Full Opinion

In the Court of Appeals Second Appellate District of Texas at Fort Worth ___________________________ No. 02-26-00544-CV ___________________________ IN THE MATTER OF C.D. On Appeal from the County Court Wichita County, Texas Trial Court No. CC-MH2026-0512 Before Kerr, Birdwell, and Bassel, JJ. Memorandum Opinion by Justice Birdwell MEMORANDUM OPINION In one issue containing three sub-issues, Appellant C.D. (Cate1) appeals from an order authorizing the involuntary administration of psychoactive medication. See Tex. Health & Safety Code § 574.106. Cate alleges that the evidence is insufficient to support the order authorizing the administration of psychoactive medication and, in her second and third sub-issues, argues that the evidence fails to satisfy the four-part test of Sell v. U.S., 539 U.S. 166, 123 S. Ct. 2174 (2003). Because the Sell test applies, and the evidence does not satisfy the test’s second factor, we reverse and render without reaching Cate’s first sub-issue. See Tex. R. App. P. 47.1; Valk v. Copper Creek Distribs., Inc., 733 S.W.3d 9, 11 (Tex. 2026) (“When a party presents multiple grounds for reversal of a judgment on appeal, appellate courts must first address issues that, if meritorious, would require rendition.”). I. Background Cate was charged with a third-degree felony.2 A Travis County district court found that Cate was mentally incompetent to stand trial and committed her to a mental health facility on April 6, 2026. See Tex. Code Crim. Proc. art. 46B.073. Cate was We use an alias for C.D. to protect her privacy. See State ex rel. L.S., No. 13-25- 1 00364-CV, 2025 WL 3030603, at *1 n.1 (Tex. App.—Corpus Christi–Edinburg Oct. 30, 2025, no pet.). It is unclear from the record if the alleged offense is a single count of obstruction 2 and retaliation or two counts: one for obstruction and retaliation and one for stalking. However, both alleged offenses are third-degree felonies. See Tex. Penal Code §§ 36.06(c), 42.072(b). 2 transported to the North Texas State Hospital on July 1, 2026, and her treating psychiatrist, Dr. Mohona Sadhu, completed an “Application for Order to Administer Psychoactive Medication-Forensic” on August 10, 2026. Two days later, the Wichita County trial court conducted a hearing on Dr. Sadhu’s application. Dr. Sadhu testified that Cate was being treated for delusional disorder, involving very strongly held, fixed beliefs that, despite rational evidence being presented, did not fluctuate. According to Dr. Sadhu, Cate believed that she was involved in an elaborate conspiracy—for which she was a whistleblower—and that she had been investigated for the past 30 years. Cate also believed that, since 1992, she had been working undercover to help the FBI stop crimes related to human trafficking, organized crime, and racketeering. Since her admission to the hospital, Cate’s condition had remained the same, and she had consistently refused medication. Cate had told Dr. Sadhu that she did not need the prescribed medication because she did not have a mental illness. Dr. Sadhu stated that Cate had not exhibited any verbal or physical aggression 3 since arriving at the hospital. Cate had been “intermittently argumentative” and difficult to redirect or interrupt, making it challenging for her to engage with the treatment team and to complete the steps for her competency restoration. Dr. Sadhu testified that the 3 Although Dr. Sadhu posited that Cate—if she were released from the hospital— could “potentially” pose a danger to “other people” outside of the hospital, Dr. Sadhu also testified that Cate was not a danger to herself or to anyone in the hospital. 3 recommended medication would improve Cate’s thought process, decrease the severity of her delusions, and allow her to engage meaningfully in her treatment plan, thereby resulting in her competency restoration. Without the medication, Dr. Sadhu expected Cate to continue to experience psychological distress—including disorganization and delusions—and she would be ultimately unable to regain competency. The treatment team had attempted to explain to Cate the benefits and side effects of the medication, but she had been unable to understand. Dr. Sadhu testified that, at the time of the hearing, Cate lacked the capacity to make a decision regarding her medication and that the medication was in her best interest. Given the severity of Cate’s disorganization and inability to engage with her treatment plan, Dr. Sadhu could recommend no less intrusive treatment option. The trial court’s written preliminary findings included (1) that Cate lacked the capacity to make a decision about the medication’s administration, (2) that treatment with the proposed medication was in Cate’s best interest, (3) that such treatment would improve Cate’s quality of life, and (4) that the benefits of treatment exceeded the medication’s known risks. The trial court then granted the request for authorization to administer psychoactive medication to Cate. II. Discussion In her second and third sub-issues, Cate argues that the trial court’s order was based solely on restoration of her competency to stand trial, making the Sell four-part test applicable, and that under that test, the evidence is insufficient to support the trial 4 court’s order authorizing psychoactive medication. She acknowledges that the first Sell factor was met, but argues that the second, third, and fourth factors all fail to support the trial court’s order authorizing the administration of psychoactive medication. We agree with Cate that Sell applies and that the test’s second factor was not met. 4 See Tex. R. App. P. 47.1. A. Applicability of Sell An individual has a significant liberty interest in avoiding the unwanted administration of psychoactive medication. Sell, 539 U.S. at 178, 123 S. Ct. at 2183. The Sell four-part test applies when a court seeks to administer medication involuntarily because it is significantly necessary to further a particular governmental interest—like the restoration of competency in criminal cases. In re N.S., No. 02-19-00262-CV, 2019 WL 4122612, at *6 (Tex. App.—Fort Worth Aug. 29, 2019, pet. denied) (citing Sell, 539 U.S. at 181–82, 123 S. Ct. at 2185). However, the Sell four-part test does not apply if forced medication is warranted for a different purpose, such as the defendant’s dangerousness or where the refusal to take medication puts the defendant’s health at risk. Sell, 539 U.S. at 181–82, 123 S. Ct. at 2185. As an initial matter, we note that—despite testimony that Cate was not a danger to herself or others in the hospital—there was a written finding to that effect included We note that the State’s response brief does not address Cate’s second or third 4 sub-issues related to the Sell four-part test. 5 in one of the three documents signed by the trial court after the hearing.5 However, Cate had shown no physical or verbal aggression while in the hospital, and the only testimony related to Cate’s dangerousness was a statement from Dr. Sadhu that Cate “potentially” could be dangerous to others outside of the hospital if released. In addition, as the trial court’s final order did not contain a dangerousness finding, we conclude there was no finding of dangerousness. And, despite testimony that the recommended psychoactive medication would improve Cate’s disorganization, reduce her delusions, and afford her the opportunity to engage meaningfully with her treatment plan, there was no testimony or finding that Cate’s health would be at risk if she did not take the proposed medication. See, e.g., State ex rel. F.H., 214 S.W.3d 780, 783 (Tex. App.—Tyler 2007, no pet.). In fact, the testimony seemed to support the opposite conclusion: Dr. Sadhu testified that since being admitted to the hospital, Cate’s condition had not worsened. Therefore, under the Sell four-part test, we must determine whether the involuntary administration of psychoactive medication to Cate in order to render her competent to stand trial was constitutionally permissible. See Sell, 539 U.S. at 179, 123 S. Ct. at 2184. We sustain Cate’s second sub-issue. There was neither an oral finding of dangerousness in the hearing record nor a 5 written finding of dangerousness in the trial court’s preliminary findings or the final order authorizing the administration of forced medication. 6 B. The Sell Four-Part Test The involuntary administration of psychoactive medication may be allowed to render a defendant charged with a serious criminal offense “competent to stand trial, but only if the treatment is medically appropriate, is substantially unlikely to have side effects that may undermine the fairness of the trial, and, taking account of less intrusive alternatives, is necessary significantly to further important governmental trial-related interests.” Id., 123 S. Ct. at 2184. This requires consideration of four factors: (1) whether important governmental interests are at stake, (2) whether involuntary medication will significantly further those interests, (3) whether involuntary medication is necessary to further those interests, and (4) whether the administration of the drugs is medically appropriate. Id. at 180–81, 123 S. Ct. at 2184–85. First, the government’s interest in bringing to trial an individual accused of a serious crime is important, whether the offense is against persons or against property. Id. at 180, 123 S. Ct. at 2184. The United States Supreme Court and the Texas Supreme Court define a “serious offense” as one for which a defendant may be sentenced to a term of imprisonment exceeding six months. F.H., 214 S.W.3d at 783 (first citing Baldwin v. New York, 399 U.S. 66, 69, 90 S. Ct. 1886, 1888 (1970); and then citing Ex parte Werblud, 536 S.W.2d 542, 547 (Tex. 1976)). Here, Cate was charged with a third-degree felony, which is punishable by between two and ten years’ imprisonment. See Tex. Penal Code § 12.34(a). Thus, we conclude that there are important governmental interests at 7 stake in the involuntary administration of psychoactive medication to Cate in order to render her competent to stand trial. See Sell, 539 U.S. at 180, 123 S. Ct. at 2184. Second, when there are important governmental interests at stake, we must determine whether the involuntary administration of psychoactive medication will significantly further those interests. Id. at 181, 123 S. Ct. at 2184. Specifically, we must find that the involuntary administration of psychoactive medication is substantially likely to render Cate competent to stand trial and that the medication is substantially unlikely to have side effects that will interfere significantly with her ability to assist in her trial defense. State ex rel. D.B., 214 S.W.3d 209, 213 (Tex. App.—Tyler 2007, no pet.) (citing Sell, 539 U.S. at 181, 123 S. Ct. at 2184–85). Here, Dr. Sadhu testified that treatment with the proposed medication was likely to improve Cate’s thought process and decrease the severity of her delusions, allowing her to engage meaningfully in her treatment plan and ultimately restoring her competency. However, there was no evidence that the involuntary administration of the proposed psychoactive medication would be substantially unlikely to have side effects that would interfere significantly with her ability to assist in her trial defense. See Sell, 539 U.S. at 181, 123 S. Ct. at 2184–85. There was no discussion of the medication’s possible side effects at all. Thus, because the State failed to satisfy the requirements under the second Sell factor, we need not consider the remaining two factors. See, e.g., D.B., 214 S.W.3d at 213 (finding that where no evidence is presented to support the second factor, the State fails to satisfy the Sell test and the order authorizing the 8 administration of psychoactive medication should be reversed); F.H., 214 S.W.3d at 783 (holding that failure to meet the first Sell factor ends the analysis and the trial court’s order authorizing the administration of psychoactive medication should be reversed). But see State ex rel. K.M.E., No. 12-11-00188-CV, 2011 WL 6000702, at *5 (Tex. App.— Tyler Nov. 23, 2011, no pet.) (finding support for second Sell factor where the treating doctor testified that the medication would not prevent the defendant from communicating with counsel but would aid her ability to do so). We sustain Cate’s third sub-issue. III. Conclusion Having sustained Cate’s second and third sub-issues, we reverse the trial court’s order authorizing the administration of psychoactive medication and render judgment denying the State’s application for an order to administer psychoactive medication. /s/ Wade Birdwell Wade Birdwell Justice Delivered: October 22, 2026 9