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Click here for the full text of this decision FACTS:J.M., an adult woman, was brought into the University of Texas Medical Branch Hospital in Galveston by her sister. The women were roommates, along with a third sister and all the women’s children. The sister told hospital staff that J.M. suffered bipolar disorder, had not been taking her medication, had been acting aggressively toward other family members, including children, had threatened suicide and had stopped bathing or brushing her teeth. The hospital admitted J.M. for inpatient treatment on Dec. 7, 2004. Two weeks later, Dr. Mireya Silva signed an application order to have J.M. committed to Austin State Hospital for 90 days or less. In support of the application, Silva and Dr. Waheedul Haque submitted certificates of medical examination. Both diagnosed J.M. with bipolar disorder and depression with psychotic factors. The facts underlying the assessment included J.M.’s aggressive behavior and her disinterest in personal hygiene. Both doctors also stated that while in UTMB, J.M. remained mute for several days, refused medication and refused to get out of bed. At a commitment hearing on Dec. 29, Haque testified that J.M. was likely to cause harm to herself. He stated that J.M. was experiencing substantial mental or physical deterioration of her ability to function independently, as evidenced by her inability to provide for basic needs, and her inability to make rational, informed decisions about her treatment. Based on what J.M.’s sister told him when J.M. was brought to the hospital, Haque also opined that J.M. was a danger to others, though he also acknowledged that J.M. had not displayed any violent or aggressive behavior while hospitalized. Haque also acknowledged that J.M. told him that her family was trying to hospitalize her because she wasn’t giving the family money they wanted. J.M. testified, too. She admitted that she suffered from bipolar disorder and depression, and that she had once been hospitalized, but she also stated that for the past 10 years, she had led a normal life while on her medication. She had been a nurse, and though she was not currently employed, she was living off her savings. She moved in with her sister in LaMarque, J.M. said, when J.M. thought it best that her daughter move out of the Houston school system. The daughter had been doing well since the move, J.M. had made the sister’s car payments for a time, and J.M. paid for utilities and groceries, cooked meals and babysat her other sister’s daughter. J.M. testified that she had never hit any family members. Instead, she said, it was the sister who brought her into the hospital who hit her when J.M. refused to give the sister money. According to J.M., the sister hit her and told her, “Either you give us money or I will have you locked up.” The trial court determined that J.M. was mentally ill, that she was likely to cause serious harm to herself, and that she was suffering distress that made her unable to function independently. The trial court signed a commitment order for a period not to exceed 90 days. It also signed an order requiring that psychoactive medication be administered. J.M. appeals both orders. HOLDING:Reversed and rendered. The court first addresses the question of whether it has jurisdiction over the case, in light of the fact that the term of commitment has already expired. The court notes that in State v. Lodge, 608 S.W.2d 910 (Tex. 1980), the Texas Supreme Court held that the doctrine of mootness does not apply to appeal from involuntary commitment orders for temporary hospitalization � even if the commitment period has expired � because there is a collateral consequence of an improper commitment order: the stigma attached to hospitalization for mental illness. The commitment order, then, is not moot and can be appealed. So, too, can the order to administer psychoactive medication, the court concludes, distancing itself from other courts that have declined to extend the Lodge principle to medication orders. The court, instead, finds that “the stigma attached to being subject to an order to administer psychoactive medication, like that of an order for inpatient mental health treatment, is a collateral consequence that continues even after the term of the order has expired.” The court next turns to weigh the evidence supporting the trial court’s order of temporary commitment, noting that under Texas Health & Safety Code 574.034(a), the evidence must show that a recent over act or continuing pattern of behavior 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.” The court observes that Haque’s testimony tracks the language of 574.034(a), but the court says that’s not enough. Evidence simply establishing that a person is mentally ill and in need of hospitalization is not evidence that the standard for involuntary commitment has been satisfied. No overt act of violence or aggression was documented. The sister said J.M. was violent, but Haque did not observe similar behavior. J.M.’s family said J.M. threatened suicide, but no specific details were provided. The refusal of medication is insufficient evidence of an overt act or continuing pattern of behavior demonstrating the patient’s distress, the court adds. Additionally, evidence that J.M. refused to have her vital signs taken and blood drawn, like her refusal to take medication, is not evidence of an overt act or continuing pattern of behavior that would generally affect J.M.’s ability to function independently on a day-to-day basis without the imposition of court-ordered mental health services. The court finds no evidence that J.M.’s behavior would have harmed her. For instance, the state did not prove how J.M.’s muteness or refusal to get out of bed demonstrated a likelihood of harm. Also, even assuming that J.M.’s poor hygiene might result in physical problems at some point, to justify depriving an individual of her liberty, more than potential harm is necessary. Finally, the court confirms that since there is not enough evidence to support the commitment order, the evidence supporting the administration of psychoactive drugs is lacking, too. OPINION:Laura Carter Higley, J.; Taft, Alcala and Higley, JJ.

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