NUMBER 13-20-00460-CV
COURT OF APPEALS
THIRTEENTH DISTRICT OF TEXAS
CORPUS CHRISTI - EDINBURG
IN THE INTEREST OF M.W.M., AN ADULT
On appeal from the 54th District Court of McLennan County, Texas.
MEMORANDUM OPINION Before Justices Benavides, Longoria, and Tijerina Memorandum Opinion by Justice Benavides
By three issues, appellant M.W.M. 1 challenges the trial court’s order of
recommitment to a state mental hospital. M.W.M. argues that (1) he established
entitlement to outpatient treatment, (2) the evidence was factually insufficient to support
the trial court’s inpatient order, and (3) the trial court cannot renew an inpatient
commitment order without a renewal request. We reverse and remand.
1 To protect the identity of the appellant, we refer to him by aliases, as necessary. See TEX. R. APP. P. 9.8(b). I. BACKGROUND2
M.W.M. was charged with unauthorized use of a vehicle on May 23, 2019, a state
jail felony.3 See TEX. PENAL CODE ANN. § 31.07. Following his indictment, M.W.M. filed
his notice of intent to raise the affirmative defense of not guilty by reason of insanity. See
TEX. CODE CRIM. PROC. ANN. art. 46C.051. On February 7, 2020, following an examination
by a psychiatrist, the trial court found that M.W.M. was insane at the time of the offense,
found him not guilty of the offense as alleged, and ordered M.W.M. to be committed to a
state hospital.
After an initial thirty-day assessment period at the state hospital, the psychiatrist
treating M.W.M. recommended further hospitalization to the trial court. The trial court held
a hearing on April 3, 2020 and ordered M.W.M. to be committed for a period of 181 days,
pursuant to code of criminal procedure article 45C.256. See id. art. 46C.256. That period
of commitment expired on September 30, 2020.
Prior to the expiration of M.W.M.’s inpatient commitment, representatives from the
state hospital and local mental health authority filed an “Outpatient Management Plan”
with the trial court. Combined with the management plan was a forensic evaluation
conducted on August 20, 2020 by a treating psychologist at the state hospital. A hearing
was conducted on September 17, 2020 to determine if M.W.M. should be placed in
outpatient treatment. The trial court deferred its ruling, asking for the parties to gather
2 This case is before this Court on transfer from the Tenth Court of Appeals in Waco pursuant to a
docket equalization order issued by the Supreme Court of Texas. See TEX. GOV’T CODE ANN. § 73.001.
3 A state jail felony has a maximum punishment range of two years imprisonment. See TEX. PENAL CODE ANN. § 12.35. 2 more information regarding a previous offense for which M.W.M. was on parole. On
September 24, 2020, the hearing reconvened and M.W.M.’s counsel notified the trial court
that M.W.M’s parole was reinstated. However, the trial court decided, after reviewing the
documents provided, that M.W.M was a “danger to himself or others” and recommitted
M.W.M. to the state hospital for further inpatient treatment.
On September 29, 2020, the trial court held a hearing on M.W.M’s motion to
reconsider its ruling requiring inpatient treatment. M.W.M. presented Feroza Talukdar,
M.D., a psychiatrist who examined M.W.M while he was a patient at the state hospital.
Dr. Talukdar testified that M.W.M has schizoaffective disorder, bipolar type. She
explained that M.W.M. took multiple medications to control his disorders, including
Risperdal Consta, a biweekly injection that only a doctor or nurse could give him. Dr.
Talukdar stated M.W.M. had no substance abuse issues at the state hospital and it was
a very structured environment.
Dr. Lyndsay Brooks, a psychologist at the state hospital, conducted a risk
assessment on M.W.M. She explained she looked at M.W.M’s past hospitalizations and
risk factors in evaluating him. Dr. Brooks evaluated M.W.M. in August 2020 and believed
he had gained insight into his mental health issues. For example, M.W.M. appreciated
that he was at a higher risk if not stable on his medications, was aware that stopping his
medication cause “issues,” and had personally requested the Risperdal injections to help
with his condition. Dr. Brooks stated that M.W.M.’s psychiatric symptoms had been stable
for four months, he was medication compliant, he had significant social support, and she
felt a safe discharge plan had been developed. She stated that M.W.M. was able to voice
3 possible alternatives if any problems arose in his outpatient treatment and she felt that if
he remained compliant with the outpatient treatment plan, there was a low risk of M.W.M.
becoming violent. Dr. Brooks agreed that if factors changed such as M.W.M becoming
homeless, not being medicine compliant, or abusing drugs, then the level of risk would
increase and there was no way the doctors could predict the future.
Kaylee Crawford, a social worker for the state hospital, also testified. Crawford
stated that M.W.M. attended the required programs while in inpatient treatment and
volunteered to lead a substance abuse class as his treatment progressed. Crawford was
the individual who collected the documents to send to the trial court for updates, and she
stated there were no renewal documents filed, she did not know of a renewal plan to send
M.W.M. back to the state hospital, and none of the documents she reviewed indicated a
need for inpatient hospitalization. Crawford explained that in order for M.W.M. to be
returned back to inpatient treatment, he would need another evaluation conducted by the
local mental health authority to assess his risk level and determine if he was a candidate
for inpatient treatment.
The trial court declined to change its ruling and recommitted M.W.M. to inpatient
treatment at a state hospital facility for a period of 180 days. This appeal followed.
II. CONTINUING COMMITMENT TO STATE MENTAL HEALTH FACILITY
By his three issues, M.W.M. challenges his re-commitment to a state mental health
facility. He argues he established entitlement to outpatient treatment, the evidence was
factually insufficient to support the trial court’s inpatient recommitment order, and the trial
court could not renew inpatient commitment without the proper documentation from the
4 state hospital.
A. Standard of Review
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).
When the burden of proof is heightened to a clear and convincing standard, as is the case
for commitment proceedings following a finding of not guilty by reason of insanity, the
sufficiency of the evidence standards of review are also heightened. Truong v. State, 574
S.W.3d 511, 519 (Tex. App.—Houston [1st Dist.] 2019, no pet.). In conducting a factual
sufficiency review, the reviewing court gives due consideration to evidence that the
factfinder reasonably could have found to be clear and convincing. In re J.F.C., 96 S.W.3d
256, 266 (Tex. 2002). The ultimate inquiry is whether a reasonable factfinder could have
resolved disputed evidence in favor of the finding. Id. The reviewing court must avoid
supplanting its own judgment in place of the factfinder’s judgment. In re H.R.M., 209
S.W.3d 105, 108 (Tex. 2006); House v.
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NUMBER 13-20-00460-CV
COURT OF APPEALS
THIRTEENTH DISTRICT OF TEXAS
CORPUS CHRISTI - EDINBURG
IN THE INTEREST OF M.W.M., AN ADULT
On appeal from the 54th District Court of McLennan County, Texas.
MEMORANDUM OPINION Before Justices Benavides, Longoria, and Tijerina Memorandum Opinion by Justice Benavides
By three issues, appellant M.W.M. 1 challenges the trial court’s order of
recommitment to a state mental hospital. M.W.M. argues that (1) he established
entitlement to outpatient treatment, (2) the evidence was factually insufficient to support
the trial court’s inpatient order, and (3) the trial court cannot renew an inpatient
commitment order without a renewal request. We reverse and remand.
1 To protect the identity of the appellant, we refer to him by aliases, as necessary. See TEX. R. APP. P. 9.8(b). I. BACKGROUND2
M.W.M. was charged with unauthorized use of a vehicle on May 23, 2019, a state
jail felony.3 See TEX. PENAL CODE ANN. § 31.07. Following his indictment, M.W.M. filed
his notice of intent to raise the affirmative defense of not guilty by reason of insanity. See
TEX. CODE CRIM. PROC. ANN. art. 46C.051. On February 7, 2020, following an examination
by a psychiatrist, the trial court found that M.W.M. was insane at the time of the offense,
found him not guilty of the offense as alleged, and ordered M.W.M. to be committed to a
state hospital.
After an initial thirty-day assessment period at the state hospital, the psychiatrist
treating M.W.M. recommended further hospitalization to the trial court. The trial court held
a hearing on April 3, 2020 and ordered M.W.M. to be committed for a period of 181 days,
pursuant to code of criminal procedure article 45C.256. See id. art. 46C.256. That period
of commitment expired on September 30, 2020.
Prior to the expiration of M.W.M.’s inpatient commitment, representatives from the
state hospital and local mental health authority filed an “Outpatient Management Plan”
with the trial court. Combined with the management plan was a forensic evaluation
conducted on August 20, 2020 by a treating psychologist at the state hospital. A hearing
was conducted on September 17, 2020 to determine if M.W.M. should be placed in
outpatient treatment. The trial court deferred its ruling, asking for the parties to gather
2 This case is before this Court on transfer from the Tenth Court of Appeals in Waco pursuant to a
docket equalization order issued by the Supreme Court of Texas. See TEX. GOV’T CODE ANN. § 73.001.
3 A state jail felony has a maximum punishment range of two years imprisonment. See TEX. PENAL CODE ANN. § 12.35. 2 more information regarding a previous offense for which M.W.M. was on parole. On
September 24, 2020, the hearing reconvened and M.W.M.’s counsel notified the trial court
that M.W.M’s parole was reinstated. However, the trial court decided, after reviewing the
documents provided, that M.W.M was a “danger to himself or others” and recommitted
M.W.M. to the state hospital for further inpatient treatment.
On September 29, 2020, the trial court held a hearing on M.W.M’s motion to
reconsider its ruling requiring inpatient treatment. M.W.M. presented Feroza Talukdar,
M.D., a psychiatrist who examined M.W.M while he was a patient at the state hospital.
Dr. Talukdar testified that M.W.M has schizoaffective disorder, bipolar type. She
explained that M.W.M. took multiple medications to control his disorders, including
Risperdal Consta, a biweekly injection that only a doctor or nurse could give him. Dr.
Talukdar stated M.W.M. had no substance abuse issues at the state hospital and it was
a very structured environment.
Dr. Lyndsay Brooks, a psychologist at the state hospital, conducted a risk
assessment on M.W.M. She explained she looked at M.W.M’s past hospitalizations and
risk factors in evaluating him. Dr. Brooks evaluated M.W.M. in August 2020 and believed
he had gained insight into his mental health issues. For example, M.W.M. appreciated
that he was at a higher risk if not stable on his medications, was aware that stopping his
medication cause “issues,” and had personally requested the Risperdal injections to help
with his condition. Dr. Brooks stated that M.W.M.’s psychiatric symptoms had been stable
for four months, he was medication compliant, he had significant social support, and she
felt a safe discharge plan had been developed. She stated that M.W.M. was able to voice
3 possible alternatives if any problems arose in his outpatient treatment and she felt that if
he remained compliant with the outpatient treatment plan, there was a low risk of M.W.M.
becoming violent. Dr. Brooks agreed that if factors changed such as M.W.M becoming
homeless, not being medicine compliant, or abusing drugs, then the level of risk would
increase and there was no way the doctors could predict the future.
Kaylee Crawford, a social worker for the state hospital, also testified. Crawford
stated that M.W.M. attended the required programs while in inpatient treatment and
volunteered to lead a substance abuse class as his treatment progressed. Crawford was
the individual who collected the documents to send to the trial court for updates, and she
stated there were no renewal documents filed, she did not know of a renewal plan to send
M.W.M. back to the state hospital, and none of the documents she reviewed indicated a
need for inpatient hospitalization. Crawford explained that in order for M.W.M. to be
returned back to inpatient treatment, he would need another evaluation conducted by the
local mental health authority to assess his risk level and determine if he was a candidate
for inpatient treatment.
The trial court declined to change its ruling and recommitted M.W.M. to inpatient
treatment at a state hospital facility for a period of 180 days. This appeal followed.
II. CONTINUING COMMITMENT TO STATE MENTAL HEALTH FACILITY
By his three issues, M.W.M. challenges his re-commitment to a state mental health
facility. He argues he established entitlement to outpatient treatment, the evidence was
factually insufficient to support the trial court’s inpatient recommitment order, and the trial
court could not renew inpatient commitment without the proper documentation from the
4 state hospital.
A. Standard of Review
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).
When the burden of proof is heightened to a clear and convincing standard, as is the case
for commitment proceedings following a finding of not guilty by reason of insanity, the
sufficiency of the evidence standards of review are also heightened. Truong v. State, 574
S.W.3d 511, 519 (Tex. App.—Houston [1st Dist.] 2019, no pet.). In conducting a factual
sufficiency review, the reviewing court gives due consideration to evidence that the
factfinder reasonably could have found to be clear and convincing. In re J.F.C., 96 S.W.3d
256, 266 (Tex. 2002). The ultimate inquiry is whether a reasonable factfinder could have
resolved disputed evidence in favor of the finding. Id. The reviewing court must avoid
supplanting its own judgment in place of the factfinder’s judgment. In re H.R.M., 209
S.W.3d 105, 108 (Tex. 2006); House v. State, 261 S.W.3d 244, 247 (Tex. App.—Houston
[14th Dist.] 2008, no pet.).
B. Applicable Law
Texas Code of Criminal Procedure Chapter 46C governs the raising of the insanity
defense, the determination of a defendant’s sanity, and the disposition of a defendant
after a finding of not guilty by reason of insanity. See TEX. CODE CRIM. PROC. ANN. art.
46C. If a defendant is found not guilty by reason of insanity (“an acquitted person”), the
trial court shall determine whether the charged offense involved conduct that (1) caused
serious bodily injury to another person, (2) placed another person in imminent danger of
5 serious bodily injury, or (3) consisted of a threat of serious bodily injury to another person
through the use of a deadly weapon. Id. art. 46C.157; Truong, 574 S.W.3d at 519–20. If
the court determines that the offense involved conduct that caused serious bodily injury
to another person, the court retains jurisdiction over the acquitted person until either the
court discharges the person and terminates its jurisdiction or the cumulative total period
of institutionalization and outpatient or community-based treatment and supervision
equals the maximum term provided by law for the offense of which the person was
acquitted by reason of insanity. TEX. CODE CRIM. PROC. ANN. art. 46C.158.
In situations in which the court makes a finding that the offense involved dangerous
conduct, the court shall order the acquitted person to be committed for a period not to
exceed thirty days in order to evaluate the person’s present mental condition and to
determine the “proper disposition of the acquitted person,” such as whether inpatient
treatment is necessary or whether outpatient treatment is appropriate. Id. art. 46C.251(a),
(d). The trial court must hold a disposition hearing within thirty days of acquittal. Id. art.
46C.251(d). At the hearing, the court must address (1) whether the acquitted person has
a severe mental illness or mental retardation; (2) whether as a result of any mental illness
or mental retardation the person is likely to cause serious harm to another; and (3)
whether appropriate treatment and supervision can be safely and effectively provided as
outpatient or community-based treatment and supervision. Id. art. 46C.253(b).
The trial court shall order the acquitted person committed to a mental hospital for
inpatient treatment or residential care if the State establishes by clear and convincing
evidence that:
6 (1) the person has a severe mental illness or mental retardation;
(2) the person, as a result of that mental illness or mental retardation, is likely to cause serious bodily injury to another if the person is not provided with treatment and supervision; and
(3) inpatient treatment or residential care is necessary to protect the safety of others.
Id. art. 46C.256(a). In determining whether the State has proved that inpatient treatment
is necessary, the court shall consider whether the evidence shows both that (1) an
adequate regimen of outpatient or community-based treatment will be available to the
acquitted person; and (2) the person will follow that regimen. Id. art. 46C.256(b). An order
for commitment to inpatient treatment expires on the 181st day after the date the order is
issued, but it is subject to renewal as provided by statute. Id. art. 46C.256(c).
A trial court that orders an acquitted person committed to inpatient treatment shall
determine on an annual basis whether to renew the order. Id. art. 46C.261(a). At least
thirty days before the order is scheduled to expire, the institution to which the acquitted
person is committed or the State may request that the commitment order be
renewed. Id. art. 46C.261(b). The request must explain in detail why renewal is being
requested and why outpatient or community-based treatment and supervision is not
appropriate. Id. The court “shall renew the order only if the court finds that the party who
requested the renewal has established by clear and convincing evidence that continued
mandatory supervision and treatment are appropriate.” Id. art. 46C.261(h). The court may
modify the order to provide for outpatient treatment “if the court finds the acquitted person
has established by a preponderance of the evidence that treatment and supervision can
be safely and effectively provided as outpatient or community-based treatment and
7 supervision.” Id. art. 46C.261(i). A renewed order authorizes inpatient or outpatient
treatment for not more than one year. Id. art. 46C.261(h).
The trial court may order an acquitted person to participate in outpatient treatment
on renewal of a commitment order under article 46C.261. Id. art. 46C.263(a). The court
may order the acquitted person to participate in outpatient treatment only if (1) the court
receives and approves an outpatient treatment plan that comprehensively provides for
the outpatient treatment and supervision, and (2) the court finds that the outpatient
treatment provided for by the plan will be available and provided to the acquitted
person. Id. art. 46C.263(b). If the trial court signs an order requiring the acquitted person
to participate in outpatient treatment, the order “must identify the person responsible for
administering an ordered regimen of outpatient or community-based treatment and
supervision.” Id. art. 46C.263(f). “In determining whether an acquitted person should be
ordered to receive outpatient or community-based treatment and supervision rather than
inpatient care or residential treatment, the court shall have as its primary concern the
protection of society.” Id. art. 46C.263(g). An acquitted person may appeal from an order
renewing inpatient commitment entered under article 46C.261. Id. art. 46C.270(b)(3).
C. Discussion
In order to determine whether inpatient treatment is “appropriate” in the context of
renewing an inpatient commitment order, the trial court must necessarily consider
whether the acquitted person continues to meet the requirements for inpatient treatment
as set out in articles 46C.253 and 46C.256. The trial court’s findings stated:
The Court hereby FINDS, from clear and convincing evidence, that:
8 (1) the acquitted person has a severe mental illness or, as a result of that mental illness, the acquitted person is likely to cause serious bodily injury or serious harm to another if the acquitted person is not provided treatment and supervision;
(2) the appropriate treatment and supervision for the acquitted person’s mental illness cannot be safely or effectively provided as outpatient or community-based treatment and supervision; and
(3) inpatient treatment or residential care is necessary to protect the safety of others.
The Court further FINDS:
(1) Continued mandatory supervision and treatment are appropriate;
(2) The defense counsel, has not established by a preponderance of the evidence that care and treatment can be effectively provided through out- patient and community-based supervision;
(1) That modifying to outpatient would not comport to the best interest of society.
All of the evidence presented to the trial court in M.W.M’s case supported a release
into outpatient treatment. The State did not request recommitment and presented no
witnesses and no evidence to support a request for recommitment.4 All of the testimony
and evidence presented showed that although M.W.M. did have prior criminal history, the
progress he made while committed at the state hospital was positive and his witnesses
all testified as much. Also submitted to the trial court was the Texas Health and Human
Services outpatient management plan for M.W.M., which established that the Heart of
Texas Mental Health and Mental Retardation (the local mental health authority) would
arrange for a psychiatric assessment with its psychiatrist within ten days of discharge
4 The State did not submit a brief to assist the Court with the disposition of this case. 9 from the state hospital. The local mental health authority also previously determined that
it would be able to follow M.W.M’s scheduled medicine monitoring and treatment plan
and would notify the trial court to any changes that would be required. The management
plan also stated that M.W.M. would be seen “at least monthly” by the psychiatrist. The
plan also had in place a qualified mental health professional which would be assigned to
M.W.M. to help with any services he needed, including at the least bi-weekly
appointments. M.W.M. would also receive housing assistance through the Heart of Texas
Supportive Rental Assistance program for at least one year, as well as be set up for social
security disability assistance. The management plan required M.W.M. to submit to
random drug and alcohol testing due to his past history and attend alcohol and drug
meetings weekly. If there were any changes to M.W.M.’s situation, the plan stated that a
risk assessment would be conducted and if needed, the trial court and District Attorney’s
Office would be immediately notified.
No evidence was presented that supported the trial court’s determination that
M.W.M.’s mental illness could not be treated on an outpatient basis. According to the
testimony, M.W.M. was compliant during his hospitalization with all requests and
medication, he willingly participated in the services offered to him and even volunteered
to lead a substance abuse class that required him to share his experiences, became self-
aware of his illness and its triggers, and could verbalize alternative scenarios if necessary
if released to outpatient case. The only evidence presented of any continuing “threat” to
society was that each doctor testified that they could not “predict” the future; if M.W.M.
did not comply with the medication requirements and returned to drug and alcohol abuse,
10 then his risk level would be elevated.
However, a future possible risk does not rise to a clear and convincing standard
as required in commitment cases. See In re J.F.C., 96 S.W.3d at 266. The State brought
forward no evidence, other than historical, to show that M.W.M.’s outpatient treatment
plan would be ineffective at keeping the community safe. The trial court “cannot make a
finding to the contrary simply because inpatient care may be more reliable than outpatient
care.” Rodriquez v. State, 525 S.W.3d 734, 743 (Tex. App.—Houston [14th Dist.] 2017,
no pet.). The trial court did not have sufficient evidence to recommit M.W.M. to inpatient
treatment based on the evidence presented. We sustain M.W.M.’s second issue.5
III. CONCLUSION
We reverse the trial court’s commitment order and remand to the trial court for
proceedings consistent with this memorandum opinion.
GINA M. BENAVIDES Justice
Delivered and filed on the 25th day of February, 2021.
5 Because M.W.M.’s second issue is dispositive, we need not address his remaining issues. See TEX. R. APP. P. 47.1. 11