Opinion
No. 05-09-00085-CV
Opinion issued June 11, 2009.
On Appeal from the Probate Court No. 3 as a Mental Health Court, Dallas County, Texas, Trial Court Cause No. MI-09-00014 and MED-09-80004.
Before Justices FITZGERALD, LANG, and FILLMORE.
MEMORANDUM OPINION
D.F. brings this accelerated appeal from the trial court's judgment ordering D.F. to submit to temporary in-patient mental health services at Green Oaks Hospital, for a period of time not to exceed 90 days. In six issues, D.F. contends the evidence is legally and factually insufficient to support the trial court's findings, by clear and convincing evidence, that: (1) D.F. was likely to cause harm to herself, (2) D.F.'s ability to function was deteriorating because of a mental illness, and (3) there was a recent overt act or continuing pattern of behavior confirming the first two findings. We disagree. Accordingly, we affirm the trial court's orders. At the time of the proceeding below, D.F. was fifty-seven years old; she was married, with a grown daughter and grandchildren. D.F. left her home on December 17, 2007. She stayed in hotels for a number of days. Eventually her husband cancelled her access to bank accounts and obtained a mental health warrant. D.F. was living in her car at that point in time. On December 31, D.F. was found wandering around a business area after she had locked herself out of her car. Police officers were called and, after being informed there was a mental health warrant outstanding, they brought D.F. to Green Oaks Hospital. Doctor Raza Sayed observed and evaluated D.F. at Green Oaks and certified she was "psychotic, sleeping in her car, losing weight, sleeping poorly, delusional, paranoid, disorganized, deteriorating without treatment." Doctor Rodolfo Molina was D.F.'s treating physician at Green Oaks; he certified that she was "paranoid, loose, placing self in precarious situations." Based on these medical opinions, the State applied for temporary court-ordered mental health services.
Pursuant to the judgment, the trial court signed both an Order of Commitment and an Order to Administer Psychoactive Medication. Although D.F.'s notice of appeal identifies both orders, her brief challenges only the Order of Commitment. We limit our opinion to that order as well.
She had been staying away from the home without explanation for longer and longer periods of time before this final departure.
D.F.'s case was tried to the court. A trial court may order temporary inpatient mental health services only if it finds, from clear and convincing evidence, that the patient is mentally ill and that at least one of three criteria set forth in the mental health statute results from that mental illness. Tex. Health Safety Code Ann. § 574.034(a) (Vernon 2003). In this case, the trial court found that D.F. was likely to cause serious harm to herself and that she suffered severe mental, emotional or physical distress, deterioration in her ability to function independently, and inability to make a rational and informed decision about treatment. See id. § 574.034(a)(2)(A), (C).
Clear and convincing evidence is "that measure or degree of proof which 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." D.M. v. State, 181 S.W.3d 903, 914 (Tex.App. 2006, no pet.) (quoting State v. Addington, 588 S.W.2d 569, 570 (Tex. 1979)). To constitute clear and convincing evidence under section 574.034, the evidence must include expert testimony and evidence of a recent, overt act or a continuing pattern of behavior that tends to confirm: (1) the likelihood of serious harm to the proposed patient or others; or (2) the proposed patient's distress and the deterioration of the proposed patient's ability to function. Id. § 574.034(d) (Vernon 2003); see also D.M., 181 S.W.3d at 914.
When the standard of proof is clear and convincing evidence, we review legal sufficiency challenges by looking 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 finding was true. In re J.F.C., 96 S.W.3d 256, 266 (Tex. 2002). We assume the factfinder resolved disputed facts in favor of its finding if a reasonable factfinder could do so, and we disregard all evidence that a reasonable factfinder could have disbelieved or found to have been incredible. Id. In a factual sufficiency review, we give due consideration to evidence that the factfinder could reasonably have found to be clear and convincing and ask whether the evidence is such that a factfinder could reasonably form a firm belief or conviction about the truth of the State's allegations. Id. If, in light of the entire record, the disputed evidence that a reasonable factfinder could not have credited in favor of the finding is so significant that a factfinder could not reasonably have formed a firm belief or conviction, then the evidence is factually insufficient. Id.
D.F. does not challenge the mental-illness finding on appeal. She does challenge the findings that, as a result of her mental illness, she is likely to cause serious harm to herself and that her ability to function was deteriorating because of a mental illness. If the State offered legally and factually sufficient evidence of either of these criteria, we will affirm the judgment. The evidence was uncontroverted that D.F. was living in her car after she moved out of her home. She refused to consider going to a shelter. Moreover, because of her extraordinary distrust of her family, she said she would not call home if she needed help. Dr. Molina testified D.F. was suffering from an intense paranoia and her thoughts were very scattered. In that confused condition, he explained, she was unable to make good, practical judgments for herself. He saw a definite risk that D.F. would place herself in compromising situations, for example situations in which she could be mugged or assaulted. We conclude the record supports Dr. Molina's concerns. Specifically, on two occasions in December D.F. locked herself out of her car and was unable to make a good, practical judgment about what to do. She apparently just wandered in a confused and dazed manner until someone she came into contact with called for help; both occasions ended with the police involved. They could just as easily have ended with D.F. seriously injured.
In addition, medical evidence in the record indicates D.F. was not sleeping well or eating well, and she was losing weight. Other than blood pressure medicine, she was refusing all medications. Indeed, Dr. Molina rated her ability to take care of her activities of daily living in an unstructured environment, outside the hospital, as zero. D.F.'s own testimony evidences a detachment from reality. For example, D.F. believed someone had charged her with child abuse two years before, that her husband knew about this legal matter, but he would not tell her what he knew. D.F. also believed her husband had secretly divorced her. Her husband testified there were no legal charges of any kind against D.F. and there certainly had been no secret divorce. Both Dr. Molina and D.F.'s husband testified her condition was deteriorating. Looking at all the evidence in the light most favorable to the court's finding, a reasonable trier of fact could certainly have formed a firm belief or conviction that D.F. was likely to cause harm to herself. See J.F.C., 96 S.W.3d at 266. Thus, we conclude the evidence is legally sufficient to support that finding. Our evaluation does not change when we give due consideration to evidence that the factfinder could reasonably have found to be clear and convincing and ask whether the evidence is such that a factfinder could reasonably form a firm belief or conviction about the truth of the State's allegations. Id. For example, D.F. believed family members were stealing her ADHD medicine. Her husband testified he did not know of such theft. But a factfinder could have credited D.F.'s belief because her daughter, who had abused prescription drugs in the past, was living with D.F. and her husband at the time. Nevertheless, the factfinder could still form a firm conviction that D.F. was likely to harm herself based on D.F.'s conduct, rather than her beliefs. Thus, we conclude the evidence is factually sufficient to support the finding.
Finally, the occasions when D.F. locked her keys in the car and was unable to resolve the problem provide ample evidence of recent, overt acts that tend to confirm the likelihood of serious harm to D.F. herself. See Tex. Health Safety Code § 574.034(d). Clear and convincing evidence supports the trial court's findings under section 574.034(a)(2)(A). Id. Accordingly, we affirm the trial court's judgment.
Given this conclusion, we need not address D.F.'s arguments concerning the trial court's findings under section 574.034(a)(2)(C).