Fourth Court of Appeals San Antonio, Texas MEMORANDUM OPINION No. 04-13-00192-CV & 04-13-00193-CV
THE STATE OF TEXAS FOR THE BEST INTEREST AND PROTECTION OF S.S.
From the Probate Court No. 1, Bexar County, Texas Trial Court Nos. 2013-MH-0591 & 2013-MH-0659 Honorable Polly Jackson Spencer, 1 Judge Presiding
Opinion by: Rebeca C. Martinez, Justice
Sitting: Sandee Bryan Marion, Justice Rebeca C. Martinez, Justice Luz Elena D. Chapa, Justice
Delivered and Filed: May 14, 2014
AFFIRMED
The trial court found that appellant S.S. was mentally ill and met the criteria for court-
ordered temporary mental health services, and ordered appellant to be temporarily committed for
inpatient mental health services pursuant to section 574.034 of the Texas Health and Safety Code.
By separate order, the court authorized treatment with psychoactive medications during appellant’s
temporary commitment. Appellant appeals from both orders, challenging the legal and factual
sufficiency of the trial court’s findings. We affirm the trial court’s orders.
1 The Honorable Oscar Kazen presided over the hearing and verbally made the rulings on the underlying applications. The Honorable Polly Jackson Spencer signed the written orders. 04-13-00192-CV & 04-13-00193-CV
STANDARD OF REVIEW
To obtain either an order for temporary commitment or an order to administer psychoactive
medication, the State must prove its case by clear and convincing evidence. See TEX. HEALTH &
SAFETY CODE ANN. § 574.034(a) (West Supp. 2013), § 574.106(a-l) (West 2010). Because the
State’s burden of proof is clear and convincing evidence, we apply a heightened standard of review
to sufficiency-of-the-evidence challenges. See In re C.H., 89 S.W.3d 17, 25 (Tex. 2002). When
reviewing the legal sufficiency of the evidence in a case requiring proof by clear and convincing
evidence, we determine whether the evidence is such that a factfinder could reasonably form 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). We review all the evidence in the light most
favorable to the finding to determine whether a reasonable factfinder could have formed a firm
belief or conviction that the finding was true. State v. K.E.W., 315 S.W.3d 16, 20 (Tex. 2010).
We resolve disputed fact questions in favor of the finding if a reasonable factfinder could have
done so, and we disregard all contrary evidence unless a reasonable factfinder could not have done
so. Id.; City of Keller v. Wilson, 168 S.W.3d 802, 817 (Tex. 2005).
In reviewing the evidence for factual sufficiency under the clear and convincing standard,
we inquire “whether the evidence is such that a factfinder could reasonably form a firm belief or
conviction about the truth of the State’s allegations.” See In re C.H., 89 S.W.3d at 25. We consider
whether disputed evidence is such that a reasonable factfinder could not have resolved that
disputed evidence in favor of its finding. In re J.F.C., 96 S.W.3d 256, 266 (Tex. 2002). In so
doing, we must give “due consideration to evidence that the factfinder could reasonably have found
to be clear and convincing.” Id. We examine the entire record to determine whether “the disputed
evidence that a reasonable factfinder could not have credited in favor of the finding is so significant
-2- 04-13-00192-CV & 04-13-00193-CV
that a factfinder could not reasonably have formed a firm belief or conviction”; if it is, the evidence
is factually insufficient. Id.
COMMITMENT ORDER
In its commitment order, the trial court found that appellant is mentally ill and that as a
result of that mental illness the Patient:
is suffering severe and abnormal mental, emotional, or physical distress; is experiencing substantial mental or physical deterioration of her ability to function independently, which is exhibited by the proposed patient’s inability, except for reasons of indigence, to provide for her basic needs, including food, clothing, health, or safety; and unable to make a rational and informed decision as to whether or not to submit to treatment.
See TEX. HEALTH & SAFETY CODE ANN. § 574.034(a)(1) & (a)(2)(C) (providing statutory
requirements for temporary commitment).
“To be clear and convincing under Subsection (a), 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: (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.”
Id. § 574.034(d). Expert testimony recommending involuntary temporary commitment must be
supported by a factual basis; a bald diagnosis alone is insufficient to support commitment. In re
Breeden, 4 S.W.3d 782, 784 (Tex. App.—San Antonio 1999, no pet.).
The State sought the temporary commitment of appellant to University Hospital. At the
hearing, appellant and Dr. Stephen Burkholder, a psychiatrist with the hospital, testified.
Burkholder testified he had been involved in appellant’s care since her admission to the hospital
and, based on his personal knowledge, her history, and her medical records, he diagnosed appellant
with delusional disorder. He agreed this diagnosis was an illness, disease, or condition that
substantially impaired appellant’s thought, perception of reality, emotional process, or judgment.
-3- 04-13-00192-CV & 04-13-00193-CV
Appellant first presented with suicide ideation, but had not threatened to commit suicide since
being hospitalized. She had not threatened to harm any other patients. Burkholder testified that
appellant is not likely to cause serious harm to herself or others as a result of her mental illness.
Burkholder agreed that as a result of appellant’s mental illness she suffers severe and
abnormal mental, emotional, or physical distress; and she is experiencing substantial mental or
physical deterioration in her ability to function independently. Burkholder conceded that appellant
is able to provide for her own basic needs, including food and clothing, health and safety, but
clarified that she had just concluded a four-day fast for religious purposes. Burkholder testified
that as a result of her delusions, appellant has a tendency to misinterpret various things in her
environment, particularly her interactions with people. Appellant described interactions with her
neighbors and with an off-duty police officer in which she felt they were making aggressive actions
towards her and she responded inappropriately. Appellant also described to Burkholder that she
is experiencing pressure in her head due to police radar and that she is hearing sounds in the attic
of her apartment. Burkholder stated that appellant continues to believe that the police and doctors
are conspiring to keep her in the hospital.
Burkholder stated appellant is unable to make a rational and informed decision about
whether to submit to treatment.
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Fourth Court of Appeals San Antonio, Texas MEMORANDUM OPINION No. 04-13-00192-CV & 04-13-00193-CV
THE STATE OF TEXAS FOR THE BEST INTEREST AND PROTECTION OF S.S.
From the Probate Court No. 1, Bexar County, Texas Trial Court Nos. 2013-MH-0591 & 2013-MH-0659 Honorable Polly Jackson Spencer, 1 Judge Presiding
Opinion by: Rebeca C. Martinez, Justice
Sitting: Sandee Bryan Marion, Justice Rebeca C. Martinez, Justice Luz Elena D. Chapa, Justice
Delivered and Filed: May 14, 2014
AFFIRMED
The trial court found that appellant S.S. was mentally ill and met the criteria for court-
ordered temporary mental health services, and ordered appellant to be temporarily committed for
inpatient mental health services pursuant to section 574.034 of the Texas Health and Safety Code.
By separate order, the court authorized treatment with psychoactive medications during appellant’s
temporary commitment. Appellant appeals from both orders, challenging the legal and factual
sufficiency of the trial court’s findings. We affirm the trial court’s orders.
1 The Honorable Oscar Kazen presided over the hearing and verbally made the rulings on the underlying applications. The Honorable Polly Jackson Spencer signed the written orders. 04-13-00192-CV & 04-13-00193-CV
STANDARD OF REVIEW
To obtain either an order for temporary commitment or an order to administer psychoactive
medication, the State must prove its case by clear and convincing evidence. See TEX. HEALTH &
SAFETY CODE ANN. § 574.034(a) (West Supp. 2013), § 574.106(a-l) (West 2010). Because the
State’s burden of proof is clear and convincing evidence, we apply a heightened standard of review
to sufficiency-of-the-evidence challenges. See In re C.H., 89 S.W.3d 17, 25 (Tex. 2002). When
reviewing the legal sufficiency of the evidence in a case requiring proof by clear and convincing
evidence, we determine whether the evidence is such that a factfinder could reasonably form 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). We review all the evidence in the light most
favorable to the finding to determine whether a reasonable factfinder could have formed a firm
belief or conviction that the finding was true. State v. K.E.W., 315 S.W.3d 16, 20 (Tex. 2010).
We resolve disputed fact questions in favor of the finding if a reasonable factfinder could have
done so, and we disregard all contrary evidence unless a reasonable factfinder could not have done
so. Id.; City of Keller v. Wilson, 168 S.W.3d 802, 817 (Tex. 2005).
In reviewing the evidence for factual sufficiency under the clear and convincing standard,
we inquire “whether the evidence is such that a factfinder could reasonably form a firm belief or
conviction about the truth of the State’s allegations.” See In re C.H., 89 S.W.3d at 25. We consider
whether disputed evidence is such that a reasonable factfinder could not have resolved that
disputed evidence in favor of its finding. In re J.F.C., 96 S.W.3d 256, 266 (Tex. 2002). In so
doing, we must give “due consideration to evidence that the factfinder could reasonably have found
to be clear and convincing.” Id. We examine the entire record to determine whether “the disputed
evidence that a reasonable factfinder could not have credited in favor of the finding is so significant
-2- 04-13-00192-CV & 04-13-00193-CV
that a factfinder could not reasonably have formed a firm belief or conviction”; if it is, the evidence
is factually insufficient. Id.
COMMITMENT ORDER
In its commitment order, the trial court found that appellant is mentally ill and that as a
result of that mental illness the Patient:
is suffering severe and abnormal mental, emotional, or physical distress; is experiencing substantial mental or physical deterioration of her ability to function independently, which is exhibited by the proposed patient’s inability, except for reasons of indigence, to provide for her basic needs, including food, clothing, health, or safety; and unable to make a rational and informed decision as to whether or not to submit to treatment.
See TEX. HEALTH & SAFETY CODE ANN. § 574.034(a)(1) & (a)(2)(C) (providing statutory
requirements for temporary commitment).
“To be clear and convincing under Subsection (a), 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: (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.”
Id. § 574.034(d). Expert testimony recommending involuntary temporary commitment must be
supported by a factual basis; a bald diagnosis alone is insufficient to support commitment. In re
Breeden, 4 S.W.3d 782, 784 (Tex. App.—San Antonio 1999, no pet.).
The State sought the temporary commitment of appellant to University Hospital. At the
hearing, appellant and Dr. Stephen Burkholder, a psychiatrist with the hospital, testified.
Burkholder testified he had been involved in appellant’s care since her admission to the hospital
and, based on his personal knowledge, her history, and her medical records, he diagnosed appellant
with delusional disorder. He agreed this diagnosis was an illness, disease, or condition that
substantially impaired appellant’s thought, perception of reality, emotional process, or judgment.
-3- 04-13-00192-CV & 04-13-00193-CV
Appellant first presented with suicide ideation, but had not threatened to commit suicide since
being hospitalized. She had not threatened to harm any other patients. Burkholder testified that
appellant is not likely to cause serious harm to herself or others as a result of her mental illness.
Burkholder agreed that as a result of appellant’s mental illness she suffers severe and
abnormal mental, emotional, or physical distress; and she is experiencing substantial mental or
physical deterioration in her ability to function independently. Burkholder conceded that appellant
is able to provide for her own basic needs, including food and clothing, health and safety, but
clarified that she had just concluded a four-day fast for religious purposes. Burkholder testified
that as a result of her delusions, appellant has a tendency to misinterpret various things in her
environment, particularly her interactions with people. Appellant described interactions with her
neighbors and with an off-duty police officer in which she felt they were making aggressive actions
towards her and she responded inappropriately. Appellant also described to Burkholder that she
is experiencing pressure in her head due to police radar and that she is hearing sounds in the attic
of her apartment. Burkholder stated that appellant continues to believe that the police and doctors
are conspiring to keep her in the hospital.
Burkholder stated appellant is unable to make a rational and informed decision about
whether to submit to treatment. Appellant cannot be treated in an out-patient setting because she
denies having a mental illness and would not take medication or attend follow-up appointments.
If she were to continue misinterpreting the stimuli in her environment, Burkholder opined that it
was possible she would end up in further legal and/or physical harm. Burkholder did not believe
that appellant could distinguish safety from danger, and felt that she was at risk for being involved
with the police. He noted that appellant had been aggressive with him and accused him and the
hospital staff of putting words in her mouth and lying to her. Burkholder stated that appellant
misinterprets the attempts of other people to help her. -4- 04-13-00192-CV & 04-13-00193-CV
Appellant testified that she was hospitalized for threatening to commit suicide. She stated
that she had weapons at her home, including a firearm. She testified that she is a licensed firearms
instructor in New Jersey. She does not randomly use the gun, and last fired it at a ranch. She
occasionally feels pressure in her head and hears a beeping sound. She believes that her neighbors
at the apartment complex are targeting her for harassment. Multiple times, she has come home to
an unlocked door. She has heard movement in the attic above her and assumes it is someone from
the apartment. On one occasion, appellant found what she believed to be a human fetus on her
doorstep. Appellant sent a letter documenting this harassment to the Texas Rangers.
On appeal, appellant asserts the evidence is legally and factually insufficient to order her
temporarily committed for inpatient mental health services. In particular, she argues there was no
evidence presented that she was unable to provide for her basic needs, including food, clothing,
health or safety, except for reasons of indigence. We disagree. Having reviewed the record as a
whole, we conclude the foregoing evidence permitted the trial judge to form a firm belief or
conviction that the findings necessary to support appellant’s temporary commitment were proven
true. While appellant was able to provide for most of her basic needs, the evidence of the expert
established that appellant suffers from delusions and that she is unable to distinguish safety from
danger. Appellant’s mental deterioration is evidenced by delusions that cause her to misinterpret
her interactions with others and to respond inappropriately, which could cause her legal or physical
harm. Additionally, her threats to commit suicide, coupled with her possession of a weapon, show
that she is unable to provide for her own safety. Therefore, the evidence is both legally and
factually sufficient to support the trial court’s commitment order.
ADMINISTRATION OF PSYCHOACTIVE MEDICATIONS
“The court may issue an order authorizing the administration of one or more classes of
psychoactive medication to a patient who . . . is under a court order to receive inpatient mental -5- 04-13-00192-CV & 04-13-00193-CV
health services . . . .” TEX. HEALTH & SAFETY CODE ANN. § 574.106(a). Here, after issuing the
commitment order, the trial court held a hearing on and granted the State’s application for an order
to administer psychoactive medications. On appeal, the only basis on which appellant challenges
the trial court’s medication order is that the evidence is insufficient to support the trial court’s
commitment order. Because we have determined the evidence is sufficient to support the trial
court’s commitment order, the evidence is also sufficient to support the trial court’s order to
compel psychoactive medications. See State ex rel. D.V., Nos. 04-12-00511-CV & 04-12-00512-
CV, 2012 WL 6618217, at *3 (Tex. App.—San Antonio Dec. 19, 2012, no pet.).
CONCLUSION
We overrule appellant’s issues on appeal and affirm the trial court’s orders.
Rebeca C. Martinez, Justice
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