Peo in Interest of Parrett

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.