Opinion
No. 12-04-00265-CV
Opinion Delivered May 4, 2005.
Appeal from the County Court at Law Cherokee County, Texas.
Panel consisted of WORTHEN, C.J., GRIFFITH, J., and DeVASTO, J.
MEMORANDUM OPINION
Appellant J.C. appeals from an order of commitment for temporary inpatient mental health services. After a hearing without a jury, the trial court entered orders committing J.C. to Rusk State Hospital for a period not to exceed ninety days and authorizing the hospital officials to administer psychoactive medication. In seven issues, J.C. asserts state and federal due process and equal protection violations, legal and factual sufficiency of the evidence, and failure to meet statutory conditions precedent. We reverse and render.
BACKGROUND
On August 10, 2004, the State filed an application for court-ordered temporary mental health services requesting that the trial court commit J.C. to Rusk State Hospital for a period not to exceed ninety days. The State supported its application with two certificates of medical examination for mental illness. The first was prepared by Dr. C. Cuellar. Dr. Cuellar examined J.C. on August 9 and diagnosed her as suffering from schizoaffective disorder. In his physician's certificate, Dr. Cuellar stated that J.C. is mentally ill, is likely to cause serious harm to herself, and is suffering severe and abnormal mental, emotional, or physical distress, is experiencing substantial mental or physical deterioration of her ability to function independently, which is exhibited by her inability, except for reasons of indigence, to provide for her basic needs, including food, clothing, health, or safety, and is unable to make a rational and informed decision as to whether or not to submit to treatment. Dr. Charles Plyler examined J.C. on August 10, diagnosing her with schizoaffective disorder. However, Dr. Plyler failed to check at least one of the three additional criteria required by section 574.034(a). See TEX. HEALTH SAFETY CODE ANN. § 574.034(a) (Vernon 2003).
At a hearing held on August 13, Dr. Plyler testified, first reiterating that J.C. is mentally ill, suffering from schizoaffective disorder. Dr. Plyler stated it was an oversight on his part that he did not check at least one of the additional criteria. Appellant objected based on notice, relevancy, and due process. The trial court overruled her objection. Dr. Plyler then testified that he would have checked the first prong — that J.C. is likely to cause serious harm to herself. He stated that he also agreed with Dr. Cuellar's analysis about the third prong — that J.C. is suffering severe and abnormal mental, emotional, or physical distress that would make her incapable of functioning independently outside the hospital, and is unable to make a rational and informed decision as to whether or not to submit to treatment; however, he did not believe there was sufficient information to support it.
Dr. Plyler based his opinion on J.C.'s diminished capacity to test reality — that she cannot see to her own safety and her behavior leads her into dangerous situations. Dr. Plyler explained that J.C. is intrusive in the hospital ward and her intrusiveness provokes hostility from other patients. He also stated that J.C. has trouble communicating with the staff because of the extent of her delusions. Further, the doctor stated that J.C. has to be observed continually to prevent her from running into the street although he conceded that she was no longer on "close observation." Dr. Plyler testified that Rusk State Hospital is the least restrictive option available.
The State moved for a trial amendment to allow Dr. Plyler to complete his physician's certificate. Appellant objected and the trial court sustained the objection.
On cross examination, Appellant questioned Dr. Plyler about the three prongs. Dr. Plyler reiterated that he could not support the third prong with evidence although he was not opposed to Dr. Cuellar's assessment. He also conceded that he knows of no recent overt act to support any of the prongs.
Dr. Plyler testified that J.C. would have difficulty "cooking, starting fires, all kinds of things." He explained further that if J.C. is not supervised all the time, she is in danger. J.C. cannot care for her basic needs, such as safety. Further, she is unable to make a rational and informed decision to submit to treatment. Dr. Plyler testified that J.C. requires assistance feeding herself. He doubted that she would be capable of ordering food from a restaurant. The doctor explained that her continuing delusions and intrusive behavior invites threatening responses from others. Dr. Plyler cited J.C.'s numerous interruptions in the courtroom as an example of her intrusiveness. He conceded he could not think of any recent overt act that would indicate that she is likely cause harm to herself.
After the State rested, Appellant again objected that the incomplete physician's certificate was insufficient to meet the statutory requirements. She also moved for a directed verdict. The trial court denied the motions. J.C. then testified on her own behalf. She denied having problems with anyone at the hospital other than one person who was expecting a phone call and was "driving [her] off." J.C. denied needing assistance dressing herself or walking to the cafeteria. She denied being in any fights. Although she does not cook, she does her own shopping. J.C. testified that she had a place to stay should she be released. She also stated that she was not disabled and could work.
Appellant then called Dr. Plyler to testify. The doctor conceded that J.C.'s appearance in court was acceptable and that she was not responding to internal stimuli. He also testified that she made coherent and rational responses to the questions posed. Finally, Dr. Plyler conceded that J.C. would be able to survive safely in freedom if, in fact, she had friends or family to help her.
On August 13, the trial court entered an order of temporary inpatient mental health services after determining that the evidence supports the allegations that J.C. is mentally ill, is likely to cause serious harm to herself, is suffering severe and abnormal mental, emotional, or physical distress, is experiencing substantial mental or physical deterioration of her ability to function independently, which is exhibited by her inability, except for reasons of indigence, to provide for her basic needs, including food, clothing, health, or safety, and is unable to make a rational and informed decision as to whether or not to submit to treatment. The trial court ordered J.C. committed to Rusk State Hospital for a period not to exceed ninety days.
After a recess, the trial court held a hearing on the State's application for court-ordered administration of psychoactive medication. Dr. Plyler testified that J.C. refused to accept medications voluntarily. The doctor stated that he did not believe J.C. has the capacity to make a rational decision regarding the administration of psychoactive medications. He explained that the classes of medications he set forth in Exhibit A are in the proper course of treatment for J.C, in her best interest, and if administered, will likely benefit her. Dr. Plyler testified that the benefits outweigh the risks and that her time at the hospital will likely be shortened with medication.
Dr. Plyler testified that when he discussed medications with J.C., she "jumped up and ran out of the room." He believed J.C. did so because she has been on medication before and believes she does not need it. The doctor stated that there are no alternatives that could render the same or similar results.
J.C. testified on her own behalf. She testified that she did not want to take any medications, explaining that she knows what works and what does not. J.C. stated that Zoloft and Ativan are "just trash." "Sir, I want Zyprexa. Zyprexa is what I have taken. I have no problem with it." In a separate order signed the same day, the trial court authorized the hospital officials to treat J.C. with psychoactive medication. This appeal followed.
STATUTORY CONDITIONS PRECEDENT
In her sixth issue, J.C. asserts that the trial court erred in conducting a hearing on the State's application and entering an order of commitment because the statutory conditions precedent were not met. We agree.
The State failed to a file a brief on appeal.
Applicable Law
The Mental Health Code provides that a hearing for court-ordered mental health services may not be held unless two physician's certificates are on file with the trial court. TEX. HEALTH SAFETY CODE ANN. § 574.009(a) (Vernon 2003). If the certificates are not on file at the time set for the hearing, the judge shall dismiss the application and order the immediate release of the proposed patient. Id. § 574.009(d).
Section 574.011 of the Mental Health Code sets forth the requirements for a certificate of medical examination for mental illness (the physician's certificate). TEX. HEALTH SAFETY CODE ANN. § 574.011 (Vernon 2003). Such a certificate must include (among other things) the examining physician's opinion that the examined person is mentally ill and as a result of that illness the examined person is likely to cause serious harm to herself or to others or is suffering severe and abnormal mental, emotional, or physical distress, experiencing substantial mental or physical deterioration of her ability to function independently, and not able to make a rational and informed decision as to whether or not to submit to treatment. Id. § 574.011(a), (3).
It is undisputed that Dr. Cuellar's physician's certificate was completed properly. It is also undisputed that Dr. Plyler's certificate did not state that J.C. was likely to cause serious harm to herself or others. See id. § 574.011(a)(7)(B). Further, it did not state that J.C. was suffering "severe and abnormal mental, emotional, or physical distress, experiencing substantial mental or physical deterioration . . . and was not able to make a rational and informed decision as to whether or not to submit to treatment." See id. § 574.011(a)(7)(B)(i) — (iii). Thus, Dr. Plyler's certificate was insufficient to meet the statutory requirements.
The statutory requirements for an involuntary commitment are strict because an involuntary commitment is a drastic measure. In re Breeden , 4 S.W.3d 782, 789 (Tex.App.-San Antonio 1999, no pet.). Because Dr. Plyler's certificate did not conform to the statutory requirements, we hold the trial court erred in conducting a hearing on the application for court-ordered temporary mental health services and entering an order of commitment. See Marroquin v. State , 112 S.W.3d 295, 303-04 (Tex.App.-El Paso 2003, no pet.). We sustain J.C.'s sixth issue.
Psychoactive Medication
In her seventh issue, T.A. asserts the evidence is legally and factually insufficient to support the order authorizing administration of psychoactive medication. She argues that such an order must be based on a valid order for inpatient mental health care and, due to the reasons asserted in her first six issues, the trial court's order for inpatient mental health care is not valid.
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). We have concluded that the trial court's order for temporary mental commitment is invalid. Therefore, the order authorizing administration of psychoactive medication is also invalid. See id. We sustain J.C.'s seventh issue.
DISPOSITION
We reverse the trial court's orders of commitment for temporary inpatient health services and administration of psychoactive medication. We render judgment denying the State's applications for court-ordered temporary mental health services and for an order to administer psychoactive medication.