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

NO. 12-06-00054-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 M.T. CHEROKEE COUNTY, TEXAS

MEMORANDUM OPINION

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

Background

On February 10, 2006, Dr. Larry Hawkins signed an application for a court order to administer psychoactive medication to M.T. In the application, Dr. Hawkins stated that M.T. 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 M.T. had been diagnosed with schizophrenia and requested the trial court to compel M.T. to take four psychoactive medications: an antidepressant, an antipsychotic, an anxoilytic/sedative/hypnotic, and a mood stabilizer. M.T. had refused to take the medications voluntarily. In the doctor s opinion, M.T. lacked the capacity to make a decision regarding administration of psychoactive medications because M.T. denied she was mentally ill, had engaged in bizarre behavior, and could not weigh the risks versus the benefits of medication. Dr. Hawkins concluded that these medications were the proper course of treatment for M.T. and that her prognosis would be good if she were treated with the medications. The doctor noted that M.T. had responded favorably in the past to medication. Dr. Hawkins believed that M.T. would harm herself if she were not treated with the proposed medication. Dr. Hawkins stated he had considered other medical alternatives to psychoactive medications, but had determined that those alternatives would not be as effective. Further, he believed the benefits of the psychoactive medication outweighed the risks in relation to the current medical treatment being provided and were in M.T. s best interest.

On February 21, 2006, the trial court held a hearing on the application. Dr. Hawkins testified that he is M.T. s treating physician and that he had completed the application for the order to administer psychoactive medication. Dr. Hawkins testified that M.T. was under a temporary order for mental health services and that she had displayed very serious delusions and failed to bathe or otherwise take care of herself while in the hospital. Dr. Hawkins testified that M.T. was extremely ill and did not recognize her illness. Dr. Hawkins testified that M.T. would harm herself and that, based on the neglect he had observed in the hospital, he anticipated that she would neglect her children as well.

Dr. Hawkins testified that the benefits from the medications outweighed the risks and that the hospital could work with M.T. to attempt to minimize any side effects. The doctor indicated that he had considered other courses of treatment including counseling, but that those treatments would not be effective because M.T. was denying that she was ill. Dr. Hawkins testified that the proposed medications were the proper course of treatment for M.T. s diagnosis, that the medications were in the best interest of M.T., and that she would likely benefit from their administration. The doctor also testified that M.T. had been treated with medication previously and had been helped.

M.T. testified on her own behalf. She acknowledged, in a circuitous manner, that she needed to be hospitalized. She indicated that she wished to refuse medication because she believed patients should have a choice in such matters and because she believed there should not be a power struggle between a patient and doctor. She indicated that she was a spiritual person, but said medication would not interfere with her beliefs in some regards. She did not testify that the medication would interfere with her beliefs. She did testify that she would prefer to stay longer instead of taking the medication and that she did not feel medication was appropriate at this time. M.T. testified that she had been forced to take medication in the past and that she had not been hurt by the medication, although she had felt that she did not need medication at that time either.

After considering all the evidence, including the application and the expert testimony, the trial court found treatment with the proposed medications to be in the best interest of M.T. and that M.T. lacked the capacity to make a decision regarding administration of the medication. The trial court authorized the Department to administer the proposed psychoactive medications to M.T. This appeal followed.

Sufficiency of the Evidence

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

Standard of Review

When a finding must be supported by clear and convincing evidence, we review the legal sufficiency of the evidence by considering all of the evidence in the light most favorable to the finding and determining whether a reasonable trier of fact could have formed a firm belief or conviction that would support the finding. In re J.F.C., 96 S.W.3d 256, 266 (Tex. 2002). We assume that disputed factual issues were resolved in favor of the finding if that could reasonably be done. Id. We will disregard any evidence that a reasonable fact finder 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, including the evidence that supports and detracts from trial court s findings. In re C.H., 89 S.W.3d 17, 27 29 (Tex. 2002). We must give due consideration to evidence that the fact finder could reasonably have found to be clear and convincing. Id. at 25. We must determine whether the evidence is such that a fact finder 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. The trier of fact is the exclusive judge of the credibility of the witnesses and the weight to be given their testimony. In re C.H., 89 S.W.3d 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

A 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, that the patient lacks the capacity to make a decision regarding the administration of the proposed medication, and that treatment with the proposed medication is in the best interest of the patient. Tex. Health & Safety Code Ann. 574.106(a-1)(1) (Vernon 2005). 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 to make a decision whether to undergo the proposed treatment. Id. 574.101(1). In making its findings, the trial court must 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 of taking the medication, the consequences to the patient if the psychoactive medication is not administered, the prognosis for the patient if not treated with psychoactive medication, and any alternative treatment including less intrusive treatment likely to produce the same results or likely to secure the patient s agreement. Id. 574.106(b).

M.T. does not dispute that the evidence is legally and factually sufficient to show that she was 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 she lacked the capacity to make a decision regarding the administration of psychoactive medications and whether the proposed medication was in her best interest. In the application, Dr. Hawkins stated that M.T. suffers from schizophrenia. He believed M.T. lacks the capacity to make a decision regarding administration of psychoactive medications because M.T. had displayed very serious delusions and denied that she was suffering from a mental illness. He testified that she had been treated with medications a year prior and was able to function, but that she had stopped taking the medications and now had to be hospitalized and prompted to do simple things like bathe herself. Further, Dr. Hawkins testified that M.T. may harm herself or her children through neglect if not treated with these medications. Dr. Hawkins concluded that it was in M.T. s best interest to take the medications, the benefits outweighed the risks, and alternate therapies would not be effective because M.T. s inability to comprehend that she was ill would not allow her to respond favorably to alternate therapies.

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 M.T. lacked the capacity to make a decision regarding administration of the proposed medications and that the proposed medications were in M.T. 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. M.T. asserted that she did not wish to take the medication and alluded to spiritual grounds as the basis for her refusal. M.T. was not specific about her beliefs, and her reasons for not wanting to take the medications appear to be related to her desire to vindicate a right to refuse medication and for greater patient choice. The right to refuse treatment, and the right of patients, generally, to direct the course of their treatment are important. By its very nature, however, involuntary treatment is against the stated wishes of a patient. The trial court must consider M.T. s preferences and beliefs, but need not simply defer to them. See Tex. Health & Safety Code Ann. 574.106(b).

M.T. testified that she did not believe she needed psychoactive medication. It was her preference simply to wait out the statutory ninety day commitment period and be released. The doctor testified that she was mentally ill and unable to make important decisions. It is presumed that the trial court gave M.T. s preferences and beliefs due consideration. The basic thrust of the doctor s testimony, that M.T. s mental illness precluded her consideration of the taking of the medication, was unrebutted. Furthermore, her prior treatment history suggests that treatment with medication had been helpful to M.T., had allowed her to function, and was without significant complications or side effects.

Based upon our review of the record as a whole, we conclude that the conflicting evidence is not so significant that a reasonable trier of fact could not have reconciled the evidence in favor of its finding and formed a firm belief or conviction that M.T. lacked the capacity to make a decision regarding administration of the proposed psychoactive medications and that the proposed medications were in M.T. 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. We overrule M.T. s sole issue.

Disposition

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

SAM GRIFFITH

Justice

Opinion delivered June 30, 2006.

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

(PUBLISH)