Provisions and Standard of Review
Under former article 46.03 of the Texas Code of Criminal Procedure, applicable to this case, recommitment hearings for persons found not guilty by reason of insanity must be conducted pursuant to the Texas Mental Health Code. See Act of May 25, 1983, 68th Leg., R.S., ch. 454, 1983 Tex. Gen. Laws 2640, 2644B46 (repealed 2005) (current version at Tex. Crim. Proc. Code Ann. art. 46C.261 (Vernon Supp. 2006)). Under section 574.066 of the Mental Health Code, a court may renew an order for inpatient mental health services if it finds the patient meets the criteria for involuntary commitment set forth in section 574.035(a) of the Mental Health Code. See Tex. Health & Safety Code Ann. ' 574.066(f) (Vernon 2003) (specifying the procedure for the renewal of an order for extended mental health services).
Section 574.035(a) provides that a court may order extended inpatient mental health services if the trier of fact finds, by clear and convincing evidence, that, among other requirements, the proposed patient meets the following criteria:
(1) the proposed patient is mentally ill; and
(2) as a result of that mental illness the proposed patient:
(A) is likely to cause serious harm to himself;
(B) is likely to cause serious harm to others; or
(C) is:
(i) suffering severe and abnormal mental, emotional, or physical distress;
(ii) experiencing substantial mental or physical deterioration of the proposed patient=s ability to function independently, which is exhibited by the proposed patient=s inability, except for reasons of indigence, to provide for the proposed patient=s 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. ' 574.035(a) (Vernon 2003). The trial court must specify which of the criteria under subsection (a)(2) forms the basis for recommitment. Tex. Health & Safety Code Ann. ' 574.035(c) (Vernon 2003).
In order to be clear and convincing under section 574.035(a), 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 (1) the likelihood of serious harm to the proposed patient or others, or (2) the proposed patient=s distress and the deterioration of the proposed patient=s ability to function. Tex. Health & Safety Code Ann. ' 574.035(e) (Vernon 2003). The court cannot make its findings solely from certificates of examination for mental illness but shall Ahear testimony.@ Tex. Health & Safety Code Ann. ' 574.035(g) (Vernon 2003). Further, the trial court may not enter an order for extended mental health services unless appropriate findings are made and are supported by testimony taken at the hearing. Id. This testimony must include competent medical or psychiatric testimony. Id.
When the burden of proof is heightened to a clear-and-convincing standard, the standard of review for legal sufficiency of the evidence is also heightened. In re F.M., 183 S.W.3d 489, 492 (Tex. App.CHouston [14th Dist.] 2005, no pet.). In a legal sufficiency review when the burden of proof is clear-and-convincing evidence, the reviewing court must consider 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 as to the truth of the allegations sought to be established. In re J.F.C., 96 S.W.3d 256, 266 (Tex. 2002); State v. Addington, 588 S.W.2d 569, 570 (Tex. 1979).
III. Legal Sufficiency of the Evidence
In his first issue, appellant argues that under the clear-and-convincing standard that the evidence is legally insufficient to support the trial court=s recommitment order. We agree. Preliminarily, we note that the trial court did not make written findings regarding which criterion of section 574.035(a) it relied on when ordering recommitment. However, the trial court concluded at the recommitment hearing that appellant is mentally ill, and as a result of his mental illness, he is likely to cause harm to himself or others, as outlined under section 574.035(a).[1]
Appellant contends there is no evidence of a recent overt act or a continuing pattern of behavior tending to confirm the likelihood of serious harm to himself or others as required by section 574.035(e). It is not clear from the trial court=s comments whether it found a recent overt act or a continuing pattern of behavior. The trial court stated: A[B]ased on his history he=s had ideation of both [harm to himself and others] and acting out in one of those.@ Nevertheless, even if these comments can be construed as a finding of a recent overt act, a continuing pattern of behavior, or both, appellant contends there is no evidence to support the findings.
Specifically, appellant asserts the evidence shows only Avague behaviors,@ on appellant=s part, which indicate at most that he is mentally ill, but do not constitute a recent overt act or a continuing pattern of behavior tending to confirm the likelihood of serious harm to himself or others.
Evidence showing only that an individual is mentally ill and in need of hospitalization does not meet the statutory requirements for confinement. See In re L.H., 183 S.W.3d 905, 911 (Tex. App.CTexarkana 2006, no pet.); In re K.D.C., 78 S.W.3d 543, 551 (Tex. App.CAmarillo 2002, no pet.); D.J. v. State, 59 S.W.3d 352, 355 (Tex. App.CDallas 2001, no pet.); Johnstone v. State, 961 S.W.2d 385, 389B90 (Tex. App.CHouston [1st Dist.] 1997, no writ); Broussard v. State, 827 S.W.2d 619, 622 (Tex. App.CCorpus Christi 1992, no pet.); In re J.S.C., 812 S.W.2d 92, 95 (Tex. App.CSan Antonio 1991, no writ). A[B]are psychiatric expert opinion of a >potential danger= to others is insufficient to support a commitment.@ Broussard, 827 S.W.2d at 622. Rather, an expert=s opinions must be supported by a showing of the factual basis. Id.; In re J.S.C., 812 S.W.2d at 95. The expert=s conclusions cannot merely mirror the statutory standards for commitment without a factual basis. K.T. v. State, 68 S.W.3d 887, 893 (Tex. App.CHouston [1st Dist.] 2002, no pet.).
Further, even if a court finds a recent overt act or a continuing pattern of behavior, the recent overt act or continuing pattern of behavior must Atend to confirm@ one of the section 574.035(a)(2) requirements. See In re J.J.K., 2003 WL 22996950, at *1, 4 (Tex. App.CHouston [14th Dist.] Dec. 23, 2003, no pet.) (mem. op.) (finding overt acts where the patient engaged in verbal altercations and knocked a door off its hinges while in a seclusion room but holding that these two overt acts did not tend to confirm the patient would cause serious harm to self or others).
A. Evidence at the Recommitment Hearing
At the recommitment hearing on November 28, 2005, the State presented testimony from Dr. Robert Altschuler and entered appellant=s complete medical records into evidence.[2] Dr. Robert Altschuler is a semi-retired, private psychiatrist. He previously examined appellant for his 2004 recommitment hearing. On October 7, 2005, Dr. Altschuler examined appellant for approximately one-and-a-half hours for the 2005 recommitment hearing at issue.
In a letter to the trial court on October 18, 2005, he opined that appellant Acontinues to be a danger to himself and others if placed in a less restrictive environment.@ At trial, Dr. Altschuler testified as to the factors on which he based his conclusion. These factors focused on appellant=s lack of insight into his illness, guardedness in answering Dr. Altschuler=s questions, and paranoia.
First, Dr. Altschuler testified that appellant had a lack of insight into his illness. He explained he Areally hoped@ that appellant Ahad a much better understanding of his psychiatric illness@ that resulted in his mother=s death. Specifically, Dr. Altschuler testified appellant had no understanding what occurred in 1996 when his mother died. During the interview, when Dr. Altschuler asked appellant what had happened to him, appellant said people have told him that Ahe may have been responsible for his mother=s death.@ Dr. Altschuler found this statement significant because if appellant could not understand what he did, then he may now feel he has been unjustly hospitalized. Dr. Altschuler opined that appellant knew why he was at Rusk State Hospital only because others had told him during his therapy. Further, Dr. Altschuler explained it was important for paranoid schizophrenics to deal with their underlying aggressive act because, by definition, paranoid schizophrenics believe people are out to get them. However, when asked if appellant=s lack of insight into his illness was a continuing pattern of behavior, Dr. Altschuler testified, AI don=t think those two words can go together. He continues to have good behavior at Rusk most of the time.@ When asked if appellant=s lack of insight would lead to a likelihood of serious harm to himself or others if placed in an outpatient setting, Dr. Altschuler stated that he thought lack of insight and paranoia were the reasons why appellant was a likely harm to himself or others. When asked if appellant=s lack of insight into his illness could lead to a deterioration of his ability to function if placed in an outpatient setting, Dr. Altschuler explained that appellant=s failure to deal with some of the issues associated with his illness could possibly cause a deterioration of his mental condition and refusal to take psychotropic medications.
Furthermore, Dr. Altschuler testified appellant had experienced paranoid thoughts in the past year. Dr. Altschuler relied on a January 28, 2005 note in appellant=s medical records indicating Aparanoid thought content.@ Due to appellant=s lack of understanding of his illness and paranoid thoughts, Dr. Altschuler opined appellant might walk away from an outpatient treatment setting.
On cross examination, Dr. Altschuler testified appellant knew the name of his mental illness, knew that he had suffered hallucinations in the past, defined a hallucination as Ahearing voices,@ and said why he thought he was in the hospital. When asked what specific words appellant used in the interview to indicate he was suffering from paranoia, Dr. Altschuler said there were Ano exact words.@ Instead, Dr. Altschuler concluded appellant was suffering paranoia based his Aguardedness@ in answering Dr. Altschuler=s questions and on the medical record notes indicating paranoia. Dr. Altschuler said appellant was guarded because he Ashut-down@ when asked about issues related to his mother=s death. As for the paranoia, Dr. Altschuler said that the medical notes did not indicate why the nurse wrote appellant was suffering from paranoia. Appellant=s counsel also referred to a portion of Dr. Altschuler=s report filed with the trial court in which Dr. Altschuler wrote that as reflected in a nursing assessment dated October 7, 2004, appellant had decompensated Aunder the stress and disappointment of returning to Rusk State Hospital@ after his last recommitment and there was a Adeterioration of self care, homicidal threats, aggression and decompensation.@ However, when appellant=s counsel showed Dr. Altschuler the nurse assessment report from October 7, 2004, Dr. Altschuler agreed that the portion of the nurse assessment report stating Adecompensation, deterioration of self care, homicidal threat, aggression@ was actually a Ahistory entry.@
B. Analysis
Appellant argues that the evidence offered by the State only shows appellant is mentally ill but does not satisfy the clear-and-convincing requirement of a recent overt act or continuing pattern of behavior tending to confirm the likelihood of serious harm to appellant or others. See Tex. Health & Safety Code Ann. ' 574.035(e). Specifically, appellant contends that Dr. Altschuler=s assertions are based on vague behaviors such as appellant=s Aguardedness,@ Alack of insight,@ and Aparanoid ideation,@ which at best prove he is mentally ill. We agree.
First, we note that section 574.035(e) does not define a Arecent overt act or continuing pattern of behavior.@ We also note Texas courts of appeals finding a Arecent overt act or a continuing pattern of behavior@ have tended to focus on identifiable, observable, physical acts. For example, in L.S. v. State, the Austin Court of Appeals found sufficient evidence of a recent overt act or a continuing pattern of behavior where the patient ritualistically burned the skin on his fingers with cigarettes, drank water excessively, causing him to gain ten pounds within an eight-hour period, and left the hospital without authorization for six days. 867 S.W.2d 838, 842 (Tex. App.CAustin 1993, no writ); see D.M. v. State, 181 S.W.3d 903, 904 (Tex. App.CDallas 2006, no pet.) (finding evidence of a recent overt act or a continuing pattern of behavior where the female patient had made a comment to and pushed a male patient, hid contraband in a locker, and attacked the staff when they confiscated the contraband, requiring three people to subdue her); In re S.E.W., 2002 WL 31599910, at *3 (Tex. App.CHouston [14th Dist.] Nov. 21, 2002, no pet.) (mem. op.) (finding evidence of an overt act where the medical records indicated appellant had been found wandering in a church; told the church workers that her father was trying to kill her; and did not know where she was, her age, whom she lived with, or how she came to be in the church).
In support of his argument that the evidence proved only appellant was mentally ill, he cites cases in which testimony reflecting only that a patient was mentally ill was not sufficient to meet the clear-and-convincing standard under the statute. See Broussard, 827 S.W.2d at 621B22 (holding evidence of delusions, incoherency of thoughts, and tendency to ramble about various ideas that had no relationship to the topic being discussed only proved patient was mentally ill); D.J., 59 S.W.3d at 355B57 (finding no overt act or pattern of behavior where doctor testified only that defendant was paranoid schizophrenic, likely to harm himself, suffer severe distress, deteriorating, delusional, not taking medication, not able to make treatment decision, and left halfway house); Johnstone, 961 S.W.2d at 389B90 (finding evidence was legally insufficient to show overt act or continuing pattern of behavior where evidence only showed patient suffered from chronic schizophrenia, auditory hallucinations, paranoid thinking, uncooperative, hostile to staff, and refused to take his medication); In re J.S.C., 812 S.W.2d at 95 (finding evidence legally insufficient to support commitment order where evidence only showed patient suffered from chronic schizophrenia, hallucinations, and was catatonic).
In particular, appellant asserts that Whitaker v. State is instructive. Nos. 01-03-00576-CV & 01-03-00577-CV, 2003 WL 22413511 (Tex. App.CHouston [1st Dist.] Oct. 23, 2003, no pet.). In Whitaker, the defendant was found incompetent to stand trial for the alleged offenses of assault and criminal mischief. Id. at *1. At the commitment hearing, in addition to the psychiatrist=s diagnosis of the defendant=s mental illness, the State offered the psychiatrist=s expert opinion that without treatment the defendant would again be in a serious psychotic state and would be a danger to himself and others. Id. at *3. The defendant believed he owned large amounts of property, was of royal heritage, and suffered paranoid thoughts that people were trying to take advantage of him. Id. The psychiatrist testified he was concerned that because the defendant did not recognize he had a mental illness, he would stop taking his medicine and deteriorate. Id. He also opined that the defendant was a danger to himself and others because due to his delusions, he could easily go on someone=s property, say he owns it, and become involved in an argument. Id. The jury found the defendant was mentally ill and likely to cause harm to himself and others and if not treated would continue to suffer severe and abnormal mental, emotional, or physical distress and continue to experience substantial mental or physical deterioration of his ability to function independently. Id. at *1B2.
On appeal, the defendant argued that the State failed to produce any evidence of a recent overt act. Id. at *2. The First Court of Appeals noted that the psychiatrist=s testimony tracked the language of section 574.035 and merely summarized his report. Id. at *3. Further, the court explained that the behavior the psychiatrist relied on as the factual basis for his opinion Aconstituted nothing more than evidence of [the defendant=s] mental illness and did not amount to evidence tending to confirm that [the defendant] was experiencing substantial mental or physical deterioration.@ Id. As a result, the court held the evidence was legally insufficient because there was no evidence of a recent overt act or continuing pattern of behavior tending to confirm the likelihood of serious harm to the defendant or others or the defendant=s distress and deterioration of his ability to function. Id.
We agree with appellant that this case is similar to Whitaker. First, in both cases, the psychiatrist=s opinion is based on symptoms of the mental illness. In Whitaker, the expert relied on delusions and paranoid thoughts that people were trying to take advantage of him. Id. In this case, Dr. Altschuler also relied on symptoms of appellant=s mental illness. Dr. Altschuler=s opinion that appellant will be a harm to himself or others is based on Alack of insight@ into his illness and paranoia. Further, Dr. Altschuler testified appellant said Ano exact words@ indicating he was paranoid, the January 29, 2005 note did not indicate why the nurse wrote Aparanoid ideation@ in the note, and appellant never said that he thought people were out to get him. Neither Dr. Altschuler=s interview nor the medical records provided an identifiable overt act or continuing pattern of behavior. Instead, Dr. Altschuler relied on appellant=s Aguardedness@ in answering Dr. Altschuler=s questions on the specifics of what occurred when his mother died and a nurse=s note with no indication why she wrote Aparanoid ideation.@[3]
Further, here, as in Whitaker, the State=s psychiatrist, Dr. Altschuler, testified he was Aconcerned@ because if appellant did not adequately recognize his mental disorder, he would most likely stop taking his medications, which would cause serious deterioration, making him a danger to himself or others. In drawing this conclusion, both Dr. Altschuler and the psychologist in Whitaker relied upon several inferences to predict that harm would come to the appellant or others. In Whitaker, because the defendant experienced delusions that he owned land, the psychiatrist inferred his delusions could cause him to trespass on another person=s property, causing a possible argument and violence. Id. The court considered the delusions but did not find that they were sufficient to constitute an overt act sufficient to satisfy section 574.035. Id. In this case, Dr. Altschuler=s theory of appellant=s possible danger to self or others was as follows: if appellant were granted outpatient status, due to his lack of insight into his illness and possible paranoia, he would stop taking his medication; the caseworkers at the outpatient facility would not notice, which would cause a deterioration of his mental state; the caseworkers would also not notice the deterioration, which would then render appellant a danger to himself or others. We agree with appellant that these inferences, similarly considered in Whitaker, are not enough to supplant the lack of evidence of a recent overt act or continuing pattern of behavior that tends to show appellant will cause harm to himself or others.
In response, the State contends that this case is similar to Campbell v. State. Nos. 14-99-00620-CV & 14-99-00621-CV, 2000 WL 675142 (Tex. App.CHouston [14th Dist.] May 25, 2000, pet. denied). We disagree. In Campbell, the defendant attacked his girlfriend attempting to remove both of her eyes with a knife. Id. at *1. He was found not guilty by reason of insanity for aggravated assault and kidnaping. Id. On appeal from a recommitment order, he argued the trial court=s findings were unsupported by evidence of a recent overt act or continuing pattern of behavior. Id. at *6. The State=s expert testified that Campbell presented a risk of serious harm to both himself and to others if not immediately restrained. Id. at *4. The expert explained that Campbell would be a A>a severe risk to the general public at large, particularly females=@ and that he had a A>pattern of hostile dependency upon women=@ which remained to be dealt with and if not resolved would place women close to him at risk for harm. Id. Furthermore, a written report was admitted into evidence that Campbell should have received long-term psychotherapy when he was transferred to Rusk; however, he never received the treatment. Id. Therefore, the expert opined that, because the treating professionals at Rusk Hospital never addressed factors in Campbell=s psyche which led to the assault, including his hostility towards women, his A>affinity for rough sex,=@ or how he should confront negative emotions with people he is close to, the factors were still present. Id. Furthermore, the expert testified that he was in denial about having any anger or hostility, having an affinity for rough sex, and about accepting responsibility for what he did. Id. *4B5. In a narrow holding, this court found a Acontinued pattern of behavior@ where ACampbell continued to exhibit a pattern of denial with regards to his anger and hostility toward women.@ Id. at *6. This court relied on the expert=s testimony that Agiven Campbell=s vicious attack on his girlfriend, [his] continued state of denial, and his complete lack of treatment while at Rusk State Hospital on the issue of hostility,@ to conclude he would continue to be dangerous to others. Id. (emphasis added).
The State contends this case is factually similar to Campbell because appellant=s inability to discuss his underlying crime is a continuing pattern of behavior and his denial of his January 29, 2005 delusional state is a recent overt act. We disagree.
First, the basis for Dr. Altschuler=s testimony as to appellant=s inability to discuss his underlying crime was that appellant was Aguarded@ in his answers, his answers Alacked emotion,@ and he did not answer when asked about what occurred in 1996 when his mother died. We do not believe appellant=s refusal to openly discuss what occurred in 1996 during a one-and-half-hour interview with someone he did not know or see regularly amounts to a continuing pattern of behavior. Further, at the hearing when Dr. Altschuler was asked whether appellant=s Alack of insight@ into his illness was a continuing pattern of behavior, Dr. Altschuler did not agree. Instead, Dr. Altschuler testified, AI don=t think those two words can go together. He continues to have good behavior at Rusk most of the time.@ This was Dr. Altschuler=s only testimony as to a continuing pattern of behavior, and he did not testify specifically that appellant=s inability to discuss the underlying crime was a continuing pattern of behavior.
Second, there are additional facts that distinguish this case from Campbell. In Campbell , the appellant continuously denied his hostile feelings toward women that led him to assault his girlfriend, and there was evidence that he had not received any treatment for those hostile feelings. Id. at *5. The doctor who treated Campbell at Rusk State Hospital testified that he was experiencing denial. Id. In this case, there is no evidence in the record that appellant did not receive the requested treatment for his illness at Rusk State Hospital, as there was in Campbell. In addition, the doctors treating appellant at Rusk State Hospital attached reports to the hospital superintendent=s letter recommending that appellant be released to an outpatient setting. These opinions contrast with the opinions of Campbell=s treating doctor who testified that his unresolved issues with women could be grounds for recommitment.
We disagree with the State=s argument that appellant=s Adenial of his delusional state@ in a January 29, 2005 note in his medical records represents a recent overt act.[4] Dr. Altschuler relies on the entry in the note that states he is not delusional. We cannot identify any entries in the January 29, 2005 medical record note or Dr. Altschuler=s testimony which would support the assertion that appellant=s denial of delusions constitutes an Aovert act.@ Succinctly, an overt act that renders appellant a danger to himself or others must be more than appellant=s statement that he is not delusional.
The State asserts that the cases cited by appellant are distinguishable, with the exception of Whitaker, because they are appeals from court orders committing a person to 90 days for temporary inpatient mental health services, and none involved a patient with an underlying criminal case. However, former article 46.03 of the Code of Criminal Procedure clearly provides recommitment hearings are to be conducted pursuant to the provisions of the Mental Health Code. See Act of May 25, 1983, 68th Leg., R.S., ch. 454, 1983 Tex. Gen. Laws 2640, 2644B46 (repealed 2005) (current version at Tex. Crim. Proc. Code Ann. art. 46C.261 (Vernon Supp. 2006)). These Mental Health Code provisions are also applied for the purpose of committing a mentally ill person in a civil context. See Tex. Health & Safety Code Ann. ' 574.034 (Vernon 2003); In re F.M., 183 S.W.3d at 491B92. Therefore, we see no reason why courts may not look to both types of cases for guidance on the application of Mental Health Code Section 574.035.
In our review of appellant=s medical records, we observed that between January 29, 2005 and May 22, 2005, there were eight notes by the same nurse as the January 29 note, all with the same or nearly the same language as the January 29 note. However, based on our review of the the medical records, Dr. Altschuler=s testimony, and Dr. Altschuler=s report, we find no evidence of an overt act or continuing pattern of behavior. We acknowledge that appellant is mentally ill. However, evidence showing only that an individual is mentally ill and in need of hospitalization does not meet the statutory requirements for confinement. See In re L.H., 183 S.W.3d at 911; In re K.D.C., 78 S.W.3d at 551; D.J., 59 S.W.3d at 355B57; Johnstone, 961 S.W.2d at 389B90; Broussard, 827 S.W.2d at 622; In re J.S.C., 812 S.W.2d at 95.
We are reluctant to intervene in court-ordered treatment for anyone who is mentally ill. See In re J.K.K., 2003 WL 22996950 at *5; Johnstone, 961 S.W.2d at 389B90; Broussard, 827 S.W.2d at 622. We are even more reluctant to intervene relative to court-ordered treatment when the individual committed a violent act due to the mental illness. However, under former article 46.03 of the Code of Criminal Procedure, we must apply civil commitment statutes to recommitment hearings for persons found not guilty by reason of insanity. See Act of May 25, 1983, 68th Leg., R.S., ch. 454, 1983 Tex. Gen. Laws 2640, 2644B46 (repealed 2005) (current version at Tex. Crim. Proc. Code Ann. art. 46C.261 (Vernon Supp. 2006)). Finally, we understand why the trial court said: AThere is nothing really clear to me.@ The evidence presented by the State did not meet the clear-and-convincing standard set forth in the Mental Health Code.[5] See Tex. Health & Safety Code Ann. ' 574.035(e). Because we find no evidence of a recent overt act or a continuing pattern of behavior as contemplated by the statute, the evidence is legally insufficient.[6] We sustain appellant=s first issue.
In light of our holding, we need not consider appellant=s remaining issues. Accordingly, we reverse the trial court=s order renewing the prior order for inpatient extended mental health services, and we render judgment denying the State=s application for renewal of the prior order for extended mental health services.
/s/ Charles W. Seymore
Justice
Judgment rendered and Majority and Dissenting Opinions filed February 20, 2007.
Panel consists of Chief Justice Hedges and Justices Yates and Seymore. (Yates, J., dissenting.)
Publish C Tex. R. App. P. 47.2(b).
[1] Specifically, at the end of the hearing, after first stating that, AI don=t think anything is clear. . . . There=s nothing really clear to me . . . ,@ and opining the State and community have inadequate facilities to care for the mentally ill, the trial court stated,
Right now, at this point in time I don=t feel that the community or you would be safe in releasing you to a personal care home, which is really the only thing that we have for you other than Rusk. . . . I=ll order you recommitted based on the fact that I do find you are mentally ill and that you=re likely to cause harm to yourself or others. I=m not sure which, but I think there=s a possibility there in a personal care home that, that would or could happen.
After the State asked the trial court to make a finding regarding appellant=s Aability to make
rational and informed decisions as to whether he is to continue treatment,@ the trial court stated,
[A]side from the fact that the Court finds that he is mentally ill, as a result of the mental illness, he=s likely to cause harm to himself or others. I=m not going to distinguish between the two because I think based on his history he=s had ideation of both [harm to himself and others] and acting out in one of those.
[2] Although appellant=s medical records were admitted into evidence in their entirety, they were not filed with this Court. We issued an order that the medical records be delivered to this court.
[3] We note that Dr. Amina Abdula, the expert witness for appellant who met with appellant one to two times a week for fifteen minutes from early September 2005 until and including the day of the hearing, testified that it does not make any difference whether a paranoid schizophrenic can recall the details of their violent act because Awhen the act is occurring, most of the time, they are not aware of it . . . because they are in a psychotic state.@ However, she explained that with medication and meeting with a therapist, they can talk about it. Appellant also told Dr. Abdulla Awhat happened, but he doesn=t know why he did it.@
[4] The January 29, 2005 note verbatim:
RN weekly level of observation: routine orientation: name, place, posture: normal eye contact: short communication barriers: mental status behaviors: self-converses speech: clear affect/mood: depressed thought processes: impaired, delusional, paranoid thought content: delusional, paranoid suicidal ideations: denies homicidal ideations: history of homicide insight judgment: poor attention span: brief memory: impaired grooming/ hygiene: clean, self care activities of daily living: self care diet/ appetite: good neurological: alert respiratory: even and unlabored, HX, + PPD skin: warm and dry cardiovascular: hyperlipidemia genitourianry: no known problem gastrointestinal: no known problem musculoskeletal: moves all extremeties well: treatments provided: meds. Additional notes: MHMI self converses, cannot hold a conversation. He has been med compliant. Did not want to talk about meds. Pt. states he is not having any problems and is not paranoid. He states he is not delusional. Pt. is med compliant.
(emphasis added).
[5] We recognize the Texas Legislature recently decided that annual recommitment hearings will no longer be conducted under the Texas Mental Health Code for persons found not guilty by reason of insanity. The applicable new statute pertains to offenses committed on or after September 1, 2005. Moreover, the legal standard will be whether the party requesting renewal Ahas established by clear and convincing evidence that continued mandatory supervision and treatment are appropriate.@ Act of May 27, 2005, 78th Leg. R.S., ch. 831, 2005 Tex. Gen. Laws 2841, 2849 (codified at Tex. Code Crim. Proc. Ann. Art. 46C.261)(emphasis added).
[6] As a result of this holding, appellant may be allowed to enter an outpatient treatment center where he will continue to receive medication and be observed. Under the former article 46.03 Code of Criminal Procedure, applicable in this case, if appellant shows any signs of deterioration, the administrators at the outpatient facility should notify the administering trial court, at which time the trial court may conduct a hearing to decide whether to recommit appellant. See Act of May 25, 1983, 68th Leg., R.S., ch. 454, 1983 Tex. Gen. Laws 2640, 2644B46 (repealed 2005) (current version at Tex. Crim. Proc. Code Ann. art. 46C.261 (Vernon Supp. 2006)).