Peo in Interest of Duran

24CA1388 Peo in Interest of Duran 10-24-2024

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA1388
Pueblo County District Court No. 24MH30050
Honorable Timothy O’Shea, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Joseph Louis Duran,

Respondent-Appellant.

ORDER AFFIRMED

Division III
Opinion by JUDGE DUNN
Navarro and Gomez, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced October 24, 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 Joseph Louis Duran appeals the district court’s order

authorizing the involuntary administration of antipsychotic and

mood-stabilizing medications. We affirm.

I. Background

¶2 Duran was committed to Colorado Mental Health Hospital in

Pueblo (CMHHIP) after being found incompetent to proceed in a

criminal case. He was diagnosed with bipolar disorder and

presented as “hyper-verbal, grandiose, persistently irritable, and

preoccupied with non-bizarre, persecutory delusional beliefs

surrounding his involvement with the legal and medical systems.”

¶3 At the request of CMHHIP staff psychiatrist Dr. Martin Ahern,

the People petitioned the district court to authorize the involuntary

administration of (1) Zyprexa, an antipsychotic; (2) Haldol, another

antipsychotic; (3) Depakote, a mood stabilizer; and (4) Vistaril, a

medication for agitation and anxiety.

¶4 The district court held an evidentiary hearing at which Dr.

Ahern and Duran testified. Dr. Ahern explained Duran’s bipolar

disorder and accompanying symptoms. And he described the four

requested medications, their side effects, and their necessity in

treating Duran’s symptoms.

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¶5 Duran denied having a mental condition.

¶6 Finding that Dr. Ahern testified “credibly and persuasively,”

the court granted the petition and entered an order authorizing the

involuntary administration of the requested medications.

II. Legal Principles and Standard of Review

¶7 An involuntarily committed person retains the right to refuse

treatment. See People v. Medina, 705 P.2d 961, 971 (Colo. 1985).

Even so, a court may authorize the involuntary administration of

medication if the People prove the following elements by clear and

convincing evidence:

(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 condition

or to prevent the likelihood of the person causing serious harm

to himself 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 his bona fide and legitimate interest in refusing

treatment.

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Id. at 973.1 We 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. A physician’s testimony alone may be sufficient to satisfy

the Medina test. Id. at ¶ 30.

¶8 Applying the Medina test presents a mixed question of fact and

law, meaning we defer to the district court’s factual findings if

supported by the record but review its legal conclusions de novo.

People in Interest of R.C., 2019 COA 99M, ¶ 7. It’s for the district

court, as the fact finder, to determine witness credibility; the

sufficiency, probative effect, and weight of the evidence; and the

inferences and conclusions to be drawn from it. Id.

III. Discussion

¶9 Duran doesn’t contest the district court’s findings on the first

and third Medina elements. But he contends that the People didn’t

1 A different test applies to petitions to administer involuntary

medication solely to restore competency. Sell v. United States, 539
U.S. 166, 180-81 (2003). But the parties don’t dispute that People
v. Medina, 705 P.2d 961 (Colo. 1985), applies here because the
purpose of the medications is to prevent a significant and long-term
deterioration in Duran’s mental condition. See Sell, 539 U.S. at
181-83.

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present sufficient evidence to prove the second and fourth Medina

elements. We disagree.

A. The Second Medina Element

¶ 10 The second Medina element may be satisfied by showing either

a significant and likely long-term deterioration or the likelihood of

serious harm to self or others in the institution. Medina, 705 P.2d

at 973. The court here found that the recommended treatment is

necessary “to prevent a significant and long-term deterioration” in

Duran’s mental condition (not that Duran was a threat to himself or

others).

¶ 11 On this point, the court expressly credited and adopted Dr.

Ahern’s testimony. Dr. Ahern opined that, without the requested

medications, there would be a significant and likely long-term

deterioration in Duran’s mental condition. He explained that Duran

had been given antipsychotic and mood-stabilizing medications on

an emergency basis, and during that time, Duran’s condition

demonstrably improved. In particular, Duran was “more pleasant”

and “cooperative,” “less paranoid” and “verbose,” and “generally in

much more control of his behavior.” But when the emergency

medication period ended, Duran refused to continue taking the

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medications voluntarily, and his condition promptly deteriorated.

Duran once again became “disruptive, loud, argumentative, [and]

provocative to other patients,” and he showed “poor impulse

control” and “more paranoia” and “mood symptoms.” Given the

“short window of seeing improvement on medication and prompt

deterioration” after stopping medication, Dr. Ahern expected to see

“a prolonged impairment in [Duran’s] ability to function as a result

of not being medicated.”

¶ 12 Duran admits that his condition improves while medicated but

nevertheless asserts that Dr. Ahern’s testimony regarding the “short

window” and “prompt deterioration” doesn’t support a finding of

long-term deterioration as required by Medina. In support, Duran

points out that he has been hospitalized three times since 1995 but

that he went decades between hospitalizations. He says this

establishes a “history of maintaining his independence without

medication.”

¶ 13 But Dr. Ahern opined that, without medication, Duran’s

“mental state would continue to deteriorate or would remain in this

impaired and symptomatic state.” And Dr. Ahern explained that

bipolar disorder is “a chronic condition that requires maintenance

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medication” to prevent periods of mania and depression. To the

extent Duran asks us to second-guess witness credibility or draw

different inferences from the testimony, we won’t do that. See R.C.,

¶ 7.

¶ 14 Thus, we conclude that sufficient evidence supports the

district court’s finding that the requested medications are necessary

to prevent a significant and likely long-term deterioration in

Duran’s mental condition.

B. The Fourth Medina Element

¶ 15 In assessing the fourth Medina element — whether the

patient’s need for treatment is sufficiently compelling to override

any legitimate interest in refusing treatment — a court must

consider “whether the patient’s refusal is bona fide and legitimate”

and, if it is, “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.” Medina, 705 P.2d at 974.

¶ 16 Duran asserts that the state’s interest in treating him is

insufficient to overcome his bona fide and legitimate interest in

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avoiding severe side effects by refusing treatment. More specifically,

he claims Dr. Ahern testified that he exhibited such side effects in

the form of tremors and that he has several underlying chronic

medical conditions.

¶ 17 We acknowledge Duran’s legitimate concern regarding

potentially harmful side effects, particularly considering his other

medical conditions. But Dr. Ahern testified that Duran didn’t

report or display “any sort of tremors while taking the medication.”

Instead, Duran exhibited “an arm tremor and head bobbing after

cessation of the medications.” (Emphasis added.) As a result, Dr.

Ahern couldn’t say whether these symptoms resulted from the

medications or “another medical process.”

¶ 18 Beyond that, Dr. Ahern testified that Duran’s providers had

consulted the medical team, would closely monitor Duran’s physical

and mental conditions, and would adjust or prescribe medications

for any side effects he might experience. And Dr. Ahern explained

that (1) the need to treat Duran with the medications outweighed

the risk of side effects, even considering his other medical

conditions; (2) no alternative treatment would be both as effective

and less intrusive than the medications; (3) without the

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medications, there would be a significant and likely long-term

deterioration in Duran’s mental condition; and (4) when given the

medications on an emergency basis, his condition improved.

¶ 19 We therefore conclude that sufficient evidence supports the

district court’s finding that the need to treat Duran’s mental

condition is sufficiently compelling to override his bona fide and

legitimate interest in refusing treatment.

IV. Disposition

¶ 20 We affirm the order.

JUDGE NAVARRO and JUDGE GOMEZ concur.

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