TEXAS COURT OF APPEALS, THIRD DISTRICT, AT AUSTIN
NO. 03-12-00496-CV
In the Interest of A. H.
FROM THE COUNTY COURT AT LAW NO. 3 OF BELL COUNTY
NO. 8261, HONORABLE REBECCA DEPEW, JUDGE PRESIDING
MEMORANDUM OPINION
In June 2012, Bell County filed an application for court-ordered temporary mental
health services, seeking to have appellant A.H., who was in custody in the county jail, committed
for observation and treatment in a mental hospital. Following a hearing, the trial court signed a writ
of commitment, ordering A.H. committed to the Austin State Hospital. As grounds, the court found
that A.H. was mentally ill; that, as a result, she was likely to cause serious harm to herself; and that,
if not treated, she would continue to suffer severe and abnormal mental, emotional or physical
distress, her ability to function independently would continue to deteriorate, and she was currently
unable to make rational, informed decisions about whether to submit to treatment. See Tex. Health
& Safety Code § 574.034(a). A.H. appeals, contending that the evidence is insufficient to support
the grounds for her commitment. Specifically, she argues that the State did not provide clear and
convincing evidence that she was a danger to herself or that her condition was deteriorating such that
she could not provide for her basic needs. We affirm the trial court’s writ of commitment.
Discussion1
A trial court may order temporary inpatient mental health services if it finds by clear
and convincing evidence that the proposed patient is mentally ill and as a result (1) is likely to cause
serious harm to herself; (2) is likely to cause serious harm to others; or (3) 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 about whether to submit to treatment. Id. The evidence must include expert testimony
and must show a “recent overt act or a continuing pattern of behavior that tends to confirm” the
likelihood of serious harm to the proposed patient or to others or her distress and the deterioration
of her ability to function. Id. § 574.034(d). We review a trial court’s commitment order under the
standards explained in State v. K.E.W., 315 S.W.3d 16, 20-24 (Tex. 2010).
A.H. argues that the record is “devoid” of testimony showing that she is a danger
to herself and that the evidence was insufficient to show that she was experiencing severe and
abnormal distress or a deterioration in her ability to function or that she was unable to make
rational and informed treatment decisions. She asserts that the medical testimony provided by
Dr. Philip Scott was conclusory and cannot support the trial court’s order. We disagree.
A.H. had been committed to the state hospital for about five weeks in early 2012 and
after her return to the jail in early March 2012, had been volatile, defiant, angry, aggressive,
threatening, and uncooperative with jail employees; flooded her cell and laid down in the water;
1
The facts are well-known to the parties, and we will not recite them in detail in this
opinion. See Tex. R. App. P. 47.1 (appellate court opinions should be as “brief as practicable”),
47.4 (memorandum opinions should be “no longer than necessary to advise the parties of the court’s
decision and the basic reasons for it”).
2
destroyed her mattress; refused to take her psychiatric medications; and had been uncommunicative
and “totally uncooperative” with her attorney. Dr. Charles Pierce concluded that A.H. exhibited
rapid mood swings and “severely dysregulated” emotions; had “grossly impaired” judgment and
delusional thoughts; suffered from bipolar and impulse control disorders; was not legally competent
to stand trial; showed no reasonable likelihood of being restored to competency in the near
future; and “must be considered a chronic threat due to past gestures and her severe illness.” Pierce
concluded that A.H. was likely to reject monitoring and case management and needed inpatient
mental health care. Another doctor stated in a certificate of medical examination that A.H. showed
signs of schizoaffective disorder with active manic and psychotic symptoms, threatened to kill
people who “put[] handcuffs on” her, and grew agitated and abusive during an interview.
Dr. Philip Scott also interviewed A.H. and reviewed her records, concluding that she
suffers from “schizoaffective disorder bipolar type.” A.H. was disoriented to date and place and had
disorganized speech and thought and rapid mood swings. Her thought process, perception of reality,
and judgment were all impaired, and Scott believed it was possible that A.H. was likely to cause
serious harm to herself, explaining that he “could see where she could be—place herself in danger
of being harmed herself, such as, an example, walking out in traffic.” He further believed she was
likely to cause serious harm to others because she had threatened other people and assaulted a police
officer. Scott said A.H. was suffering severe and abnormal distress, shown by her disorientation
during the interview. Scott testified, “It’s my presumption that she is experiencing a deterioration
[in her ability to function independently]. We know that without appropriate treatment, especially
when there is ongoing psychosis, that permanent brain damage can occur without appropriate
treatment.” He also said it appeared that, based on her records, disorganization of thought and
3
speech, and rapid mood swings, A.H. was homeless, incapable of caring for herself, and unable to
make rational informed decisions about medical treatment.
Angela H., A.H.’s older sister, testified that she had adopted A.H.’s daughter because
it was not safe for A.H. to care for the child or even to visit with her. Angela last saw A.H. about
seven months before the hearing, when their brother called to say he had seen A.H. “walk down the
streets.” Angela said she went to get A.H. “like we normally do, [to] shower, feed her, dress her,
clothe her, you know.” During that visit, A.H. yelled at and threatened to hit the child, so Angela
“put her out.” Asked whether she thought A.H. might harm the child, Angela answered, “Yeah. I
know she would.” Angela said that A.H. had suffered from mental illness for more than fifteen
years, since she was thirteen, and had been to at least seven hospitals. Medications did not seem to
work because A.H. would stop taking them when released from psychiatric care. She said, “I think
if she was permanently placed in a hospital facility to where she was being taken care of and not
being released because she’s knocked the interview, I think it would help her tremendously.” She
said that A.H. needed permanent care “where she can be treated every day, directed every day and
encouraged every day in a facility” and that she needed to be there “[f]orever, for life, till she dies,
permanent.” Angela did not believe A.H. would ever be able to take care of herself.
Employees of the jail testified that during the year and one-half that she had been
incarcerated, A.H. was moody; talked to people who were not there; would sometimes shower for
two or three hours, until the water was turned off; and had threatened physical aggression, although
she had not actually been physically aggressive. A.H. was being jailed in a separation cell because
her mood swings and behavior were such that “we’re just afraid she might actually harm somebody
or maybe somebody might harm her.” The jail mental health supervisor testified that he had worked
4
with A.H. for the last ten years and that she was sent from the jail to the state hospital five times
in the last year because her “behavior had escalated to where she was either not safe to herself or
to others.” She would show improvement upon her return, but then would deteriorate because she
would not take her medications regularly.
About two months before the hearing, a doctor at the state hospital found that A.H.
was legally incompetent and showed no possibility of regained competence in the foreseeable future
and that she therefore did not require further inpatient treatment to address her legal competence.
Finally, there was evidence that in the year leading up to the hearing, A.H. was arrested four or five
times for criminal trespass, once for shoplifting, and once for resisting arrest. A.H. had a pattern of
refusing to leave a location when asked to do so by managers, police, or owners, and then becoming
threatening or belligerent to customers, police, or employees. At one point during the hearing, A.H.
interrupted the testimony and was removed from the courtroom.
The evidence is sufficient to support the trial court’s commitment order under
section 574.034(a)(2)(C). There was evidence that A.H. was disorganized in thought, suffered multiple
and rapid mood swings, and did not know where she was or what the date was, leading Dr. Scott to
conclude that she was suffering from severe and abnormal mental or emotional distress. Scott
believed A.H.’s condition was deteriorating, noting that untreated mental illnesses worsened in
severity over time. See State ex rel. S.W., 356 S.W.3d 576, 583 (Tex. App.—Texarkana 2011, no
pet.) (patient’s “schizoaffective disorder of the bipolar-type,” if not treated, would worsen over time,
but patient was receiving treatment and had husband who would make sure patient continued with
medication and treatment regimen). A.H., who has been in and out of jail for more than ten years,
5
had been arrested at least six times in the year before the hearing, usually because she would refuse
to leave a business when asked and would become abusive and belligerent. She had also been
hospitalized five times in the past year and was chronically homeless. Her family, when they saw
her “walk[ing] down the streets,” would pick her up to feed, bathe, and clothe her, but after A.H.
threatened to assault her young daughter the last time, her sister had been forced to throw A.H. out
of the house. A.H.’s sister believed A.H. needed to be committed permanently and would never be
able to take care of herself, and A.H. consistently and repeatedly failed to take her medications of
her own volition, a sign that she is unable to make rational, informed medical decisions. See id.
Finally, Scott feared that, left to her own devices, A.H. could come to harm due to her disorganized
thinking, and jail employees kept her separated from other inmates because they feared her behavior
could cause someone else to harm her.
Conclusion
On this record, the evidence is both legally and factually sufficient to support the
court’s finding that A.H. should be committed under section 574.034(a)(2)(C). We need not consider
whether commitment was also justified under section 574.034(a)(2)(A).
__________________________________________
David Puryear, Justice
Before Justices Puryear, Pemberton, and Field
Affirmed
Filed: March 14, 2014
6