Peo in Interest of West

24CA1468 Peo in Interest of West 10-24-2024

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA1468
Adams County District Court No. 24MH343
Honorable Sara Price, Magistrate

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Hilary West,

Respondent-Appellant.

ORDER AFFIRMED

Division VII
Opinion by JUDGE SCHUTZ
Tow and Pawar, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced October 24, 2024

Donna Fegler Daiss, County Attorney, Mellissa Sager, Assistant County
Attorney, Brighton, Colorado, for Petitioner-Appellee

Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant
¶1 Hilary A. West appeals a magistrate’s order authorizing her

certification for short-term mental health treatment and

involuntarily administered medication. We affirm.

I. Background

¶2 West was admitted to the inpatient psychiatric unit at

UCHealth University of Colorado Hospital after she went to the

emergency room to report that she was sexually assaulted. She

exhibited psychotic symptoms, including paranoid delusions and

disorganized speech and thoughts, and was diagnosed with

schizoaffective disorder bipolar type. West was placed on a seventy-

two-hour emergency mental health hold.

¶3 Pursuant to section 27-65-109, C.R.S. 2024, Dr. Alec

Aaronson, West’s treating psychiatrist, sought an order authorizing

West’s certification for short-term mental health treatment.

Through the Adams County Attorney, Dr. Aaronson also requested

an order authorizing the hospital to administer involuntary

medications to West. Following a hearing, the magistrate granted

the certification for short-term treatment for a period not to exceed

three months. The magistrate found that, as a result of her mental

illness, West is gravely disabled. The magistrate also found that the

1
county attorney had met its burden under People v. Medina, 705

P.2d 961 (Colo. 1985), to prove the need for the involuntary

administration of antipsychotic medications, namely, aripiprazole

(Abilify), haloperidol (Haldol), olanzapine (Zyprexa), paliperidone

(Invega), quetiapine (Seroquel), risperidone (Risperdal);

benzodiazepines medications, including clonazepam (Klonopin) and

diazepam (Valium); and medications to manage side effects,

including benztropine (Cogentin), diphenhydramine (Benadryl), and

propranolol (Inderal). The magistrate authorized this broad list of

possible medications “to accommodate variable responses to given

medication combinations.”

¶4 West appeals the magistrate’s order.

II. Legal Principles and Standard of Review

¶5 As applicable here, to authorize short-term mental health

treatment, a court must find by clear and convincing evidence that

the patient has a mental health disorder and, as a result, is a

danger to herself or others or is gravely disabled. People in Interest

of Ramsey, 2023 COA 95, ¶ 25; §§ 27-65-109(1)(a), 27-65-113(1),

C.R.S. 2024.

2
¶6 An order authorizing the involuntary administration of

medications must likewise be supported by clear and convincing

evidence. Ramsey, ¶ 39; Medina, 705 P.2d at 971. A court may

authorize the involuntary administration of medication if the

requesting party establishes each of the following elements: (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 causing serious

harm to herself or others in the institution; (3) a 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.

¶7 Both an order of short-term certification and an order

authorizing the involuntary administration of medications present

mixed questions 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

3
the evidence, viewed as a whole and in the light most favorable to

the People, is sufficient to support the court’s order. People in

Interest of R.K.L., 2016 COA 84, ¶ 13. The resolution of testimonial

conflicts and determinations of witness credibility are solely within

the province of the fact finder. Ramsey, ¶ 23. Where there is

record support for the court’s findings and conclusions, we may not

substitute our judgment for that of the district court. Id.

III. Discussion

¶8 West contends that the magistrate erred by determining that

sufficient evidence supported the requirements for both short-term

certification and the involuntary administration of medication. As

to the short-term certification, she asserts only that the evidence

was insufficient to support a finding that she is gravely disabled or

a danger to herself or others. And as to the involuntary

administration of medications, she asserts only that insufficient

evidence supported the first and second Medina elements. We

discern no error.

A. Gravely Disabled

¶9 “Gravely disabled” means that, due to a mental health

disorder, a person is incapable of making informed decisions about

4
or providing for their essential needs without significant supervision

and assistance from other people. § 27-65-102(17), C.R.S. 2024.

As a result, such a person “is at risk of substantial bodily harm,

dangerous worsening of any concomitant serious physical illness,

significant psychiatric deterioration, or mismanagement of the

person’s essential needs that could result in substantial bodily

harm.” Id.

¶ 10 A person is “gravely disabled” if they are “unable to take care

of basic personal needs.” People v. Taylor, 618 P.2d 1127, 1134

(Colo. 1980). Basic personal needs means “those fundamental

necessities of human existence, such as food, shelter, clothing, and

medical care, which an individual must obtain and maintain in

order to live safely.” Id.

¶ 11 Bearing these standards in mind, we conclude that the

evidence supports the magistrate’s determination that West is

gravely disabled.

¶ 12 At the hearing, Dr. Aaronson, provided expert opinion

testimony that West is gravely disabled as a result of her mental

illness. He opined that her psychotic symptoms are “quite severe”

and “limit[] her ability to . . . do the basics of taking care of herself.”

5
Of particular concern to Dr. Aaronson was the fact that,

notwithstanding available “resources to obtain housing,” West’s

paranoid delusions and thought disorganization impaired her

ability to obtain basic shelter for herself. Consequently, Dr.

Aaronson opined, West is “being placed in extremely vulnerable

positions in the community” with the potential for assaults and

medical issues that come with a lack of shelter and other basic

necessities. Indeed, as Dr. Aaronson noted, West came to the

emergency room to report that she had been sexually assaulted.

¶ 13 This testimony supports the magistrate’s finding that West is

gravely disabled. Nonetheless, West asserts, her testimony

established that she could secure immediate housing, and Dr.

Aaronson’s testimony established that resources are available to

assist her in doing so. Be that as it may, Dr. Aaronson opined that

West was unable to obtain basic shelter despite available resources.

Further, the magistrate placed greater weight on Dr. Aaronson’s

testimony than West’s, and we are not free to reweigh the evidence.

See Ramsey, ¶ 23.

6
B. The First Medina Element

¶ 14 Because the record supports it, we discern no error in the

magistrate’s determination that West is not competent to effectively

participate in the relevant treatment decision. Dr. Aaronson

testified that West’s “psychotic symptoms [are] severe enough that

she’s not able to participate in these decisions.” He further testified

that “she has very little insight” into her mental illness or mental

health symptoms and is unable to “participate in a risk-benefit

discussion about antipsychotic medication and why they may be

beneficial for her.” Instead, the doctor testified, “She’s very

insistent that Adderall is the only medication that works for her, for

both her mental and medical symptoms, despite . . . education that

that’s not the case.”

¶ 15 On this record, we will not disturb the magistrate’s finding

that West is not competent to effectively participate in the decision

of whether the requested medications are needed. We are not

persuaded otherwise by West’s assertion that her conflicting

testimony demonstrates the contrary. As noted, the resolution of

such conflicts and determinations of witness credibility are solely

within the province of the fact finder. Id.

7
C. The Second Medina Element

¶ 16 The second Medina element requires a showing that the

patient is in danger of either a significant and likely long-term

deterioration of her mental condition or of causing harm to herself

or others. Medina, 705 P.2d at 973. Here, the magistrate’s order

was based on the deterioration component of this Medina element.

¶ 17 Dr. Aaronson testified that the requested medications were

necessary to prevent a significant and likely long-term deterioration

in West’s mental condition. He noted that, in the approximately two

weeks since he initially saw her in the emergency department to the

date of the hearing, West had decompensated and was more

paranoid and afraid, “less willing to engage or talk about [the] risk

[and] benefits of these medications,” and less willing to engage in

education around her mental health symptoms.

¶ 18 Although West testified that she did not think she would suffer

significant or likely long-term deterioration if she didn’t take the

requested medications, the magistrate was persuaded by Dr.

Aaronson’s testimony and “assign[ed] more credibility to [his]

professional testimony and professional expert opinion” than to

8
West’s testimony. We may not disregard this resolution of

conflicting testimony. Ramsey, ¶ 23.

¶ 19 To the extent that West relies on an assertion that the

testimony does not establish that she poses a danger to herself or

others, we need not resolve this question because the second

Medina element is phrased in the disjunctive and the record

supports the magistrate’s determination that the medication was

necessary to prevent significant and likely long-term deterioration

in West’s mental condition. See Lombard v. Colo. Outdoor Educ.

Ctr., Inc., 187 P.3d 565, 571 (Colo. 2008) (“Generally, we presume

the disjunctive use of the word ‘or’ marks distinctive categories.”).

¶ 20 Because they are uncontested, we do not address the third

and fourth Medina elements.

IV. Disposition

¶ 21 For the reasons stated, the order is affirmed.

JUDGE TOW and JUDGE PAWAR concur.

9