Peo in Interest of GLC

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.