The State of Texas for the Best Interest and Protection of G. H. v. the State of Texas ( 2023 )

NO. 12-23-00243-CV
IN THE COURT OF APPEALS
TWELFTH COURT OF APPEALS DISTRICT
TYLER, TEXAS
THE STATE OF TEXAS § APPEAL FROM THE
FOR THE BEST INTEREST AND § COUNTY COURT AT LAW
PROTECTION OF G. H. § CHEROKEE COUNTY, TEXAS
MEMORANDUM OPINION
This is an accelerated appeal of the trial court’s order that G.H. involuntarily be
administered psychoactive medication. In one issue, G.H. argues that the evidence is legally and
factually insufficient to support the trial court’s order. We affirm.
BACKGROUND
G.H. is a patient at Rusk State Hospital (RSH) pursuant to a court order for in-patient
mental health services. On August 31, 2023, an application was filed for court-ordered
administration of psychoactive medications to G.H. On September 5, the trial court conducted
an evidentiary hearing on the matter.
The trial court ultimately granted the application for administration of psychoactive
medications. In so doing, the court found that G.H. presents a danger to himself or others in the
in-patient mental health facility and that treatment with the proposed medications was in his best
interest. This appeal followed.
EVIDENTIARY SUFFICIENCY
In his sole issue, G.H. argues that the evidence is both legally and factually insufficient to
support the trial court’s order to administer psychoactive medications.
Standard of Review
Texas law requires that orders authorizing administration of psychoactive medication be
supported by clear and convincing evidence. See TEX. HEALTH & SAFETY CODE ANN.
§ 574.106(a–1) (West 2017). Clear and convincing evidence is that degree of proof which will
produce in the mind of the trier of fact a firm belief or conviction as to the truth of the allegations
to be established. State v. Addington, 588 S.W.2d 569, 570 (Tex. 1979) (per curiam). This
intermediate standard falls between the preponderance standard of civil proceedings and the
reasonable doubt standard of criminal proceedings. Id.; In re G.M., 596 S.W.2d 846, 847 (Tex.
1980). While the proof must weigh heavier than merely the greater weight of the credible
evidence, there is no requirement that the evidence be unequivocal or undisputed. Addington,
588 S.W.2d at 570. This higher burden of proof elevates the appellate standard of legal
sufficiency review. Diamond Shamrock Ref. Co., L.P. v. Hall, 168 S.W.3d 164, 170 (Tex.
2005); Sw. Bell Tel. Co. v. Garza, 164 S.W.3d 607, 622, 625 (Tex. 2004).
In reviewing a legal sufficiency claim, we 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 finding was 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.When reviewing factual sufficiency, we must give due consideration to evidence that the
fact finder could reasonably have found to be clear and convincing and then determine whether,
based on the entire record, a fact finder could reasonably form a firm conviction or belief that the
allegations in the application were proven. Id. 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. In re C.H., 89 S.W.3d 17, 27–29 (Tex. 2002). The reviewing court
must consider whether the disputed evidence is such that a reasonable fact finder could not have
reconciled that disputed evidence in favor of its finding. 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 in the finding, the evidence is factually insufficient. Id.
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Applicable Law
A trial court may issue an order authorizing the administration of one or more classes of
psychoactive medications to a patient who is under a court order to receive inpatient mental
health services. TEX. HEALTH & SAFETY CODE ANN. § 574.106(a)(1). The court may issue an
order under this section only if, after a hearing, it finds by clear and convincing evidence that
(1) the patient presents a danger to the patient or others in the mental health facility in which the
patient is being treated as a result of a mental disorder or mental defect and (2) treatment with the
proposed medication is in the best interest of the patient. Id. § 574.106(a–1)(2)(A).
“Capacity” refers to a patient’s ability to (1) understand the nature and consequences 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. Id. § 574.101(1) (West 2017).
A patient does not have the capacity to make a decision regarding the administration of
medications if the patient does not understand the nature of his mental illness or the necessity of
the medications. See A.S. v. State, 286 S.W.3d 69, 73 (Tex. App.–Dallas 2009, no pet.). In
making its finding that treatment with the proposed medication is in the best interest of the
patient, 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
treated with psychoactive medication, (6) alternative, less intrusive treatments that are likely to
produce the same results as 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).
Discussion
On appeal, G.H. argues that the State’s evidence is conclusory and lacks sufficient detail
regarding whether the administration of medications is in his best interest. In support of his
contention, he relies on State ex rel. E.G., 249 S.W.3d 728 (Tex. App.–Tyler 2008, no pet.).
However, in E.G., the only evidence offered with regard to the “best interest” element was the
conclusory statement by the treating physician in the state’s application. See id. at 731. We held
that the trial court erred in entering its order to administer psychoactive medication, in part,
because the treating physician offered no testimony as to whether the administration of the
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proposed medications was in the appellant’s best interest. See id. at 731–32. We explained that
a conclusory statement in the application, absent testimony from the physician at the hearing,
cannot produce in the mind of the trier of fact a firm belief or conviction as to the truth of the
allegations sought to be established. Id. We also noted that the Texas Health and Safety Code
does not authorize the trial court to base its findings solely on the treating physician’s
application, because pleadings, such as the physician’s application, are not evidence that the
statutory standard has been met. Id.; see TEX. HEALTH & SAFETY CODE ANN. §§ 574.031(e)
(West Supp. 2022) (stating that the Texas Rules of Evidence apply to the hearing for court
ordered mental health services unless the rules are inconsistent with this subtitle), 574.101–.110
(West 2017 & Supp. 2022); In re E.T., 137 S.W.3d 698, 700 (Tex. App.–San Antonio 2004, no
pet.); see also Laidlaw Waste Sys. (Dallas), Inc. v. City of Wilmer, 904 S.W.2d 656, 660 (Tex.
1995) (noting that, generally, pleadings are not competent evidence, even if sworn and verified).
Thus, in that case, because the record contained nothing more than the physician’s conclusory
statement in the application, the evidence that the administration of the medications would be in
the appellant’s best interest was insufficient. E.G., 249 S.W.3d at 731–32.
Here, G.H. argues that the evidence adduced at the hearing is tantamount to the evidence
we concluded to be insufficient in E.G. because the only evidence regarding G.H.’s best interest
came from a conclusory statement from his treating physician. But a review of the record from
the hearing reveals that Robert Lee, M.D. testified at the hearing that G.H. suffered from mental
illness, namely Bipolar Disorder Type 1, Mixed, and that he refused expressly to take
medications voluntarily to treat this condition. More specifically, Lee stated that G.H. refused to
take certain mood stabilizers and antipsychotic medications. Lee further testified that while G.H.
has been at RSH, he has been quite irritable and there have been numerous incidents in which he
exhibited verbal aggression. According to Lee, G.H.’s irritability was directly related to his
mental illness diagnosis and, without treatment, his mental condition will continue to deteriorate.
Lee further related that on August 22, 2023, G.H. was acting suspiciously in a peer’s room and
threatened security staff.
According to Lee, G.H. lacked the capacity to make rational decisions about medications
and is unable to engage in a rational discussion of his need for medications. Lee referred to
Appendix A to the State’s application, which sets forth the classification of the medications that
potentially would be administered. Lee stated that the medications would be used in the proper
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course of G.H.’s treatment, were in his best interest, and that there were no alternative treatment
protocols which would be less intrusive for G.H. Lee testified that the benefits of these
medications would outweigh the risks, and if the medications were not used, G.H.’s mental
condition would continue to deteriorate and he likely would be a danger to himself and others.
He opined that G.H. likely would regain competency faster if medications are used versus if
G.H. does not take any additional medications. Lee explained that the risks of G.H.’s not taking
these medications were that his mental condition would continue to deteriorate and he likely
would continue to exhibit aggressive behaviors, which would pose a risk of harm to others and
himself. Lee stated that he and Dr. Satyajeet Lahiri, who completed the application, had
sufficient time with G.H. to form opinions related to G.H.’s willingness to take these medications
and that he agreed with Dr. Lahiri’s statements in the application. During cross-examination,
Lee testified that G.H. had not objected to taking medications based on their side-effects or based
on other “constitutional” objections. He specified that G.H. did not make a religious objection to
him about taking the medications.
G.H. also testified at the hearing. On direct examination, when asked about his concerns
about the medications, he stated that he did not believe the doctors spent enough time evaluating
him to determine the appropriate medications and that he was concerned about side-effects from
the medications. G.H. explained that while he believed his body to be a temple, he did not have
a religious objection to taking medications generally; rather, he was concerned about getting the
“right mix” of medication that does not offend his religious beliefs. G.H. stated that he believed
he was doing well with his current regimen of medications and, thus, did not require additional
medications. G.H. further opined that he was not aggressive and denied that he was incompetent,
stating that he “could pass that test today.”
In sum, Lee offered specific testimony regarding the consequences to G.H. if the
psychoactive medications are not administered, the prognosis for G.H. if he is treated with the
psychoactive medications, and the absence of alternative, less intrusive treatments that are likely
to produce the same results as treatment with psychoactive medications. See TEX. HEALTH &
SAFETY CODE ANN. § 574.106(b). Based on the foregoing, and our review of the evidence
adduced at the hearing, we conclude that the trial court could have formed a firm belief or
conviction as to the truth of the findings that (1) G.H. presents a danger to himself or others in
the in-patient mental health facility and (2) treatment with the proposed medication is in G.H.’s
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best interest. See id. § 574.106(a-1)(2)(A). Thus, we hold that there is clear and convincing,
legally sufficient evidence to support the trial court’s order to administer psychoactive
medications.
Turning to the issue of factual sufficiency, we note that the only disputed evidence
offered at the hearing was G.H.’s testimony. As noted above, G.H. expressed his concern about
the amount of time the doctors spent evaluating him and as to side-effects from the medications.
He also denied that he was incompetent and that he had engaged in aggressive behavior.
Moreover, he stated no religious objection to taking medication generally, and the record reflects
that he currently was taking other medications. Having considered whether this disputed
evidence is such that the trial court could not have reconciled it in favor of its finding, we
conclude that such disputed evidence is not so significant that the trial court could not reasonably
have formed a firm belief in the evidence in support of the findings on which its order is based.
See In re J.F.C., 96 S.W.3d at 266. Accordingly, we hold that the evidence is factually
sufficient to support the trial court’s order to administer psychoactive medications. G.H.’s sole
issue is overruled.
DISPOSITION
Having overruled G.H.’s sole issue, we affirm the trial court’s order to administer
psychoactive medications.
JAMES T. WORTHEN
Chief Justice
Opinion delivered December 14, 2023.
Panel consisted of Worthen, C.J., Hoyle, J., and Neeley, J.
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COURT OF APPEALS
TWELFTH COURT OF APPEALS DISTRICT OF TEXAS
JUDGMENT
DECEMBER 14, 2023
NO. 12-23-00243-CV
THE STATE OF TEXAS FOR THE BEST INTEREST AND PROTECTION OF G. H.
Appeal from the County Court at Law
of Cherokee County, Texas (Tr.Ct.No. 43564)
THIS CAUSE came to be heard on the appellate record and briefs filed
herein, and the same being considered, it is the opinion of this court that there was no error in the
judgment.
It is therefore ORDERED, ADJUDGED and DECREED that the judgment
of the court below be in all things affirmed, and that this decision be certified to the court
below for observance.
James T. Worthen, Chief Justice.
Panel consisted of Worthen, C.J., Hoyle, J., and Neeley, J.
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