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24CA1233 Peo in Interest of Baricelli 09-12-2024

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA1233

Arapahoe County District Court No. 24MH183

Honorable Michelle A. Amico, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Mario Baricelli,

Respondent-Appellant.

ORDER AFFIRMED

Division I

Opinion by JUDGE J. JONES

Lipinsky and Sullivan, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)

Announced September 12, 2024

Ron Carl, County Attorney, Meghan Rubincam, Senior Assistant County

Attorney, Aurora, Colorado, for Petitioner-Appellee

Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant

¶ 1 Respondent, Mario Baricelli, appeals the district court’s order

authorizing the staff at the Rocky Mountain Regional Veterans

Affairs Medical Center (the VA) to administer his prescribed

medications by injection if he refuses to take them orally. We

affirm.

I. Background

¶ 2 Baricelli has a documented history of schizophrenia. In March

2024, he was admitted to the VA after being placed on a mental

health hold following a welfare check because he was running into

traffic and making delusional and paranoid statements.

¶ 3 In early April, the district court found that Baricelli was

gravely disabled due to his schizophrenia, and it entered an order

certifying him for short-term treatment at the VA through June 22,

2024. A division of this court affirmed that ruling. See People in

Interest of Baricelli, (Colo. App. No. 24CA0615, June 6, 2024) (not

published pursuant to C.A.R. 35(e)).

¶ 4 Baricelli was released from the VA in mid-April, but he was

readmitted a week later after a home visit revealed that he wasn’t

taking his medications and that his apartment was in disarray

(including trash spread across the floor in all the rooms, broken

cabinets and blinds, tape covering the windows, and nonsensical

writing on the ceiling and a wall).

¶ 5 In early May, the People filed a petition for the involuntary

administration of any necessary antipsychotic medications, mood

stabilizing medications, anti-anxiety medications, and medications

to treat any side effects of the other medications. Baricelli, through

his counsel, then entered into a stipulation agreeing to take the

medications listed in the petition, while reserving the right to

request a hearing on the issue. The parties agreed in the

stipulation that “the medications will be offered on a voluntary

basis at each dosage, and only if [Baricelli] refuses that medication

will the medication be administered involuntarily.”

¶ 6 Baricelli later objected to the involuntary administration of

medications and requested a hearing, while the People moved to

extend the short-term treatment certification and filed another

petition to involuntarily medicate him. According to the People’s

filing, Baricelli had only intermittently engaged in psychiatric

treatment since his readmission to the VA, and he told his

treatment providers that he wouldn’t continue taking his

medications after being discharged from the VA. His treatment

providers opined that Baricelli “only tacitly engage[s] in short-term

stabilization to facilitate discharge without continuing long-term

care, which has contributed to continuing psychiatric

decompensation over the past many years.”

¶ 7 At a hearing on June 10, Baricelli clarified that he wasn’t

objecting to extending the certification for short-term treatment or

to any of the medications listed in the petition. But he said that he

would only take his medications orally and objected to having them

administered by injection. He explained that the injections caused

pain at the injection site, he was concerned about potential side

effects, and he had experienced trauma from forceable injections in

the past.

¶ 8 A VA psychiatrist, who was qualified as an expert in

psychiatry, testified that Baricelli was currently prescribed the

antipsychotic medication aripiprazole to be taken daily, and that it

was appropriate to continue that medication. She also testified that

he had a positive response, with minimal side effects, to that

medication in oral form, which was a good indicator that the same

would be true if he were administered the medication by injection.

(She further testified that taking the medication by injection would

likely cause fewer appreciable side effects than taking the

medication orally.)

¶ 9 Following the hearing, the district court issued an order

extending the certification for short-term treatment to September

22, 2024. Finding the psychiatrist’s testimony to be credible, it also

authorized the involuntary administration of medication by

injection. However, the court ruled that “[t]he medications shall be

offered on a voluntary basis at each dosage and only if [Baricelli]

refuses that medication shall the medication be administered

involuntarily.”

II. Legal Principles and Standard of Review

¶ 10 A district court may authorize the involuntary administration

of medication if the People demonstrate by clear and convincing

evidence that (1) the 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 person

causing serious harm to himself or others; (3) a less intrusive

treatment alternative isn’t 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. People v.

Medina, 705 P.2d 961, 973 (Colo. 1985).

¶ 11 Applying this test involves mixed questions of fact and law.

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

court’s factual findings if they’re supported by the record, but we

review the court’s legal conclusions de novo. Id. The resolution of

conflicts in testimony and determinations of the credibility of the

witnesses are solely within the fact finder’s province. 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

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 by itself to satisfy the Medina test. Id.

at ¶ 30.

III. Analysis

¶ 13 Baricelli doesn’t contest the district court’s ruling that the

second element of the Medina test was met; he challenges the

court’s rulings that the first, third, and fourth elements of the

Medina test were met.

A. The First Medina Element

¶ 14 In terms of the first Medina element, we discern no error in the

district court’s determination that Baricelli is incompetent to

effectively participate in the treatment decision that prescribed

medications be administered by injection in the event he refuses to

take the medications orally.

¶ 15 The district court found, with record support, that Baricelli

lacks insight regarding the benefit of the long-acting injectable

medications, which remain in the body longer than do oral

medications, thereby eliminating the need to take a pill every day

upon his release from the VA. The court also found, with record

support, that Baricelli has a history of noncompliance with taking

his medications and that he engages in short-term stabilization to

facilitate discharge without continuing long-term care. And the

court found, with record support, that Baricelli’s condition would

deteriorate absent consistent medication.

¶ 16 We also note that, in this case, the first Medina factor is

closely related to the fourth Medina factor. Below, we conclude that

the district court didn’t err by finding that Baricelli’s need for

treatment is sufficiently compelling to override any bona fide and

legitimate interest he has in refusing treatment. The record

indicates that Baricelli believes that his concerns about taking the

medications by injection outweigh any possible need in

administering the medications by injection. But the record

indicates that although it is critical for Baricelli to consistently take

aripiprazole, he hasn’t been consistent in taking that medication.

Thus, the record supports the district court’s conclusion that

Baricelli isn’t competent in understanding that it is critical for him

to take the medication by injection if he stops voluntarily taking the

medication orally.

B. The Third Medina Element

¶ 17 In terms of whether a less intrusive treatment alternative was

available, it is significant that the district court’s order requires the

VA to provide Baricelli with the medications in oral form at each

dosage, and only if he refuses to take them orally can the VA

involuntarily medicate him by injection. So the express terms of the

order give Baricelli the less intrusive option of taking the

medications orally. Only if Baricelli refuses that less intrusive

option can the VA administer the medications by injection.

¶ 18 Further, although Baricelli asserts that he “has been

compliant in taking these medications,” the district court found,

with record support, that he has only intermittently complied. And

the court also found, with record support, that Baricelli’s history of

noncompliance includes completely stopping taking the medications

when he was released from the VA in April 2024. See People in

Interest of Strodtman, 293 P.3d 123, 133 (Colo. App. 2011) (rejecting

the respondent’s argument that taking her medication orally was an

effective, less intrusive alternative to injection because she lacked

the capacity to consistently take her medication orally).

C. The Fourth Medina Element

¶ 19 Finally, in terms of the fourth Medina element, the district

court found that the need to administer Baricelli’s medications by

injection — which it allowed only if he refuses to take his

medications orally — is sufficiently compelling to override his

concerns about pain at the injection site, possible side effects, and

the trauma of forcible injection.

¶ 20 With regard to Baricelli’s need for treatment, the court found

that, without consistent medication, the deterioration in his

condition would be immediate and dangerous. That finding is

supported by the psychiatrist’s testimony that the prognosis for

untreated schizophrenia is poor and that each time a patient with

schizophrenia stops taking his antipsychotic medication, his

schizophrenia will worsen because his brain will not return to its

previous level of functioning. See Medina, 705 P.2d at 974 (Under

the fourth Medina element, a court must determine whether “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.”). The court also emphasized Baricelli’s history of

noncompliance in taking his medications orally, but, despite that,

the court still required the VA to offer the medications to him in oral

form at each dosage before resorting to an injection.

¶ 21 Regarding Baricelli’s concern about pain at the injection site,

although he testified that such pain lasts “all month,” the court

found that such physical discomfort “will subside quickly,” which is

supported by the psychiatrist’s testimony that such local pain and

swelling typically last between four and twenty-four hours. In

terms of side effects, the court credited the psychiatrist’s testimony

that, because Baricelli has had minimal side effects with oral

aripiprazole, it is likely that the same would be true of aripiprazole

in injectable form. Although the record indicates that Baricelli had

a negative experience with the injectable form of a different

medication, nothing in the record reveals that he would have a

negative reaction to the injectable form of aripiprazole. Further,

Baricelli’s prior history of experiencing trauma from forced

injections can be avoided if he voluntarily takes his medications in

oral form.

IV. Disposition

¶ 22 The order is affirmed.

JUDGE LIPINSKY and JUDGE SULLIVAN concur.

24CA1233 Peo in Interest of Baricelli 09-12-2024

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA1233
Arapahoe County District Court No. 24MH183
Honorable Michelle A. Amico, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Mario Baricelli,

Respondent-Appellant.

ORDER AFFIRMED

Division I
Opinion by JUDGE J. JONES
Lipinsky and Sullivan, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced September 12, 2024

Ron Carl, County Attorney, Meghan Rubincam, Senior Assistant County
Attorney, Aurora, Colorado, for Petitioner-Appellee

Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant
¶1 Respondent, Mario Baricelli, appeals the district court’s order

authorizing the staff at the Rocky Mountain Regional Veterans

Affairs Medical Center (the VA) to administer his prescribed

medications by injection if he refuses to take them orally. We

affirm.

I. Background

¶2 Baricelli has a documented history of schizophrenia. In March

2024, he was admitted to the VA after being placed on a mental

health hold following a welfare check because he was running into

traffic and making delusional and paranoid statements.

¶3 In early April, the district court found that Baricelli was

gravely disabled due to his schizophrenia, and it entered an order

certifying him for short-term treatment at the VA through June 22,

2024. A division of this court affirmed that ruling. See People in

Interest of Baricelli, (Colo. App. No. 24CA0615, June 6, 2024) (not

published pursuant to C.A.R. 35(e)).

¶4 Baricelli was released from the VA in mid-April, but he was

readmitted a week later after a home visit revealed that he wasn’t

taking his medications and that his apartment was in disarray

1
(including trash spread across the floor in all the rooms, broken

cabinets and blinds, tape covering the windows, and nonsensical

writing on the ceiling and a wall).

¶5 In early May, the People filed a petition for the involuntary

administration of any necessary antipsychotic medications, mood

stabilizing medications, anti-anxiety medications, and medications

to treat any side effects of the other medications. Baricelli, through

his counsel, then entered into a stipulation agreeing to take the

medications listed in the petition, while reserving the right to

request a hearing on the issue. The parties agreed in the

stipulation that “the medications will be offered on a voluntary

basis at each dosage, and only if [Baricelli] refuses that medication

will the medication be administered involuntarily.”

¶6 Baricelli later objected to the involuntary administration of

medications and requested a hearing, while the People moved to

extend the short-term treatment certification and filed another

petition to involuntarily medicate him. According to the People’s

filing, Baricelli had only intermittently engaged in psychiatric

treatment since his readmission to the VA, and he told his

2
treatment providers that he wouldn’t continue taking his

medications after being discharged from the VA. His treatment

providers opined that Baricelli “only tacitly engage[s] in short-term

stabilization to facilitate discharge without continuing long-term

care, which has contributed to continuing psychiatric

decompensation over the past many years.”

¶7 At a hearing on June 10, Baricelli clarified that he wasn’t

objecting to extending the certification for short-term treatment or

to any of the medications listed in the petition. But he said that he

would only take his medications orally and objected to having them

administered by injection. He explained that the injections caused

pain at the injection site, he was concerned about potential side

effects, and he had experienced trauma from forceable injections in

the past.

¶8 A VA psychiatrist, who was qualified as an expert in

psychiatry, testified that Baricelli was currently prescribed the

antipsychotic medication aripiprazole to be taken daily, and that it

was appropriate to continue that medication. She also testified that

he had a positive response, with minimal side effects, to that

3
medication in oral form, which was a good indicator that the same

would be true if he were administered the medication by injection.

(She further testified that taking the medication by injection would

likely cause fewer appreciable side effects than taking the

medication orally.)

¶9 Following the hearing, the district court issued an order

extending the certification for short-term treatment to September

22, 2024. Finding the psychiatrist’s testimony to be credible, it also

authorized the involuntary administration of medication by

injection. However, the court ruled that “[t]he medications shall be

offered on a voluntary basis at each dosage and only if [Baricelli]

refuses that medication shall the medication be administered

involuntarily.”

II. Legal Principles and Standard of Review

¶ 10 A district court may authorize the involuntary administration

of medication if the People demonstrate by clear and convincing

evidence that (1) the 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

4
mental health condition or to prevent the likelihood of the person

causing serious harm to himself or others; (3) a less intrusive

treatment alternative isn’t 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. People v.

Medina, 705 P.2d 961, 973 (Colo. 1985).

¶ 11 Applying this test involves mixed questions of fact and law.

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

court’s factual findings if they’re supported by the record, but we

review the court’s legal conclusions de novo. Id. The resolution of

conflicts in testimony and determinations of the credibility of the

witnesses are solely within the fact finder’s province. 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

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 by itself to satisfy the Medina test. Id.

at ¶ 30.

5
III. Analysis

¶ 13 Baricelli doesn’t contest the district court’s ruling that the

second element of the Medina test was met; he challenges the

court’s rulings that the first, third, and fourth elements of the

Medina test were met.

A. The First Medina Element

¶ 14 In terms of the first Medina element, we discern no error in the

district court’s determination that Baricelli is incompetent to

effectively participate in the treatment decision that prescribed

medications be administered by injection in the event he refuses to

take the medications orally.

¶ 15 The district court found, with record support, that Baricelli

lacks insight regarding the benefit of the long-acting injectable

medications, which remain in the body longer than do oral

medications, thereby eliminating the need to take a pill every day

upon his release from the VA. The court also found, with record

support, that Baricelli has a history of noncompliance with taking

his medications and that he engages in short-term stabilization to

facilitate discharge without continuing long-term care. And the

6
court found, with record support, that Baricelli’s condition would

deteriorate absent consistent medication.

¶ 16 We also note that, in this case, the first Medina factor is

closely related to the fourth Medina factor. Below, we conclude that

the district court didn’t err by finding that Baricelli’s need for

treatment is sufficiently compelling to override any bona fide and

legitimate interest he has in refusing treatment. The record

indicates that Baricelli believes that his concerns about taking the

medications by injection outweigh any possible need in

administering the medications by injection. But the record

indicates that although it is critical for Baricelli to consistently take

aripiprazole, he hasn’t been consistent in taking that medication.

Thus, the record supports the district court’s conclusion that

Baricelli isn’t competent in understanding that it is critical for him

to take the medication by injection if he stops voluntarily taking the

medication orally.

B. The Third Medina Element

¶ 17 In terms of whether a less intrusive treatment alternative was

available, it is significant that the district court’s order requires the

7
VA to provide Baricelli with the medications in oral form at each