Peo in Interest of BAH

24CA1231 Peo in Interest of BAH 09-19-2024

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA1231
Pueblo County District Court No. 24MH30046
Honorable Timothy O’Shea, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of B.A.H.,

Respondent-Appellant.

ORDER AFFIRMED

Division I
Opinion by JUDGE LIPINSKY
J. Jones and Sullivan, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced September 19, 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 B.A.H. appeals the district court’s order authorizing staff at

the Colorado Mental Health Hospital in Pueblo (the hospital) to

involuntarily medicate him. We affirm.

I. Background

¶2 B.A.H. was admitted to the hospital in June 2024 after being

found incompetent to proceed in two criminal cases. While he was

in jail, before his admission to the hospital, he told personnel at the

jail that his food was being poisoned. He stopped eating a majority

of his meals over a two-week period, including not eating for eight

consecutive days. The record indicates that the jail’s medical staff

“was concerned and wanted to make sure that [B.A.H.] wasn’t

developing any . . . negative consequences due to starvation,” but

that B.A.H. “was very paranoid and resistant to any sort of medical

evaluation at that time.”

¶3 The psychiatrist overseeing B.A.H.’s care at the hospital

diagnosed him as having unspecified schizophrenia spectrum and

other psychotic disorder. According to the psychiatrist, B.A.H. was

experiencing persistent delusions with associated disorganized

behavior, including a belief that his food was also being poisoned at

the hospital.

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¶4 Upon B.A.H.’s admission to the hospital on June 6, 2024, he

was offered psychiatric medication to target his psychosis, but he

declined it. On June 13, B.A.H. was placed on emergency

psychiatric medication because of his increasingly erratic and

unpredictable behavior, including threatening another patient.

¶5 After B.A.H. began taking the medications, he maintained an

appropriate diet, was more compliant with hospital staff, and was

less aggressive toward and threatening to other patients. However,

B.A.H. was caught trying to divert his oral medications, and on

June 25, he told his psychiatric provider, “Take me off the

medications. I do not want them and I do not need them.” When

he stopped taking the medications, he again became impulsive and

aggressive.

¶6 On July 2, the People filed a petition for an order authorizing

the involuntary administration of medications — specifically

Zyprexa, Abilify, and Depakote — to B.A.H. In the petition, the

People said that the medications were “necessary to prevent a

significant and long-term deterioration in [B.A.H.’s] mental

condition and/or prevent the likelihood of [B.A.H.] causing serious

harm to [himself] or others.”

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¶7 B.A.H.’s psychiatrist and B.A.H. testified at the hearing on the

petition. The psychiatrist explained that Zyprexa and Abilify are

antipsychotic medications, and that Depakote is a mood stabilizer.

He said that B.A.H. was already prescribed Zyprexa and Depakote,

but that he hoped to transition B.A.H. from Zyprexa to Abilify,

which has a more favorable side effect profile and can be given in

long-acting injectable form. In addition, the psychiatrist said that

he was no longer recommending Depakote because B.A.H. had

elevated liver enzymes that caused him abdominal discomfort,

which is a known side effect of Depakote.

¶8 At the hearing, B.A.H. denied he had schizophrenia and made

clear that he was still refusing to voluntarily take the medications

that his psychiatrist prescribed.

¶9 At the conclusion of the hearing, the court found that B.A.H.’s

psychiatrist had testified “credibly and persuasively” and adopted

the psychiatrist’s opinions. Then, applying the four-factor test from

People v. Medina, 705 P.2d 961, 973 (Colo. 1985), the court held

that administration of Zyprexa and Abilify to B.A.H. was necessary

(1) to prevent a significant and long-term deterioration in his mental

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condition and (2) to prevent the likelihood that he will cause serious

harm to himself or others at the hospital.

II. Legal Principles and Standard of Review

¶ 10 We agree with the parties that the four-factor test from Medina

applies. (Although B.A.H. was admitted to the hospital because he

was found incompetent to proceed in his two criminal cases, the

district court’s ruling did not address whether the medications at

issue were necessary to restore his competency in those cases.

Instead, the court ruled that the medications were necessary to

prevent a significant and long-term deterioration in B.A.H.’s mental

condition and to prevent him from serious harm to himself or

others. Therefore, the Medina test applies. See People in Interest of

R.F., 2019 COA 110, ¶ 11 n.1, 451 P.3d 1238, 1241 n.1.)

¶ 11 A 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 patient’s

causing serious harm to himself or others in the institution; (3) a

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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. Medina, 705 P.2d at 973.

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

and law. People v. Marquardt, 2016 CO 4, ¶ 8, 364 P.3d 499, 502.

We defer to the district court’s factual findings if they are supported

by the record but 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 fact finder.

People in Interest of Ramsey, 2023 COA 95, ¶ 23, 541 P.3d 1198,

1204.

¶ 13 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, 412 P.3d 827, 832. The testimony of the physician

seeking to administer treatment may be sufficient, without more, to

satisfy the Medina test. Id. at ¶ 30, 412 P.3d at 834.

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III. Analysis

¶ 14 B.A.H. does not contest the district court’s rulings that the

first, second, and fourth elements of the Medina test were met.

Instead, he only challenges the sufficiency of the evidence

supporting the court’s ruling that a less intrusive treatment

alternative was not available.

¶ 15 B.A.H. initially asserts that the psychiatrist “testified that [he]

is responding well to his current medical regime of Zyprexa and

Depakote.” However, the court found, and the record shows, that

B.A.H. began refusing to take those two medications approximately

two weeks before the hearing, which is presumably what led the

People to file their petition.

¶ 16 B.A.H. also asserts that, given that Zyprexa and Depakote

worked effectively for him, it would be “unnecessarily intrusive to

transition [him] to a third medication [Abilify], putting him at risk of

experiencing additional side effects.” But the psychiatrist testified

that he planned to transition B.A.H. from Zyprexa to Abilify, not to

prescribe full doses of both antipsychotics at the same time.

Further, the court found, with record support, that Abilify has a

better side effect profile than does Zyprexa. Although B.A.H.

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focuses on the side effects he experienced from Zyprexa and

Depakote, he does not suggest that he has ever taken Abilify.

Accordingly, the record does not support B.A.H.’s contention that

Abilify might cause him negative side effects.

¶ 17 B.A.H. further asserts that, because the psychiatrist did not

review B.A.H.’s medical history, “it is impossible to determine the

level of intrusiveness of any medication as it specifically pertains” to

him. This argument rests on the psychiatrist’s testimony that he

did not have B.A.H.’s “prior medical records” and that he did not

know if B.A.H. had any “underlying health conditions that could be

affected or worsened by the medications.” But the psychiatrist did

not testify that, based on the information available to him, he was

unable to determine the medications needed to treat B.A.H.’s

mental health disorder or the appropriate dosages of such

medications. And nothing in the record indicates that the

psychiatrist’s review of B.A.H.’s medical records would have led to a

different treatment decision.

¶ 18 Finally, B.A.H. argues that, if the danger posed by not

medicating him is his refusal to eat food, “surely there is a less

intrusive method of improving [his nutrition] than forcibly

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administering psychiatric medications.” However, the record

indicates that one of the primary manifestations of his psychosis

was his belief that his food was being poisoned. The record reveals

that B.A.H. maintained an appropriate diet when he took Zyprexa

and Depakote. Thus, the record shows that B.A.H.’s refusal to eat

resulted from his mental health disorder, which alternative feeding

techniques would not address.

IV. Disposition

¶ 19 The order is affirmed.

JUDGE J. JONES and JUDGE SULLIVAN concur.

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