State ( 2006 )

                NO. 12-05-00274-CV

IN THE COURT OF APPEALS

TWELFTH COURT OF APPEALS DISTRICT

TYLER, TEXAS

§          APPEAL FROM THE

THE STATE OF TEXAS FOR THE

BEST INTEREST AND PROTECTION    §          COUNTY COURT AT LAW OF

OF D.O.,

§          CHEROKEE COUNTY, TEXAS

MEMORANDUM OPINION

            Appellant D.O. appeals from an order authorizing the Texas Department of Mental Health and Mental Retardation (the “Department”) to administer psychoactive medications.  In one issue, D.O. asserts the evidence is legally and factually insufficient to support the trial court’s order. We affirm.

Background

            On August 17, 2005, Dr. Laurence Taylor signed an application for an order to administer psychoactive medication to D.O. In the application, Taylor stated that D.O. was subject to an order  for temporary inpatient mental health services under Section 547.034 of the Texas Health and Safety Code. Taylor stated that D.O. had been diagnosed with paranoid schizophrenia and requested the trial court to compel D.O. to take four psychoactive medications: an antidepressant, an anxoilytic/sedative/hypnotic, an antipsychotic, and a mood stabilizer.  Taylor stated that D.O. refused to take the medications voluntarily and that, in his opinion, D.O. lacked the capacity to make a decision regarding administration of psychoactive medications because she exhibited “grandiosity excessive religiosity,” had very poor insight and judgment, and also suffered from paranoid schizophrenia.  Taylor concluded that these medications are the proper course of treatment for D.O. and that, if she were treated with the medications, her prognosis would be good. However, Taylor believed that, if D.O. were not administered the medications, her mental health would deteriorate to a more severe psychotic state.  Taylor considered other medical alternatives to psychoactive medication, but determined that those alternatives would not be as effective.  Moreover, Taylor believed the benefits of the psychoactive medications outweighed the risks in relation to present medical treatment and D.O.’s best interest.

            On August 23, the trial court held a hearing on the application.  At the beginning of the hearing, D.O. chose to represent herself and waived her right to an attorney.  The trial court discharged D.O.’s appointed counsel except for consulting purposes during the hearing. D.O. continually interrupted both her former attorney and the trial court.

            Taylor testified that he is D.O.’s treating physician and that she is currently under an order for temporary mental health services. Taylor stated that he completed the application for an order to administer psychoactive medication because D.O. suffers from paranoid schizophrenia, but refuses  medication.  Taylor testified that the medications listed in the exhibit attached to the application are in D.O.’s best interest and that treatment with these medications is in the proper course of treatment for D.O.  Taylor believes that D.O. lacks the capacity to make a rational decision regarding the administration of psychoactive medication and that use of these medications will likely benefit D.O. Taylor further stated that the benefits of these medications outweigh the risks and that D.O.’s stay in the hospital will likely be shortened if Taylor has access to medication.  He testified that D.O. stated she could not take medication because of constitutional or religious reasons.  However, social services had not been able to verify that D.O. is a Christian Scientist.  On cross examination, Taylor stated that these medications are beneficial and successful. Taylor also testified that he has been at Rusk State Hospital for a period of time, that he had treated D.O. previously, and that she had responded well to medication. 

            Before her narrative testimony, D.O. stated that she is a Christian Scientist and that it is against her beliefs to be in the hospital.  She also informed the trial court that she would like to call Jesus Christ as a witness. D.O. stated that antipsychotic drugs are killing her and that she has stomach cancer, skin cancer, and renal failure. According to D.O., these drugs cause brain damage, cause one to hear voices and see things, and are not a cure for mental illness.  She declared that she has never been mentally ill, does not want medication that causes her to vomit and die, and is a victim of satanic abuse.  D.O. testified that her mother took her to psychiatrists, who like to put demons “into you.”  D.O. stated that although she previously had demons in her, God healed her and she does not hear voices or see things.  D.O. stated that these medications made her feel bad and that she could not get a job. According to D.O., she is hopeless because she does not have a job.  D.O. stated that her parents had forced her to take antipsychotic medications since 1995. She had been in seminary and almost has a master’s degree in divinity.  However, D.O. stated that her mother “locked [her] up before finals” because her mother does not believe in God. Then D.O. stated, “[T]hat’s what God tells me.”  She declared that she is a preacher and a Christian Scientist.  After testifying, D.O. stated that she had “lots” of witnesses, including a dead man.

            At the close of the evidence, the trial court granted the application.  After considering all the evidence, including the application and the expert testimony, the trial court found that the allegations in the application are true and correct and supported by clear and convincing evidence.  Further, the trial court found that treatment with the proposed medication is in the best interest of D.O. and that D.O. lacks the capacity to make a decision regarding administration of the medication.  The trial court authorized the Department to administer to D.O. psychoactive medications, including antidepressants, antipsychotics, mood stabilizers, and anxiolytics/sedatives/hypnotics.  This appeal followed.

Sufficiency of the Evidence

            In her sole issue, D.O. argues that the evidence is legally and factually insufficient to support the trial court’s order to administer psychoactive medications.  More specifically, D.O. contends that the evidence presented at trial does not rise to the level of clear and convincing proof that she lacks the capacity to  make a decision regarding the administration of psychoactive medications.  The State disagrees.

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. 

Order to Administer Psychoactive Medication

            A trial court may issue an order authorizing the administration of one or more classes of psychoactive medications only if the trial court finds by clear and convincing evidence after the hearing that (1) the patient is under an order for temporary or extended mental health services, (2) the patient lacks the capacity to make a decision regarding the administration of the proposed medication, and (3) treatment with the proposed medication is in the best interest of the patient.  Tex. Health & Safety Code Ann. § 574.106(a) (Vernon 2003).  “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 to treatment with psychoactive medication.  Tex. Health & Safety Code Ann. § 574.106(b) (Vernon 2003).

Analysis

            D.O. does not dispute that the evidence is legally and factually sufficient to show that she is under an order for temporary mental health services or that treatment with the proposed medication is in her best interest.  Thus, we will only consider whether the evidence is legally and factually sufficient to support a finding that she lacked the capacity to make a decision regarding the administration of psychoactive medications.  In the application, Taylor stated that he believed D.O. lacked the capacity to make a decision regarding administration of psychoactive medications because she had “grandiosity excessive religiosity,” very poor insight and judgment, and paranoid schizophrenia.  Further, Taylor determined that, if D.O. were not administered these medications, her mental health would deteriorate to a more severe psychotic state.  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 D.O. lacked the capacity to make a decision regarding administration of the proposed medications.  See  Tex. Health & Safety Code Ann. § 574.106(a); 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 25.  According to Taylor, D.O. asserted that she could not take medication because of constitutional or religious reasons.  However, Taylor testified that social services had been unable to verify that D.O. is a Christian Scientist.  D.O. informed the trial court that she is a Christian Scientist and that it was against her beliefs to be in the hospital.  During the hearing, she attempted to call witnesses, including Jesus Christ and a man who had died.  D.O. stated that antipsychotic drugs were killing her and that she has cancer and renal failure.  She asserted that these drugs cause brain damage, cause one to hear voices and see things, make her feel bad, and are not a cure for mental illness.  D.O. declared that she is not mentally ill, that she had been forced by her parents to take antipsychotic medications, and that psychiatrists like to put demons “into you.”  She stated that God healed the demons in her and that she no longer hears voices or sees things.  She also claimed that her mother had her committed before finals for her master’s degree in divinity because her mother does not believe in God.  D.O. also suggested that this is what God told her.

            The trial court was entitled to disbelieve D.O. and disregard the evidence contrary to the State’s position.  See id.  Further, the trial court is not required to defer to D.O.’s preferences and beliefs, but must consider them.  See Tex. Health & Safety Code Ann. § 574.106(b).  Because D.O. presented evidence to the trial court that, based upon her personal and religious beliefs, she preferred to avoid hospitalization and to avoid antipsychotic medication, it is presumed that the trial court gave her 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 D.O. lacked the capacity to make a decision regarding administration of the proposed medications. See Tex. Health & Safety Code Ann. § 574.106(a), (b); In re C.H., 89 S.W.3d at 25.  Therefore, the evidence is factually sufficient to support the trial court’s order.  See In re C.H., 89 S.W.3d at 25. Accordingly, we conclude that the trial court met the obligations imposed by Section 574.106 of the Texas Health & Safety Code and overrule D.O.’s sole issue.

Disposition

            The judgment of the trial court is affirmed.

                                                                                                     JAMES T. WORTHEN   

                                                                                                                 Chief Justice

Opinion delivered February 28, 2006.

Panel consisted of Worthen, C.J., Griffith, J., and DeVasto, J.

(PUBLISH)