NUMBER 13-25-00364-CV
COURT OF APPEALS
THIRTEENTH DISTRICT OF TEXAS
CORPUS CHRISTI – EDINBURG
THE STATE OF TEXAS FOR THE BEST INTEREST AND PROTECTION OF L.S. JR.
ON APPEAL FROM THE PROBATE COURT OF HIDALGO COUNTY, TEXAS
MEMORANDUM OPINION
Before Justices Silva, Peña, and West Memorandum Opinion by Justice West
Appellant L.S. Jr. 1 appeals the trial court’s order committing him to a mental
hospital for temporary in-patient mental health services and its order directing the hospital
to compel psychoactive medication. Appellant argues that the evidence is legally and
1 Although not required by rule or statute, we use appellant’s initials to protect his privacy in this
mental health proceeding. See, e.g., State ex rel. D.L.S., 446 S.W.3d 506, 510 (Tex. App.—El Paso 2014, no pet.) (referring to appellant by his initials in appeal challenging trial court’s order for involuntary commitment); State ex rel. T.M., 362 S.W.3d 850, 851 (Tex. App.—Dallas 2012, no pet.) (same); see also State for C.G., No. 13-22-00501-CV, 2022 WL 17844128, at *1 (Tex. App.—Corpus Christi–Edinburg Dec. 22, 2022, no pet.) (mem. op.) (same). factually insufficient to support both orders. He specifically argues that the State failed to
show “a recent overt act or a continuing pattern of behavior” that tends to confirm the
likelihood of serious harm to himself or substantial deterioration of his ability to function
independently. Because the State presented scant and contradictory evidence at the
hearing on the trial court’s orders, we agree. Accordingly, we reverse and render.
I. BACKGROUND
On June 26, 2025, Ana Grimaldo, a therapist from the South Texas Behavioral
Health Hospital (the hospital), filed an application for temporary commitment for mental
health services, requesting that the trial court commit appellant to the hospital for a period
not to exceed forty-five days. That same day, the State filed a motion for protective
custody of appellant accompanied by a physician’s certification of medical examination
for temporary commitment.
In the certification, Cesar Matos-Martinez, M.D., explained that appellant was
voluntarily admitted to the hospital on June 21, 2025, “due to altered mental status and
paranoia that someone is under his home and that his family is trying to kill him,” and he
was “experiencing suicidal ideations without disclosing a plan.” He also explained that
while appellant signed in voluntarily for treatment, he was “refusing medications to help
stabilize current symptoms.” Dr. Matos-Martinez attested that appellant was diagnosed
with paranoid schizophrenia, and because of his mental illness, he was likely to cause
serious harm to himself. The certification stated that appellant had “active psychosis and
paranoia behaviors towards family,” was “refusing to provide specifics that lead to his
symptoms, minimizing [his] symptoms,” and was “at high risk due to his history of suicide
attempt last year and inability to recognize the need for assistance.” Dr. Matos-Martinez
2 attested that, if not treated, appellant “will continue to experience psychosis, paranoia[,]
and suicidal ideations, leading to a mental deterioration if [appellant] is not provided with
the proper treatment.” And because of his past “suicide attempt and paranoid behaviors,”
appellant’s “imminent risk to self and others will increase significantly.”
On July 3, 2025, Dr. Matos-Martinez, on behalf of the State of Texas, requested
an order to administer psychoactive medication to appellant. A second physician’s
certification of medical examination for temporary commitment was filed by Scott Joseph,
MD. Dr. Joseph also diagnosed appellant with paranoid schizophrenia. He attested that
appellant was likely to cause serious harm to himself because he “continues to display
delusional thinking, poor insight into his current situation, and continues to be at high risk
of severe decompensation.” And like Dr. Matos-Martinez, Dr. Joseph attested that
appellant’s risk of self-harm “will increase significantly due to [appellant] having history of
suicide attempt [sic] which may lead to a completion of suicide.”
A hearing on both the application for temporary commitment and the motion to
administer psychoactive medication commenced on July 7, 2025. At the beginning of the
hearing, the trial court took judicial notice of “all contents of the Court’s file, including the
second physician’s certificate.”
The State called Dr. Matos-Martinez, and the parties stipulated to his qualifications.
Dr. Matos-Martinez testified that appellant was admitted to the hospital because he was
having paranoid and delusional thoughts that there were people living under his house
who were planning to kill him. Dr. Matos-Martinez explained that appellant was diagnosed
with “schizophrenia, paranoid type,” and appellant’s paranoid thoughts and delusions
have not stopped since he entered the hospital. He also testified that appellant had “been
3 treated before for the same mental condition” at the hospital; however, he did not explain
or elaborate further on appellant’s prior treatments.
Despite the contents of his certification, Dr. Matos-Martinez testified that, to his
knowledge, appellant has not expressed any suicidal ideations while at the hospital. And
when asked if he had any information on appellant’s prior suicide attempt, he replied, “No.
I do not have that information, no.” He further testified that appellant “is not aggressive,
he’s cooperative, he follows the rules, he doesn’t require any emergency medication,
[and] he doesn’t make threats to anyone.” He explained: “It’s just the symptoms,
delusions, the paranoia that is the problem, and he isn’t taking any medications.” On
cross-examination, Dr. Matos-Martinez again testified that appellant had not voiced any
suicidal ideations during his time at the hospital, nor had he tried to physically harm
himself. He also testified that he believes appellant has been “compliant with other forms
of treatment” like “group therapy.”
When asked if appellant is likely to cause serious harm to himself unless he is
further treated at the hospital, Dr. Matos-Martinez responded:
Well, he could, yes, because he’s not taking any medications. He hasn’t done what we ask him to do . . . and take the medications and see how the medications start working. So we have not been able to complete that part of the process.
And when asked why he believes that appellant poses a danger to himself, he responded:
Well, I think that he continues to have these paranoid thoughts. It might not come to any bad choice, decisions of harming himself, but so far he’s not saying that, that he’s going to kill himself, nothing like that. He’s not doing that. Although he could later.
Dr. Matos-Martinez maintained that appellant was under “severe distress” because
his delusions and paranoid thoughts cause him “a lot of anguish.” He also stated that if
4 left untreated, appellant is “going to go back to the same environment, to the same ideas
and delusions,” and appellant “cannot function independently because of the paranoid
thoughts.” Dr. Matos-Martinez explained that appellant believes his delusions and
paranoid thoughts are real, and “he has no insight into his condition.”
Concerning the medication sought in the application for the administration of
psychoactive medicine, Dr. Matos-Martinez testified that appellant has refused to take the
prescribed antipsychotic medications because he “doesn’t believe that medications will
help.” Lastly, Dr. Matos-Martinez testified that appellant cannot make a rational and
informed decision as to whether to submit to treatment, there were no less restrictive
means of treatment, and he believed that it was in appellant’s best interest to take the
medications.
The State called appellant to testify. Appellant denied that he had paranoid
schizophrenia and maintained that he does not “have symptoms like that whatsoever.”
When asked if he believes he has a mental illness, he responded, “No ma’am. I have high
blood pressure.” Then the following exchange occurred:
[The State]: And so why do you believe you’re in the hospital today?
[Appellant]: Because what the doctor says, that I think and what I feel. What I think, I’m living it out there in where I live. I’m the one that’s living it. I’m the one that my neighbor, she says all that, what I say, and what the doctor said, that Ms. Laura Martinez Jasso, she says this to me.
[The State]: Okay. So you believe that there are people who want to harm you?
[Appellant]: Well, she says it herself, and she doesn’t—she says it to me, and she sends people to the residence.
....
[The State]: And you feel these people want to kill you?
5 [Appellant]: Well, it’s been going on with Laura Martinez [Jasso] since April 2022, 2023, 2024 and this year. Her friends and her harass against me. And my way of, let’s say like saying something back to her is calling the law or making statements towards her, and that’s what I have done, and she has made false statements against me.[ 2]
At the end of his testimony, appellant confirmed that he attempted suicide in July
of last year by walking onto the highway and was struck by a moving vehicle. Appellant
maintained, however, “[t]hat’s in the past,” and he does not have “symptoms like that”
anymore. Instead, he insisted that “the threats and harassment” between him and Ms.
Jasso have continued.
After hearing the evidence, the trial court entered an order committing appellant to
the hospital for a period not to exceed forty-five days. The trial court found that appellant
is mentally ill and, as a result of his mental illness, (1) “is likely to cause serious harm to
himself,” or (2) “will, if not treated, continue to suffer severe and abnormal mental,
emotional, or physical distress and . . . experience deterioration of his ability to function
independently and is unable to make a rational and informed decision as to whether or
not to submit to treatment.” The trial court also entered its order permitting the hospital to
administer the psychoactive medication, finding that treatment with the proposed
medication was in the best interest of appellant, and appellant lacked the capacity to
make a decision regarding administration of said medication. This appeal followed.
2 The State presented no evidence to rebut appellant’s assertions that his neighbor, Ms. Jasso,
had a history of threatening or harassing him. In fact, appellant’s trial counsel maintained at closing that this case merely involves “a neighbor who is bullying a mentally ill man.”
6 II. APPLICABLE LAW & STANDARD OF REVIEW
A. Order for Temporary Inpatient Mental Health Services
A court may order temporary inpatient mental health services only if the court finds,
from clear and convincing evidence, that:
(1) the proposed patient is a person with mental illness; and
(2) as a result of that mental illness the proposed patient:
(A) is likely to cause serious harm to the proposed patient;
(B) is likely to cause serious harm to others; or
(C) is:
(i) suffering severe and abnormal mental, emotional, or physical distress;
(ii) experiencing substantial mental or physical deterioration of the proposed patient’s ability to function independently, which is exhibited by the proposed patient’s inability, except for reasons of indigence, to provide for the proposed patient’s 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.
See TEX. HEALTH & SAFETY CODE ANN. § 574.034(a). 3 The evidence must include expert
testimony and 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). The recent overt act or continuing pattern of behavior shown
3 The Texas Legislature amended Texas Health & Safety Code § 574.034. See Act of Aug. 28,
2025, 89th Leg., 2nd C.S., ch. 7, § 11B.02, section 574.034, 2025 Tex. Sess. Law Serv (effective Sept. 1, 2025). The new version of the statute went into effect after the State filed its protective order in this case and the trial court handed down the commitment order. Thus, we apply the former version of the statute. See id. All references to § 574.034 herein refer to the version of the statute in effect prior to the September 1, 2025.
7 by the State must relate to the criterion on which the judgment is based. In re C.O., 65
S.W.3d 175, 181 (Tex. App.—Tyler 2001, no pet.).
B. Clear and Convincing Evidence
“[D]ue process demands clear and convincing proof before the state may
involuntarily confine a person in a mental institution.” In re C.H., 89 S.W.3d 17, 22 (Tex.
2002) (citing Addington v. Texas, 441 U.S. 418, 423 (1979)). As such, both orders were
required to be supported by clear and convincing evidence rather than the lower
preponderance of the evidence standard generally applicable to civil suits at large. See
TEX. HEALTH & SAFETY CODE ANN. §§ 574.106(a-1), 574.034(a); State ex rel. D.L.S., 446
S.W.3d 506, 514 (Tex. App.—El Paso 2014, no pet.).
Clear and convincing evidence is that “degree of proof which will produce in the
mind of the trier of fact a firm belief or conviction as to the truth of the allegations sought
to be established.” State ex rel. T.M., 362 S.W.3d 850, 851–852 (Tex. App.—Dallas 2012,
no pet.) (quoting State v. Addington, 588 S.W.2d 569, 570 (Tex. 1979) (per curiam)). “In
evaluating evidence for legal sufficiency under a clear and convincing standard, 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 fact finder could have done so, and we
disregard all contrary evidence unless a reasonable fact finder could not have done so.”
State ex rel. R.P., 511 S.W.3d 71, 76 (Tex. App.—El Paso 2014, no pet.).
“In a factual sufficiency review, we must give due consideration to evidence that
the factfinder could reasonably have found to be clear and convincing.” State ex rel. M.P.,
8 418 S.W.3d 850, 853 (Tex. App.—Dallas 2013, no pet.); see In re J.F.C., 96 S.W.3d 256,
266 (Tex. 2002). The inquiry is whether the evidence, both disputed and undisputed, is
such that a factfinder could reasonably form a firm belief or conviction about the truth of
the State’s allegations. In re J.F.C., 96 S.W.3d at 266. We must consider whether the
disputed evidence is of such a nature that a reasonable factfinder could not have resolved
it in favor of its finding. 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.” Id.
III. ANALYSIS
Appellant argues that the evidence is legally and factually insufficient to support
the trial court’s orders. 4
A. Temporary Inpatient Commitment Order
1. Person with a Mental Illness
Appellant first challenges the trial court’s finding that he is a person with a mental
illness. See TEX. HEALTH & SAFETY CODE ANN. § 574.034(a)(1). Because we sustain both
of appellant’s issues below, we will assume without deciding that the evidence is legally
and factually sufficient to produce in the mind of the factfinder a firm belief or conviction
that appellant is a person with a mental illness. See TEX. R. APP. P. 47.1 (“The court of
appeals must hand down a written opinion that is as brief as practicable but that
addresses every issue raised and necessary to final disposition of the appeal.”).
4 Forty-five days have already elapsed since the trial court’s orders, which means both orders have
now expired. However, neither order is moot, as the mootness doctrine does not apply to appeals of mental health commitments such as this. See State v. K.E.W., 315 S.W.3d 16, 20 (Tex. 2010) (citing State v. Lodge, 608 S.W.2d 910, 912 (Tex. 1980)). Therefore, we will address the merits of this appeal.
9 2. Recent Overt Act or a Continuing Pattern of Behavior
Appellant next challenges the trial court’s findings that, because of his mental
illness, he is (1) likely to cause serious harm to himself and (2) experiencing substantial
mental or physical deterioration of his ability to function independently. See TEX. HEALTH
& SAFETY CODE ANN. § 574.034(a)(2)(A), (a)(2)(C). He argues that there is no evidence
of “a recent overt act or a continuing pattern of behavior” that tends to confirm the
likelihood of these two elements. See id. § 574.034(d)(1).
i. Harm to Self
The trial court took judicial notice of all the contents of its files, which included Dr.
Matos-Martinez’s and Dr. Joseph’s medical examination certificates. Both doctors
attested that appellant was having suicidal ideations and was at high risk of self-harm
because of his previous suicide attempt. However, Dr. Matos-Martinez contradicted his
certification at the commitment order hearing. He testified that appellant never had
suicidal ideations during his time at the hospital, never threatened or attempted to hurt
himself while in the hospital, and he had no knowledge of appellant’s prior suicide attempt.
In fact, the only evidence of appellant’s prior suicide attempt came from appellant, who
maintained that he was no longer having suicidal thoughts or ideations. Moreover, it was
undisputed that appellant was not aggressive, never threatened others, or needed
emergency medication. And besides refusing to take his medications, he was cooperative
with hospital staff, followed the rules, and was compliant with other forms of treatment.
Here, the only evidence indicating that appellant had suicidal ideations upon
admission to the hospital are the allegations in the doctors’ certifications. “However, an
expert’s opinion recommending involuntary commitment must be supported by the factual
10 bases on which it is grounded and not simply recite the statutory criteria.” J.M. v. State,
178 S.W.3d 185, 193 (Tex. App.—Houston [1st Dist.] 2005, no pet.); State ex rel. E.R.,
287 S.W.3d 297, 302–03 (Tex. App.—Texarkana 2009, no pet.) (same). In J.M., the
Houston court of appeals found that medical records indicating that the appellant had
threatened suicide before her hospitalization were insufficient to prove an overt act or a
continuing pattern of behavior under § 574.034 because “no specific details were
provided about the purported threats of suicide made by [appellant] before her admission
to” the hospital. 178 S.W.3d at 193–94 (“The record does not reveal exactly when the
threats were made, specifically to whom they were made, under what circumstances the
threats were made, or their severity.”). Similarly, here, both doctors’ certifications provided
no details about appellant’s suicidal ideations or past suicide attempt. Therefore, by
themselves, the doctors’ certifications are insufficient to show that appellant is likely to
cause serious harm to himself. See id.; In re C.O., 65 S.W.3d at 181; see also State ex
rel. B.A., No. 12-16-00183-CV, 2016 WL 4628106, at *3 (Tex. App.—Tyler Sept. 7, 2016,
no pet.) (mem. op.) (finding insufficient evidence of overt act or pattern of behavior that
appellant would hurt himself because the expert doctor “offered no specific evidence” that
the appellant “posed a substantial threat of harm to herself or that she demonstrated any
actual dangerous behavior manifested by some overt act or threats in the recent past”).
Other testimony by Dr. Matos-Martinez was likewise insufficient to show a recent
overt act or continuing pattern of behavior that appellant is likely to cause serious harm
to himself. When asked why he believes appellant poses a danger to himself, Dr. Matos-
Martinez primarily testified about how appellant refused to take his prescribed
medications. However, Texas courts have consistently held that refusal of medication
11 alone is insufficient evidence of an overt act or a continuing pattern of behavior. See State
ex rel. E.R., 287 S.W.3d at 306; J.M., 178 S.W.3d at 194; see also State ex rel. G.H., No.
12-17-00310-CV, 2018 WL 345788, at *7 (Tex. App.—Tyler Jan. 10, 2018, no pet.) (mem.
op.). While Dr. Matos-Martinez stated that appellant “could” harm himself later, potential
harm is insufficient to uphold a commitment order. See J.M., 178 S.W.3d at 193; In re
C.O., 65 S.W.3d at 181–82 (holding that physician’s testimony that the appellant “may
cause serious harm to others” but failure to “state any facts that would justify such a
conclusion” was legally insufficient to prove a recent over act to support involuntary
commitment); Broussard v. State, 827 S.W.2d 619, 622 (Tex. App.—Corpus Christi–
Edinburg 1992, no writ) (“Bare psychiatric expert opinion of a ‘potential danger’ to others
is insufficient to support a commitment.”).
Considering the evidence, we hold that the State failed to present evidence of a
recent overt act or a continuing pattern of behavior that tends to confirm the likelihood
that appellant is likely to cause serious harm to himself. See State ex rel. D.L.S., 446
S.W.3d at 517 (holding that the evidence was factually insufficient to show the appellant
was likely to cause serious harm to himself primarily because there was no evidence that
the appellant had “ever attempted suicide or expressed any form of suicidal ideation,”
“was in bad health, malnourished, involved in violent criminal activity, or otherwise
recklessly placing himself into situations where a substantial risk of bodily harm would
befall him”); State ex rel. J.W., 312 S.W.3d 301, 306 (Tex. App.—Dallas 2010, no pet.)
(finding that there was no evidence of a recent overt act or continuing pattern of behavior
showing that appellant was likely to cause serious harm to herself because there was no
evidence in the record that appellant was malnourished or suicidal); J.M., 178 S.W.3d at
12 194–95 (finding evidence of appellant’s prior suicide threats insufficient to establish a
recent overt act or pattern of behavior to support commitment because “no specific details
were provided about the purported threats of suicide” and no other evidence was
presented as to how appellant was a danger to herself); In re C.O., 65 S.W.3d at 181–
82; see also State ex rel. B.A., 2016 WL 4628106, at *3.
ii. Physical Deterioration
There was also insufficient evidence of an overt act or pattern of behavior showing
appellant’s deterioration of his ability to function independently. No evidence was
presented as to how appellant’s mental illness prevented him from taking care of himself
or hindered his ability to function independently. See State ex rel. J.W., 312 S.W.3d at
307 (finding that there was no evidence that appellant was experiencing substantial
deterioration of her ability to function independently in part because there was no
evidence in the record that appellant “could not provide for her own food, clothing, or
health”); J.M., 178 S.W.3d at 195–96 (finding evidence of appellant’s poor hygiene and
“refusal to talk to the staff at the hospital” insufficient acts to establish overt act or pattern
of behavior to support commitment showing deterioration of appellant’s ability to function).
Dr. Matos-Martinez testified that appellant had been admitted to the hospital
before. However, as mentioned, an expert’s opinion recommending involuntary
commitment must be supported by the factual bases on which it is grounded. J.M., 178
S.W.3d at 193; State ex rel. E.R., 287 S.W.3d at 302–03. Dr. Matos-Martinez provided
no details about appellant’s prior admissions, nor explained how his prior admissions
were relevant to this case. See J.M., 178 S.W.3d at 193; Johnstone v. State, 961 S.W.2d
385, 389 (Tex. App.—Houston [1st Dist.] 1997, no writ) (“We note that in Broussard, even
13 the patient’s repeated admissions to mental institutions for the same condition was held
insufficient to show a continuing pattern of behavior.”); Broussard v. State, 827 S.W.2d
619, 622 (Tex. App.—Corpus Christi–Edinburg 1992, no writ) (holding that evidence of
the appellant’s “continuing delusional behavior” and multiple hospital visits was
insufficient to “show the deterioration of her ability to function” and was merely evidence
which reflected that she was mentally ill); see also State ex rel. G.H., 2018 WL 345788,
at *7 (providing that appellant’s previous hospitalizations for his mental illness were
insufficient to demonstrate overt act or pattern of behavior because it was simply evidence
that appellant was mentally ill).
In sum, we hold that the evidence is legally and factually insufficient to support the
trial court’s order of commitment because the State failed to present evidence of a recent
overt act or a continuing pattern of behavior that tends to confirm the likelihood that
appellant will cause serious harm to himself or tends to show the deterioration of his ability
to function independently. We sustain appellant’s first issue.
B. Order for the Administration of Psychoactive Medication
By his second issue, appellant argues that because the evidence is legally and
factually insufficient to support the trial court’s order of a temporary commitment, the
evidence is also insufficient to support the order to administer psychoactive medications.
We agree. In the absence of a valid order for temporary or extended mental health
services, the order authorizing the administration of psychoactive medication is not
authorized by statute. See TEX. HEALTH & SAFETY CODE ANN. § 574.106(a)(1). Because
14 we found that there is legally and factually insufficient evidence to support the trial court’s
order of temporary commitment, we sustain appellant’s second issue. 5 See id.
VI. CONCLUSION
The State presented an expert physician who contradicted his own medical
certification at the commitment hearing and otherwise failed to provide evidence of an
overt act or pattern of behavior that showed appellant was at risk to himself or the
deterioration of his ability to function independently. In short, the State failed to prove its
case. As this Court stated in Broussard, while we are reluctant to deny court-ordered
treatment to a man who is mentally ill, we cannot lower the requirements imposed under
§ 574.034(a) of the Health and Safety Code. 827 S.W.2d at 622. The State has a strong
interest in protecting the mental health of its citizens; however, it also has a strong interest
in preserving the due process rights of one of its most vulnerable populations. See State
ex rel. D.L.S., 446 S.W.3d at 514; Johnstone, 961 S.W.2d at 390 (Cohen, J., concurring).
Accordingly, the judgment of the trial court is reversed, and judgment is rendered denying
the State’s petition for temporary court-ordered mental health services and order to
administer medications to appellant.
JON WEST Justice
Delivered and filed on the 30th day of October, 2025.
5 Appellant argues in the alternative that Dr. Matos-Martinez’s testimony was conclusory and insufficient to uphold the order to administer psychoactive medications. Because we have resolved this issue in favor of appellant, we need not address this argument. See TEX. R. APP. P. 47.1.