COURT OF APPEALS

SECOND DISTRICT OF TEXAS

FORT WORTH

NO. 02-13-00129-CV

IN THE MATTER OF A.S.K.

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FROM COUNTY COURT AT LAW NO. 1 OF WICHITA COUNTY

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MEMORANDUM OPINION1

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Appellant A.S.K. appeals from the trial court’s order authorizing 

psychoactive medication. We affirm.

On February 25, 2013, Appellant was committed to a mental-health facility

for evaluation and treatment toward the specific objective of attaining 

competency to stand trial for burglary of a habitation and possession of 

marijuana in a drug-free zone. See Tex. Code Crim. Proc. Ann. art. 46B.073(b) 

 1

See Tex. R. App. P. 47.4.
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(West Supp. 2012). On March 21, Appellant’s treating psychiatrist at the facility, 

Nadeem H. Bhatti, filed an application for an order to authorize psychoactive 

medication—specifically, antipsychotics, anxiolytics, and mood stabilizers—

because Appellant was diagnosed with severe bipolar disorder with psychosis 

and refused to take the medication voluntarily. See Tex. Health & Safety Code 

Ann. § 574.104 (West 2010). The trial court appointed counsel for Appellant and 

set a hearing on Bhatti’s application. See id. § 574.105.

At the April 8 hearing, Angela Wood, Appellant’s psychiatrist,2 testified that 

Appellant did not have the capacity to make a decision regarding whether or not 

to take the recommended medications. When Appellant arrived at the facility, he 

refused to take any medication. Once Appellant was told that Bhatti had filed an 

application seeking an order requiring Appellant to take the medications, 

Appellant voluntarily began to take the medications and had been taking them 

consistently for over two weeks at the time of the hearing. Appellant had not

complained of any side effects of the medications. Even so, Wood testified that 

Appellant continued to have delusions, was not competent to stand trial, and 

could not completely understand why the medications were necessary. Wood 

believed that more time on the medications and adjustments to the dosages 

would render Appellant competent. Although Appellant began taking the 

medications consistently, Wood stated that she continued to pursue Bhatti’s 

 2

Wood replaced Bhatti as Appellant’s treating psychiatrist the week before 

the hearing.
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application because “if we did not go through with the application, . . . [Appellant] 

would know that then they weren’t being sought and might refuse to take them.”

Wood believed a court order was “necessary to have him continue taking 

medication.” If Appellant did not take his medication, Wood stated he would not 

be competent and he would not be able to function in society. Wood believed 

Appellant was not a danger to himself “other than not being able to function and 

the ramifications of that.” She was concerned about his danger to others 

because “when people do not believe his [delusions] about himself, . . . he can 

become very irritable, upset, angry.”3

 Wood stated there was no alternative to 

court-ordered medication that would render Appellant competent.

At the conclusion of the hearing, the trial court granted the application, 

finding that Appellant “does not have the capacity to consent to such treatment 

even though the treatment may be in his best interest and improve his quality of 

life with the benefits exceeding the known risks.” In its subsequent written order, 

the trial court found that Appellant “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 [Appellant].” Appellant filed this 

accelerated appeal and now argues that the evidence was legally and factually 

 3

Specifically, Appellant believed he was French, his name was Francois, 

and his identity had been stolen. This delusion persisted up to the week before 

the hearing and after Appellant had started taking the medications.
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insufficient to justify granting the application. See id. §§ 574.070, 574.108; Tex. 

R. App. P. 28.1(a).

 A trial court may enter an order authorizing psychoactive medication if the 

clear and convincing evidence admitted at a hearing shows either:

(1) that 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; or

(2) if the patient was ordered to receive inpatient mental health 

services by a criminal court with jurisdiction over the patient, that 

treatment with the proposed medication is in the best interest of the 

patient and either:

(A) the patient presents a danger to the patient or others in the 

inpatient mental health facility in which the patient is being treated as 

a result of a mental disorder or mental defect as determined under 

Section 574.1065; or 

(B) the patient:

(i) has remained confined in a correctional facility, as defined 

by Section 1.07, Penal Code, for a period exceeding 72 hours while 

awaiting transfer for competency restoration treatment; and

(ii) presents a danger to the patient or others in the 

correctional facility as a result of a mental disorder or mental defect 

as determined under Section 574.1065.

Tex. Health & Safety Code Ann. § 574.106(a-1) (West 2010). A patient lacks 

capacity under section 574.106(a-1)(1) if he is unable to “understand the nature 

and consequences of a proposed treatment, including the benefits, risks, and 

alternatives to the proposed treatment” and cannot “make a decision whether to 

undergo the proposed treatment.” Id. § 574.101(1). The trial court did not solely 
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rely on section 574.106(a-1)(1) or section 574.106(a-1)(2), including both findings 

in its order.

Clear and convincing evidence, as referenced in section 574.106(a-1), is 

that measure or degree of proof that 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. E.G., 249 S.W.3d 728, 730–31 (Tex. App.—Tyler 2008, no pet.); see 

also U-Haul Int’l, Inc. v. Waldrip, 380 S.W.3d 118, 137 (Tex. 2012). While the 

proof must be of a heavier weight than merely the greater weight of the credible 

evidence, there is no requirement that the evidence be unequivocal or 

undisputed. State v. Addington, 588 S.W.2d 569, 570 (Tex. 1979). The factfinder, not this court, is the sole judge of the credibility and demeanor of the 

witnesses. In re J.O.A., 283 S.W.3d 336, 346 (Tex. 2009).

In evaluating the evidence for legal sufficiency, we must determine 

whether the evidence is such that a fact-finder could reasonably form a firm belief 

or conviction that its finding was true. In re J.F.C., 96 S.W.3d 256, 266 (Tex. 

2002). We review all the evidence in the light most favorable to the finding. Id.

In a factual-sufficiency review, we determine whether, on the entire record, a 

fact-finder could reasonably form a firm conviction or belief that its finding was 

true. In re C.H., 89 S.W.3d 17, 25 (Tex. 2002). If the entire record reveals that 

the disputed evidence is so significant that a reasonable fact-finder could not 

have reasonably formed a firm belief or conviction, then the evidence is factually 

insufficient. J.F.C., 96 S.W.3d at 266; C.H., 89 S.W.3d at 27–29.
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Appellant argues that the evidence was insufficient because he was 

voluntarily taking the medications and because he had the capacity to make a 

decision regarding whether to take the medications. Appellant does not dispute 

that the medications are in his best interest. See Tex. Health & Safety Code 

Ann. § 574.106(a-1), (b).

A patient’s refusal to take medication is not a prerequisite to a trial court’s 

order authorizing psychoactive medication; a patient’s refusal only is part of the 

application. Cf. In re P.R.G., No. 02-12-00375-CV, 2012 WL 5439015, at *3, 6 

(Tex. App.—Fort Worth Nov. 8, 2012, no pet.) (mem. op.) (holding evidence 

sufficient to find lack of capacity under section 574.106(a-1)(1) even though 

patient “very polite and compliant at times”). Compare Tex. Health & Safety 

Code Ann. § 574.104(a) (listing requirements for physician application for order 

to authorize psychoactive medication), with id. § 574.106(a-1) (authorizing trial 

court to enter order authorizing psychoactive medication if patient lacks capacity 

or presents a danger to himself or others). Further, Wood testified she was 

concerned that if the specter of a court order were removed, Appellant would 

stop taking the medications. She based this on the fact that he refused to take 

the medications for the first thirteen days of his hospitalization and only became 

compliant when he was informed of the application filed with the court. The 

evidence is legally and factually sufficient to support the trial court’s implicit 

conclusion that the order was necessary to ensure Appellant continued taking the 

medications in order to attain competency.
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The evidence is also legally and factually sufficient to support the trial 

court’s conclusion that the clear and convincing evidence supported entering an 

order authorizing psychoactive medication. Although the trial court authorized 

the medication under both section 574.106(a-1)(1) and section 574.106(a-1)(2), 

sufficient evidence of either would support the trial court’s order. Cf. In re C.S., 

208 S.W.3d 77, 83–84 (Tex. App.—Fort Worth 2006, pet. denied) (finding legally 

sufficient evidence to support trial court’s order authorizing psychoactive 

medication under section 574.106(a-1)(1)). The clear and convincing evidence 

supported the trial court’s order to the extent it was based on section 574.106(a1)(1). As recited above, the evidence showed that (1) Appellant, who was 

diagnosed with bipolar disorder with psychosis, would not take medication 

consistently without a court order or the possibility of a court order; (2) there were 

no alternatives to the administration of the medications; (3) Appellant did not 

have the capacity to make a decision regarding the administration of medication 

because he did not fully appreciate the nature of his illness or the necessity of 

the medications; (4) Appellant’s condition would not improve without the 

medications; and (5) the medications were in Appellant’s best interest. This 

evidence is legally and factually sufficient to support the trial court’s order. See 

A.S. v. State, 286 S.W.3d 69, 73 (Tex. App.—Dallas 2009, no pet.) (finding 

evidence sufficient to support lack-of-capacity conclusion). We overrule 

Appellant’s sole issue and affirm the trial court’s order.
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LEE GABRIEL

JUSTICE

PANEL: LIVINGSTON, C.J.; MEIER and GABRIEL, JJ.

DELIVERED: July 18, 2013