Opinion
No. 12-05-00426-CV
Opinion delivered April 28, 2006.
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 authorizing the Texas Department of State Health Services (the "Department") to administer psychoactive medications-forensic. In one issue, J.C. asserts the evidence is legally and factually insufficient to support the trial court's order. We reverse and render.
BACKGROUND
On December 16, 2005, Dr. Laurence Taylor signed an application for an order to administer psychoactive medication-forensic to J.C. In the application, Taylor stated that J.C. was subject to an order for inpatient mental health services issued under Chapter 46B (incompetency to stand trial) of the Texas Code of Criminal Procedure. Taylor stated that J.C. had been diagnosed with paranoid schizophrenia and requested the trial court to compel J.C. to take six psychoactive medications: an antidepressant, an anxoilytic/sedative/hypnotic, three antipsychotics, and a mood stabilizer. According to Taylor, J.C. refused to take the medications voluntarily and, in his opinion, J.C. lacked the capacity to make a decision regarding administration of psychoactive medications because she exhibited "grandiosity, excessive," very poor insight and judgment, and paranoid schizophrenia.
Taylor concluded that these medications are the proper course of treatment for J.C. and that, if she were treated with the medications, her prognosis would be good. However, Taylor believed that, if J.C. were not administered the medications, her mental health would deteriorate to a more severe psychotic state. Taylor considered other medical alternatives to psychoactive medication, but determined that those alternatives would not be as effective. He believed the benefits of the psychoactive medications outweighed the risks in relation to present medical treatment and J.C.'s best interest. Taylor also considered less intrusive treatments likely to secure J.C.'s agreement to take the medications.
On December 27, the trial court held a hearing on the application. Taylor testified that he is J.C.'s treating physician and that she is currently under a Chapter 46B order (incompetency to stand trial) for inpatient mental health services. Taylor stated that J.C. has verbally, or otherwise, refused to accept medication. Taylor believes that J.C. lacks the capacity to make a decision regarding the administration of psychoactive medication. Taylor stated that he completed the application for an order to administer psychoactive medication-forensic because J.C. suffers from paranoid schizophrenia. Taylor testified that the medications listed in the exhibit attached to the application are in J.C.'s best interest and that treatment with these medications is the proper course of treatment for J.C. Taylor further stated that the benefits of these medications outweigh the risks and that J.C.'s stay in the hospital will likely be shortened if these medications are administered.
Taylor does not believe J.C. understands right from wrong. Although Taylor stated that J.C. can help in her criminal trial "up to a degree," he does not believe she is competent to assist in her defense. Taylor admitted that he discussed his desire to use these medications with J.C. and that she understood the discussion. According to Taylor, J.C. discussed her concerns about the potential side effects of these medications, such as seizures. She also informed him that she was allergic to penicillin. According to Taylor, J.C.'s fears of the potential side effects was one of the bases of her desire not to take these medications. However, he does not believe that J.C.'s interaction with him or her expression of concern was a reasonable and fair discussion. Taylor admitted that J.C. had a seizure in the past, but he did not believe it was from these medications. He also admitted that potential side effects of these medications was a reasonable concern, but that J.C. carried her concern to a point that was not appropriate. Taylor stated that J.C. would be monitored by medical staff while being given these medications and, if she suffered severe side effects, the medications would be stopped immediately. If necessary, medication would be given to counteract the side effects. Taylor testified that there were no alternatives to the use of psychoactive medications that could render the same or similar results and that J.C.'s condition would deteriorate without medication. He admitted that it is possible J.C. could improve without medication, but not probable.
J.C. testified that she spoke with Taylor regarding his desire to use medications and her concerns about taking these medications. She admitted that she understood Taylor completely and that "this" was in reference to her competency to stand trial. J.C. stated that she discussed Taylor's emergency application with him and questioned his reasons for the application because she had not caused any problems or harmed herself or others. J.C. testified that she does not take medications at all. According to J.C., she informed Taylor that she was allergic to penicillin and at least one other medication, suffering break outs and two seizures. She cannot recall the medication prescribed, but testified that she "broke out" and had to be taken to the hospital. J.C. testified that she was afraid of taking medications because she might get sick, have a seizure, and pass out. J.C. stated that she would prefer being given Pepto-Bismol instead of Tylenol, for example, because she does not consider Pepto-Bismol to be a medication.
Further, according to J.C., she does not take drugs because of her religion. J.C. stated that because of her Jewish religion, she does not put things into her body that are not healthy. She believes that taking medication affects her spirit and her relationship with God because she would not have kept her "temple" clean and pure. J.C. also testified that she believes in faith healing. According to J.C., she has not been given a diet of healthy food and testified that she has to watch what she eats. On one occasion, she informed the hospital that she believed she was having a slight seizure because of the food.
At the close of the evidence, the trial court granted the application. On December 27, after considering all the evidence, including the application and the expert testimony, the trial court found that the allegations in the application are true and correct and supported by clear and convincing evidence. Further, the trial court found that treatment with the proposed medication is in J.C.'s best interest and that J.C. lacks the capacity to make a decision regarding administration of the medication. The trial court authorized the Department to administer to J.C. psychoactive medications, including antidepressants, antipsychotics, mood stabilizers, and anxiolytics/sedatives/hypnotics. This appeal followed.
SUFFICIENCY OF THE EVIDENCE
In her sole issue, J.C. argues that the evidence is legally and factually insufficient to support the trial court's order to administer psychoactive medications. More specifically, J.C. contends that she does not lack the capacity to make a decision regarding administration of psychoactive medications and that these medications are not in her best interest. Further, J.C. argues that the trial court failed to consider her religious beliefs. 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. Order to Administer Psychoactive Medication
A trial court may issue an order authorizing the administration of one or more classes of psychoactive medications to a patient who is under a court order to receive inpatient mental health services. TEX. HEALTH SAFETY CODE ANN. § 574.106(a) (Vernon Supp. 2005). The court may issue an order if it finds, by clear and convincing evidence that (1) the patient lacks the capacity to make a decision regarding the administration of the proposed medication and (2) treatment with the proposed medication is in the best interest of the patient. Id. § 574.106(a-1). "Capacity" means a patient's ability to (1) understand the nature and consequence of a proposed treatment, including the benefits, risks, and alternatives to the proposed treatment, and (2) make a decision whether to undergo the proposed treatment. TEX. HEALTH SAFETY CODE ANN. § 574.101(1) (Vernon 2003). In making its findings, the trial court shall consider (1) the patient's expressed preferences regarding treatment with psychoactive medication, (2) the patient's religious beliefs, (3) the risks and benefits, from the perspective of the patient, of taking psychoactive medication, (4) the consequences to the patient if the psychoactive medication is not administered, (5) the prognosis for the patient if the patient is treated with psychoactive medication, (6) alternatives to treatment with psychoactive medication, and (7) less intrusive treatments likely to secure the patient's agreement to take the medication. TEX. HEALTH SAFETY CODE ANN. § 574.106(b) (Vernon Supp. 2005).
Analysis
J.C. does not dispute that the evidence is legally and factually sufficient to show that she is under an order for temporary mental health services. Thus, we will consider whether the evidence is legally and factually sufficient to support a finding that she lacked capacity to make a decision regarding the administration of psychoactive medications and that treatment with the proposed medications is in her best interest. In the application, Taylor stated that he believed J.C. lacked the capacity to make a decision regarding administration of psychoactive medications because she had "grandiosity, excessive," very poor insight and judgment, and paranoid schizophrenia. Further, Taylor determined that, if J.C. were not administered these medications, her mental health would deteriorate to a more severe psychotic state. Considering 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.C. lacked the capacity to make a decision regarding administration of the proposed medications and that treatment with the proposed medications were in her best interest. See TEX. HEALTH SAFETY CODE ANN. § 574.106(a-1); 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 finding, 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. At the hearing, Taylor testified that he did not believe J.C. understood right from wrong, nor was she competent to assist in her defense in her criminal trial. He also believed that her discussion with him regarding administration of these medications was not reasonable and fair. J.C. informed Taylor that she was allergic to penicillin and that she was concerned about the potential side effects of these medications, such as seizures. Taylor admitted that potential side effects of these medications was a reasonable concern. However, Taylor stated that J.C. carried her concern to a degree that was not appropriate. Nonetheless, Taylor testified that J.C. has suffered a seizure in the past, although he did not believe it was from these medications.
J.C. testified that she understood Taylor's discussion with her regarding administration of these medications. She discussed Taylor's application with him and why he filed it when she had not caused any problems or harmed herself or others. J.C. stated that she did not take medications at all. She informed Taylor that she was allergic to penicillin and at least one other medication. J.C. expressed her fear of taking these medications because she had suffered two seizures and was afraid of getting sick, having a seizure, and passing out. Further, J.C. testified that she did not take drugs because of her religion. According to J.C., she did not put things into her body that were not healthy. She believed taking medication would affect her spirit and her relationship with God because she would not have kept her "temple" clean and pure. J.C. was also cautious about food and complained that she had not been given a healthy diet.
J.C. stated her religious objections to taking medications. The trial court is not required to defer to J.C.'s preferences and beliefs, but must consider them. See TEX. HEALTH SAFETY CODE ANN. § 574.106(b). Because J.C. presented evidence to the trial court of her preference to avoid medications based upon her religious beliefs, it is presumed that the trial court gave her preferences and beliefs due consideration. As noted above, J.C. preferred to be treated without medications. See TEX. HEALTH SAFETY CODE ANN. § 574.106(b). Although Taylor testified that J.C. would be monitored while being given these medications, her fear of potential side effects was not unreasonable, especially considering her history of seizures and allergies to medications. From her perspective, the risks of these medications outweighed the benefits. See id. Further, the consequences of taking these medications could be severe, including more seizures. See id. J.C. understood Taylor's discussion with her regarding administration of these medications, but questioned his emergency application, observing that she had not caused problems, harmed herself, or others. See id. § 574.101(1).
Based upon J.C.'s reasoned refusal to take the proposed medications because of her history of seizures and religious objections, we conclude that the State failed to introduce clear and convincing evidence of J.C.'s lack of capacity to make a decision regarding administration of these medications or that these medications were in her best interest. The disputed evidence is so significant that the trial court could not reasonably have formed a firm belief or conviction that J.C. lacked the capacity to make a decision regarding administration of the proposed medications or that treatment with the proposed medications was in her best interest. See id. § 574.106(a-1); In re J.F.C. , 96 S.W.3d at 266. Thus, in considering all the evidence, the evidence is factually insufficient to support the trial court's finding based upon section 574.106(a-1) of the Texas Health and Safety Code. Accordingly, we sustain J.C.'s sole issue as to factual sufficiency.
CONCLUSION
Based upon our review of the record, we conclude that the evidence is factually insufficient to support the trial court's order to administer psychoactive medications-forensic. Therefore, we reverse the trial court's order and render judgment denying the State's application for an order to administer psychoactive medication-forensic.