State, 01-15-00784-CV

Background

Patient E.S.R., with a long history of serious mental illness, moved to Houston to live with his parents and within weeks exhibited paranoid, delusional, and agitated behavior.
On August 24 he reportedly threatened to kill his parents if they sought psychiatric care, requested return of his gun, and claimed people were stalking, assaulting, and shooting at him.
Father obtained emergency detention; doctors (Dr. Hawkins and Dr. Smith) examined E.S.R., diagnosed psychosis/schizophrenia, and certified he could not care for or protect himself.
Probate court held a hearing, heard doctor testimony and father’s affidavit (stipulated), and found by clear and convincing evidence that E.S.R. was mentally ill and (1) likely to cause harm to others and (2) suffering distress with deterioration of functioning.
Court entered a temporary inpatient commitment (up to 90 days) and separately authorized administration of psychoactive medication; E.S.R. appealed both orders, arguing the commitment order was unsupported.

Issues

Issue	Appellant's Argument	Appellee's Argument	Held
Whether clear and convincing evidence supported temporary commitment under Tex. Health & Safety Code § 574.034	E.S.R. denied threatening his parents and challenged sufficiency of the State’s factual support for the statutory criteria	State relied on father’s affidavit, doctors’ certificates and testimony, and observed overt acts (threats, request for gun, hallucinations, refusal of meds) to meet the statutory test	Commitment order affirmed: threats and related conduct suffice as overt acts confirming likelihood of harm and deterioration
Whether the medication authorization under Tex. Health & Safety Code § 574.106 was valid	E.S.R. contended medication order invalid if the underlying commitment is invalid	State argued medication order depends on a valid commitment and otherwise satisfied statutory criteria (lack of capacity, best interest, needed classes identified)	Medication order affirmed as dependent on and supported by valid commitment order
Whether expert testimony had adequate factual basis	E.S.R. argued Dr. Hawkins failed to establish dates/clinical basis for diagnosis	State noted Dr. Hawkins relied on the father’s affidavit and his own in-hospital observations; appellant waived some cross-exam points	Court accepted expert testimony as having sufficient factual basis for clear-and-convincing standard
Whether refusal of medication alone can support commitment	E.S.R. argued refusal alone is insufficient under precedent	State showed both refusal and specific medication classes, expected effects, and overt behavior—making refusal probative of deterioration	Court relied on precedent distinguishing mere refusal from refusal plus proof of needed medication and deterioration; evidence sufficient

Key Cases Cited

State v. K.E.W., 315 S.W.3d 16 (Tex. 2010) (defines clear-and-convincing test and examples of overt acts showing likely harm to others)
M.S. v. State, 137 S.W.3d 131 (Tex. App.—Houston [1st Dist.] 2004) (clear-and-convincing standard and review framework)
J.M. v. State, 178 S.W.3d 185 (Tex. App.—Houston [1st Dist.] 2005) (refusal-of-medication alone insufficient without evidence of necessary medication and consequences)
Goldwait v. State, 961 S.W.2d 432 (Tex. App.—Houston [1st Dist.] 1997) (examples where overt acts and continuing behavior supported commitment)