State ( 2006 )

                                                NO. 12-05-00214-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 G.A.         §                      CHEROKEE COUNTY, TEXAS

MEMORANDUM OPINION

            Appellant G.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 Mental Health and Mental Retardation to administer psychoactive medication to G.A.  In one issue, G.A. asserts that the evidence is legally and factually insufficient to support the order.  We affirm.

Background

            On June 21, 2005, the trial court entered an order requiring G.A. to submit to temporary inpatient mental health services. On the same day, Dr. Laurence Taylor filed an application requesting the court order an authorization for the administration of psychoactive medication to G.A.  The application recites that G.A. suffers from Bipolar I disorder, manic with psychosis.  Dr. Taylor indicated that G.A. verbally refuses to take the medication voluntarily. The doctor believes G.A. lacks the capacity to make a decision regarding administration of psychoactive medication because she suffers from paranoia and hallucinations and exhibits poor insight and judgment.  Dr. Taylor determined that the requested medication is the proper course of treatment for G.A.  However, even with this treatment, her prognosis is poor.  Additionally, without the requested treatment, G.A.’s condition will deteriorate to a more psychotic state.  Medical alternatives would not be as effective as administration of psychoactive medication and the benefits of psychoactive medication outweigh the risks.

            Dr. Taylor testified at the hearing, stating that G.A., who is under court ordered temporary mental health services, refused to take her medications voluntarily and lacks the capacity to make a decision regarding the administration of psychoactive medications.  Dr. Taylor testified that G.A. is suffering from Bipolar I disorder, manic, with psychosis and that the medications indicated in the exhibit attached to the application are in the proper course of treatment for G.A. and in her best interest.  He stated that G.A. would likely benefit from taking these medications and the benefits outweigh the risks.  G.A.’s hospital stay would likely be shortened if medications are used.

            On cross examination, Dr. Taylor said he spoke with G.A. regarding the possible use of medication.  G.A. told him that she does not require medication.  The doctor explained that she was very hyper and could not sit still when admitted.  Although she sat still during the hearing, he said her condition had not improved while at the hospital.  With medication, Dr. Taylor thinks G.A. can leave the hospital within four weeks.  He explained that he or someone at his direction would maintain close supervision of G.A. to monitor side effects.  The doctor stated there are no alternatives to the use of psychoactive medications that could render the same or similar results. While at the hospital, G.A. has been feeding herself and has not expressed fear of the food or air.  Dr. Taylor explained that G.A. will not stand still to talk to him.  She is “running around cleaning, and doesn’t have time to talk” to the doctor.  Dr. Taylor testified that G.A. has not indicated an intent to harm herself, but she has not discussed anything with him. 

            G.A. testified in her own behalf.  When asked about her desires regarding the use of medications, she explained that she never actually refused.  She did not mean she would never want the medication or that she would not look into treatment.  She does not feel that she needs anti-psychotic medication.  She explained that the last time she was given medication it made her fall asleep in class and caused confusion and slurred speech.  She wanted to go without medication, see where the problem is, and then take medication that does not have side effects.  G.A. said she was “willing to work with whatever.”  However, she repeated her belief that she does not need medication.  She said she knows she can be a good citizen, she is not a threat to herself or other people, and she does not like to take medication because of the side effects. She then ignored counsel’s question and asked him about a Dr. Colvin and where she would be treated.  G.A. stated that she hoped the doctors evaluate her without medication.  Counsel asked, “So you do not want the doctors to have access to medication?” G.A. responded that she did not understand the question.  She then offered the following explanation: “I was working at the Salvation Army as a volunteer, and I did quite well.  I can take a bath.  I can eat. I know my times.  I know I have to go to bed, eat, brush my teeth.  I can do the basic things of life without medication, so why would I need medication?”  G.A. said God made food for us to eat and for survival and she does not believe she is currently dying.  She said she is not impaired without medication and does not want to take something that will impair her by its side effects.

            In response to the court’s question, Dr. Taylor said he believes G.A. is still having hallucinations.  She races up and down the halls on the unit.  She was admitted to the hospital ten days before the hearing and has had no medication while there.  Counsel for G.A. asked the doctor what his basis is for concluding she is currently experiencing hallucinations.  He responded that she did not interact with him or staff. She “just buzzes around.”  He explained that she is “running around, pinning up little signs on the doors. They are nice little signs, like maybe she’s getting a word from God, that sort of thing, but she will not stop and have a conversation.”  She “buzzes off’ carrying a plastic bag with trash in it. She runs up and down the hall. She will not speak to the doctor or staff.  Dr. Taylor explained that, when she first came to the hospital she said the food and air were poison.  Now, she enjoys the food and told him she is “detoxing from poisons.”  When he tried to question her about this, he got no answer.

            The trial court granted the application and entered an order to administer psychoactive medication for the period of temporary commitment.

Sufficiency of the Evidence

            In her sole issue, G.A. asserts the evidence is neither legally nor factually sufficient to support the order to administer psychoactive medication.  She contends that the State did not prove by clear and convincing evidence that she lacks the capacity to make a decision regarding administration of psychoactive medication or that the medication is in her best interest.

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 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 and Analysis

            The court may enter an order authorizing the administration of psychoactive medication if it finds by clear and convincing evidence that the patient is under an order to receive inpatient mental health services, the patient lacks the capacity to make a decision regarding the administration of the proposed medication, and treatment with the proposed medication is in the best interest of the patient.  Tex. Health & Safety Code Ann. § 574.106(a), (a-1) (Vernon Supp. 2005).  In determining that there is a need for psychoactive medication, the court is required to consider the following:

                (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;

                (6)           alternatives to treatment with psychoactive medication; and

                (7)           less intrusive treatments likely to secure the patient’s agreement to take the psychoactive medication.

Tex. Health & Safety Code Ann. § 574.106(b) (Vernon Supp. 2005).  The Health and Safety Code defines capacity as a patient’s ability to understand the nature and consequences of a proposed treatment, including the benefits, risks, and alternatives to the proposed treatment, and make a decision whether to undergo the proposed treatment.  Tex. Health & Safety Code Ann. § 574.101(1) (Vernon 2003).

            Dr. Taylor testified that G.A. was, at the time of the hearing, under an order for temporary mental health services.  G.A. suffers from Bipolar I disorder, manic, with psychosis and lacks the capacity to make a decision regarding administration of psychoactive medication.  The medications are in G.A.’s best interest, the benefits outweigh the risks, and her hospital stay would be shortened if medications are used.  Dr. Taylor testified that G.A. will not discuss anything with him.  She continues to hallucinate and does not interact with him or staff.  Dr. Taylor testified that he or his staff would monitor G.A. for ill side effects of medications.  Further, if one medication did not resolve all the symptoms, he would change the medication.  Without medication, there had been no improvement in ten days and the doctor expected her condition to deteriorate.  With medication, the doctor anticipated G.A. could leave the hospital in four weeks. 

            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 G.A. lacked the capacity to make a decision regarding administration of the proposed medication and that the proposed medication is in G.A.’s best interest.  See In re J.F.C., 96 S.W.3d at 266.  This evidence satisfies the statutory requirement for clear and convincing evidence in support of the order for administration of psychoactive medication.  See Tex. Health & Safety Code Ann. § 574.106(a), (a-1).  The evidence is legally sufficient to support the trial court’s order.  See In re J.F.C., 96 S.W.3d at 266.

            In addressing G.A.’s factual sufficiency complaint, we consider all 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.  G.A. testified that she does not need to take anti-psychotic medication.  She said she can do the basic things in life without medication and she is concerned about side effects.  G.A. indicated a willingness to consider medication.  However, she seemed confused when on the stand.  Dr. Taylor testified that he was unable to discuss the topic of medications with G.A.  She is experiencing hallucinations and will not speak to him or staff.  He stated that he or other staff members would monitor G.A. for side effects.  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 the trial court could not reasonably form a firm belief or conviction that G.A. lacks the capacity to make a decision regarding the administration of the proposed medication and that treatment with the proposed medication is in her best interest.  See id.  Thus, the evidence is factually sufficient to support the trial court’s findings.  See Tex. Health  & Safety Code Ann. § 574.106(a).  Because we hold the evidence is both legally and factually sufficient to support the trial court’s order, we overrule G.A.’s sole issue.

Disposition

            We affirm the trial court’s order for administration of psychoactive medication.

                                                                                                    SAM GRIFFITH   

                                                                                                               Justice

Opinion delivered February 27, 2006.

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

(PUBLISH)