24CA0911 Peo in Interest of Parrett 07-18-2024
COLORADO COURT OF APPEALS
Court of Appeals No. 24CA0911
Pueblo County District Court No. 24MH30023
Honorable Timothy O’Shea, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Bradley Kenneth Parrett,
Respondent-Appellant.
ORDER AFFIRMED
Division VI
Opinion by JUDGE SCHUTZ
Freyre and Lipinsky, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced July 18, 2024
Cynthia Mitchell, County Attorney, Kate H. Shafer, Special Assistant County
Attorney, Pueblo, Colorado, for Petitioner-Appellee
Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant
1
¶ 1 Respondent, Bradley Kenneth Parrett, appeals the district
court’s order authorizing the staff at the Colorado Mental Health
Hospital in Pueblo (CMHHIP) to involuntarily administer
medication. We affirm.
I. Background
¶ 2 Parrett was committed to CMHHIP for competency restoration
in a criminal case. When Parrett arrived at CMHHIP in November
2023, he was irritable, exhibited thought blocking and disorganized
thinking, and expressed paranoid delusions. Over time, Parrett’s
condition deteriorated, and he became physically aggressive. His
physical aggression progressed over time: (1) on March 15, without
provocation, he pushed a peer from behind; (2) on April 8, he made
threatening statements to staff; and (3) on April 24, he hit a peer
with his fists. The medical staff started him on emergency
medication after the last incident.
¶ 3 Dr. Paul Mattox, a staff psychiatrist at CMHHIP and Parrett’s
attending psychiatrist, diagnosed Parrett with schizophrenia and
sought to treat him with Olanzapine (Zyprexa), but Parrett refused
to take this medication voluntarily. On May 7, 2024, the People
2
filed a motion seeking a court order to authorize the involuntary
administration of the medication.
¶ 4 The district court held a hearing on May 13, 2024. Dr. Mattox
testified for the People and Parrett testified on his own behalf. At
the end of the hearing, the court concluded that the People had
proved all four elements set forth in People v. Medina, 705 P.2d 961
(Colo. 1985), and issued an order allowing CMHHIP staff to
administer the requested medication to Parrett against his will.
II. Discussion
¶ 5 Parrett contends that the evidence presented to the district
court was insufficient to support the involuntary medication order.
While he concedes that sufficient evidence supports the first,
second, and third Medina factors, he asserts there was insufficient
evidence to establish the fourth factor. We are not persuaded.
A. Applicable Law and Standard of Review
¶ 6 An involuntarily committed or legally incompetent person
retains the right to refuse treatment. Id. at 971. But a district
court may order that a patient be involuntarily administered
medications if the People prove, by clear and convincing evidence,
the four factors outlined in Medina:
3
(1) the patient is incompetent to effectively
participate in the treatment decision;
(2) treatment by antipsychotic and other
medications is necessary to prevent a
significant and likely long-term deterioration in
the patient’s mental condition, or to prevent
the likelihood of the patient causing serious
harm to himself or others in the institution;
(3) a less intrusive treatment alternative is not
available; and
(4) the patient’s need for treatment by
antipsychotic and other medications is
sufficiently compelling to override any bona
fide and legitimate interest he or she has in
refusing treatment.
Id. at 973.
¶ 7 The State must prove each Medina factor by clear and
convincing evidence. People in Interest of R.K.L., 2016 COA 84,
¶ 30. A treating physician’s testimony may be sufficient to satisfy
the State’s burden of proof. See People v. Pflugbeil, 834 P.2d 843,
847 (Colo. App. 1992).
¶ 8 Where, as here, a patient challenges the sufficiency of the
evidence supporting the district court’s finding on any of these
elements, we review the court’s conclusions of law de novo and
defer to its factual findings if supported by the evidence. People v.
Marquardt, 2016 CO 4, ¶ 8. We view the evidence as a whole and in
4
the light most favorable to the People, leaving the resolution of
conflicts in the testimony and determinations of witness credibility
solely to the fact finder. People v. Fuentes, 258 P.3d 320, 326 (Colo.
App. 2011). Where “ample evidence in the record . . . support[s] the
trial court’s findings and conclusion[s], based on clear and
convincing evidence,” we may not “substitute[] [our] judgment for
that of the trial court.” People in Interest of A.J.L., 243 P.3d 244,
255 (Colo. 2010).
B. Analysis
¶ 9 To satisfy the fourth Medina factor, a court must determine
whether the patient’s refusal is bona fide and legitimate. Medina,
705 P.2d at 974. If so, the court must then determine “whether the
prognosis without treatment is so unfavorable that the patient’s
personal preference must yield to the legitimate interests of the
state in preserving the life and health of the patient placed in its
charge and in protecting the safety of those in the institution.” Id.
¶ 10 The district court found that Parrett had a bona fide and
legitimate interest in refusing treatment based on his religion
(which prohibits him from taking pharmaceuticals because they are
considered poison) and his preference for natural medications.
5
However, the court also found that Parrett’s “prognosis [was] so
unfavorable that his bona fide and legitimate interest for refusing
medication must yield to the legitimate interest the State has in
preserving his life and health and protecting [the] safety of those in
the institution.” The record supports these findings.
¶ 11 During the hearing, Parrett’s attorney asked him, “Do you
have any religious, cultural, or background beliefs that preclude
you from taking pharmaceuticals or Zyprexa specifically?” Parrett
responded, “I would be given the tithing as a Messianic Jew, a
Jewish Christian, a Christian that there are other diasporas,
scattered seeds, sections of such religion. Such teachings of which
are given through holy scripture has given me means to search as
for what pharmaceuticals are.” Parrett’s counsel followed up by
asking, “If you would just explain how your religious belief
precludes you from taking medication?” Parrett responded,
I would come to search for knowledge for the
correct path of which man may walk. That is
where we come to believe knowledge that is
given to us. And with this knowledge that is
given how we come and decide to walk in the
paths that we would take.
6
On cross-examination, Parrett added that he refuses “poison, not
medicine” and, according to him, Zyprexa is poison because it is a
pharmaceutical.
¶ 12 Dr. Mattox testified that Zyprexa has adverse side effects, but
that the failure to medicate Parrett would be more harmful than the
risks that Zyprexa posed. Dr. Mattox noted his concerns (which
were based on his clinical observations of Parrett) that, without
Zyprexa Parrett would again deteriorate and become assaultive. He
testified that, while he is aware Parrett has “made references to
wanting to take something natural,” but Dr. Mattox was not “able to
really understand precisely what that means or what his objections
are for medications and if those objections are grounded in rational
thought.” Moreover, Dr. Mattox testified that he was not aware of a
natural supplement or medicine that has been shown to be effective
at treating Parrett’s symptoms. And he testified that, while Parrett
had not observed or reported any side effects since he started
taking Zyprexa, the medical staff would continue to monitor him for
side effects.
7
¶ 13 The district court found Dr. Mattox’s testimony credible and
persuasive, and his testimony was sufficient to support the court’s
findings on the fourth Medina factor.
¶ 14 Nevertheless, Parrett asserts that, because the district court
was unable to ascertain the connection between Parrett’s religious
beliefs and his refusal of treatment — describing his statements on
the topic as “non sequiturs” — the court was unable to properly
weigh them against the State’s interest in forcibly medicating him.
But the district court considered Parrett’s religious views and
preference for natural medications and treated them as bona fide
and legitimate. Any lack of understanding on the court’s part was
based on Parrett’s nonresponsive and incongruous answers to his
counsel’s questions regarding the nature of his religious objections.
And given this testimony, we cannot say the court erred by
concluding that Parrett’s danger to himself or others outweighed his
religious beliefs. See Medina, 705 P.2d at 974. (While the “patient’s
refusal may stem from . . . an absolute and unequivocal religious
belief or practice,” the court must nevertheless “determine whether
the patient’s refusal is bona fide and legitimate” and weigh the
patient’s preference with the “legitimate interests of the state in
8
preserving the life and health of the patient placed in its charge and
in protecting the safety of those in the institution.”).
¶ 15 Because the record supports the district court’s findings, we
conclude that it did not err by finding that any desire Parrett might
have in refusing medication was overridden by his sufficiently
compelling need for treatment. See R.K.L., ¶¶ 13, 30.
III. Disposition
¶ 16 The order is affirmed.
JUDGE FREYRE and JUDGE LIPINSKY concur.
