24CA0827 Peo in Interest of GLC 07-18-2024
COLORADO COURT OF APPEALS
Court of Appeals No. 24CA0827
Pueblo County District Court No. 22MH343
Honorable Timothy O’Shea, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of G.L.C.,
Respondent-Appellant.
ORDER AFFIRMED
Division VI
Opinion by JUDGE LIPINSKY
FREYRE and SCHUTZ, 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 G.L.C. 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 In September 2022, G.L.C. was committed to CMHHIP for
restoration to competency in a criminal case. He was diagnosed
with schizoaffective disorder bipolar type, and presented symptoms
such as auditory hallucinations, delusions, and significant mood
shifts with manic symptoms.
¶ 3 Beginning in November 2022, G.L.C. was subject to multiple
involuntary treatment orders based on his refusal to take the
antipsychotic medication prescribed for him. The People’s most
recent petition for review of G.L.C.’s refusal of treatment was filed
on April 30, 2024.
¶ 4 The district court held an evidentiary hearing on the petition.
Dr. Charles Dygert, a staff psychiatrist at CMHHIP and G.L.C.’s
attending physician, testified for the People, and G.L.C. 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
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CMHHIP staff to administer the requested medications —
Fanapt/iloperidone, Depakote or Depakene/valproate,
Thorazine/chlopromazine, and Ativan/lorazepam — to G.L.C.
against his will, and for “[l]aboratory studies (and associated blood
draws) to safely and effectively utilize the [medications] [and]
periodic or as medically indicated physical examination[s] by a
qualified practitioner.”
II. Discussion
¶ 5 G.L.C. 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 that insufficient
evidence established 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. Medina, 705 P.2d 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:
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(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,
412 P.3d 827, 834, and 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 finding of fact if supported by the evidence. People v.
Marquardt, 2016 CO 4, ¶ 8, 364 P.3d 499, 502. We view the
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evidence as a whole and in 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).
a. 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 G.L.C. had a bona fide and
legitimate interest in refusing treatment based on his Rastafarian
religious and cultural beliefs, and to avoid the side effects of the
medications. However, the court also found that G.L.C.’s
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“prognosis without the medication is so unfavorable that his
personal preference must yield to the legitimate interest the State
has in preserving his life and health and protecting the safety of
those in the institutions.” The record supports these findings.
¶ 11 While Dr. Dygert testified that the medications had adverse
side effects, he also testified that the failure to medicate G.L.C.
would be more harmful than the risks that the medications posed,
and those risks outweighed G.L.C.’s religious and cultural beliefs
that preclude him from taking the medications. Dr. Dygert
explained that “the intensity of [G.L.C.’s] symptoms without the
medication[s] [is] so great that [the symptoms] markedly affect his
functioning” and “make him a danger to others.” Moreover, Dr.
Dygert testified that, while G.L.C. is already on “a low dose of
medication which appears to be effective and with relatively few side
effects,” Dr. Dygert would continue to monitor him for any
additional potential side effects.
¶ 12 We are not persuaded by G.L.C.’s argument that, because he
is not currently a management problem, it would be unreasonable
to maintain the court-ordered medication in perpetuity based on
the concern that he may at some point return to his previous state.
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Although “the abstract possibility that a patient’s condition may
deteriorate in the future is insufficient to support a Medina order,”
Marquardt, ¶ 21, 364 P.3d at 504, “[i]f the patient is stable on the
current dose, then adhering to that dose will not cause additional
harm.” Id. at ¶ 24, 364 P.3d at 505; see also R.K.L., ¶ 43, 412 P.3d
at 836-37. The requested medications (and amounts) are either the
same or less than the prior order authorizing involuntary
medication.
¶ 13 Prior Colorado cases have not addressed whether, in cases
where the court-ordered administration of medication has stabilized
the patient’s condition, the patient’s religious beliefs and practices
can override the treating physician’s recommendation for continued
administration of the medication. But a central tenet of Medina is
that a court may order the involuntary administration of medication
so long as the need for the medication “is sufficiently compelling to
override any legitimate interest of the patient in refusing treatment.”
Medina, 705 P.2d at 974. This principle applies where, as here, the
physician testifies that the patient’s condition would likely
deteriorate if the administration of the mediation was stopped.
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¶ 14 Dr. Dygert opined that G.L.C. would again become a
management problem if he were to stop his current regimen of
medications. Dr. Dygert explained that stopping the requested
medications, or even reducing them, would result in “an increase in
— in delusional thoughts, eventually a return of auditory
hallucinations, and then increased agitation and threatened
behavior.” He explained that, without medications or “when he’s
been on an ineffective dose of those medications,” G.L.C. exhibited
“a marked increase in symptoms and decrease in his ability to
function on a unit, as well as increased irritability” and “a
movement towards agitation and potential aggression.” The district
court credited Dr. Dygert’s testimony, finding it both credible and
persuasive, and we are bound by those findings. Fuentes, 258 P.3d
at 326.
¶ 15 We do not doubt that G.L.C.’s concerns are bona fide and
legitimate. But a patient’s religious beliefs or practices are not
absolute; in cases such as this, they “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.” Medina, 705 P.2d at 974.
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¶ 16 Because the record supports the district court’s findings, we
conclude that it did not err by finding that any desire G.L.C. might
have in refusing medication was overridden by his sufficiently
compelling need for treatment. See R.K.L., ¶¶ 13, 30, 412 P.3d at
832, 834.
III. Disposition
¶ 17 The order is affirmed.
JUDGE FREYRE and JUDGE SCHUTZ concur.
