Peo Interest of Robinson ( 2024 )

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<div>24CA1432 Peo in Interest of <span>Robinson 10</span>-17-2024 </div>
<div> </div>
<div>COLORADO COURT OF APPEALS </div>
<div> </div>
<div> </div>
<div>Court of Appeals No. 24CA1432 </div>
<div>Pueblo County District Court No. 24MH30059 </div>
<div>Honorable <span>Timothy O’Shea</span>, Judge </div>
<div> </div>
<div> </div>
<div>The People of the State of Colorado, </div>
<div> </div>
<div>Petitioner-Appellee, </div>
<div> </div>
<div>v. </div>
<div> </div>
<div>In the Interest of Benjamin Dane <span>Robinson</span>, </div>
<div> </div>
<div>Respondent<span>-Appellant. </span>
</div>
<div> </div>
<div> </div>
<div>ORDER AFFIRMED </div>
<div> </div>
<div>Division VII </div>
<div>Opinion by JUDGE SCHUTZ </div>
<div>Tow and Pawar, JJ., concur </div>
<div> </div>
<div>NOT PUBLISHED PURSUANT TO C.A.R. 35(e) </div>
<div>Announced October 17, 2024 </div>
<div> </div>
<div> </div>
<div>Cynthia Mitchell, County Attorney, <span>Kat</span>e H. Shafer, Special Assistant County </div>
<div>Attorney, Pueblo, Colorado, for Petitioner-Appellee </div>
<div> </div>
<div>Tezak Law, P.C., Mary Tezak, <span>Florence, Colorado, for <span>Respondent</span></span>-Appellant </div>
<div> </div>
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<div>1 </div>
<div>¶ 1<span> </span><span>Respondent, Benjamin Dane Robinson, appeals the district </span>
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<div>court’s order authorizing staff at the Colorado Ment<span></span>al Health </div>
<div>Hospital in Pueblo (CMHHIP), or any other designated facility, <span></span>to </div>
<div>involuntarily administer medication to him. We affirm. </div>
<div>I.<span> <span>Background </span></span>
</div>
<div>¶ 2<span> </span><span>Robinson was committed to CMHHIP for competency </span>
</div>
<div>restoration in a criminal case. He was diagnosed with </div>
<div>schizoaffective disorder and presented with symptoms that included </div>
<div>paranoia, delusional thinking, grandiosity, and intermittently </div>
<div>agitative behaviors.<span> </span>Robinson, who has a history of medication </div>
<div>noncompliance, was previously restored to competency at <span></span>CMHHIP </div>
<div>on a combination of Abilify and Lithium. However, since his </div>
<div>current admission he has refused to take any antipsychotic or </div>
<div>mood stabilizing medications.<span> </span>
</div>
<div>¶ 3<span> </span><span>The People filed a petition seeking the involuntary </span>
</div>
<div>administration of Abilify, Abilify Maintena, Lithium, and Zyprexa </div>
<div>(olanzapine), as well as any lab work to monitor the medication<span></span>s<span>. </span>
</div>
<div>The Zyprexa (olanzapine) was requested for use only if Robinson </div>
<div>refused to take Abilify orally.<span> </span>
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<div>2 </div>
<div>¶ 4<span> </span><span>The district court held an evidentiary hearing on the petition.<span> </span></span>
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<div>Dr. Hareesh Pillai, the CMHHIP staff psychiatrist overseeing </div>
<div>Robinson’s care<span>, testified, as did Robinson. At the end of t<span></span>he </span>
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<div>hearing, the court found that Dr. Pillai had testified “credi<span></span>bly and </div>
<div>persuasively,” and concluded that the People had proved all <span></span>four </div>
<div>elements set forth in <span>People v. Medina</span>, 705 P.2d 961 (Colo. 1<span></span>985). </div>
<div>The court issued an order authorizing CMHHIP staff to administe<span></span>r </div>
<div>the requested medications to Robinson against his will.<span> </span>
</div>
<div>II.<span> <span>Discussion </span></span>
</div>
<div>¶ 5<span> </span><span>Robinson concedes that the People met their burden of </span>
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<div>proving, by clear and convincing evidence, the first three <span>Medina</span> </div>
<div>factors. He contends, however, that the evidence presented at the </div>
<div>hearing was insufficient to prove the fourth <span>Medina </span>factor: that <span></span>his </div>
<div>need for treatment is sufficiently compelling to override h<span></span>is bona </div>
<div>fide and legitimate interest in refusing treatment. We are n<span></span>ot </div>
<div>persuaded. </div>
<div>A.<span> <span>Applicable Law and Standard of Review </span></span>
</div>
<div>¶ 6<span> </span><span>A district court may order the involuntary administration of </span>
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<div>medication to a patient only if the People prove, by clear an<span></span>d </div>
<div>convincing evidence, each of the four factors outlined <span></span>in <span>Medina</span><span>: </span> </div>
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<div>3 </div>
<div>(1) the patient is incompetent to effectively </div>
<div>participate in the treatment decision; </div>
<div>(2) treatment by antipsychotic medication is </div>
<div>necessary to prevent a significant and likely </div>
<div>long-term deterioration i<span>n the patient’s mental </span>
</div>
<div>condition or to prevent the likelihood of the </div>
<div>patient’s causing serious harm to himself or </div>
<div>others in the institution; </div>
<div>(3) a less intrusive treatment alternative is not </div>
<div>available; and </div>
<div>(4) the patient’s need for treatment by </div>
<div>antipsychotic medication is sufficiently </div>
<div>compelling to override any bona fide and </div>
<div>legitimate interest of the patient in refusing </div>
<div>treatment. </div>
<div>¶ 7<span> <span>Id.<span> at 973.<span> </span><span>A psychiatrist’s testimony may suffice to meet this </span></span></span></span>
</div>
<div>burden. <span>See People v. Pflugbeil</span><span>, </span>834 P.2d 843, 847 (Colo. App. </div>
<div>1992). </div>
<div>¶ 8<span> </span><span>When a patient challenges the sufficiency of the evidence </span>
</div>
<div>supporting an involuntary medication order, we review the district </div>
<div>court’s legal conclusions de novo but defer to its findings of <span></span>fact if </div>
<div>they have record support. <span>People v. Marquardt</span>, 2016 CO 4, ¶ <span></span>8. We </div>
<div>view the evidence as a whole and in the light most favorable to the </div>
<div>People to determine if it is sufficient to support the d<span></span>istrict court’s </div>
<div>order. <span>People in Interest of R.K.L.</span>, 2016 COA 84, ¶ 13. If <span></span>it is, we </div>
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<div>4 </div>
<div>may not substitute our judgment for that of the district court. <span>See </span>
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<div>People in Interest of A.J.L.<span>, <span>243 P.3d 244, 255 (Colo. 201<span></span>0). </span></span>
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<div>B.<span> <span>Fourth <span>Medina </span>Factor </span></span>
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<div>¶ 9<span> </span><span>The fourth <span>Medina</span> factor requires a court to first determine </span>
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<div>“whether the patient’s refusal is bona fide and legitimate.” <span>Medina</span><span>, </span>
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<div>705 <span>P.2d at 974. If so, the court must determine “whet<span></span>her the </span>
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<div>prognosis without treatment is so unfavorable that t<span></span>he patient’s </div>
<div>personal preference must yield to the legitimate interests of the </div>
<div>state in preserving the life and health of the patient placed in its </div>
<div>charge and in protecting the safety of those in the institution.<span></span>”<span> </span><span>Id.</span><span> </span>
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<div>¶ 10<span> </span><span>The district court found that Robinson has a bona fide and </span>
</div>
<div>legitimate interest in refusing treatment based on his sincere </div>
<div>religious beliefs.<span> </span><span>However, the court also found that Robinson’<span></span>s </span>
</div>
<div>“prognosis, absent the medication, is so unfavorable t<span></span>hat his </div>
<div>personal preference to not be medicated must yield to the legitimate </div>
<div>interest the state has in preserving his life and health.”<span> <span>The record </span></span>
</div>
<div>supports these findings. </div>
<div>¶ 11<span> </span><span>Dr. Pillai testified that without the requested medications </span>
</div>
<div>Robinson “displays overt symptoms of his mental illness<span>,</span>” which </div>
<div>“influences his thinking and his behavior<span>,</span>” and <span>including </span>
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<div>5 </div>
<div>“disorganization, illogical thinking, and grandiose delusions.”<span> <span>Dr. </span></span>
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<div>Pillai <span>explained that Robinson is “currently on the suicide 1 </span>
</div>
<div>precautions and assault 1 precautions” unit and “last week he<span> was </span>
</div>
<div>documented to use racial slurs and profanity towards staff<span></span>, and </div>
<div>then he made comments of feeling hopeless and helpless.”<span> Dr. Pillai </span>
</div>
<div>added that “there were some staff reports over the weekend that<span></span> he </div>
<div>was antagonizing some peers on the unit and required frequent </div>
<div>redirection.”<span> </span>
</div>
<div>¶ 12<span> </span><span>These recent symptoms were consistent with the types of </span>
</div>
<div>aggressive and assaultive behaviors that Robinson exhibite<span></span>d upon </div>
<div>his 2019 hospitalization, which led to him being isolated and </div>
<div>restrained at that time until he was stabilized on medication. <span></span> And </div>
<div>it was <span>Dr. Pillai’s</span> opinion that without the requested medicati<span></span>ons </div>
<div>Robinson’s mental condition would likely, and significantly, </div>
<div>continue to deteriorate long-term. </div>
<div>¶ 13<span> </span><span>During <span>Robinson’s</span> 2019 admission at CMHHIP, these same </span>
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<div>medications <span>—</span> namely, Abilify and Lithium <span>—</span> which were </div>
<div>prescribed and administered at <span>Robinson’s </span><span>request</span><span>, </span>improved his </div>
<div>mental state “significantly”<span> </span>and “he did well<span>.</span><span>”</span><span> Dr. Pillai testified <span></span>that </span>
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<div>the requested medications did create the potential for adverse side </div>
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<div>6 </div>
<div>effects but when Robinson took them in the past, <span>they were “not </span>
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<div>very intrusive to him as he did not have significant side effects.<span>” </span> </div>
<div>Dr. Pillai also explained how Robinson would be monitored for any </div>
<div>potential new side effects once he started the requested medicati<span></span>on </div>
<div>regimen. And Dr. Pillai testified that there was not <span>an</span> alternativ<span></span>e </div>
<div>method of treating Robinson that would be both effective an<span></span>d less </div>
<div>intrusive than the requested medications.<span> </span>
</div>
<div>¶ 14<span> </span><span>Robinson asserts that the district court failed to support its </span>
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<div>findings by pointing to any specific evidence from the hearing and </div>
<div>therefore failed to specifically balance the state’s interest in <span></span>forcibly </div>
<div>medicating him against his interest in refusing the medications.<span> </span>
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<div>But the court cited <span>Dr. Pillai’s</span> testimony regarding <span>Robinson’s </span>
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<div>“symptoms without the medication” <span>as well as his testimony that<span></span> </span>
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<div>Robinson’s<span> </span><span>“</span><span>symptoms were alleviated to a great degree with these </span>
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<div>very medications in 2019.<span>”</span> These findings provide record support </div>
<div>for the court’s conclusion <span>that </span><span>Robinson’s</span><span> </span>“liberty interest in not </div>
<div>being forced to take [the requested medication] over his <span></span>objection” </div>
<div>must yield to “the State’s interest in treating [him].”<span> <span>Moreover, the </span></span>
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<div>court credited Dr. Pillai’s testimony, finding it both <span></span>credible and </div>
<div>persuasive. </div>
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<div>7 </div>
<div>¶ 15<span> </span><span>Even if it would have been better practice for the district court </span>
</div>
<div>to identify additional evidence in support of its findings, wh<span></span>ere, as </div>
<div>here, the record <span>contains support for the court’s findings, <span></span>we will </span>
</div>
<div>not disturb them. <span>See People in Interest of Ramsey</span>, 2023 COA <span></span>95, </div>
<div>¶ 57 (evidence was sufficient to satisfy the fourth factor where t<span></span>he </div>
<div>physician testified that taking the requested medication to t<span></span>reat </div>
<div>respondent’s mental illness was an “essential need” and the failure </div>
<div>to treat her “would be more harmful tha<span>n the potential side eff<span></span>ects </span>
</div>
<div>of the medications”).<span> </span>
</div>
<div>¶ 16<span> </span><span>The district court found that <span>Robinson’s </span>religious concerns are </span>
</div>
<div>bona fide and legitimate. But a patient’s religious belief<span></span>s or </div>
<div>practices do not give them absolute authority to reject necessa<span></span>ry </div>
<div>treatment. Rather, <span>in cases such as this, they “must yield to the </span>
</div>
<div>legitimate interests of the state in preserving the life and health <span></span>of </div>
<div>the patient placed in its charge and in protecting the safety of <span></span>those </div>
<div>in the institution.” <span>Medina</span><span>, 705 P.2d at 974. </span>
</div>
<div>¶ 17<span> </span><span>B<span>ecause the record supports the district court’s findings, <span></span>we </span></span>
</div>
<div>conclude that it did not err by finding that any concern Robinson </div>
<div>might have in refusing the requested medication was overridden <span></span>by </div>
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<div>8 </div>
<div>his sufficiently compelling need for treatment. <span>See R.K.L.</span>, ¶¶ 13, </div>
<div>30.<span> </span>
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<div>III.<span> <span>Disposition </span></span>
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<div>¶ 18<span> </span><span>The order is affirmed. </span>
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<div>JUDGE TOW and JUDGE PAWAR concur. </div>
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