The State of Texas for the Best Interest and Protection of T. M.--Appeal from County Court at Law of Cherokee County

  NO. 12-05-00389-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 T.M. CHEROKEE COUNTY, TEXAS

MEMORANDUM OPINION

Appellant T.M. appeals from an order authorizing the Texas Department of Mental Health and Mental Retardation to administer psychoactive medication. In one issue, T.M. asserts the evidence is legally and factually insufficient to support the trial court s order. We affirm.

Background

On November 15, 2005, Dr. Larry Hawkins signed an application for an order to administer psychoactive medication to T.M. In the application, Dr. Hawkins stated that T.M. was subject to an order for inpatient mental health services under Section 547.034 of the Texas Health and Safety Code. Dr. Hawkins stated that T.M. had been diagnosed with schizophrenia paranoid and requested the trial court to compel T.M. to take three psychoactive medications: an antipsychotic, an anxoilytics/sedative/hypnotic, and a mood stabilizer. T.M. refused to take the medications voluntarily. In the doctor s opinion, T.M. lacks the capacity to make a decision regarding administration of psychoactive medications because T.M. denies he is mentally ill and cannot weigh the risks versus the benefits of medication. Dr. Hawkins concluded that these medications are the proper course of treatment for T.M. and that, if he were treated with the medications, his prognosis would be good. However, Dr. Hawkins believed that if T.M. were not administered the psychoactive medications, he may harm others. Dr. Hawkins considered other medical alternatives to psychoactive medication, but determined that those alternatives would not be as effective. Further, he believed the benefits of the psychoactive medication outweighed the risks in relation to present medical treatment and T.M. s best interest.

On November 22, 2005, the trial court held a hearing on the application. Dr. Plyler1 testified that he is T.M. s treating physician. Dr. Plyler stated that Dr. Hawkins completed the application for the order to administer psychoactive medication. Dr. Plyler said that he disagrees with Dr. Hawkins s diagnosis of paranoid schizophrenia, believing instead, that T.M. suffers from delusional disorder. However, Dr. Plyler stated that he agrees with Dr. Hawkins s assessment in requesting the specified classes of drugs for T.M., stating that the proposed medications are the proper course of treatment for both diagnoses. Dr. Plyler said that the medications are in the best interest of T.M. and that T.M. will likely benefit from their administration. Further, Dr. Plyler said that the benefits will outweigh the risks and T.M. s stay in the state hospital will be shortened if the medications are used. Dr. Plyler testified that T.M. stated he could not take the medication because it would be contrary to his religious beliefs. However, T.M. interrupted during Dr. Plyler s testimony, stating, It is an assumption they have made.

T.M. testified on his own behalf. He said he is not mentally ill and that he has never taken any kind of psychiatric medication nor does he feel a need to do so now. He said he would require a doctor to convince him that he is suffering some delusion before agreeing to take the medication voluntarily. Further, T.M. said he wanted to call several witnesses from the Rusk County Sheriff s Department and Dr.Colvin from another medical clinic. T.M. said,

The sheriff was kind enough to ask me to cast a lot in front of him asking: Am I Elijah the prophet? And I did it in front of him. Definitely, yes. Dr. Colvin, at the other medical clinic, I cast the lot in front of him: Am I Elijah the prophet? And the answer was definitely yes.

T.M. continued,

I m not delusional. This is not a delusion. If you review this material I ll be more than welcome to provide it and it has information that God has disclosed to me because of who I am. We have entered the tribulation period. God sent me on October 8th, 2004, a week after the Lord issued a judgment against the United States. If you want to know the truth, I can give you the truth. This is real. This is reality. You can choose to accept or deny the truth. I m not mentally ill. The scriptures tell me, and us, the truth. . . . I m asking for an appeal with the testimony and the doctor who witnessed the casting of lots and the information that I have that I m willing to provide if anyone wants to know the truth. . . . I am not mentally ill.

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 T.M. and that T.M. lacks the capacity to make a decision regarding administration of the medication. The trial court authorized the Department to administer psychoactive medications to T.M.. This appeal followed.

Sufficiency of the Evidence

In his sole issue, T.M. asserts the evidence is neither legally nor factually sufficient to support the trial court s order authorizing the administration of psychoactive medication. He contends that the State did not prove by clear and convincing evidence that he lacks the capacity to make a decision regarding administration of psychoactive medication or that the medication is in his best interest.

Standard of Review

In a legal sufficiency review where the burden is clear and convincing, 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 challenge, we must consider all of 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). 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.).

Order to Administer Psychoactive Medication

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 for temporary or extended 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) (Vernon 2003). Capacity means a patient s ability to 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. Id. 574.101(1). In making its findings, the trial court shall consider the patient s expressed preferences regarding treatment with psychoactive medication, the patient s religious beliefs, the risks and benefits from the perspective of the patient, the consequences to the patient if the psychoactive medication is not administered, the prognosis for the patient if not treated with psychoactive medication, and alternatives to treatment with psychoactive medication. Id. 574.106(b).

T.M. does not dispute that the evidence is legally and factually sufficient to show that he is under an order for temporary mental health services. Thus, we will only consider whether the evidence is legally and factually sufficient to support a finding that he lacked the capacity to make a decision regarding the administration of psychoactive medications and whether the proposed medication was in his best interest. In the application, Dr. Hawkins stated that T.M. suffers from schizophrenia paranoid. He believed T.M. lacked the capacity to make a decision regarding administration of psychoactive medications because T.M. denies [that] he is mentally ill and cannot weigh the risks versus the benefits of medication. Further, Dr. Hawkins testified that, if T.M. were not administered these medications, he may harm others. Dr. Hawkins concluded that the medications are in T.M. s best interest and the benefits outweigh the risks.

At the hearing, Dr. Plyler testified that T.M. lacks the capacity to make a decision regarding the administration of psychoactive medications. T.M. suffers from delusional disorder and does not believe he is mentally ill. Dr. Plyler concluded that the medications proposed are in the best interest of T.M., the benefits outweigh the risks involved, and the use of medication would most likely shorten T.M. s stay at the state hospital. 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 T.M. lacks the capacity to make a decision regarding administration of the proposed medications and that the proposed medications are in T.M. s best interest. See id. 574.106(a); In re J.F.C., 96 S.W.3d at 266. Thus, the evidence is legally sufficient to support the trial court s order.

Having determined that the evidence is legally sufficient, 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 Dr. Hawkins and Dr. Plyler, T.M. asserted that he is not mentally ill. Dr. Plyler said that T.M. does not want to take the medications for religious reasons. T.M. testified that he does not believe he is mentally ill and would not voluntarily take the medications unless a doctor convinced him that he was delusional. When asked whether he believes he needs the medication, T.M. responded that the Lord did not give me a spirit of fear and of a sound mind. He continued with a narrative about casting lots and being Elijah the prophet.

The trial court was entitled to disbelieve T.M. and disregard the evidence contrary to the State s position. See id. Further, the trial court is not required to defer to T.M. s preferences and beliefs, but must consider them. See Tex. Health & Safety Code Ann. 574.106(b). T.M. presented evidence to the trial court that he does not believe he needs psychoactive medication. Dr. Plyler testified about T.M. s religious preferences. Thus, it is presumed that the trial court gave his preferences and beliefs due consideration. Based upon our review of the record as a whole, we conclude that 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 T.M. lacks the capacity to make a decision regarding administration of the proposed psychoactive medications and that the proposed medications are in T.M. s best interest. See id. 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. Id. Accordingly, we conclude that the trial court met the obligations imposed by Section 574.106 of the Texas Health & Safety Code and overrule T.M. s sole issue.

Disposition

Having overruled T.M. s sole issue, we affirm the judgment of the trial court.

SAM GRIFFITH

Justice

Opinion delivered May 24, 2006.

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

(PUBLISH)

1 The record does not reflect Dr. Plyler s full name.