Peo in Int of MR

24CA1700 Peo in Interest of MR 12-12-2024

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA1700
Pueblo County District Court No. 22MH124
Honorable Timothy O’Shea, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of

M.R.,

Respondent-Appellant.

ORDER AFFIRMED

Division III
Opinion by JUDGE BERNARD*
Dunn and Gomez, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced December 12, 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

*Sitting by assignment of the Chief Justice under provisions of Colo. Const. art.
VI, § 5(3), and § 24-51-1105, C.R.S. 2024.
¶1 M.R., whom we shall call “the patient,” appeals the district

court’s order authorizing staff at the Colorado Mental Health

Hospital in Pueblo, which we shall call “the hospital,” to medicate

her involuntarily. We affirm.

I. Background

¶2 The patient was originally committed to the hospital in 2021

after a judge found that she was incompetent to proceed in a

criminal case. In 2022, the judge dismissed the criminal charges

against the patient because the hospital’s staff could not restore her

competency. But the judge ruled that she would remain at the

hospital under a civil certification to be treated for her mental

illness.

¶3 Since then, the court in this case has, on numerous

occasions, authorized the hospital to administer medication to the

patient involuntarily. (We note that the patient, on occasion,

consented to receive her medications.)

¶4 The most recent of those orders, which is the subject of this

appeal, was issued on September 23, 2024. That order granted the

government’s request to administer the following medications

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involuntarily to the patient: (1) the anti-psychotic medications

clozapine and Zyprexa; (2) the mood stabilizing medications

Depakote and lithium; and (3) the anti-seizure and anti-anxiety

medication clonazepam.

¶5 At the hearing on this motion, the patient’s hospital

psychiatrist, who testified as an expert in clinical psychiatry, said

that the patient’s diagnosis is schizoaffective disorder, bipolar type.

When not taking her medication, her symptoms include (1) auditory

hallucinations; and (2) manic and psychotic behavior, including

unprovoked assaults on the hospital’s staff and patients and

running around naked. The psychiatrist testified that, based on the

patient’s 118 assaults at the hospital over the past three years, she

is one of the most assaultive patients he has encountered there.

¶6 The psychiatrist added that he had prescribed different

combinations of medications for the patient since her original

admission in 2021. He explained that her current medications,

which we have listed above, had proven to be the most effective

combination for treating her condition. Specifically, he thought that

the combination of clozapine, Zyprexa, Depakote, and lithium has

been effective in treating the symptoms caused by her condition,

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while the clonazepam had stopped seizures from occurring. He

explained that, if this combination of medications continued to be

effective, and if the patient did not commit any assaults for three

months, then the hospital could finally place her in a supervised

community setting.

¶7 The patient testified during the hearing. She said that, of the

five medications, the one that she was unwilling to take was

Depakote because it made her very nauseous.

¶8 But the psychiatrist told the court that he did not have

confidence in the patient’s assertion that she would take the four

medications in addition to the Depakote because she had, at times,

previously refused to take them. And, when the patient was given

Depakote in pill form, she would often not swallow it; rather, she

would hide it in one of her cheeks.

¶9 The court found that the psychiatrist was credible and

persuasive, adding that it was convinced by the psychiatrist’s

opinions. It then applied each of the four elements of the governing

test from People v. Medina, 705 P.2d 961, 973 (Colo. 1985). It

concluded that all four of them had been met, leading it to enter the

order that is the subject of this appeal.

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II. Applicable Law and Standard of Review

¶ 10 A court may authorize the involuntary administration of

medication if the government demonstrates by clear and convincing

evidence that (1) a person is incompetent to effectively participate in

the treatment decision; (2) the treatment is necessary to prevent a

significant and likely long-term deterioration in the person’s mental

health condition or to prevent the likelihood of the patient causing

serious harm to herself or others in the institution; (3) a less

intrusive treatment alternative is not available; and (4) the person’s

need for treatment is sufficiently compelling to override any bona

fide and legitimate interest of the person in refusing treatment. Id.

¶ 11 Application of the Medina test involves mixed questions of fact

and law. People v. Marquardt, 2016 CO 4, ¶ 8. We defer to the

court’s factual findings if they have support in the record, and we

review the court’s legal conclusions de novo. Id. Resolving conflicts

in testimony and determining the credibility of the witnesses are

solely within the province of the court as the finder of fact. People

in Interest of Ramsey, 2023 COA 95, ¶ 23.

¶ 12 We must determine whether the evidence, viewed as a whole

and in the light most favorable to the prevailing party, is sufficient

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to support the court’s order. People in Interest of R.K.L., 2016 COA

84, ¶ 13. The testimony of the physician seeking to administer

treatment may be sufficient, without more, to satisfy the Medina

test. Id. at ¶ 30.

III. Analysis

¶ 13 The patient does not contest the court’s rulings that the first,

second, and third Medina elements were satisfied. Instead, she

only challenges the sufficiency of the evidence supporting the

court’s ruling that the fourth Medina element was met. Specifically,

she contends that her need for treatment is not sufficiently

compelling to override any bona fide and legitimate interest she has

in refusing treatment.

¶ 14 The patient submits that the court’s ruling severely minimized

the significance of the side effects she experiences from taking the

medications. She adds that, given the court’s minimization of her

side effects, it could not properly conduct the balancing test

required by the fourth Medina element.

¶ 15 Concerning the patient’s nausea, she and the psychiatrist

agreed that Depakote likely caused it. The psychiatrist also

testified that, if the patient would willingly take Depakote in pill

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form rather than presumably via injection, her nausea would be

reduced or eliminated. But, because the patient often would not

swallow the Depakote pills, hiding them in her cheek, the hospital’s

staff had been forced to administer the Depakote in the alternative

form, which causes more nausea. As a result, it appears that the

patient has control over limiting or eliminating the nausea caused

by Depakote by agreeing to swallow the pills.

¶ 16 The patient also points out that the combination of

medications had previously caused seizures.

¶ 17 But the psychiatrist said that the patient’s most recent seizure

occurred in June 2024 before he had prescribed the antiseizure

medication clonazepam, which has effectively prevented more

seizures from occurring. The psychiatrist also explained that, in

addition to prescribing clonazepam, he has reduced the risk of

seizures by moderating the patient’s dosage of clozapine and

lithium. So the risk of seizures seems less likely based on the

combination of the five medications at their present dosage.

¶ 18 Even if we assume that the court did not sufficiently credit the

patient’s interest in not taking the medications, the court

nevertheless concluded that “even if her reasons were bona fide and

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legitimate, it’s clear that her prognosis is so unfavorable without the

medication” that her interest in not taking the medications “has to

yield to the [government’s] legitimate interest in protecting the

safety of those in the institution, and preserving her life and

health.” (Emphasis added.) That conclusion is well supported by

the evidence showing that (1) this combination of medications has

been effective in treating the patient’s severe symptoms; (2) when

she stops taking Depakote, “she goes [on] a binge of assaults”; (3)

her nausea would be reduced or eliminated if she took (and actually

swallowed) Depakote in pill form; and (4) her seizures stopped once

the psychiatrist added clonazepam and moderated the dosages of

clozapine and lithium.

¶ 19 We therefore conclude that the record supports the court’s

determination that the fourth Medina element was met.

¶ 20 The order is affirmed.

JUDGE DUNN and JUDGE GOMEZ concur.

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