State

• Court: Court of Appeals of Texas
• Decided: January 8, 2004
• Docket: 12-03-00242-CV
• Status: Published

Opinion

NO. 12-03-00242-CV

IN THE COURT OF APPEALS

TWELFTH COURT OF APPEALS DISTRICT

TYLER, TEXAS

THE STATE OF TEXAS FOR THE

§ APPEAL FROM THE

BEST INTEREST AND PROTECTION

§ COUNTY COURT AT LAW

OF Y.A-Y.

§ CHEROKEE COUNTY, TEXAS

MEMORANDUM OPINION

Appellant Y.A-Y. appeals from an order of commitment for temporary inpatient mental health services. After a hearing without a jury, the trial court ordered Y.A-Y. committed to Rusk State Hospital for a period not to exceed ninety days. In one issue, Y.A-Y. asserts the evidence is legally and factually insufficient to support the order. We affirm.

Background

On July 8, 2003, an application for court-ordered temporary mental health services was filed requesting the court commit Y.A-Y. to Rusk State Hospital for a period not to exceed ninety days. The application was supported by a certificate of medical examination for mental illness, prepared by a physician, Dr. Srinivasan, who had examined Y.A-Y. on July 8. Dr. Srinivisan diagnosed Y.A-Y. as suffering from Psychosis NOS. The doctor indicated that Y.A-Y. is mentally ill, is likely to cause serious harm to himself, and is suffering severe and abnormal mental, emotional or physical distress, is experiencing substantial mental or physical deterioration of his ability to function independently, and is unable to make a rational and informed decision as to whether to submit to treatment. He based this opinion on Y.A-Y.'s behavior. Y.A-Y. was mute, confused, and stared at people.

On July 9, 2003, Y.A-Y. was examined by Dr. Shakil Siddiqui who then also prepared a certificate of medical examination for mental illness. Dr. Siddiqui diagnosed Y.A-Y. as suffering from "major depression with psychosis." He found that Y.A-Y. is mentally ill and is likely to cause serious harm to himself. On July 9, 2003, Y.A-Y. said that he had stopped taking his medication, he is under a lot of stress, and he had lost ten pounds. He was feeling depressed and tired. On July 8, 2003, Y.A-Y. was mute, confused, and stared at people. For all of those reasons, Dr. Siddiqui found that Y.A-Y. presents a substantial risk of serious harm to himself or others if not immediately restrained, which was demonstrated by his behavior and by evidence of severe emotional distress and deterioration in his mental condition to the extent that he cannot remain at liberty.

Dr. Siddiqui testified at the hearing. He examined Y.A-Y. on July 9. He stated that Y.A-Y. suffers from major depression with psychosis and is likely to cause serious harm to himself. Dr. Siddiqui explained that Y.A-Y.'s depression led him to stop talking to anyone. He did not want to live any more so he stopped eating and drinking for at least four to five days, which resulted in a ten-pound weight loss. He was withdrawn from the community and was responding to internal stimuli. He was not taking his medications, was stressed due to his responsibilities at school, and wanted to die. Y.A-Y. told Dr. Siddiqui that he was feeling hopeless and worthless and he wanted to go to sleep and never wake up. Dr. Siddiqui explained that if Y.A-Y. had continued without food or water he would have continued to lose weight and his body functions might have shut down because of dehydration. The doctor's diagnosis is based on his personal examination of Y.A-Y., an examination of the medical records and history, and on reasonable medical probability. Dr. Siddiqui testified that Rusk State Hospital is the least restrictive available option for Y.A-Y. at the time.

On cross-examination, Dr. Siddiqui explained that Y.A-Y. has been eating and drinking since being admitted to the hospital and his condition is improving. The doctor believes Y.A-Y. intended to harm himself by not eating or drinking and would deteriorate upon release. Y.A-Y. is still self-conversing and still mute. He takes his medications only with prompting. He feeds himself and maintains his personal hygiene only with prompting. He can initiate conversation and respond to questions when he wants to. The doctor estimated Y.A-Y. should be hospitalized for two to three weeks. However, Y.A-Y. had been hospitalized for one week at the time of the hearing and still "looked pretty bad." He was still talking to himself, confused, and mute.

Y.A-Y. took the witness stand in his own behalf. He said a two- to three-week stay in the hospital is too long because he is in school. When asked what school, he responded that the doctor got their conversation "mixed up" when he came to the hospital. He explained that he was not eating the way he usually did. He was on a meal plan with two meals a day. He lost ten pounds because he was working out, but he never started deteriorating. He dresses himself every morning. He does not speak because he does not know these people. He stated that he thought the doctor's testimony was accurate, but he made it seem a lot more severe than it is. He explained that he missed finals and he intends to attend the second semester of summer school. He is a senior at Stephen F. Austin State University, majoring in kinesiology with a general business minor. He stated, "I don't see a problem with me." He said that, before he came to the hospital, he had stopped seeing his doctor because the doctor told him that if he took his medicine he did not have to continue seeing him. He said he does take his medicine and he does not wish to hurt himself. He explained that he works out a lot and he does not refuse to speak; he just gets quiet sometimes.

The trial court found that Y.A-Y. is mentally ill and is likely to cause serious harm to himself. The trial court entered an order reflecting these findings and ordering Y.A-Y. committed to Rusk State Hospital for inpatient care for a period not to exceed ninety days.

Sufficiency of the Evidence

In his sole issue, Y.A-Y. asserts the evidence is neither legally nor factually sufficient to support the order of commitment. He complains that Dr. Siddiqui's testimony explaining why he thought Y.A-Y. is likely to cause serious harm to himself does not provide the necessary factual bases upon which his opinion is grounded. He contends that this evidence does not show an overt act or continuing pattern of behavior tending to confirm that Y.A-Y. is likely to cause serious harm to himself. Thus, he argues, the State failed to meet its evidentiary burden under the statute.

In a legal sufficiency review where the burden of proof is clear and convincing evidence, the reviewing court must consider 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 that its finding was true. In re J.F.C., 96 S.W.3d 256, 266 (Tex. 2002). The reviewing court must assume that the factfinder resolved disputed facts in favor of its finding if a reasonable factfinder could do so. Id. A court should disregard all evidence that a reasonable factfinder could have disbelieved or found to have been incredible. Id.

In addressing a factual sufficiency of the evidence challenge, this court must give due consideration to evidence that the factfinder could reasonably have found to be clear and convincing. In re C.H., 89 S.W.3d 17, 25 (Tex. 2002). We must determine whether the evidence is such that a factfinder could reasonably form a firm belief or conviction about the truth of the State's 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 reasonably have formed a firm belief or conviction, then the evidence is factually insufficient." In re J.F.C., 96 S.W.3d at 267.

The trial judge may order a proposed patient to receive court-ordered temporary inpatient mental health services if the judge or jury finds, from clear and convincing evidence, that the proposed patient is mentally ill and, as a result of the mental illness he is likely to cause serious harm to himself, is likely to cause serious harm to others, or is (i) suffering severe and abnormal mental, emotional, or physical distress, (ii) experiencing substantial mental or physical deterioration of his ability to function independently, which is exhibited by his inability, except for reasons of indigence, to provide for his 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) (Vernon 2003). To be clear and convincing under this statute, 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 either the likelihood of serious harm to the proposed patient or others, or the proposed patient's distress and the deterioration of his ability to function. Tex. Health & Safety Code Ann. § 574.034(d) (Vernon 2003).

The State provided expert testimony explaining that Y.A-Y. is mentally ill and describing his behavior and some specific acts. On the day he arrived at the hospital, Y.A-Y. was mute, confused, and merely stared at people. On the following day, he told Dr. Siddiqui that he had stopped taking his medication and was depressed. The depression caused him to stop talking and withdraw from the community. Moreover, Y.A-Y. was so depressed he no longer wanted to live. The essence of the testimony is that he attempted to take his own life by starving himself to death. Even if the attempt is not successful, failing to eat for days at a time is likely to cause serious harm including the loss of body functions. This is expert testimony of an overt act that tends to confirm the likelihood of serious harm to Y.A-Y.

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 these findings were true. See In re J.F.C., 96 S.W.3d at 266. This evidence satisfies the statutory requirement for clear and convincing evidence in support of the order for temporary inpatient mental health services. See Tex. Health & Safety Code Ann. § 574.034(d). The evidence is legally sufficient to support the trial court's order. See In re J.F.C., 96 S.W.3d at 266.

In addressing Y.A-Y.'s factual sufficiency complaint, we consider the evidence the factfinder could reasonably have found to be clear and convincing. In re C.H., 89 S.W.3d at 25. There is some evidence that Y.A-Y. had a place to live and was still interested in attending college. The evidence shows Y.A-Y. can feed himself and take care of his personal hygiene without assistance but requires prompting to do so. He can initiate conversation and respond to conversation when he wants to. He admitted that Dr. Siddiqui's testimony was accurate, but denied having a problem. He also said he does take his medicine and denied wanting to hurt himself. In light of the entire record, the evidence that the trial court could not have credited in favor of its findings is not so significant that it could not reasonably form a firm belief or conviction that Y.A-Y. is mentally ill and is likely to cause serious harm to himself. See id. Thus, the evidence is factually sufficient to support the trial court's findings. Because we hold the evidence is both legally and factually sufficient to support the trial court's order, we overrule Y.A-Y.'s sole issue.

Conclusion

The evidence is legally and factually sufficient to support the trial court's order of commitment for temporary inpatient mental health services.

We affirm the trial court's order of commitment for temporary inpatient mental health services.

SAM GRIFFITH

Justice

Opinion delivered January 8, 2004.

Panel consisted of Worthen, C.J., Griffith, J., and DeVasto, J.

(PUBLISH)