Opinion
NO. 02-16-00096-CV
05-31-2016
IN THE MATTER OF K.S.
FROM COUNTY COURT AT LAW NO. 1 OF WICHITA COUNTY
TRIAL COURT NO. 39707-LR-D MEMORANDUM OPINION
See Tex. R. App. P. 47.4.
Appellant K.S. appeals from an order authorizing psychoactive medication. We will affirm.
By an order signed on February 25, 2016, and pursuant to code of criminal procedure article 46B.073, the trial court ordered K.S. committed to an inpatient mental health facility for the purpose of attaining competency to stand trial for the felony offense of retaliation against a public official. See Tex. Code Crim. Proc. Ann. art. 46B.073(b) (West Supp. 2015). On March 8, 2016, Rohini Ravindran, M.D. filed an application seeking an order to authorize the administration of psychoactive medication to K.S.—specifically, antipsychotics, mood stabilizers, and anxiolytics—regardless of his refusal. See Tex. Health & Safety Code Ann. § 574.104(a) (West 2010). Among other things, Dr. Ravindran indicated in the application that she had diagnosed K.S. with "Bipolar Disorder MRE Manic with psychotic features" and that K.S. had refused to take the proposed medications voluntarily.
According to her application, Dr. Ravindran believed that K.S. lacked the capacity to make a decision regarding the administration of psychoactive medication because he "is psychotic and aggressive to the staff until he required emergency medications and has no insight into his illness."
The trial court appointed K.S. counsel, and after a hearing at which both Dr. Ravindran and K.S. testified, the trial court granted the relief requested in the application and signed an order authorizing the administration of psychoactive medication to K.S, finding by clear and convincing evidence in part as follows:
• "[K.S.] is in custody awaiting trial in a criminal proceeding and was ordered to receive inpatient mental health services in the six months preceding a hearing under this section"; andSee id. § 574.106(a)(2), (a-1)(2)(A) (West 2010). K.S. filed a pro se notice of appeal, and the trial court appointed him appellate counsel. See id. § 574.108(a) (West 2010) (permitting appeal of order authorizing psychoactive medication).
• "[K.S.] was ordered to receive inpatient mental health services by a criminal court with jurisdiction over [him] and [he] presents a danger to [himself] or others in the inpatient facility in which [he] is being treated as a result of a mental disorder or mental defect as determined under Section 574.1065, Texas Health and Safety Code, and treatment with the proposed medication is in the best interest of [K.S.]"
In his only issue, K.S. argues that the evidence is legally and factually insufficient to support the order authorizing psychoactive medication.
The State's burden of proof under health and safety code section 574.106 is clear and convincing evidence. See id. § 574.106(a-1). Clear and convincing evidence is that measure or degree of proof that will 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. Tex. Civ. Prac. & Rem. Code Ann. § 41.001(2) (West Supp. 2015); Tex. Fam. Code Ann. § 101.007 (West 2014); U-Haul Int'l, Inc. v. Waldrip, 380 S.W.3d 118, 137 (Tex. 2012); State v. K.E.W., 315 S.W.3d 16, 20 (Tex. 2010).
In evaluating the evidence for legal sufficiency, we must determine whether the evidence is such that a factfinder could reasonably form a firm belief or conviction that its finding was true. K.E.W., 315 S.W.3d at 20; Columbia Med. Ctr. of Las Colinas, Inc. v. Hogue, 271 S.W.3d 238, 248 (Tex. 2008). We review all the evidence in the light most favorable to the finding. Waldrip, 380 S.W.3d at 138; Hogue, 271 S.W.3d at 248. We resolve any disputed facts in favor of the finding if a reasonable factfinder could have done so. K.E.W., 315 S.W.3d at 20; Hogue, 271 S.W.3d at 248. We disregard all evidence that a reasonable factfinder could have disbelieved. Hogue, 271 S.W.3d at 248. We consider undisputed evidence even if it is contrary to the finding. Id.; City of Keller v. Wilson, 168 S.W.3d 802, 817 (Tex. 2005). That is, we consider evidence favorable to the finding if a reasonable factfinder could, and we disregard contrary evidence unless a reasonable factfinder could not. See K.E.W., 315 S.W.3d at 20; Hogue, 271 S.W.3d at 248.
In evaluating the evidence for factual sufficiency, we determine whether, on the entire record, a factfinder could reasonably form a firm conviction or belief that its finding was true. In re H.R.M., 209 S.W.3d 105, 108 (Tex. 2006). If, in light of the entire record, the disputed evidence that a reasonable factfinder could not have credited in favor of the finding is so significant that a factfinder could not reasonably have formed a firm belief or conviction in the truth of its finding, then the evidence is factually insufficient. Id.
The trial court's health and safety code section 574.106(a-1) finding tracks subsection (2)(A), which provides that a court may issue an order authorizing psychoactive medication if it finds by clear and convincing evidence after a hearing:
(2) if the patient was ordered to receive inpatient mental health services by a criminal court with jurisdiction over the patient, that treatment with the proposed medication is in the best interest of the patient and . . . .Tex. Health & Safety Code Ann § 574.106(a-1)(2)(A). Regarding the best interest inquiry, section 574.106(b) states the following:
(A) the patient presents a danger to the patient or others in the inpatient mental health facility in which the patient is being treated as a result of a mental disorder or mental defect as determined under Section 574.1065[.]"
In making the finding that treatment with the proposed medication is in the best interest of the patient, the court shall consider:Id. § 574.106(b).
(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) 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.
K.S. argues that the State "failed to meet its burden to prove best interest of the patient" because K.S. raised concerns regarding the first, third, and sixth best interest considerations that Dr. Ravindran never addressed. Specifically, Dr. Ravindran testified that at a minimum, she wants to start K.S. on Zyprexa, but K.S. explained that he was allergic to it, that it "makes the situation worse," and that he had attempted suicide in the past while taking Zyprexa in combination with several other medications. K.S. instead stated a preference for Adderall—a medication that he "never had any trouble" with.
Dr. Ravindran responded to K.S.'s concerns about Zyprexa and preference for Adderall. She not only testified that K.S. had been given Zyprexa in the past and that he had not experienced an allergic reaction to it, but she clarified that K.S. had not experienced an allergic reaction to any of the medications that she wants to prescribe. Dr. Ravindran also explained that she could not prescribe Adderall to K.S. because "he's too psychotic and manic . . . to even consider doing Adderall" and because "Adderall is not a medication that we typically prescribe in the hospital. That's more done on an outpatient basis."
Dr. Ravindran further specifically opined that it was in K.S.'s best interest to be medicated. She testified that K.S. is "psychotic, very delusional, and . . . has no insight into his illness"; she said that if medicated, she would expect K.S. to improve by becoming very polite, cooperative, and organized; she thought that the medications would help restore K.S.'s competency to stand trial; she stated that there were no alternatives to court-ordered medications that were likely to produce the same results; she reasoned that there were no less-intrusive treatments that were likely to secure K.S.'s agreement to take the psychoactive medications; she explained that any side effects—such as weight gain and elevated blood sugars and lipids—would be monitored and counteracted with other medication; and she opined that K.S. did not understand the risks and benefits of the medication. We conclude that, although K.S. offered some contrary evidence, the trial court nevertheless could reasonably have formed a firm belief or conviction that it was in K.S.'s best interest to be treated with psychoactive medication. See K.E.W., 315 S.W.3d at 20; H.R.M., 209 S.W.3d at 108.
K.S. also challenges the sufficiency of the evidence to support the trial court's finding that he presents a danger to himself or to others because none of his behavior appeared "to be infliction of substantial physical harm, an attempt of such, or a threat of the same." K.S. is referencing part of health and safety code section 574.1065, which provides that in determining whether a patient presents a danger to himself or to others, the court shall consider:
(1) an assessment of the patient's present mental condition;Tex. Health & Safety Code Ann. § 574.1065 (West 2010).
(2) whether the patient has inflicted, attempted to inflict, or made a serious threat of inflicting substantial physical harm to the patient's self or to another while in the facility; and
(3) whether the patient, in the six months preceding the date the patient was placed in the facility, has inflicted, attempted to inflict, or made a serious threat of inflicting substantial physical harm to another that resulted in the patient being placed in the facility.
In support of her opinion that K.S. is a danger to others at the facility as a result of his mental illness, Dr. Ravindran testified that K.S. suffers from bipolar disorder; that he is psychotic and delusional; that he has been loud, aggressive, and intrusive; that he had to be given emergency medication at one point because he was about to get into a fist fight with another patient; that he had attempted to charge into the nurses' station multiple times, causing them to feel threatened; that he had made aggressive gestures; and that he is constantly yelling and screaming at staff.
In Moore v. State, the court of appeals held that clear and convincing evidence did not support the trial court's finding that appellant presented a danger to herself or others because the physician testified that appellant "did not behave in an assaultive or aggressive manner" and "could not point to any specific behavior that would [lead] a person to believe [that] Appellant was a danger to herself or others." No. 07-10-00507-CV, 2011 WL 3587439, at *5 (Tex. App.—Amarillo Aug. 16, 2011, no pet.) (mem. op.). Unlike the physician's testimony in Moore, Dr. Ravindran testified about K.S.'s repeated aggressive behavior, including behavior that would cause a person to believe that he is a danger to others. Legally and factually sufficient evidence supports the trial court's finding that K.S. presents a danger to others. See K.E.W., 315 S.W.3d at 20; H.R.M., 209 S.W.3d at 108.
In the agreed judgment finding that K.S. is incompetent to stand trial, the trial court found by clear and convincing evidence that K.S. "is a danger to others." --------
K.S. also argues that the State "failed to prove that as a result of a mental disorder or mental defect, [he] presented a danger to others to the extent that court-ordered psychoactive medications were justified." Dr. Ravindran testified that she was treating K.S. for "Bipolar disorder, most recent episode manic with psychotic features," and that some of the "defining characteristics" of that illness were that "[p]atients are very aggressive; they have racing thoughts; they don't sleep very much; and they can basically be very delusional, talk really fast, make threats." As stated, Dr. Ravindran testified that K.S. had exhibited symptoms of his mental illness by being aggressive to other patients, being involved in fights and arguments with peers, and making the nurses feel threatened. K.S. offered an alternative explanation for his behavior—he had been assaulted and bitten by a black widow spider—but as the factfinder, the trial court chose to resolve the conflicting testimony in favor of Dr. Ravindran, finding that K.S. presents a danger as a result of his bipolar disorder with psychotic features rather than merely as a response to being assaulted or bitten by a spider, and we have no authority on appeal to alter that factual determination. See In re J.O.A., 283 S.W.3d 336, 346 (Tex. 2009); H.R.M., 209 S.W.3d at 109. The evidence is legally and factually sufficient to support the trial court's finding that K.S. presents a danger to others as a result of a mental disorder or mental defect. See K.E.W., 315 S.W.3d at 20; H.R.M., 209 S.W.3d at 108.
We overrule K.S.'s sole issue and affirm the trial court's order authorizing psychoactive medication.
PER CURIAM PANEL: MEIER, DAUPHINOT, and GARDNER, JJ. DELIVERED: May 31, 2016