The State of Texas for the Best Interest and Protection of A. D. S. v. the State of Texas

NO. 12-23-00143-CV

IN THE COURT OF APPEALS

TWELFTH COURT OF APPEALS DISTRICT

TYLER, TEXAS

THE STATE OF TEXAS FOR THE § APPEAL FROM THE

BEST INTEREST AND PROTECTION § COUNTY COURT AT LAW

OF A.D.S. § CHEROKEE COUNTY, TEXAS

MEMORANDUM OPINION
A.D.S. appeals from an order authorizing the administration of psychoactive medication.
In his sole issue, A.D.S. challenges the legal and factual sufficiency of the evidence to support the
trial court’s order. We affirm.

BACKGROUND
A.D.S. was found incompetent to stand trial and committed to Rusk State Hospital for
examination and treatment with the specific objective of attaining competency. A.D.S. refused to
take medication prescribed for his condition and denied needing medication. On May 17, 2023,
Dr. Jill K. Pontius signed an application to order the administration of psychoactive medication.
After conducting a hearing, the trial court signed an order authorizing the administration of
psychoactive medication. In its order, the trial court stated that the allegations in the application
are supported by clear and convincing evidence. The trial court concluded that A.D.S. lacks the
capacity to make a decision regarding the administration of psychoactive medication and that
treatment with the proposed medications is in his best interest. This appeal followed.

SUFFICIENCY OF THE EVIDENCE
In his sole issue, A.D.S. argues that the evidence is legally and factually insufficient to
support the trial court’s order authorizing administration of psychoactive medication. Specifically,
A.D.S. contends the evidence failed to establish that the proposed medications were in his best
interest.
Standard of Review
Texas law requires that orders authorizing administration of psychoactive medication be
supported by clear and convincing evidence. TEX. HEALTH & SAFETY CODE ANN. § 574.106(a-1)
(West 2017). “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). Although the
proof must weigh more heavily than merely the greater weight of the credible evidence, the
evidence need not be unequivocal or undisputed. Id.
In conducting a legal sufficiency review when the burden of proof is clear and convincing
evidence, we 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 assume that the factfinder settled disputed facts
in favor of its finding if a reasonable factfinder could do so and disregard all evidence that a
reasonable factfinder could have disbelieved or found incredible. Id. When reviewing factual
sufficiency, we must give due consideration to evidence that the factfinder could reasonably have
found to be clear and convincing and then determine whether, based on the entire record, a
factfinder could reasonably form a firm conviction or belief that the allegations in the petition were
proven. Id. We must consider whether the disputed evidence is such that a reasonable factfinder
could not have reconciled that disputed evidence in favor of its finding. Id. If the disputed
evidence is so significant that a factfinder could not reasonably have formed a firm belief in the
finding, the evidence is factually insufficient. Id. The factfinder is the sole arbiter of the credibility
and demeanor of witnesses. In re H.R.M., 209 S.W.3d 105, 109 (Tex. 2006).
Applicable Law
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 patient’s best interest. Id. § 574.106 (a-1).

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“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. Id. § 574.101(1) (West 2017). In making a
finding that treatment with the proposed medication is in the patient’s best interest, 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 patient’s
perspective, of taking psychoactive medication, (4) the consequences to the patient if the
psychoactive medication is not administered, (5) the patient’s prognosis if he 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).
Analysis
Dr. Pontius’s application states that A.D.S. is subject to an order for court-ordered inpatient
mental health services due to his incompetency to stand trial. According to the application, Dr.
Pontius diagnosed A.D.S. with schizoaffective disorder, bipolar type; cocaine use disorder; opioid
use disorder; and HIV infection. Additionally, the application states that (1) A.D.S. refuses to take
the medication voluntarily and (2) A.D.S. lacks the capacity to make a decision regarding
administration of psychoactive medication because, although A.D.S. initially agreed to take
medication and signed consent forms, he “refused monitoring lab draws,” “declined several doses
of medications,” and “is unable to engage in a rational discussion of his need for medications or
the risks [versus] benefits of taking them daily.” Dr. Pontius also stated in the application that if
treated with psychoactive medication, A.D.S. will have an “[i]mproved prognosis with possibility
of competency restoration.” The application also stated that if the medications were not
administered, A.D.S. would suffer psychotic deterioration and would need prolonged
hospitalization. Moreover, Dr. Pontius stated in the application that she considered alternatives to
psychoactive medication, but determined that medical alternatives would not be as effective as
administration of psychoactive medication. Furthermore, Dr. Pontius’s application indicated that
the benefits of psychoactive medication outweigh the risks, and that treatment with the proposed
medication is in A.D.S.’s best interest.
At the hearing on the application, Dr. Pontius testified that she is A.D.S.’s treating
physician, and when asked if she swears that the statements in the application for administration

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of psychoactive medication are true and correct, she responded affirmatively. Dr. Pontius
explained that A.D.S. suffers from schizoaffective disorder, bipolar type; cocaine use disorder;
opioid use disorder; and HIV infection. According to Dr. Pontius, A.D.S. “initially agreed to take
the medication and signed consent forms for it, then he refused monitoring lab draws and has
declined . . . both of the medications.” Dr. Pontius indicated that A.D.S. is “unable to engage in a
rational discussion of his need for medication or the risks versus the benefits of taking them daily.”
When asked whether the proposed medications are the proper course of treatment and are in
A.D.S.’s best interest, Dr. Pontius stated, “Yes, they are.”
Dr. Pontius testified that there are no less intrusive alternative treatment protocols, the
benefits of the proposed medications outweigh their risks, and if the medications are not
administered, A.D.S. will be a danger to others. Dr. Pontius explained that A.D.S. will regain
competency faster if the medications are administered. Dr. Pontius stated that the medications
could potentially interfere with A.D.S.’s ability to confer with his attorney regarding his
underlying criminal charge, but she explained, “we monitor for side effects and make sure the
patient tolerates their regimen[,]” and “if there was a problem, we would be aware of it and would
be able to adjust his medication.” Dr. Pontius testified that there is no indication that the
medication is causing substantial side effects for A.D.S. Dr. Pontius explained that A.D.S. has not
objected to the medications on religious or constitutional grounds; rather, A.D.S.’s “main objection
is he doesn’t think he needs to be here[,] and he doesn’t think he needs treatment for mental
illness.”
When asked what his objections to medication are, A.D.S. testified, “I like my medication,
but I don’t want to be here no more.” A.D.S. indicated that he believed the hearing was about his
competency rather than administration of medication, and when corrected by his attorney, A.D.S.
stated, “Well, I am taking my medication. I want to leave. I don’t want to be here.” A.D.S.
responded in the negative when asked a second time whether he has any objection to the
medication.
With respect to the sufficiency of the evidence as to best interest, A.D.S. argues that his
case is analogous to State ex rel. E.G., 249 S.W.3d 728 (Tex. App.—Tyler 2008, no pet.), in which
we held that the evidence was insufficient to support a finding that the proposed medications were
in the patient’s best interest. In E.G., the only evidence regarding the patient’s best interest was
in the application, and we determined that a conclusory statement in the application, without

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testimony from a physician at the hearing, could not support the order for administration of
psychoactive medication. Id. at 731-32.
We conclude that E.G. is distinguishable from the instant case. In this case, Dr. Pontius
testified that she is A.D.S.’s treating physician, and she prepared the application for administration
of psychoactive medication. Dr. Pontius testified that A.D.S. will regain competency more quickly
if psychoactive medications are administered, and the medications constitute the proper course of
treatment for A.D.S., the benefits outweigh the risks, and taking the medications is in A.D.S.’s
best interest. Dr. Pontius further testified that no alternatives were available. Although Dr. Pontius
reiterated much of what was in the application and provided succinct answers at the hearing, her
testimony addressed the majority of the required items listed in Section 574.106(b). See TEX.
HEALTH & SAFETY CODE ANN. § 574.106(b). “While mindful that unsupported conclusions are
legally insufficient to support the existence of the fact asserted, there may be a fine line between
conclusory and succinct. However, the trial court may well be able to connect the dots, based on
its knowledge of the law and brief testimony.” State of Tex. for Best Interest & Prot. of S.P., 592
S.W.3d 508, 513 (Tex. App.—Tyler 2019, no pet.).
As discussed above, in evaluating legal sufficiency, we must assume that the factfinder
settled disputed facts in favor of its finding if a reasonable factfinder could do so and disregard all
evidence that a reasonable factfinder could have disbelieved or found incredible. In re J.F.C., 96
S.W.3d at 266. Considering all the evidence in the light most favorable to the finding, we conclude
that a reasonable trier of fact could have formed a firm belief or conviction that its findings were
true. See id. Therefore, the evidence is legally sufficient. See id.
In evaluating factual sufficiency, we consider whether a reasonable factfinder could not
have resolved disputed evidence in favor of its finding and, if there is such evidence, whether that
evidence is so significant that a factfinder could not have reasonably formed a firm belief or
conviction that administering the medication is in the patient’s best interest. See id. There was no
disputed evidence that the trial court could not reasonably have resolved in favor of its ruling. See
id.; S.P., 592 S.W.3d at 514. Accordingly, the evidence is factually sufficient to support the trial
court’s finding. See In re J.F.C., 96 S.W.3d at 266; S.P., 592 S.W.3d at 514. We overrule
A.D.S.’s sole issue.

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DISPOSITION
Having overruled A.D.S.’s sole issue, we affirm the trial court’s judgment.

JAMES T. WORTHEN
Chief Justice

Opinion delivered July 31, 2023.
Panel consisted of Worthen, C.J., Hoyle, J., and Neeley, J.

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COURT OF APPEALS

TWELFTH COURT OF APPEALS DISTRICT OF TEXAS

JUDGMENT

JULY 31, 2023

NO. 12-23-00143-CV

THE STATE OF TEXAS FOR THE
BEST INTEREST AND PROTECTION OF A.D.S.

Appeal from the County Court at Law
of Cherokee County, Texas (Tr.Ct.No. 43500)

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 the decision be certified to the court below for
observance.
James T. Worthen, Chief Justice.
Panel consisted of Worthen, C.J., Hoyle, J., and Neeley, J.