State

Opinion

                NO. 12-06-00317-CV

IN THE COURT OF APPEALS

TWELFTH COURT OF APPEALS DISTRICT

TYLER, TEXAS

§          APPEAL FROM THE

THE STATE OF TEXAS FOR THE

BEST INTEREST AND PROTECTION    §          COUNTY COURT AT LAW OF

OF M.S.

§          CHEROKEE COUNTY, TEXAS

MEMORANDUM OPINION

            Appellant M.S. appeals from an order to administer psychoactive medication.  After a hearing without a jury, the trial court entered an order authorizing the Texas Department of Mental Health and Mental Retardation to administer psychoactive medication to M.S.  In one issue, M.S. asserts that the evidence is legally and factually insufficient to support the order.  We affirm.

Background

            On August 8, 2006, the trial court entered an order requiring M.S. to submit to temporary inpatient mental health services.  On August 17, 2006, Dr. Robert Bouchat filed an application requesting the court order an authorization for the administration of psychoactive medication to M.S.  The application recites that M.S. suffers from schizoaffective disorder.  Dr. Bouchat indicated that M.S. verbally and by other indication refuses to take the medication voluntarily.  The doctor believes M.S. lacks the capacity to make a decision regarding administration of psychoactive medication because she is delusional, manic, often agitated, and devoid of insight.  Dr. Bouchat determined that the requested medication is the proper course of treatment for M.S. and with this treatment her prognosis is fair.  Without the requested treatment, M.S. will become more aggressive.  Medical alternatives would not be as effective as administration of psychoactive medication and the benefits of psychoactive medication outweigh the risks.

            Dr. Bouchat testified at the hearing, stating that M.S., who is receiving court ordered temporary mental health services, has refused to take her medications voluntarily and, although she recently accepted some medication that was offered to her, lacks the capacity to make a decision regarding the administration of psychoactive medications.  Dr. Bouchat testified that the medications indicated in the exhibit attached to the application are in the proper course of treatment for M.S. and in her best interest.  He stated that M.S. would likely benefit from taking these medications and the benefits outweigh the risks.  M.S.’s hospital stay would likely be shortened if medications are used.  The doctor testified that there are no less intrusive means for obtaining the same or similar results as with the psychoactive medication.

            On cross examination, Dr. Bouchat said that M.S. consented to take certain medications.  However, she does not have insight and is likely to be argumentative if any changes are made in her medication.  He explained that, while she consented to the medication, she more or less tells the staff which medications she will allow them to give her and in what doses.  Dr. Bouchat explained that she has the capacity to appreciate the need for some medication and to understand the side effects and benefits of the medication.  But she takes the medication to appease the treatment team, not to seek treatment for her mental illness.  The doctor felt that she could rescind permission at any time. After hearing Dr. Bouchat’s testimony, the trial court granted the application and entered an order to administer psychoactive medication for the period of temporary commitment.

Sufficiency of the Evidence

            In her sole issue, M.S. asserts the evidence is neither legally nor factually sufficient to support the order to administer psychoactive medication.  She contends that the State did not prove by clear and convincing evidence that she lacks the capacity to make a decision regarding administration of psychoactive medication.

Standard of Review

            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, we must consider all the evidence in the record, both in support of and contrary to the trial court’s findings.  In re C.H., 89 S.W.3d 17, 27-29 (Tex. 2002).  This court must give due consideration to evidence that the factfinder could reasonably have found to be clear and convincing.  Id. at 25.  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.  We must consider whether disputed evidence is such that a reasonable trier of fact could not have reconciled that disputed evidence in favor of its finding.  In re J.F.C., 96 S.W.3d at 266.  Appellate courts retain deference for the constitutional roles of the factfinder.  In re C.H., 89 S.W.3d at 26.  The trier of fact is the exclusive judge of the credibility of the witnesses and the weight to be given their testimony.  See id. at 27; In re J.J.O., 131 S.W.3d 618, 632 (Tex. App.–Fort Worth 2004, no pet.).

Applicable Law and Analysis

            The court may enter an order authorizing the administration of psychoactive medication if it finds by clear and convincing evidence that the patient is under an order to receive inpatient mental health services, the patient lacks the capacity to make a decision regarding the administration of the proposed medication, and treatment with the proposed medication is in the best interest of the patient.  Tex. Health & Safety Code Ann. § 574.106(a), (a-1) (Vernon Supp. 2006).  The Health and Safety Code defines capacity as a patient’s ability to understand the nature and consequences of a proposed treatment, including the benefits, risks, and alternatives to the proposed treatment, and make a decision whether to undergo the proposed treatment.  Tex. Health & Safety Code Ann. § 574.101(1) (Vernon 2003).

            Dr. Bouchat testified that M.S. was, at the time of the hearing, under an order for temporary mental health services.  He stated that M.S. suffers from schizoaffective disorder and lacks the capacity to make a decision regarding administration of psychoactive medication.  The medications are in M.S.’s best interest, the benefits outweigh the risks, and her hospital stay would be shortened if medications are used.  Dr. Bouchat stated in his application that M.S. is unable to make a decision regarding administration of psychoactive medication because she is delusional, manic, often agitated, and devoid of insight.  At the hearing, he testified that M.S. tells the staff which medications she will allow and in what doses.  The doctor explained that she does not agree to the medication in order to treat her mental illness. 

            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 M.S. lacked the capacity to make a decision regarding administration of the proposed medication and that the proposed medication is in M.S.’s best interest.  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 administration of psychoactive medication.  See Tex. Health & Safety Code Ann. § 574.106(a),(a-1).  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 M.S.’s factual sufficiency complaint, we consider all the evidence, giving due consideration to evidence the factfinder could reasonably have found to be clear and convincing.  In re C.H., 89 S.W.3d at 25.  Dr. Bouchat testified that M.S. consented to take certain medication, she has the capacity to appreciate the need for some medication, and she can understand the side effects and benefits of the medication.  However, she has not agreed to take any and all prescribed medication and she does not take medication to treat her mental illness but, rather, for an unrelated reason.  Even though she exhibits some understanding of some of the factors involved in determining the appropriateness of medication, due to the symptoms of her mental illness, she is still unable to make a decision whether to undergo the proposed treatment.  See Tex. Health & Safety Code Ann. § 574.101(1).  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 the trial court could not reasonably form a firm belief or conviction that M.S. lacks the capacity to make a decision regarding the administration of the proposed medication and that treatment with the proposed medication is in her best interest.  See In re C.H., 89 S.W.3d at 25.  Thus, the evidence is factually sufficient to support the trial court’s findings.  See Tex. Health & Safety Code Ann. § 574.106(a-1).  Because we hold the evidence is both legally and factually sufficient to support the trial court’s order, we overrule M.S.’s sole issue.

Disposition

            We affirm the trial court’s order for administration of psychoactive medication.

                                                                                                     JAMES T. WORTHEN   

                                                                                                                 Chief Justice

Opinion delivered December 20, 2006.

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

(PUBLISH)