NO. 12-15-00046-CV

IN THE COURT OF APPEALS

TWELFTH COURT OF APPEALS DISTRICT

TYLER, TEXAS

THE STATE OF TEXAS FOR THE 

BEST INTEREST AND PROTECTION 

OF T. M.

§

§

§

APPEAL FROM THE

COUNTY COURT AT LAW

CHEROKEE COUNTY, TEXAS

MEMORANDUM OPINION

T.M. appeals from an order authorizing the Texas Department of State Health Services 

(the Department) to administer psychoactive medication-forensic. In one issue, T.M. asserts the 

evidence is legally insufficient to support the trial court’s order. We affirm.

BACKGROUND

On February 5, 2015, Larry Hawkins, M.D. signed an application for an order to 

administer psychoactive medication-forensic to T.M. In the application, Hawkins stated that 

T.M. was subject to an order for inpatient mental health services issued under Chapter 46C (not 

guilty by reason of insanity) of the Texas Code of Criminal Procedure. He stated further that 

T.M. had been diagnosed with schizoaffective disorder and requested the trial court to compel 

T.M. to take psychoactive medications including antidepressants, anxoilytic/sedative/hypnotics, 

antipsychotics, and mood stabilizers. According to Hawkins, T.M. verbally refused to take the 

medications. Hawkins stated further that, in his opinion, T.M. lacked the capacity to make a 

decision regarding administration of psychoactive medications because he denies that he has any 

mental illness and cannot weigh the risks versus the benefits of psychoactive medications. 

Hawkins concluded that these medications were the proper course of treatment for T.M. and that, 

if he were treated with the medications, his prognosis would be good, he should improve, and his 

symptoms would be kept in remission. Hawkins believed that, if T.M. were not administered 

these medications, he might harm himself or others. Hawkins considered other medical 
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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 T.M.’s best interest. Hawkins also considered less 

intrusive treatments likely to secure T.M.’s agreement to take psychoactive medication.

The trial court held a hearing on the application. At the close of the evidence, the trial 

court granted the application. 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 T.M.’s best interest and that T.M. lacked the 

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

authorized the Department to administer psychoactive medications to T.M., including 

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

appeal followed.

SUFFICIENCY OF THE EVIDENCE

In his sole issue, T.M. argues that the evidence is legally insufficient to support the trial 

court’s order to administer psychoactive medication-forensics. More specifically, T.M. 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.

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 
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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, 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 2010). 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). “Capacity” 

means a patient’s ability to (1) understand the nature and consequences 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) 

(West 2010). 

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. TEX. HEALTH & SAFETY CODE ANN. 

§ 574.106(b) (West 2010).
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Analysis

At trial, Hawkins testified that he did not believe T.M. could weigh the risks versus the 

benefits of medications or make a rational and informed decision because he did not want to 

grasp the concept that he has a mental illness. He also testified that T.M. has a history of mental 

health disorders, had been treated at the hospital two and one-half years ago, and had been 

hospitalized twice in the last six months in Harris County. According to Hawkins, T.M. had

recently been hospitalized as a result of psychosis and possibly manic symptoms, failed to stay at 

a group home or take medications as ordered by a court, and believed that his sister’s stuffed 

animals and trophies were idols and invoked evil spirits. Hawkins believed that even though 

T.M. showed no recent aggression, he could be a danger to himself or others.

T.M. expressed his concern about taking psychoactive medications because of his history 

of side effects including weight gain, a sluggish feeling in his body, upset stomach, constipation, 

irregular heart palpitations, a clouded sense of cognitive thinking, and akathisia, i.e., a feeling of 

uneasiness and restlessness in his legs. The trial court is not required to defer to T.M.’s 

preferences, but must consider them. See TEX. HEALTH & SAFETY CODE ANN. § 574.106(b).

Here, the trial court considered T.M.’s side effects in granting the Department’s application by 

requesting that Hawkins work with T.M. in order to find the appropriate medication and level of 

dosage. From Hawkins’s testimony, it is apparent that he was unaware of T.M.’s previous side 

effects, and said that he would take into account T.M.’s past experiences when these medications 

are prescribed in the future. See In re E.K., No. 12-06-00407-CV, 2007 WL 1492104, at *4 

(Tex. App.—Tyler May 23, 2007, no pet.) (mem. op.); In re D.H., No. 12-04-00181-CV, 2004 

WL 2820896, at *4 (Tex. App.—Tyler Dec. 8, 2004, no pet.) (mem. op.).

Further, T.M. had religious objections to taking psychoactive medications. He stated that 

he was a practicing Roman Catholic Christian, and testified that in a letter in the New Testament, 

Paul warned against sorcery. According to T.M., the ancient Greek word for sorcery is 

pharmakeia, which translates into the modern word for pharmacy, i.e., the administration of 

medication. Hawkins testified that T.M.’s belief system became exaggerated when he was 

psychotic. He said that T.M.’s beliefs bordered on delusions, were not consistent, and did not 

follow the tenets of any particular faith. Again, the trial court is not required to defer to T.M.’s 

beliefs, but must consider them. See TEX. HEALTH & SAFETY CODE ANN. § 574.106(b). 
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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 T.M. lacked the 

capacity to make a decision regarding administration of the proposed medications and that 

treatment with the proposed medications was 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. 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. Accordingly, we 

overrule T.M.’s sole issue.

DISPOSITION

Having overruled T.M.’s sole issue, we affirm the trial court’s order.

BRIAN HOYLE

Justice

Opinion delivered May 29, 2015.

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

(PUBLISH)
COURT OF APPEALS

TWELFTH COURT OF APPEALS DISTRICT OF TEXAS

JUDGMENT

MAY 29, 2015

NO. 12-15-00046-CV

THE STATE OF TEXAS FOR THE BEST

INTEREST AND PROTECTION OF T. M.

Appeal from the County Court at Law 

of Cherokee County, Texas (Tr.Ct.No. 41,349)

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.