NO. 12-08-00081-CV

IN THE COURT OF APPEALS

TWELFTH COURT OF APPEALS DISTRICT

TYLER, TEXAS

THE STATE OF TEXAS FOR § APPEAL FROM THE 

THE BEST INTEREST AND § COUNTY COURT AT LAW

PROTECTION OF B.L. § CHEROKEE COUNTY, TEXAS

 

MEMORANDUM OPINION

Appellant B.L. appeals from an order authorizing the Texas Department of State Health

Services (the “Department”) to administer psychoactive medication-forensic. In one issue, B.L.

asserts the evidence is legally and factually insufficient to support the trial court’s order. We reverse

and render.

BACKGROUND

On January 29, 2008, Dr. Satyajeet Lahiri signed an application for an order to administer

psychoactive medication-forensic to B.L. In the application, Lahiri stated that B.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. Lahiri stated that B.L. had been diagnosed with

schizoaffective disorder and requested the trial court to compel B.L. to take five psychoactive

medications: an antidepressant, an anxoilytic/sedative/hypnotic, two antipsychotics, and a mood

stabilizer. According to Lahiri, B.L. refused to take the medications voluntarily and, in his opinion,

B.L. lacked the capacity to make a decision regarding administration of psychoactive medications

because he was acutely psychotic.

Lahiri concluded that these medications were the proper course of treatment for B.L. and that,
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if he were treated with the medications, his prognosis would be fair with “chances of competency

being restored.” Lahiri believed that, if B.L. were not administered the medications, the

consequences would be poor. Lahiri considered other medical alternatives to psychoactive

medication, 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 B.L.’s best interest. Lahiri also considered less intrusive treatments likely to secure

B.L.’s agreement to take psychoactive medication.

On February 1, the trial court held a hearing on the application. Dr. Larry Hawkins testified

that he was B.L.’s treating physician and that B.L. was currently under a Chapter 46B order,

incompetency to stand trial, for inpatient mental health services. He stated that B.L. had verbally,

or otherwise, refused to accept medication voluntarily. According to Hawkins, he believed that B.L.

lacked the capacity to make a decision regarding the administration of psychoactive medication. He

also stated that he reviewed the application for an order to administer psychoactive medicationforensic completed by Lahiri and agreed with all the statements contained in the application.

Hawkins also agreed with Lahiri’s diagnosis of schizoaffective disorder, and reviewed the

attachment to the application setting forth the classifications of medications that Lahiri wished to

access. He testified that treatment with these medications was the proper course of treatment for

B.L. and was in his best interest. Hawkins stated that if these medications were used, B.L. would

benefit and that these benefits outweighed the risks. Further, he stated that B.L.’s hospitalization

would likely be shortened if these medications were used. He believed that the underlying charge

against B.L. was burglary of a habitation, a felony.

Hawkins testified that B.L. refused to take psychoactive medications, stating that he would

not take any medications and did not believe he needed medications. According to Hawkins, B.L.

had been on medications during a prior hospitalization, became competent to stand trial, was

returned to jail, stopped taking his medications, was found incompetent to stand trial, and returned

to the hospital. He stated that if B.L. was administered these medications, he would improve.

However, Hawkins stated that if B.L. did not take these medications, he would be incompetent to

stand trial. 

B.L. testified that he was a veteran, having served in the United States Army from 1963 to
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1970 in Vietnam and South Korea. He stated that he did not have schizophrenia because he did not

suffer from flashbacks. In the past, according to B.L., he told a Dr. Brown in the psychiatric ward

of a hospital that he was tired of being constipated and blacking out. He stated that, at that time, he

was buying pickup trucks for other people, driving the pickups, and “blacking out” when he was

taking psychotropic medicines. He stated that there was nothing wrong with him, but he was

“forced” to take Thorazine in a state hospital in Vernon, Texas. B.L. agreed that the Hospital was

trying to help him, but that he was not taking psychotropic drugs. He testified that he was

competent, did not need help, and was “all right.” According to B.L., he could sleep without drugs,

and had not been in any fights. He stated that when he was “at Nueces,” he did not take any

medications except for Rinodyne for his hiatal hernia. B.L. testified that he took Zantac, was given

Protonix, was in “good shape,” and that “that’s all it takes.” 

At the close of the evidence, the trial court granted the application. On February 1, after

considering all the evidence, including the application and the expert testimony, the trial court found

that the allegations in the application were true and correct and supported by clear and convincing

evidence. Further, the trial court found that treatment with the proposed medication was in B.L.’s

best interest and that B.L. lacked the capacity to make a decision regarding administration of the

medication. The trial court authorized the Department to administer to B.L. psychoactive

medications, including antidepressants, antipsychotics, mood stabilizers, and

anxiolytics/sedatives/hypnotics. This appeal followed.

SUFFICIENCY OF THE EVIDENCE

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

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

contends that the State failed to prove, by clear and convincing evidence, that he lacked the capacity

to make a decision regarding administration of medication and 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
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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

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, then 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) (Vernon Supp. 2008). The court may

issue an order if it finds, by clear and convincing evidence, 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). “Capacity” means a patient’s ability to (1) understand

the nature and consequence of a proposed treatment, including the benefits, risks, and alternatives

to the proposed treatment, and (2) make a decision whether to undergo the proposed treatment. TEX.

HEALTH & SAFETY CODE ANN. § 574.101(1) (Vernon 2003). In making its findings, the trial court

shall consider (1) the patient’s expressed preferences regarding treatment with psychoactive
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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, and (6) alternatives to treatment with psychoactive medication. TEX.

HEALTH & SAFETY CODE ANN. § 574.106(b) (Vernon Supp. 2008).

Analysis

In the application, Lahiri stated that he believed B.L. lacked the capacity to make a decision

regarding administration of psychoactive medications because he was acutely psychotic. He

determined that if B.L. were not administered these medications, the consequences would be poor.

He also believed the benefits of the psychoactive medications were in B.L.’s best interest. At the

hearing, Hawkinsstated that B.L. refused to accept medication voluntarily. According to Hawkins,

B.L. refused to take psychoactive medications because he did not believe he needed these

medications. B.L. testified that he refused to take psychotropic drugs because he suffered from

constipation and “black outs.” Hawkins testified that treatment with the medications listed in the

exhibit attached to the application was the proper course oftreatment for B.L. and in his best interest.

Further, he stated that if these medications were used, B.L. would benefit and that these benefits

outweighed the risks. Hawkins testified that if B.L. did not take these medications, he would be

incompetent to stand trial. Although Hawkins stated that B.L. lacked the capacity to make a decision

regarding the administration of psychoactive medication, he did not explain why B.L. lacked such

capacity. 

We note that nothing in the Texas Health and Safety Code regarding court ordered

administration of psychoactive medication authorizes a trial court to base its findings solely on the

physician’s application. See TEX. HEALTH & SAFETY CODE ANN. § 574.101-.110 (Vernon 2003 &

Supp. 2008). Pleadings, such as the physician’s application here, are not evidence that the statutory

standard has been met. See id. § 574.031 (Vernon 2003) (stating that the Texas Rules of Evidence

apply to the hearing for court ordered mental health services unless the rules are inconsistent with

the subtitle); In re E.T., 137 S.W.3d 698, 700 (Tex. App.–San Antonio 2004, no pet.); see also

Laidlaw Waste Sys. (Dallas), Inc. v. City of Wilmer, 904 S.W.2d 656, 660 (Tex. 1995) (noting that,

generally, pleadings are not competent evidence, even if sworn or verified). Here, there was no
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evidence from Hawkins at the hearing regarding why B.L. lacked the capacity to make a decision

regarding administration of psychoactive medications. See In re E.G., 249 S.W.3d 728, 731-32

(Tex. App.–Tyler 2008, no pet.). A conclusory statement by Lahiri in the application, without any

testimony or explanation from Hawkins at the hearing, cannot produce in the mind ofthe trier of fact

a firm belief or conviction as to the truth of the allegations sought to be established. See Addington,

588 S.W.2d at 570.

Thus, considering all the evidence in the light most favorable to the findings, we conclude

a reasonable trier of fact could not have formed a firm belief or conviction that B.L. lacked the

capacity to make a decision regarding administration ofthe proposed medications and that treatment

with the proposed medications were in his best interest. See TEX. HEALTH & SAFETY CODE ANN.

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

to support the trial court’s findings based upon section 574.106 of the Texas Health & Safety Code.

Having determined that the evidence is legally insufficient, it is unnecessary for us to address B.L.’s

argument that the evidence is factually insufficient to support the trial court’s findings. See TEX.R.

APP. P. 47.1. We sustain B.L.’s sole issue.

CONCLUSION

Based upon our review of the record, we conclude that the evidence is legally insufficient to

support the trial court’s order authorizing the administration of psychoactive medication-forensic.

Therefore, we reverse the trial court’s order authorizing the administration of psychoactive

medication-forensic and render judgment denying the State’s application for an order to administer

psychoactive medication-forensic.

 JAMES T. WORTHEN 

 Chief Justice

Opinion delivered September 3, 2008.

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

(PUBLISH)