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). 
2

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. 
3

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 
4

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 
5

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 
6

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:
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(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 
8

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:
9

(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 outpatient and community-based supervision;

The Court further FINDS:

(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. 
10

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 selfaware 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, 
11

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.