Peo Interest of Robinson

24CA1432 Peo in Interest of Robinson 10-17-2024

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA1432
Pueblo County District Court No. 24MH30059
Honorable Timothy O’Shea, Judge

The People of the State of Colorado,

Petitioner-Appellee,

v.

In the Interest of Benjamin Dane Robinson,

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 17, 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 Respondent, Benjamin Dane Robinson, appeals the district

court’s order authorizing staff at the Colorado Mental Health

Hospital in Pueblo (CMHHIP), or any other designated facility, to

involuntarily administer medication to him. We affirm.

I. Background

¶2 Robinson was committed to CMHHIP for competency

restoration in a criminal case. He was diagnosed with

schizoaffective disorder and presented with symptoms that included

paranoia, delusional thinking, grandiosity, and intermittently

agitative behaviors. Robinson, who has a history of medication

noncompliance, was previously restored to competency at CMHHIP

on a combination of Abilify and Lithium. However, since his

current admission he has refused to take any antipsychotic or

mood stabilizing medications.

¶3 The People filed a petition seeking the involuntary

administration of Abilify, Abilify Maintena, Lithium, and Zyprexa

(olanzapine), as well as any lab work to monitor the medications.

The Zyprexa (olanzapine) was requested for use only if Robinson

refused to take Abilify orally.

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¶4 The district court held an evidentiary hearing on the petition.

Dr. Hareesh Pillai, the CMHHIP staff psychiatrist overseeing

Robinson’s care, testified, as did Robinson. At the end of the

hearing, the court found that Dr. Pillai had testified “credibly and

persuasively,” and concluded that the People had proved all four

elements set forth in People v. Medina, 705 P.2d 961 (Colo. 1985).

The court issued an order authorizing CMHHIP staff to administer

the requested medications to Robinson against his will.

II. Discussion

¶5 Robinson concedes that the People met their burden of

proving, by clear and convincing evidence, the first three Medina

factors. He contends, however, that the evidence presented at the

hearing was insufficient to prove the fourth Medina factor: that his

need for treatment is sufficiently compelling to override his bona

fide and legitimate interest in refusing treatment. We are not

persuaded.

A. Applicable Law and Standard of Review

¶6 A district court may order the involuntary administration of

medication to a patient only if the People prove, by clear and

convincing evidence, each of 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 medication 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;

(3) a less intrusive treatment alternative is not
available; and

(4) the patient’s need for treatment by
antipsychotic medication is sufficiently
compelling to override any bona fide and
legitimate interest of the patient in refusing
treatment.

¶7 Id. at 973. A psychiatrist’s testimony may suffice to meet this

burden. See People v. Pflugbeil, 834 P.2d 843, 847 (Colo. App.

1992).

¶8 When a patient challenges the sufficiency of the evidence

supporting an involuntary medication order, we review the district

court’s legal conclusions de novo but defer to its findings of fact if

they have record support. People v. Marquardt, 2016 CO 4, ¶ 8. We

view the evidence as a whole and in the light most favorable to the

People to determine if it is sufficient to support the district court’s

order. People in Interest of R.K.L., 2016 COA 84, ¶ 13. If it is, we

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may not substitute our judgment for that of the district court. See

People in Interest of A.J.L., 243 P.3d 244, 255 (Colo. 2010).

B. Fourth Medina Factor

¶9 The fourth Medina factor requires a court to first determine

“whether the patient’s refusal is bona fide and legitimate.” Medina,

705 P.2d at 974. If so, the court must 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 Robinson has a bona fide and

legitimate interest in refusing treatment based on his sincere

religious beliefs. However, the court also found that Robinson’s

“prognosis, absent the medication, is so unfavorable that his

personal preference to not be medicated must yield to the legitimate

interest the state has in preserving his life and health.” The record

supports these findings.

¶ 11 Dr. Pillai testified that without the requested medications

Robinson “displays overt symptoms of his mental illness,” which

“influences his thinking and his behavior,” and including

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“disorganization, illogical thinking, and grandiose delusions.” Dr.

Pillai explained that Robinson is “currently on the suicide 1

precautions and assault 1 precautions” unit and “last week he was

documented to use racial slurs and profanity towards staff, and

then he made comments of feeling hopeless and helpless.” Dr. Pillai

added that “there were some staff reports over the weekend that he

was antagonizing some peers on the unit and required frequent

redirection.”

¶ 12 These recent symptoms were consistent with the types of

aggressive and assaultive behaviors that Robinson exhibited upon

his 2019 hospitalization, which led to him being isolated and

restrained at that time until he was stabilized on medication. And

it was Dr. Pillai’s opinion that without the requested medications

Robinson’s mental condition would likely, and significantly,

continue to deteriorate long-term.

¶ 13 During Robinson’s 2019 admission at CMHHIP, these same

medications — namely, Abilify and Lithium — which were

prescribed and administered at Robinson’s request, improved his

mental state “significantly” and “he did well.” Dr. Pillai testified that

the requested medications did create the potential for adverse side

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effects but when Robinson took them in the past, they were “not

very intrusive to him as he did not have significant side effects.”

Dr. Pillai also explained how Robinson would be monitored for any

potential new side effects once he started the requested medication

regimen. And Dr. Pillai testified that there was not an alternative

method of treating Robinson that would be both effective and less

intrusive than the requested medications.

¶ 14 Robinson asserts that the district court failed to support its

findings by pointing to any specific evidence from the hearing and

therefore failed to specifically balance the state’s interest in forcibly

medicating him against his interest in refusing the medications.

But the court cited Dr. Pillai’s testimony regarding Robinson’s

“symptoms without the medication” as well as his testimony that

Robinson’s “symptoms were alleviated to a great degree with these

very medications in 2019.” These findings provide record support

for the court’s conclusion that Robinson’s “liberty interest in not

being forced to take [the requested medication] over his objection”

must yield to “the State’s interest in treating [him].” Moreover, the

court credited Dr. Pillai’s testimony, finding it both credible and

persuasive.

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¶ 15 Even if it would have been better practice for the district court

to identify additional evidence in support of its findings, where, as

here, the record contains support for the court’s findings, we will

not disturb them. See People in Interest of Ramsey, 2023 COA 95,

¶ 57 (evidence was sufficient to satisfy the fourth factor where the

physician testified that taking the requested medication to treat

respondent’s mental illness was an “essential need” and the failure

to treat her “would be more harmful than the potential side effects

of the medications”).

¶ 16 The district court found that Robinson’s religious concerns are

bona fide and legitimate. But a patient’s religious beliefs or

practices do not give them absolute authority to reject necessary

treatment. Rather, 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.

¶ 17 Because the record supports the district court’s findings, we

conclude that it did not err by finding that any concern Robinson

might have in refusing the requested medication was overridden by

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his sufficiently compelling need for treatment. See R.K.L., ¶¶ 13,

30.

III. Disposition

¶ 18 The order is affirmed.

JUDGE TOW and JUDGE PAWAR concur.

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