Opinion
No. 14-03-01398-CV
Memorandum Opinion filed October 26, 2004.
On Appeal from the Probate Court No. 3 Harris County, Texas, Trial Court Cause No. 108027.
Affirmed.
Panel consists of Justices YATES, EDELMAN, and GUZMAN.
MEMORANDUM OPINION
In this accelerated appeal, we must determine whether there is legally and factually sufficient evidence to support the trial court's findings underlying appellant S.D.F.-W.'s court-ordered temporary commitment to the Harris County Psychiatric Center under section 574.034 of the Health and Safety Code. TEX. HEALTH SAFETY CODE ANN. § 574.034 (Vernon 2003). Because we conclude the evidence is sufficient, we affirm.
Factual and Procedural Background
On October 29, 2003, Charles P. Foster ("Charles") filed an application for temporary mental health services regarding his sister, appellant. At the commitment hearing on November 14, 2003, the court heard testimony from Dr. Katherine Cowan, Charles, appellant's twin sister Patricia Foster Coopritz ("Patty"), and appellant.
Dr. Cowan, a psychiatrist, testified first. Dr. Cowan had been working with appellant nearly every day for the past two weeks and had made a working diagnosis of appellant's condition as paranoid schizophrenia. Appellant had been loud and aggressive with the hospital staff, denied being ill, and refused to take any medication. Appellant indicated she was "allergic" to all medication and attributed Dr. Cowan's motivation for recommending medication to owning stock in pharmaceutical companies. Dr. Cowan further observed appellant's paranoia when appellant accused her of having another agenda and of trying to take appellant's home away from her.
Appellant made several complaints about her physical health to Dr. Cowan and the hospital staff, but they could not be verified. For example, appellant claimed that she had consented to a minor surgery under local anesthesia and woke up from general anesthesia, having been subjected to an unwanted gynecological procedure and receiving an implant of some sort. A physical examination found no scars or any other evidence to confirm her belief. Dr. Cowan believed that appellant's perceptions of this incident have caused her to distrust all physicians. Appellant also complained of kidney problems. She refused to allow diagnostic tests for several days, and when she finally did, the tests showed normal renal function. Hospital staff were also unable to confirm appellant's claim that her ears had been bleeding on two separate occasions. Based on these and other incidents, Dr. Cowan concluded that appellant was delusional.
Dr. Cowan did not believe that appellant intended to harm herself or others and admitted that appellant had been eating properly and caring for herself while hospitalized. However, Dr. Cowan opined that appellant's condition would not simply go away without treatment and in fact might escalate, and she believed that appellant's poor judgment caused by her mental condition would undermine her health and safety.
The court next heard from Charles. He was concerned because appellant seemed depressed, and when he tried to talk to her, she would "get hysterical and run off and jump in her car." Appellant had not been working recently and had been depending on her family to take care of her. Charles became particularly alarmed when, on October 26, 2003, appellant told a group of family members that she was going to stop eating in an attempt to harm herself. Charles had also heard appellant say recently that she thought a doctor had removed and sold some of her organs without her consent. Although appellant believed that she still owned her home, Charles confirmed that it had been foreclosed and that she did not have any place to live.
Patty testified and also confirmed that appellant had no place to live and was unable to work because her nursing license had recently been revoked. Though Patty has been worried about appellant's mental health for years, she had recently become particularly concerned because of appellant's "radical behavior," including carrying a box cutter for protection and "peel[ing] off frantically" into traffic from Patty's house. Appellant frequently came to Patty's house seeking money, food, a shower, or to use the telephone. Patty estimated that appellant had come to her house for help at least once a day for twenty-eight days of the month before and often came multiple times per day, as many as six in one day. Once, appellant filled up a garbage can in Patty's driveway with water that she first used to care for some animals and then to bathe herself.
Finally, appellant testified. Her answers to questions were often long, rambling, and incoherent. She confirmed that she refused to take any medication because she did not believe herself to be ill and reiterated her belief that she had been subjected to unwanted surgery. As to her house, appellant insisted that she still owned her house and seemed to believe either that there had been some sort of mistake or that fraudulent papers had been filed. She testified that she would not seek shelter if released because she would return to her home. Appellant denied that her nursing license had been revoked and said Patty said this because her husband "has connections with attorneys and physicians and things like that, and he makes off-the-wall statements often." However, she explained that she has not worked for several months after she claims she was fired when she reported a doctor for sexual harassment. Appellant insisted that she took good care of herself by getting food from a food bank and borrowing money from Patty.
Appellant offered into evidence two letters she had written for the judge. She accuses Charles of being angry and hostile and having an agenda against her. She believed he was drunk and laughed at her when he brought the officers to take her to the hospital. Appellant insists that she never stated she would harm herself and never intended to do so and that she is stable, responsible, and able to care for herself. She also questioned Dr. Cowan's credentials and requested another doctor.
At the end of the hearing, the trial court ordered that appellant be involuntarily committed for a period not to exceed ninety days and further ordered, after the introduction of additional evidence from another doctor, that appellant be involuntarily administered psychoactive medication. Appellant apparently spent thirty-two days in the Harris County Psychiatric Center. She has appealed the trial court's temporary commitment order, and, in ten points of error, she challenges the legal and factual sufficiency of the trial court's findings supporting the order.
Appellant appealed only the temporary commitment order and not the order to administer psychoactive medication.
We note that although appellant has already been released from temporary commitment, her legal and factual sufficiency challenges are not moot. See State v. Lodge, 608 S.W.2d 910, 912 (Tex. 1980).
Burden of Proof
On application for court-ordered temporary inpatient mental health services, the State must prove, by clear and convincing evidence, that the proposed patient is mentally ill and at least one of the following three factors:
(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.
TEX. HEALTH SAFETY CODE ANN. § 574.034(a).
"Clear and convincing evidence" means "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). Additionally, to be clear and convincing under this section, 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:
Nothing in the record indicates that appellant waived this requirement.
(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(d).
Expert opinion recommending involuntary temporary commitment must be supported by a factual basis. K.T. v. State, 68 S.W.3d 887, 893 (Tex.App.-Houston [1st Dist.] 2002, no pet.); In re Breeden, 4 S.W.3d 782, 784 (Tex.App.-San Antonio 1999, no pet.). An expert diagnosis alone is insufficient to support involuntary commitment. Breeden, 4 S.W.3d at 784.
The trial court must specify which of the above three factors forms the basis of the commitment order, and our review is limited to the one(s) actually relied upon. TEX. HEALTH SAFETY CODE ANN. § 574.034(c); Johnstone v. State, 961 S.W.2d 385, 388 (Tex.App.-Houston [1st Dist.] 1997, no writ). In this case, the trial court made findings only under the third criterion. See TEX. HEALTH SAFETY CODE ANN. § 574.034(a)(2)(C).
Standard of Review
When reviewing factual findings required to be made by clear and convincing evidence, we apply a standard of review that reflects this burden of proof. In evaluating the legal sufficiency of the evidence, we review all the evidence in the light most favorable to the finding to determine whether a reasonable factfinder could have formed a firm belief or conviction that the finding was true. In re J.F.C., 96 S.W.3d 256, 266 (Tex. 2002). In doing so, we assume the factfinder resolved disputed facts in favor of the finding if a reasonable factfinder could do so, and we disregard all evidence that a reasonable factfinder could have disbelieved or found to have been incredible. Id. In a factual sufficiency review, we must also determine whether a factfinder could reasonably form a firm belief or conviction about the truth of the allegations. Id. 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 have reasonably formed a firm belief or conviction, then the evidence is factually insufficient. Id.
J.F.C. involved termination of parental rights, but the general definition of "clear and convincing evidence" is the same for termination of parental rights as for involuntary commitment. See J.F.C., 96 S.W.3d at 263-64 nn. 16 18; Addington, 588 S.W.2d at 570. Therefore, the standard of review analysis in J.F.C. is equally applicable here.
Discussion
In her first, third, fourth, fifth, sixth, eighth, ninth, and tenth points of error, appellant challenges the legal and factual sufficiency of the findings to support the commitment order, specifically that appellant (1) suffered from severe and abnormal mental, emotional, or physical distress and (2) experienced a deterioration in her ability to function independently and provide for her basic needs, including food, clothing, health, or safety.
As to appellant's distress, the evidence shows a continuing pattern of severe and abnormal mental and emotional distress. Dr. Cowan confirmed that appellant exhibited repeated paranoid and delusional behaviors throughout the two-week period in which she had observed appellant, including accusing Dr. Cowan of taking her home and complaining about medical conditions that did not exist. Family members testified about appellant's "radical" behavior, including threatening to stop eating, accusing a doctor of removing and selling her organs, and bathing in a garbage can in her sister's driveway. Appellant's own rambling and incoherent testimony also demonstrated her mental distress, particularly regarding her belief that she still owned her home when in fact it had been foreclosed. See Broussard v. State, 827 S.W.2d 619, 622 (Tex.App.-Corpus Christi 1992, no writ) (suggesting that evidence of "continuing delusional behavior both before and during the present hospitalization" demonstrates mental distress).
In points of error two and seven, appellant challenges the legal and factual sufficiency of the evidence to support a "finding" of a recent overt act or continuing pattern of behavior regarding her distress and ability to function. However, this standard merely describes the nature of the evidence the State must provide to meet its burden of proof. Campbell v. State, 125 S.W.3d 1, 10 (Tex.App.-Houston [14th Dist.] 2002, no pet.). The trial court did not and was not required to make any such finding. Therefore, we overrule points of error two and seven. We note, however, that we analyze the evidence for a continuing pattern of behavior in conducting our legal and factual sufficiency review in this case.
The evidence also shows a continuing pattern of the deterioration of appellant's ability to function independently and provide for her basic needs. Evidence that merely demonstrates mental illness and the need for hospitalization, standing alone, will not support a temporary involuntary commitment. M.S. v. State, 137 S.W.3d 131, 136 (Tex.App.-Houston [1st Dist.] 2004, no pet.); In re C.O., 65 S.W.3d 175, 182 (Tex.App.-Tyler 2001, no pet.). Rather, the State must prove a pattern of behavior that shows an impaired ability to function independently on a day-to-day basis. See C.O., 65 S.W.3d at 182; Broussard, 827 S.W.2d at 622. The State presented such evidence. Patty testified that she had helped appellant in twenty-eight days of the past month, up to six times per day, with needs such as food and bathing. The evidence links this behavior to her delusions and mental status, not mere indigence, in that she bathed in a garbage can in her sister's driveway and she still believes she can return to her foreclosed home to live. Dr. Cowan testified that appellant's delusions and poor judgment put her personal health and safety at risk, which is further supported by testimony from her family members of unsafe driving and threatening to refuse to eat.
After reviewing the evidence in the light most favorable to the findings and disregarding all evidence a reasonable factfinder could have disbelieved and also reviewing the disputed evidence in light of the entire record, we conclude that a reasonable factfinder could have formed a firm belief or conviction that appellant (1) suffered from severe and abnormal mental or physical distress and (2) experienced a deterioration in her ability to function independently and provide for her basic needs. Therefore, the evidence is legally and factually sufficient. We overrule appellant's first, third, fourth, fifth, sixth, eighth, ninth, and tenth points of error.
Conclusion
Having determined that the evidence is legally and factually sufficient to support the findings that were the basis of the temporary commitment order, we affirm.