Opinion
No. 05-08-00373-CV
Opinion Filed August 13, 2008.
On Appeal from the County Probate Court No. 3 as a Mental Illness Court Dallas County, Texas, Trial Court Cause No. MI-08-50461.
Before Justices FITZGERALD, RICHTER, and LANG-MIERS.
MEMORANDUM OPINION
S.C. appeals the trial court's judgment granting the State's application for court-ordered temporary mental health services. S.C. argues that the evidence is insufficient to support the trial court's findings that: (1) he is likely to cause serious harm to himself or others, (2) his ability to function is deteriorating because of mental distress, and (3) he is unable to make a rational decision as to whether or not to submit to treatment. We conclude that the evidence is legally insufficient to support the trial court's judgment. We reverse the trial court's judgment and render judgment denying the State's application for court-ordered temporary mental health services.
This appeal and its companion, case number 05-08-00263-CV, which we issue simultaneously, involve the same person but relate to separate incidents.
Factual Background
S.C. was picked up by police at the Dallas public library and taken to Parkland Hospital. Officer Mark Underwood signed an application for S.C.'s emergency detention. Officer Underwood described the basis for S.C.'s detention as follows: "[S.C.] WAS AT THE LIBRARY CAUSING A DISTURBANCE DEMANDING TO SPEAK TO THE PRESIDENT. [S.C.] WAS VERY CONFUSED ABOUT WHERE HE WAS AND WAS VERY EMOTIONAL."
Dr. Michael Lutter examined S.C. at Parkland Hospital and completed a certificate of medical examination for mental illness. His certificate describes the following "acts" committed by S.C.: "He was at the library arguing with police, demanding to see the president." The certificate also notes "agitation" and "threatening behavior," but does not list any examples of such behavior. S.C. was transferred to Green Oaks Hospital and evaluated by Dr. James Shupe. Dr. Shupe's certificate of medical examination for mental illness, signed two days after S.C. was picked up by police, states that S.C. "[r]emains delusional," but does not describe any overt acts or pattern of behavior.
The trial court held a hearing on the State's application for temporary mental health services on March 6, 2008, three days after S.C. was picked up by police. At that hearing, Dr. Shupe testified that S.C. was not suicidal, but was likely to cause serious harm to himself. The State asked Dr. Shupe why he believed that S.C. was likely to cause serious harm to himself, and Dr. Shupe responded,
Um, just his continued impulsivity. He's attempted to act on his bizarre, paranoid delusions, and agitation that goes along with that.
He was released from Terrell State Hospital on the 26th of February, 2008. Since that time he's been to a couple of different places as well as spending nights out on the street, and then he's not taking his medication. He [had] gotten so decompensated that he was picked up at the library, threatening other people there, as well as demanding to see the President because he belonged to the CIA.
When the State asked Dr. Shupe, "As a result of the mental illness is [S.C.] likely to cause serious harm to others?" he responded, "No." But the State also asked him, "Why do you believe [S.C. is] likely to cause serious harm to others?" and he responded,
Because of the degree of agitation and his belief that other people are involved in trying to harm him. He believes there are people out there after him and he becomes very agitated based on that, such as, at Parkland when he first came in he required seclusion because of agitation and aggression.
Dr. Shupe was not at the library when S.C. was picked up by police, and did not know if S.C. was inside or outside the library. He also did not testify that he spoke to the police about what occurred at the library. He testified that the specific reason that the police were called to the library was because S.C. was "loud, illogical, and bizarre." Dr. Shupe testified that when police arrived, "they said that [S.C. was] demanding to speak to the President, that he's telling them that he works for the CIA, um, and when they attempted to interact with him and calm him or, you know, resolve the situation, he just escalated. And they felt they needed to take him to Parkland."
The record indicates that S.C. was taken into custody at "7:25 a.m.," but the record does not indicate the library's operating hours.
Dr. Shupe testified that when S.C. arrived at Parkland, "[h]e was initially extremely agitated; he required emergency medication and seclusion. He was very illogical again talking about belonging to the CIA, being a bounty hunter, spending time in prison and wanting to talk to the President." Dr. Shupe also testified that when S.C. was transferred to Green Oaks Hospital, "[h]e remained loose and somewhat agitated, very upset that he was in the hospital, stating he did not need to be in the hospital, that people had to let him go and that he was going to sue everyone. He wasn't physically aggressive there."
The record does not indicate that Dr. Shupe examined S.C. at Parkland Hospital.
S.C. also testified at the hearing. He testified that he has "six brothers and sisters in the area" and has "five houses he can go to at any given time," but that he "choose[s] not to live with someone else" because he believes that is his "constitutional right, God given freedom." He gave inconsistent testimony about what occurred at the library. First he testified that he called 9-1-1 because he was outside when it started hailing. He explained, "I was caught out. I was soaking wet. I was freezing. My hands were stuck like this. I didn't know what else to do." Later, however, when the State asked him again about "the incident at the library" and whether "there was some kind of disturbance going on," S.C. testified,
The disturbance was, I'd been trying to get a phone call down there to get someone to come get me, either my brother, my sponsor, someone in the area `cause I didn't even have a dime left to get on the bus. I tried to tell the bus driver[,] "Hey, I know you guys are going this way," and that was the disturbance.
S.C. testified that when police arrived, he asked them to take him back to Parkland. The State then questioned S.C. about him demanding to see the President and stating that he belonged to the CIA:
[The State]: Why were you demanding to see the President?
[S.C.]: Because it was March 4th. I've never voted a day in my life and I had my voter registration card there and no one else was going to let me. And they kept telling me, "You can't vote no more because of this." "You can't do that because of this." "You can't do this." And I knew the Dallas Police would help me get things straight.
[The State]: Okay. And then you also told them that you belonged to the CIA?
[S.C.] Well, you know where the Boulder campus is in Boulder, Colorado? I'm perfectly, I'm pretty sure I probably do have that university.
The State also questioned S.C. about whether he was "easily upset and agitated" because he thinks people are trying to harm him, and he responded, "Ma'am, if you spent 23 years in the penitentiary doing penance for possibly a crime you did not commit or you might have that little bit of a cautious side to you."
S.C. testified that he was given some medication the last time he was released from the hospital and that he took that medication. He explained, "What I really need is hard work during the day, a good diet, okay, prayer and meditation, okay, and to be left alone to myself and my private thoughts and my own property." At the conclusion of his testimony, S.C. asked to make a final statement, and stated as follows:
Thank you. I'm sorry and I know sorry isn't the right word, but pardon. Pardon my bad manners, my looks, and other things, while coming through these courts, and some of the antics I've pulled-proved, pulled or proved both. It's the truth.
I was first locked up at 8 years old, locked up again at 12 years old, got out in time. Came to Texas to get emancipated. I heard they still had emancipation down here. Got down here, got a real big jackpot. And I've worked. I've worked very hard. And all I'm trying to do is live like a good [C]hristian man, even though I don't believe in the churches anymore. That's my prerogative. But I labor everyday and I pray everyday. And I just pray that in your heart you find a solution to this problem. Thank you.
The trial court granted the State's application and signed a judgment committing S.C. to Terrell State Hospital for up to 90 days. The trial court included findings in its judgment that S.C. met all of the requirements for court-ordered temporary inpatient mental health services: S.C. is mentally ill, and as a result, is likely to cause serious harm to himself or others, is suffering serious distress, is deteriorating in his ability to function independently, and is unable to make rational and informed decisions about his treatment. S.C. filed a joint motion for rehearing and new trial, which was overruled by operation of law. S.C. timely filed his notice of appeal.
Although the 90-day commitment period has run, this appeal is not moot. We recognize that an inappropriate commitment has effects that are "manifestly severe and prejudicially unfair," and this appeal is an opportunity for some mitigation of those effects. See State v. Lodge, 608 S.W.2d 910, 912 (Tex. 1980); D.J. v. State, 59 S.W.3d 352, 354 (Tex.App.-Dallas 2001, no pet.).
Applicable Law
Subsections (a) and (d) of section 574.034 of the Texas Health and Safety Code state the applicable criteria for court-ordered temporary inpatient mental health services. Under those subsections,
(a) The judge may order a proposed patient to receive court-ordered temporary inpatient mental health services only if the judge or jury finds, from clear and convincing evidence, that:
(1) the proposed patient is mentally ill;
(2) as a result of that mental illness the proposed patient:
(A) is likely to cause serious harm to himself;
(B) is likely to cause serious harm to others; or (C) is:
(i) suffering severe and abnormal mental, emotional, or physical distress;
(ii) experiencing substantial mental or physical deterioration of the proposed patient's ability to function independently, which is exhibited by the proposed patient's inability, except for reasons of indigence, to provide for the proposed patient's 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.
. . .
(d) To be clear and convincing under Subsection (a), 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: (1) the likelihood of serious harm to the proposed patient or others; or (2) the proposed patient's distress and the deterioration of the proposed patient's ability to function.
Tex. Health Safety Code Ann. § 574.034(a), (d) (Vernon 2003). Clear and convincing evidence is "that measure or degree of proof which 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) (per curiam); D.M. v. State, 181 S.W.3d 903, 904 (Tex.App.-Dallas 2006, no pet.).
S.C. does not challenge the trial court's finding that he is mentally ill, and we do not question Dr. Shupe's opinion that S.C. would benefit from hospitalization. Nevertheless, the fact that S.C. is mentally ill and would benefit from hospitalization is not enough to commit S.C., against his will, to inpatient mental health services. "The statutory requirements for an involuntary commitment are strict because an involuntary commitment is a drastic measure." In re C.O., 65 S.W.3d 175, 182 (Tex.App.-Tyler 2001, no pet.). An expert diagnosis of mental illness, standing alone, is not sufficient to confine a patient for treatment. M.S. v. State, 137 S.W.3d 131, 136 (Tex.App.-Houston [1st Dist.] 2004, no pet.). Likewise, evidence that merely reflects a patient's mental illness and need for hospitalization is not sufficient to meet the State's burden. Id. The expert's opinions and recommendations must be supported by a showing of the factual bases on which they are grounded. State ex rel. E.E., 224 S.W.3d 791, 794 (Tex.App.-Texarkana 2007, no pet.); T.G. v. State, 7 S.W.3d 248, 252 (Tex.App.-Dallas 1999, no pet.).
Standard of Review
In reviewing the legal sufficiency of the evidence when the burden of proof is clear and convincing evidence, we examine all the evidence in the light most favorable to the trial court's 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). We assume the fact-finder resolved disputed facts in favor of its finding if a reasonable fact-finder could do so, and we disregard all contrary evidence unless a reasonable fact-finder could not. Id.; see also City of Keller v. Wilson, 168 S.W.3d 802, 827 (Tex. 2005).
Analysis
Throughout S.C.'s appellate brief, he contends that the evidence is insufficient to support the trial court's judgment because "there was no evidence of a recent overt act or continuing pattern of behavior that tended to confirm Dr. Shupe's opinions." In other words, S.C. essentially contends that the State's evidence does not meet the standard for clear and convincing evidence under subsection 574.034(d).
The State makes two arguments in response. First, the State argues that "the disturbance at the library" is evidence of a recent overt act that "confirmed the likelihood of serious harm to [S.C.] or others" under section 574.034(d)(1). We disagree.
The evidence of what occurred at the library is vague and inconclusive. Although disturbing, it does not demonstrate a likelihood of serious harm to anyone that satisfies the requirements of the statute. See Tex. Health Safety Code Ann. §§ 574.034(a)(2)(A)-(B), (d)(1). The only other evidence that could support Dr. Shupe's opinion, and the trial court's finding, that S.C. was likely to cause serious harm to himself or others is Dr. Shupe's testimony that S.C. exhibits "continued impulsivity" and "agitation." But no evidence was presented concerning S.C.'s specific acts or behavior. And "psychotic behavior alone . . . is no evidence of a continuing pattern of behavior that tends to confirm the likelihood of serious harm to herself or others." T.G., 7 S.W.3d at 252. Because there is no evidence of a recent overt act or continuing pattern of behavior that tends to confirm the likelihood of serious harm to S.C. or others, we conclude that the State did not meet its burden to show by clear and convincing evidence that S.C. is likely to cause serious harm to himself or others under section 574.034(a)(2)(A) and (B). See Tex. Health Safety Code Ann. §§ 574.034(a)(2)(A)-(B), (d)(1).
Second, the State argues that "Dr. Shupe's testimony that [S.C] was decompensated because he was not regularly taking his medication and spending nights out on the street, was a clear indication of the distress and deterioration of [S.C.'s] ability to function" and satisfies the requirements of section 574.034(d)(2). See Tex. Health Safety Code Ann. § 574.034(d)(2). We again disagree.
It is unclear from the record whether S.C. was taking his psychiatric medication when he was picked up by police. Nevertheless, even if we assume that he was not taking his medication, this fact alone would not constitute an overt act or continuing pattern of behavior tending to confirm S.C.'s distress or a deterioration of his ability to function. See, e.g., Armstrong v. State, 190 S.W.3d 246, 252-54 (Tex.App.-Houston [1st Dist.] 2006, no pet.) ("evidence of psychotic behavior and refusal to take medicine cannot, without more, support the statutory requirement for an overt act or a continuing pattern of behavior"). Additionally, S.C. testified that he asked police to take him to Parkland because he did not have any money. And Dr. Shupe testified that S.C. was "spending nights out on the street," that his hygiene was "fairly poor," and that "[h]e will eat, although he can't provide that himself often." This evidence suggests that S.C. is indigent. But section 574.034 specifically excepts "reasons of indigence" as a basis for a finding that a proposed patient cannot provide for his basic needs. Tex. Health Safety Code Ann. § 574.034(a)(2)(c)(ii); D.J. v. State, 59 S.W.3d 352, 356 (Tex.App.-Dallas 2001, no pet.) ("Although part of the statutory standard is satisfied by evidence the proposed patient is unable to provide for her basic needs, the statute specifically excepts `reasons of indigence' as a basis for such a finding."). The record does not contain evidence, apart from evidence of indigence, that would enable a reasonable fact-finder to form a firm belief or conviction that S.C. cannot provide for his basic needs. Because there is no evidence of a recent overt act or continuing pattern of behavior that tends to confirm S.C.'s distress or a deterioration of his ability to function, we conclude that the State did not meet its burden to show by clear and convincing evidence that S.C. was "experiencing substantial mental or physical deterioration of the proposed patient's ability to function independently." See Tex. Health Safety Code Ann. § 574.034(a)(2)(C), (d)(2).
We sustain appellant's first, second, fourth, and fifth issues. Because of our disposition of these issues, we do not need to decide the remaining issues.
Conclusion
We reverse the trial court's judgment and render judgment denying the State's application for court-ordered temporary mental health services.
ELIZABETH LANG-MIERS, Justice