Peo in Interest of Vendegna

24CA0912 Peo in Interest of Vendegna 07-18-2024

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA0912

Pueblo County District Court No. 24MH103

Honorable Timothy O’Shea, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Anthony Vendegna,

Respondent-Appellant.

ORDER AFFIRMED

Division I

Opinion by JUDGE J. JONES

Welling and Schock, 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 Respondent, Anthony Vendegna, appeals the district court’s

order authorizing staff at Centennial Peaks Hospital (Centennial) to

treat him with electroconvulsive therapy (ECT) without his consent.

We affirm.

I. Background

¶ 2 In early February 2024, Mr. Vendegna was certified for up to

three months of short-term treatment at another facility based on a

physician’s diagnosis that he suffered from schizophrenia and was

gravely disabled as a result. See § 27-65-109, C.R.S. 2023.

¶ 3 In mid-April 2024, Mr. Vendegna was transferred to inpatient

care at Centennial and the certification was extended for an

additional three months of treatment. A physician there opined

that Mr. Vendegna was gravely disabled and was a danger to others

due to a mental health disorder.

¶ 4 A week later, a petition for review of Mr. Vendegna’s refusal of

treatment was filed, in which a physician opined that certain

antipsychotic medications, mood stabilizing medications, and anti-

anxiety medications were necessary to treat Mr. Vendegna’s

psychosis. In late April 2024, the district court issued an order

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authorizing staff at Centennial to administer the requested

medications to Mr. Vendegna without his consent.

¶ 5 In mid-May 2024, the petition at issue was filed, requesting

that Centennial be allowed to treat Mr. Vendegna with ECT without

his consent. In it, Mr. Vendegna’s psychiatrist at Centennial, Dr.

Roderick S. O’Brien, reported that the “aggressive pharmacotherapy

trials” had not been successful and that treatment with ECT would

give Mr. Vendegna a significantly better chance for remission.

¶ 6 At the May 20, 2024, hearing on the petition, Dr. O’Brien

testified that he had diagnosed Mr. Vendegna with schizoaffective

disorder, the bipolar type, which caused him to experience acute

psychosis and unstable mood. He testified that Mr. Vendegna’s

illness required treatment with a combination of medications and

ECT, and that if he didn’t receive ECT, he would suffer a significant

and long-term deterioration of his mental condition.

¶ 7 Mr. Vendegna testified in opposition to the petition for

involuntary treatment.

¶ 8 The district court ultimately found that Dr. O’Brien testified

“credibly and persuasively,” adopted Dr. O’Brien’s opinions, and

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granted the petition authorizing Centennial to involuntarily

administer ECT.

II. Discussion

¶ 9 The district court found that the People had proven by clear

and convincing evidence all four elements required under People v.

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

involuntary administration of medical treatment.

¶ 10 On appeal, Mr. Vendegna challenges the sufficiency of the

evidence supporting only the fourth Medina element, namely,

whether the patient’s need for the treatment is sufficiently

compelling to override any bona fide and legitimate interest of the

patient in refusing the treatment. Id. (The first three elements are

whether the patient is incompetent to effectively participate in the

treatment decision, whether the treatment 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’s causing

serious harm to himself or others in the institution, and whether a

less intrusive treatment alternative is available. Id.)

¶ 11 We conclude that the evidence is sufficient to support the

court’s finding on the fourth Medina element.

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A. Standard of Review

¶ 12 The district court’s order presents a mixed question of fact and

law. We defer to the court’s factual findings if there is evidence

supporting them, but we review the court’s legal conclusions de

novo. People in Interest of Strodtman, 293 P.3d 123, 131 (Colo. App.

2011). 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. Testimony by a physician supporting a petition for

involuntary administration of medication may be sufficient. Id. at ¶

30 (citing People v. Pflugbeil, 834 P.2d 843, 847 (Colo. App. 1992)).

B. Analysis

¶ 13 Mr. Vendegna contends that the People failed to prove the

fourth Medina element by clear and convincing evidence because

the district court “stated that it was unable to ascertain Mr.

Vendegna’s reasons for refus[ing]” to be treated with ECT. In doing

so, Mr. Vendegna highlights his testimony indicating why he

refused ECT: his concerns that ECT would be painful and that,

given that he had been a smoker for thirty years, ECT could cause

him to have a heart attack and die. Mr. Vendegna argues that the

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district court erred in analyzing the fourth Medina factor because it

didn’t sufficiently consider his bona fide and legitimate interest in

refusing the treatment (balanced against his need for the

treatment).

¶ 14 We aren’t persuaded by Mr. Vendegna’s argument. At the

hearing, the district court discussed — to a greater extent than Mr.

Vendegna suggests on appeal — Mr. Vendegna’s reasons for

refusing ECT. Specifically, the court said, “I don’t really understand

-- Mr. Vendegna’s reasons for refusal. In his testimony that was not

clear at all other than that he believes . . . that ECT . . . might cause a

heart attack in him because he was – a long term smoker.”

(Emphasis added.) The court then said, “There is no evidence in

the record to suggest that. Dr. O’Brien testified at length as to the

procedure for ECT and how safe it is and it’s the global standard as

he put it -- for mood instability.”

¶ 15 So the record indicates that the district court did specifically

address the apparent primary reason that Mr. Vendegna refused

ECT, and then balanced that concern against Mr. Vendegna’s

compelling need for ECT. The court’s findings in that regard are

supported by Dr. O’Brien’s testimony that

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• ECT is performed under general anesthesia, during

which an anesthesiologist monitors the patient’s

breathing, oxygen, heart rate, and blood pressure;

• Mr. Vendegna’s medical history doesn’t indicate any

medical conditions like cardiomyopathy or diabetes that

would increase the risk of ECT; and

• Mr. Vendegna’s history of smoking is “not in any way a

contraindication to” the recommendation for ECT.

¶ 16 Further, in terms of Mr. Vendegna’s expressed concern that

ECT would cause him pain, again, Dr. O’Brien testified that ECT is

administered when the patient is under general anesthesia.

¶ 17 The evidence was sufficient to support the district court’s

finding on the fourth Medina element.

III. Disposition

¶ 18 The order is affirmed.

JUDGE WELLING and JUDGE SCHOCK concur.