24CA0912 Peo in Interest of Vendegna 07-18-2024
COLORADO COURT OF APPEALS
Court of Appeals No. 24CA0912
Pueblo County District Court No. 24MH103
Honorable Timothy O’Shea, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Anthony Vendegna,
Respondent-Appellant.
ORDER AFFIRMED
Division I
Opinion by JUDGE J. JONES
Welling and Schock, 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
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¶ 1 Respondent, Anthony Vendegna, appeals the district court’s
order authorizing staff at Centennial Peaks Hospital (Centennial) to
treat him with electroconvulsive therapy (ECT) without his consent.
We affirm.
I. Background
¶ 2 In early February 2024, Mr. Vendegna was certified for up to
three months of short-term treatment at another facility based on a
physician’s diagnosis that he suffered from schizophrenia and was
gravely disabled as a result. See § 27-65-109, C.R.S. 2023.
¶ 3 In mid-April 2024, Mr. Vendegna was transferred to inpatient
care at Centennial and the certification was extended for an
additional three months of treatment. A physician there opined
that Mr. Vendegna was gravely disabled and was a danger to others
due to a mental health disorder.
¶ 4 A week later, a petition for review of Mr. Vendegna’s refusal of
treatment was filed, in which a physician opined that certain
antipsychotic medications, mood stabilizing medications, and anti-
anxiety medications were necessary to treat Mr. Vendegna’s
psychosis. In late April 2024, the district court issued an order
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authorizing staff at Centennial to administer the requested
medications to Mr. Vendegna without his consent.
¶ 5 In mid-May 2024, the petition at issue was filed, requesting
that Centennial be allowed to treat Mr. Vendegna with ECT without
his consent. In it, Mr. Vendegna’s psychiatrist at Centennial, Dr.
Roderick S. O’Brien, reported that the “aggressive pharmacotherapy
trials” had not been successful and that treatment with ECT would
give Mr. Vendegna a significantly better chance for remission.
¶ 6 At the May 20, 2024, hearing on the petition, Dr. O’Brien
testified that he had diagnosed Mr. Vendegna with schizoaffective
disorder, the bipolar type, which caused him to experience acute
psychosis and unstable mood. He testified that Mr. Vendegna’s
illness required treatment with a combination of medications and
ECT, and that if he didn’t receive ECT, he would suffer a significant
and long-term deterioration of his mental condition.
¶ 7 Mr. Vendegna testified in opposition to the petition for
involuntary treatment.
¶ 8 The district court ultimately found that Dr. O’Brien testified
“credibly and persuasively,” adopted Dr. O’Brien’s opinions, and
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granted the petition authorizing Centennial to involuntarily
administer ECT.
II. Discussion
¶ 9 The district court found that the People had proven by clear
and convincing evidence all four elements required under People v.
Medina, 705 P.2d 961, 973 (Colo. 1985), to authorize the
involuntary administration of medical treatment.
¶ 10 On appeal, Mr. Vendegna challenges the sufficiency of the
evidence supporting only the fourth Medina element, namely,
whether the patient’s need for the treatment is sufficiently
compelling to override any bona fide and legitimate interest of the
patient in refusing the treatment. Id. (The first three elements are
whether the patient is incompetent to effectively participate in the
treatment decision, whether the treatment 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’s causing
serious harm to himself or others in the institution, and whether a
less intrusive treatment alternative is available. Id.)
¶ 11 We conclude that the evidence is sufficient to support the
court’s finding on the fourth Medina element.
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A. Standard of Review
¶ 12 The district court’s order presents a mixed question of fact and
law. We defer to the court’s factual findings if there is evidence
supporting them, but we review the court’s legal conclusions de
novo. People in Interest of Strodtman, 293 P.3d 123, 131 (Colo. App.
2011). We must determine whether the evidence, viewed as a whole
and in the light most favorable to the prevailing party, is sufficient
to support the court’s order. People in Interest of R.K.L., 2016 COA
84, ¶ 13. Testimony by a physician supporting a petition for
involuntary administration of medication may be sufficient. Id. at ¶
30 (citing People v. Pflugbeil, 834 P.2d 843, 847 (Colo. App. 1992)).
B. Analysis
¶ 13 Mr. Vendegna contends that the People failed to prove the
fourth Medina element by clear and convincing evidence because
the district court “stated that it was unable to ascertain Mr.
Vendegna’s reasons for refus[ing]” to be treated with ECT. In doing
so, Mr. Vendegna highlights his testimony indicating why he
refused ECT: his concerns that ECT would be painful and that,
given that he had been a smoker for thirty years, ECT could cause
him to have a heart attack and die. Mr. Vendegna argues that the
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district court erred in analyzing the fourth Medina factor because it
didn’t sufficiently consider his bona fide and legitimate interest in
refusing the treatment (balanced against his need for the
treatment).
¶ 14 We aren’t persuaded by Mr. Vendegna’s argument. At the
hearing, the district court discussed — to a greater extent than Mr.
Vendegna suggests on appeal — Mr. Vendegna’s reasons for
refusing ECT. Specifically, the court said, “I don’t really understand
-- Mr. Vendegna’s reasons for refusal. In his testimony that was not
clear at all other than that he believes . . . that ECT . . . might cause a
heart attack in him because he was – a long term smoker.”
(Emphasis added.) The court then said, “There is no evidence in
the record to suggest that. Dr. O’Brien testified at length as to the
procedure for ECT and how safe it is and it’s the global standard as
he put it -- for mood instability.”
¶ 15 So the record indicates that the district court did specifically
address the apparent primary reason that Mr. Vendegna refused
ECT, and then balanced that concern against Mr. Vendegna’s
compelling need for ECT. The court’s findings in that regard are
supported by Dr. O’Brien’s testimony that
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• ECT is performed under general anesthesia, during
which an anesthesiologist monitors the patient’s
breathing, oxygen, heart rate, and blood pressure;
• Mr. Vendegna’s medical history doesn’t indicate any
medical conditions like cardiomyopathy or diabetes that
would increase the risk of ECT; and
• Mr. Vendegna’s history of smoking is “not in any way a
contraindication to” the recommendation for ECT.
¶ 16 Further, in terms of Mr. Vendegna’s expressed concern that
ECT would cause him pain, again, Dr. O’Brien testified that ECT is
administered when the patient is under general anesthesia.
¶ 17 The evidence was sufficient to support the district court’s
finding on the fourth Medina element.
III. Disposition
¶ 18 The order is affirmed.
JUDGE WELLING and JUDGE SCHOCK concur.
