Opinion
No. 12-06-00116-CV
Opinion delivered June 30, 2006.
Appeal from the County Court at Law Cherokee County, Texas.
Panel consisted of WORTHEN, C.J. and GRIFFITH, J.
MEMORANDUM OPINION
J.P. appeals from an order for temporary inpatient mental health services. In his sole issue on appeal, J.P. asserts the evidence is legally and factually insufficient to support the order. We affirm.
BACKGROUND
On March 24, 2006, an application for court ordered temporary mental health services was filed requesting the trial court to commit J.P. to the Rusk State Hospital (the "Hospital") for a period not to exceed ninety days. At the time the application was filed, J.P. was a patient at the Hospital. The application was supported by two physician's certificates of medical examination for mental illness. The first certificate stated that, on March 23, 2006, Dr. Larry R. Hawkins evaluated and examined J.P. and diagnosed him with bipolar disorder I, manic. Hawkins stated that J.P. had been under his care since March 23 and had been receiving medication. According to Hawkins, J.P. was mentally ill and was likely to cause serious harm to others. As his basis for this opinion, Hawkins stated that J.P. had pressured speech and flight of ideas and was angry, sarcastic, and reportedly hypersexual. According to Hawkins, J.P. presented a substantial risk of serious harm to himself or others if not immediately restrained, which was demonstrated by his behavior, including pressured speech, flight of ideas, grandiosity, and anger.
On March 29, 2006, Dr. Jon A. Guidry evaluated and examined J.P. and diagnosed him with bipolar disorder I manic. Guidry stated that J.P. had been receiving medication. According to Guidry, J.P. was mentally ill and was likely to cause serious harm to others. As his basis for this opinion, Guidry stated that J.P. exhibited pressured speech and grandiosity. J.P. informed Guidry that he wanted to be in the military, but if he was on "psych" medications, "they won't take" him. Guidry stated that, on March 26, J.P. received an emergency injection and was transferred to another unit because another psychiatrist documented that J.P. was sexually inappropriate and destroyed property. According to Guidry, J.P. presented a substantial risk of serious harm to himself or others if not immediately restrained, which was demonstrated by his behavior, including J.P.'s statement that he planned to stop his medication after he was discharged. Further, J.P. required a body net on March 26.
The hearing on the application was held on April 4. At trial, Guidry stated that J.P. suffered from bipolar disorder, manic. Guidry concluded that J.P. was likely to cause serious harm to others because he was transferred to Guidry's unit for his behavior, he required a body net on March 26 because of his aggression, he required emergency injections, and, at one point, he banged on the wall with his head and hands. Guidry stated that J.P. was responding to treatment and anticipated a short stay. According to Guidry, J.P.'s last emergency injection was within five or six days of the hearing. Guidry stated that J.P. was intrusive into other people's personal space and did not recognize that approaching, "say[ing] things," and being "always on" some people leads to aggression, arguing, and fighting, "which he was earlier in his stay." He also testified that J.P. was manic and grandiose, had no insight, and exhibited pressure of speech.
According to Guidry, recent reports indicated that J.P. wanted to treat his illness with alcohol and marijuana rather than psychotropic medication, which would cause him to promptly decompensate. At various times, J.P. had stated that he was not going to take psychotropic medications because he could not be in the military on these medications. Guidry stated that it would not be appropriate to release J.P. to his family because he still exhibited a lack of insight and a lack of desire to continue medications. He had also required several emergency injections since his admission and required a body net. Guidry believed that J.P.'s behavior could lead to violence if he was not in a structured environment because he banged his head and punched the wall, intruded into other people's space, lacked insight into his illness, and had some allegations of sexually inappropriate conduct requiring him to be transferred to an all male unit.
Although he stated that J.P.'s records include documentation of threats, Guidry did not have documentation of an assault on anyone. Guidry admitted that J.P.'s condition had improved and he was taking medication by written consent. However, Guidry did not currently consider J.P. a nondangerous individual. According to Guidry, he did not know if J.P. could survive safely in freedom either by himself or with the help of responsible and willing family members or friends. Guidry stated that, on March 26, another physician recorded that J.P. was aggressive and sexually inappropriate, resulting in a transfer to an all male unit. This physician also noted that J.P. destroyed property and attempted to "bust open" his forehead, requiring a body net. However, no serious injuries were reported. In Guidry's opinion, J.P. was likely to cause harm to himself or others if he was in the outside world without supervision, body nets, and emergency injections.
J.P. testified that he agreed with the record presented to the trial court reflecting his behavior at the Hospital. He denied wanting to hurt himself or anyone else. J.P. did not believe it was in his best interest to stay at the Hospital because he had a family to feed and people depending upon him, including a seventy-six-year-old grandmother. If J.P. were released, he would go to his grandmother's house in Huntsville and to his employer's house. J.P. maintained rental properties. According to J.P., he was taking medications, believed that they were helping him, and intended to continue taking these medications and to seek out appropriate medical or psychological counseling. In fact, J.P. was planning to go to Mental Health and Mental Retardation when he returned home. J.P. stated that he had been fine until he had a manic episode.
J.P. testified that he banged his head against the wall because he was put in seclusion and was upset. According to J.P., staff at the Hospital assaulted him, lied to him, and did not tell him why he was moving. He testified that the Hospital staff "put" him on the ground and forced him, against his will, to have an injection. J.P. stated that he could control himself and did not need medications to do so. He also stated that the Hospital staff removed him from seclusion for banging his head and fists, put him in the net, and continued to antagonize him. According to J.P., he bangs his head and punches the wall to prevent himself from aggressing against someone else. J.P. admitted that his behavior was not appropriate. J.P. admitted that, before arriving at the Hospital, he had medication, but was not taking it. J.P. stated that, upon release, he would take his medication. When asked what had changed, J.P. stated that he did not understand the question and that the State's counsel was his enemy and wanted him to stay in the Hospital. In an answer to the trial court, J.P. testified that he had bumps on his hands to keep from assaulting people.
On April 4, the trial court found that J.P. was mentally ill, was likely to cause serious harm to himself, and was likely to cause serious harm to others. The trial court entered an order for temporary inpatient mental health services, committing J.P. to the Hospital for a period not to exceed ninety days. This appeal followed.
SUFFICIENCY OF THE EVIDENCE
In his sole issue, J.P. argues that the evidence is neither legally nor factually sufficient to support the order of commitment. J.P. contends that the testimony fails to show an overt act or a continuing pattern of behavior that tends to confirm the likelihood of serious harm to himself or others. The State disagrees.
Standard of Review
In a legal sufficiency review where the burden of proof is clear and convincing evidence, we must 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 findings were 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.
The appropriate standard for reviewing a factual sufficiency challenge is whether the evidence is such that a fact finder could reasonably form a firm belief or conviction about the truth of the petitioner's allegations. In re C.H. , 89 S.W.3d 17, 25 (Tex. 2002). 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. Id. at 27-29. Further, we must consider whether disputed evidence is such that a reasonable fact finder could not have reconciled that disputed evidence in favor of its finding. In re 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 or conviction, then the evidence is factually insufficient. Id. Involuntary Commitment Order
The trial judge may order a proposed patient to receive court ordered temporary inpatient mental health services if the judge or jury finds, from clear and convincing evidence, that the proposed patient is mentally ill and, as a result of the mental illness, he is likely to cause serious harm to himself, is likely to cause serious harm to others, or is (i) suffering severe and abnormal mental, emotional, or physical distress, (ii) experiencing substantial mental or physical deterioration of his ability to function independently, which is exhibited by his inability, except for reasons of indigence, to provide for his basic needs, including food, clothing, health, or safety, and (iii) unable to make a rational and informed decision as to whether or not to submit to treatment. Tex. Health Safety Code Ann. § 574.034(a) (Vernon 2003).
To be clear and convincing under this statute, the evidence must include expert testimony and, unless waived, evidence of a recent overt act or a continuing pattern of behavior that tends to confirm either the likelihood of serious harm to the proposed patient or others or the proposed patient's distress and the deterioration of his ability to function. TEX. HEALTH SAFETY CODE ANN. § 574.034(d) (Vernon 2003). Clear and convincing evidence means the 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. State v. Addington , 588 S.W.2d 569, 570 (Tex. 1979). The statutory requirements for an involuntary commitment are strict because it is a drastic measure. In re C.O. , 65 S.W.3d 175, 182 (Tex.App.-Tyler 2001, no pet.).
The State provided expert testimony from Hawkins and Guidry who examined J.P. and diagnosed him with bipolar disorder I, manic. However, expert testimony confirming mental illness, standing alone, will not support an involuntary commitment. T.G. v. State , 7 S.W.3d 248, 252 (Tex.App.-Dallas 1999, no pet.). Hawkins described J.P. as grandiose, angry, sarcastic, reportedly hypersexual, with pressured speech and flight of ideas. Guidry stated that J.P. exhibited pressured speech and grandiosity and was reportedly sexually inappropriate. Evidence of continuing delusional or paranoid behavior merely reflects that an individual is mentally ill and in need of hospitalization, but does not provide the continuing pattern of behavior necessary to support a commitment. See In re C.O. , 65 S.W.3d at 182; Broussard v. State , 827 S.W.2d 619, 622 (Tex.App.-Corpus Christi 1992, no writ).
An expert opinion recommending commitment must be supported by the factual bases on which it is grounded and not simply recite the statutory criteria. See J.M. v. State , 178 S.W.3d 185, 193 (Tex.App.-Houston [1st Dist.] 2005, no pet.). What is necessary is the expert's description of the patient's specific behaviors on which his or her opinion is based. See id. We must examine the record to determine whether there is clear and convincing evidence showing an overt act or a continuing pattern of behavior that tended to confirm the likelihood of J.P.'s causing serious harm to himself or others. See TEX. HEALTH SAFETY CODE ANN. § 574.034(d).
Guidry reported that J.P.'s behavior, banging his head and hands against a wall, required him to be restrained by a body net not long before the hearing. J.P. said his actions prevented him from assaulting or beating someone else. In fact, J.P. admitted to the trial court that he had bumps on his hands to keep from assaulting people. J.P. also recognized that his behavior was not appropriate. According to Guidry, J.P.'s behavior also included intruding into other people's space, which might lead to aggression, arguing, and fighting. Guidry seemed to indicate that J.P. had been arguing and fighting earlier in his stay at the Hospital. According to Guidry, J.P. had to be administered emergency injections and was transferred to an all male unit for allegedly sexually inappropriate behavior. Guidry stated that J.P. was likely to cause serious harm to others because of the above behavior and that his behavior could lead to violence without a structured environment. Moreover, Guidry testified that J.P. indicated that he wanted to treat his illness with alcohol and marijuana rather than psychotropic medications. Guidry stated that if he did so, J.P. would promptly decompensate, i.e., his mental disorder would appear or exacerbate due to a failure of his defense mechanisms. See The American Heritage Stedman's Medical Dictionary 212 (1995). Additionally, J.P. did not want to take psychotropic medications because he could not be in the military on these medications. We consider J.P.'s admission of his aggressive feelings toward others, his behavior of banging his head and hands against a wall to prevent himself from assaulting others, and his threats to others to be recent overt acts or a continuing pattern of behavior that tended to confirm the likelihood of serious harm to others. See TEX. HEALTH SAFETY CODE ANN. § 574.034(d). We also note that viewing 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 J.P. is likely to cause serious harm to others. See TEX. HEALTH SAFETY CODE ANN. § 574.034(a), (d); In re J.F.C. , 96 S.W.3d at 266. Therefore, the evidence is legally sufficient to support the trial court's order. See In re J.F.C. , 96 S.W.3d at 266.
Having determined that the evidence is legally sufficient to support the order, 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 27-29. Guidry did not testify that J.P. actually fought or harmed others. Guidry admitted that, although there was documentation of threats in J.P.'s records, he did not have any documentary evidence that J.P. assaulted anyone. Further, Guidry admitted that J.P. was taking his medications by written consent at the time of the hearing. According to J.P., his behavior of banging his head and hands against a wall occurred because he was put into seclusion and was upset. J.P. accused the Hospital staff of lying to him, assaulting him, and antagonizing him, resulting in the body net and a forcible injection. Based upon our review of the record as a whole, we conclude that, although there is some disputed evidence, 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 J.P. was likely to cause serious harm to others. See TEX. HEALTH SAFETY CODE ANN. 574.034(a)(d); In re J.F.C. , 96 S.W.3d at 266. Therefore, the evidence is factually sufficient to support the trial court's order. Id. Having determined that the evidence is legally and factually sufficient to support one of the criteria for committing J.P. to the Hospital, we need not consider the additional criteria used to support his commitment. See TEX. HEALTH SAFETY CODE ANN. § 574.034(a); TEX. R. APP. P. 47.1. Accordingly, we conclude that the trial court met the obligations imposed by Section 574.034 of the Texas Health Safety Code and overrule J.P.'s sole issue.
DISPOSITION
The judgment of the trial court is affirmed.