NO. 12-18-00056-CV

IN THE COURT OF APPEALS

TWELFTH COURT OF APPEALS DISTRICT

TYLER, TEXAS

THE STATE OF TEXAS FOR

THE BEST INTEREST AND

PROTECTION OF C.L.

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§

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APPEAL FROM THE

COUNTY COURT AT LAW

CHEROKEE COUNTY, TEXAS

MEMORANDUM OPINION

C.L. appeals from an order authorizing the Texas Department of State Health Services (the 

Department) to administer psychoactive medication-forensic. In one issue, he challenges the legal 

and factual sufficiency of the evidence to support the trial court’s finding that administration of 

psychoactive medications was in his best interest. We affirm.

BACKGROUND

On March 8, 2018, Robert Lee, M.D. signed an application for an order to administer 

psychoactive medication-forensic to C.L. In the application, Lee stated that C.L. was subject to 

an order for inpatient mental health services issued under Chapter 46B (incompetency to stand 

trial) of the Texas Code of Criminal Procedure. He diagnosed C.L. with bipolar disorder, type 1, 

with psychotic features. He stated that C.L. verbally refused to take the medications voluntarily. 

According to Lee, C.L. lacked the capacity to make a decision regarding administration of 

psychoactive medications because he had poor insight into his mental illness and poor judgment.

He asked the trial court to compel C.L. to take five psychoactive medications, including 

antidepressants, antipsychotics, mood stabilizers, anxiolytics/sedatives/hypnotics, and 

miscellaneous drugs.

Lee concluded that these medications were the proper course of treatment for C.L. and that, 

if he were treated with the medications, his prognosis would be fair. However, he said, if C.L. was 

not administered these medications, the consequences would be mental deterioration. Lee 
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considered other medical alternatives to psychoactive medications, but determined that those 

alternatives would not be as effective. He believed the benefits of the psychoactive medications 

outweighed the risks in relation to present medical treatment and C.L.’s best interest. Lee also

considered less intrusive treatments likely to secure C.L.’s agreement to take psychoactive 

medications.

On March 13, the trial court held a hearing on the application. At the close of the evidence, 

the trial court granted the application. On the same date, after considering all the evidence, 

including the application and the expert testimony, the trial court found that the allegations in the 

application were true, correct, and supported by clear and convincing evidence. Further, the trial

court found that treatment with the proposed medications was in C.L.’s best interest and that C.L. 

lacked the capacity to make a decision regarding administration of the medications. The trial court 

authorized the Department to administer the requested psychoactive medications to C.L. This 

appeal followed.

SUFFICIENCY OF THE EVIDENCE

In his sole issue, C.L. argues that the evidence is legally and factually insufficient to support 

the trial court’s order to administer psychoactive medication-forensics. More specifically, C.L. 

contends that the State failed to prove, by clear and convincing evidence, that treatment with the 

proposed medications was in his best interest.

Standard of Review

In a legal sufficiency review where the burden of proof is clear and convincing evidence, 

we must look at all 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 findings were true. 

In re J.F.C., 96 S.W.3d 256, 266 (Tex. 2002). We must assume that the fact finder settled disputed 

facts in favor of its finding if a reasonable fact finder could do so and disregard all evidence that a 

reasonable fact finder could have disbelieved or found incredible. Id. This does not mean that we 

are required to ignore all evidence not supporting the finding because that might bias a clear and 

convincing analysis. Id. 

The appropriate standard for reviewing a factual sufficiency challenge is whether the 

evidence is such that a fact finder could reasonably form a firm belief or conviction about the truth 

of the petitioner’s allegations. In re C.H., 89 S.W.3d 17, 25 (Tex. 2002). In determining whether 
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the fact finder has met this standard, we consider all the evidence in the record, both that in support 

of and contrary to the trial court’s findings. Id. at 27-29. Further, we must consider whether 

disputed evidence is such that a reasonable fact finder could not have reconciled that disputed 

evidence in favor of its finding. In re J.F.C., 96 S.W.3d at 266. If the disputed evidence is so 

significant that a fact finder could not reasonably have formed a firm belief or conviction, the 

evidence is factually insufficient. Id. 

Order to Administer Psychoactive Medication

A trial court may issue an order authorizing the administration of one or more classes of 

psychoactive medications to a patient who is under a court order to receive inpatient mental health 

services. TEX. HEALTH & SAFETY CODE ANN. § 574.106(a) (West 2017). The court may issue an 

order if it finds by clear and convincing evidence after the hearing that (1) the patient lacks the 

capacity to make a decision regarding the administration of the proposed medication, and (2) 

treatment with the proposed medication is in the best interest of the patient. Id. § 574.106(a-1).

“Clear and convincing evidence” means the 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 v. Addington, 588 S.W.2d 569, 570 (Tex. 1979). In making its findings, the 

trial court shall consider (1) the patient’s expressed preferences regarding treatment with 

psychoactive medication, (2) the patient’s religious beliefs, (3) the risks and benefits, from the 

perspective of the patient, of taking psychoactive medication, (4) the consequences to the patient 

if the psychoactive medication is not administered, (5) the prognosis for the patient if the patient 

is treated with psychoactive medication, (6) alternative, less intrusive treatments that are likely to 

produce the same results as treatment with psychoactive medication, and (7) less intrusive 

treatments likely to secure the patient’s agreement to take the psychoactive medication. Id. 

§ 574.106(b) (West 2017).

Hearing on Application

At the hearing, Satyajeet Lahiri, M.D. testified that he was not C.L.’s treating physician, 

but was familiar with Lee’s application for an order to administer psychoactive medication—

forensic to C.L. Lahiri stated that the application was filed because C.L. suffered from bipolar 

disorder, type 1, with psychotic features. He testified that C.L. voluntarily refused to accept the 

proposed medications. According to Lahiri, C.L. is “very rigid” about the medications he will take 

and will not allow Lee to adjust or change his medication. For example, he said, C.L. only agreed 
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to take a low dose of Seroquel and verbally objected to being prescribed any additional 

medications. Lahiri stated that C.L. informed him that he had a constitutional objection to taking 

the proposed medications because he believed that the medications would interfere with his 

thinking and that he would be unable to convey or articulate his thoughts. 

Lahiri believed that C.L. lacked the capacity to make the decision about whether to accept 

medications because he has poor insight, does not believe that he has a mental illness, and has 

impaired judgment. Moreover, he said that C.L. is very argumentative and is fixated on his views.

Lahiri stated that the symptoms indicating that C.L. has a mental illness include general paranoid 

psychosis and his belief that there was a conspiracy between government agents, the treatment 

team, and the court system to act against his interests and harm him. According to Lahiri, C.L. 

has multiple felony criminal charges pending against him relating to “sexually unlawful behavior,” 

including human trafficking, sexual assault of a minor, and sexual performance by a minor. 

Lahiri testified that he wanted to have access to certain classifications of medications to 

treat C.L., including antidepressants, antipsychotics, anxiolytics/sedatives/hypnotics, mood 

stabilizers, and miscellaneous drugs. He believed these medications were in the proper course of 

treatment and in C.L.’s best interest. Lahiri stated that C.L. would regain competency for trial 

faster if these medications are administered because C.L. is very intelligent and a “very factminded” person. C.L.’s prognosis was “very good.” Lahiri did not believe that any of the proposed 

medications would interfere with C.L.’s ability to confer with his attorney and would facilitate 

communication with his attorney in the underlying criminal charges. The proposed medications 

would address C.L.’s symptoms and behaviors including his underlying psychosis, i.e., paranoid 

psychosis; hyperactivity; and aggressive risk. If he is not treated with these medications, C.L. will 

not show improvement, will not regain competency, will continue to suffer from his symptoms, 

will continue to exhibit bipolar manic symptoms, and will not be “dischargeable.” According to 

Lahiri, C.L. exhibited some disruptive behavior, such as knocking “very severely” on the door 

while the treatment team was in a meeting, and upsetting one of the patients being interviewed so 

much that the other patient decompensated. 

C.L. testified that when he entered the Hospital, he had not been taking any medications 

while in jail. He agreed that he was not in a “good mental state” when he arrived at the Hospital,

but blamed it on the treatment he received in jail. C.L. stated that he was willing to take 

medications for the “prognostications” that were diagnosed before he was arrested, including 
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depression, anxiety, a sleeping disorder, and attention deficit hyperactivity disorder (ADHD). He 

believed that his ADHD diagnosis may have been confused with a bipolar diagnosis. He testified 

that he had been taking Wellbutrin for his depression; Seroquel; Ambien for his sleeping disorder; 

and clonazepam for anxiety. He was willing to take only these medications. C.L. believed it was 

not necessary to administer any more drugs into his body. He also admitted that he was not allergic 

to any other medications nor had he suffered any adverse side effects to any other medications.

According to C.L., he was admitted to the Hospital due to the “extremely exaggerated and 

falsified initial examination” by the district attorney’s psychologist. He stated that he was 

competent to stand trial and that his admittance to the Hospital was a “dirty legal maneuver” to 

keep him entangled in the system for as long as possible. C.L. said that the recent evaluation was 

“crap,” because he refused to accept any outcome other than a dismissal or acquittal in his criminal 

case. He said that the district attorney’s psychologist characterized his refusal as irrational and 

determined him to be incompetent. Nor did he believe that taking the proposed medications would 

not affect him regarding the legal proceedings, stating that the dosage was “a lot” of medication. 

Analysis

C.L. does not dispute that the evidence is legally and factually sufficient to show that he is 

under a court order to receive inpatient mental health services. Nor does he dispute the finding 

that he lacked the capacity to make a decision regarding the administration of psychoactive 

medications. Thus, we will consider only whether the evidence is legally and factually sufficient 

to support the finding that treatment with the proposed medications was in his best interest. See 

TEX. HEALTH & SAFETY CODE ANN. § 574.106(a-1).

In the application, Lee concluded that if C.L. was treated with the proposed medications, 

his prognosis was fair. However, if not treated, the prognosis would be mental deterioration. 

According to Lahiri, C.L. will not show improvement, will not regain competency, will continue 

to suffer from his symptoms, will continue to exhibit bipolar manic symptoms, and will not be 

“dischargeable” if he is not treated with the proposed medications. The proposed medications 

would address C.L.’s underlying psychosis including his general paranoid psychosis, i.e., his belief 

that government agents, the treatment team, and the court system conspired to act against his 

interests and harm him; hyperactivity; and aggressive risk. Lahiri believed that C.L. would regain 

competency for trial faster with treatment with the proposed medications, stating that C.L. is 

intelligent and a “fact-minded” person. He described C.L.’s prognosis as “very good.” C.L., 
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however, does not believe he is incompetent, blaming the district attorney’s psychologist for his 

being declared incompetent to stand trial. 

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 treatment with the 

proposed medications was in C.L.’s best interest. See TEX. HEALTH & SAFETY CODE ANN. 

§ 574.106(a-1); In re J.F.C., 96 S.W.3d at 266. Therefore, the evidence is legally sufficient to 

support the trial court’s order. See In re J.F.C., 96 S.W.3d at 266. 

Having determined that the evidence is legally sufficient to support the finding, we now 

address factual sufficiency of the evidence. See In re C.H., 89 S.W.3d at 27-29. At the hearing, 

Lahiri testified that C.L. was “very rigid” and would not allow Lee to adjust or change his 

medications. He said that C.L. only agreed to take a low dose of Seroquel. However, C.L. testified 

that he had been taking Seroquel, Ambien, clonazepam, and possibly, Wellbutrin while in the 

Hospital. He was willing to take only these medications. Further, he believed it was not necessary 

to administer any more drugs in his body and that the proposed medications might affect him in 

his legal proceedings. The right to refuse treatment, and the right of patients, generally, to direct 

the course of their treatment are important. By its very nature, however, involuntary treatment is 

against the stated wishes of a patient. The trial court must consider C.L.’s preferences and beliefs, 

but need not simply defer to them. See TEX. HEALTH & SAFETY CODE ANN. § 574.106(b). It is 

presumed that the trial court gave C.L.’s preferences and beliefs due consideration. The basic 

thrust of Lahiri’s testimony, that C.L.’s mental illness precluded his consideration of taking 

psychoactive medication, was unrebutted. Furthermore, C.L. did not allude to any side effects or 

religious objections to taking these medications. 

Based upon our review of the record as a whole, we conclude that the conflicting evidence 

is not so significant that a reasonable trier of fact could not have reconciled the evidence in favor 

of its finding. See in re J.F.C., 96 S.W.3d at 266. Accordingly, the trial court could have formed 

a firm belief or conviction that the proposed medications were in C.L.’s best interest. See TEX.

HEALTH & SAFETY CODE ANN. § 574.106(a-1), (b); see also In re C.H., 89 S.W.3d at 25. 

Therefore, the evidence is factually sufficient to support the trial court’s order. We overrule C.L.’s 

sole issue.
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DISPOSITION

Having overruled C.L.’s sole issue, we affirm the trial court’s judgment.

BRIAN HOYLE

Justice

Opinion delivered November 14, 2018.

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

(PUBLISH)
COURT OF APPEALS

TWELFTH COURT OF APPEALS DISTRICT OF TEXAS

JUDGMENT

NOVEMBER 14, 2018

NO. 12-18-00056-CV

THE STATE OF TEXAS FOR THE BEST

INTEREST AND PROTECTION OF C.L.

Appeal from the County Court at Law 

of Cherokee County, Texas (Tr.Ct.No. 42328)

THIS CAUSE came to be heard on the appellate record and briefs filed 

herein, and the same being considered, it is the opinion of this court that there was no error in the 

judgment.

It is therefore ORDERED, ADJUDGED and DECREED that the judgment 

of the court below be in all things affirmed, and that this decision be certified to the court below 

for observance.

Brian Hoyle, Justice.

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