Opinion
No. 14-04-00689-CV
Memorandum Opinion filed October 27, 2005.
On Appeal from the 232nd District Court, Harris County, Texas, Trial Court Cause No. 877,816.
Affirmed.
Panel consists of Justices HUDSON, FROST, and SEYMORE.
MEMORANDUM OPINION
Appellant, Robert Louis Martin, appeals from a recommitment order extending inpatient mental health services for a period of one year. In two issues, appellant challenges the legal and factual sufficiency of the evidence to support the order. Because all dispositive issues are clearly settled in law, we issue this memorandum opinion and affirm. See TEX. R. APP. P. 47.4
I. BACKGROUND
In May 2001, appellant stabbed a cab driver with a knife several times in the chest and back causing serious, but nonfatal, injuries. Appellant was arrested and charged with aggravated assault. Following a bench trial, the trial court found appellant not guilty by reason of insanity, and ordered that he be committed to the maximum security unit at the North Texas State Hospital. Subsequently, the commitment order was extended four times. The most recent extension, in June of 2004, forms the basis of this appeal.
II. STATUTORY REQUIREMENTS FOR COMMITMENT
Commitment proceedings concerning persons who have been found not guilty by reason of insanity are civil in nature. Campbell v. State, 85 S.W.3d 176, 180 (Tex. 2002). A court may renew an order for inpatient mental health services if it finds the patient meets the criteria for involuntary commitment set forth in section 574.035(a) of the Texas Health and Safety Code. See TEX. HEALTH SAFETY CODE ANN. 574.066(f) (Vernon 2003) (specifying the procedure for the renewal of an order for extended mental health services).
Pursuant to Section 574.035(a), the court may order extended inpatient mental health services if the trier of fact finds, by clear and convincing evidence, that among other requirements, the proposed patient meets the following criteria:
(1) the proposed patient is mentally ill; and
(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. § 574.035(a) (Vernon 2003).
The court must also find that the proposed patient's condition is expected to continue for more than 90 days. TEX. HEALTH SAFETY CODE ANN. § 574.035(a)(3), 574.066(f) (Vernon 2003). However, here, appellant does not challenge the court's finding on this requirement.
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). In order to be clear and convincing under section 574.035(a), the evidence must also 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. § 574.035(e) (Vernon 2003).
III. SUFFICIENCY OF THE EVIDENCE
The judge or jury must specify which criterion under the Texas Health and Safety Code forms the basis for the recommitment order. Tex. Health Safety Code Ann. § 574.035(c) (Vernon 2003). In this case, the jury found that appellant met two criteria for recommitment: (1) he was likely to cause serious harm to others; and (2) he was suffering severe and abnormal distress, experiencing substantial deterioration of his ability to function independently, and was unable to make a rational decision concerning treatment.
Appellant contests the legal and factual sufficiency of the evidence to support both findings. Specifically, appellant contends that the State failed to show any recent overt act or continuing pattern of behavior that tended to confirm either the likelihood of serious harm to others, or his distress and inability to function. We conclude the evidence is legally and factually sufficient to support the finding that appellant was likely to cause serious harm to others. A. Legal Sufficiency
Because we conclude the evidence is legally and factually sufficient to support the jury's finding that appellant is likely to cause serious harm to others, we need not address his challenge to the sufficiency of the evidence to support the jury's finding concerning distress and ability to function. See TEX. HEALTH SAFETY CODE ANN. § 574.035(a)(2); In re R.M., 90 S.W.3d 909, 912 (Tex.App.-San Antonio 2002, no pet.) (terminating the analysis after holding the evidence was sufficient to support a finding under the first statutory criterion).
When the burden of proof is heightened to clear and convincing evidence, the standards of review for both legal and factual sufficiency of the evidence are also heightened. City of Keller v. Wilson, 168 S.W.3d 802, 817 (Tex. 2005); Campbell v. State, 68 S.W.3d 747, 758-59 (Tex.App.-Houston [14th Dist.] 2001), aff'd 85 S.W.3d 176 (Tex. 2002) (noting the heightened standard is required to protect the rights of the individual). In reviewing the evidence for legal sufficiency, we must look at all of 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 as to the truth of its finding. In re J.F.C., 96 S.W.3d 256, 266 (Tex. 2002) (applying heightened standard to review legal sufficiency of the evidence). We must assume that the factfinder resolved disputed facts in favor of the finding if a factfinder could reasonably do so, and disregard any evidence that the factfinder could have reasonably disbelieved or found incredible. Id.
The State's sole witness at the June 2004 recommitment hearing was JoAnna Sanchez, M.D., appellant's treating psychiatrist at North Texas State Hospital. Based on her evaluation, Dr. Sanchez diagnosed appellant with schizophrenia, paranoid type, with persecutory delusions. She testified that appellant had a very bizarre delusional system, and high risk factors for future violent behavior. However, expert diagnosis alone is not enough to support an order for involuntary commitment. Moss v. State, 539 S.W.2d 936, 949-51 (Tex.Civ.App.-Dallas 1976, no writ). Nor is the bare expert opinion of a "potential danger" to others, or a mere "possibility" of serious harm to others sufficient evidence to support commitment. Broussard v. State, 827 S.W.2d 619, 622 (Tex.App.-Corpus Christi 2002, no pet.). Expert opinion must be supported by the factual basis on which it is grounded. Moss, 539 S.W.2d at 950.
Here, Dr. Sanchez described in detail the factual basis for her opinion. She testified regarding two recent overt acts of violence which tended to confirm the likelihood of serious harm to others. In one incident, appellant retaliated after he was struck by a more severely impaired patient. Appellant inflicted a "golf ball size bump" and a half-inch laceration on the other patient's head. According to Dr. Sanchez, the other patient had already been physically restrained, and no longer posed a threat to appellant when appellant retaliated. Dr. Sanchez stated that the patient, who allegedly killed both of his parents, was so impaired that even the other patients in the unit recognize him as being severely impaired and do not react violently to him. In addition, Dr. Sanchez described appellant's reaction as overbroad and out of control. She concluded from the incident that appellant continued to pose a risk of violence.
Dr. Sanchez also described an incident in which appellant had "pummeled" a mental health care worker. She stated that appellant believed the worker was "out to get him" and putting pins or needles in his eyes. She also stated that the mental health care worker had no reason to suspect that appellant would attack and hit him several times. Further, appellant still believed the worker was a threat to him after the incident when the worker was moved to a different area.
The record reflects that the two overt acts of violence described by Dr. Sanchez occurred in a maximum security state hospital within three months prior to the hearing. Viewing the evidence in the light most favorable to the finding, and disregarding contrary evidence the jury could have reasonably disbelieved, we conclude that the jury could have formed a firm belief or conviction that appellant was likely to cause serious injury to others if released from the hospital. Accordingly, we overrule appellant's first issue.
B. Factual Sufficiency
In a factual sufficiency review under the heightened clear and convincing standard, we must also determine whether a reasonable trier of fact could have formed a firm belief or conviction as to the truth of its finding. In re C.H., 89 S.W.3d 17, 25 (Tex. 2002). If, however, the disputed evidence is so significant that a fact finder could not have reasonably formed a firm belief or conviction, then the evidence is factually insufficient. In re J.F.C., 96 S.W.3d at 266.
Appellant did not testify on his own behalf or offer any evidence. To support his sufficiency challenge, he notes that on cross-examination Dr. Sanchez indicated that she was not present at the time of either violent incident and relied on the reports of others. However, we find that the lack of corroborating evidence as to these incidents is not so significant that it would prevent a factfinder from forming a firm belief or conviction as to the likelihood of harm to others. See Roland v. State, 989 S.W.2d 797, 799-802 (Tex.App.-Fort Worth 1999, no pet.) (holding testimony of one psychiatrist sufficient to support recommitment order).
Dr. Sanchez also testified that appellant had not retaliated on two other occasions after he had been assaulted. However, we need not decide whether the absence of a violent reaction in response to provocation constitutes a break in an otherwise continuing pattern of violent behavior. Either a continuing pattern of behavior or a recent overt act is sufficient to meet the clear and convincing standard set forth by the Texas Health and Safety Code. TEX. HEALTH SAFETY CODE ANN. § 574.035(e). Dr. Sanchez's testimony demonstrated that Martin attacked a health care worker and another patient within three months prior to the hearing. Both of these incidents are recent overt acts tending to confirm the likelihood of serious harm to others. Accordingly, we overrule appellant's second issue.
The judgment of the trial court is affirmed