Peo in Interest of EME

24CA1914 Peo in Interest of EME 12-26-2024

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA1914
Pueblo County District Court No. 24MH30074
Honorable Timothy O’Shea, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of E.M.E.,

Respondent-Appellant.

ORDER AFFIRMED

Division V
Opinion by JUDGE LUM
Freyre and Grove, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced December 26, 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 E.M.E. appeals the district court’s order authorizing staff at

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

medicate him involuntarily. We affirm.

I. Background

¶2 E.M.E. was admitted to the hospital in August 2024 after

being found incompetent to proceed in a criminal case. The record

indicates that, when he arrived at the hospital, he was in a very

severe psychotic state. Specifically, he presented with severe

aggressive behavior, extreme agitation, paranoid and delusional

thought content, and impulsivity. During his first week at the

hospital, he repeatedly attempted to hit and bite hospital staff. His

combative and erratic behavior led hospital staff to detain him in

seclusion and restraints and give him emergency medications.

¶3 Later that month, the People filed a motion seeking

authorization to medicate E.M.E. involuntarily with the

antipsychotic medications Zyprexa, Thorazine, and Haldol, and the

mood-stabilizing medication Depakote. The district court granted

the motion.

¶4 E.M.E.’s psychiatrist at the hospital began treating him with

Zyprexa and Depakote on a scheduled basis, and Thorazine and

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Haldol for instances of acute agitation. Although E.M.E. showed

some improvement on the medications in terms of requiring less

frequent seclusion and restraints, he continued to exhibit paranoia,

agitation, and aggressive behavior, and he remained on assault

precautions.

¶5 In October, the People filed the motion at issue seeking

authorization to medicate E.M.E. involuntarily with the

antipsychotic medication Clozaril, in addition to the four

medications listed above.

¶6 At the hearing on the motion, E.M.E.’s psychiatrist, who

testified as an expert in clinical psychiatry, described E.M.E.’s

symptoms and said that he had been diagnosed with an unspecified

mood disorder. The psychiatrist explained that E.M.E. had

continued to exhibit paranoia, agitation, and aggressive behavior

despite increasing his Zyprexa and Depakote to the highest

therapeutic level, and despite frequent use of “PRN” medications for

agitation and aggression.1 The psychiatrist testified that the

appropriate course was to start E.M.E. on Clozaril, while

1 The record suggests that the “PRN” medications were the

Thorazine and Haldol that the court had already approved.

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maintaining him on Depakote, which would hopefully allow him to

taper off Zyprexa and reduce his need for PRN medications.

¶7 During E.M.E.’s testimony, he denied having a mental illness

and testified that he did not need any medications and would not

take the medications without a court order. He further testified

that the medications were causing him side effects of muscle

fatigue, dry skin, and weight gain. He also testified that (1) his

father is Indigenous, specifically Inuit; (2) “we believe food is

medicine and massage”; and (3) his Inuit cultural beliefs precluded

him from taking medications. On cross-examination, he testified

that the medications were “too much,” that he did not want to take

scheduled medications, and that if he took a PRN he “would request

that it be substantially less.”

¶8 Following the testimony, the district court found that the

psychiatrist had testified credibly and persuasively, and it expressly

adopted the psychiatrist’s opinions. The court then examined each

of the four elements of the test from People v. Medina, 705 P.2d

961, 973 (Colo. 1985), concluded that all four elements were met,

and granted the petition.

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II. Applicable Law and Standard of Review

¶9 Under the Medina test,2 a district 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 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 any bona fide and legitimate

interest of the person in refusing treatment. Id.

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

and law. People v. Marquardt, 2016 CO 4, ¶ 8. We defer to the

2 A different test applies to petitions to administer involuntary

medication for the purpose of restoring competency. See People in
Interest of R.F., 2019 COA 110, ¶ 11 n.1. Although E.M.E. was
admitted to the hospital for that purpose, the parties do not
dispute — and we agree — that People v. Medina, 705 P.2d 961
(Colo. 1985), applies here because the purpose of the petition in
this case is to prevent E.M.E. from causing harm to others and to
prevent a significant and long-term deterioration in his mental
condition. R.F., ¶ 11 n.1.

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district court’s factual findings if they have record support, while we

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.

¶ 11 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 district court’s order. People in Interest of R.K.L.,

2016 COA 84, ¶ 13. The testimony of the physician seeking to

administer treatment may be sufficient, without more, to satisfy the

Medina test. Id. at ¶ 30.

III. Analysis

¶ 12 E.M.E. concedes that the first, second, and third elements of

the Medina test were met. He only challenges the sufficiency of the

evidence regarding the fourth Medina element, specifically, that his

need for medications is sufficiently compelling to override any bona

fide and legitimate interest he has in refusing the medications.

¶ 13 Addressing E.M.E.’s interests in not taking the medications,

the district court said, “[E.M.E.] testified that he experiences muscle

fatigue and dry skin as side effects from the current medications.

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And, also, that he is of indigenous heritage, specifically Inuit. And

that in his culture, food and massage constitute medical

treatment . . . over pharmaceuticals.” The court then found that

these interests were not bona fide and legitimate, explaining as

follows: “[E.M.E.] also testified that he would take less medications

as PRN. So it’s not clear to the Court that his indigenous heritage,

his Inuit background, strictly prohibits pharmaceutical

medications . . . . So the Court cannot make a finding that his

reasons for refusal are bona fide and legitimate.”

¶ 14 The district court’s finding that E.M.E.’s interests were not

bona fide and legitimate is not sufficiently supported by the record

or the court’s statements explaining its finding. Notably, the court

did not make a specific credibility finding about E.M.E.’s testimony.

Also, the court appears to have employed some heightened

standard in implying that E.M.E.’s Inuit background must “strictly

prohibit[]” pharmaceutical medications for his cultural beliefs to be

considered a “bona fide and legitimate” interest. And finally, unlike

E.M.E.’s cultural beliefs, the court did not specifically address the

legitimacy of E.M.E.’s interest in avoiding the side effects he had

been experiencing from the medications.

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¶ 15 That being said, we discern no error in the court’s ultimate

conclusion that E.M.E.’s need for the medications was sufficiently

compelling to override any bona fide interest in refusing the

medications. We reach that conclusion because the record clearly

demonstrates the severity of E.M.E.’s condition and symptoms —

his severe aggressive behavior, extreme agitation, and paranoid and

delusional thought content — which often required “extreme staff

intervention,” seclusion, and restraints. Additionally, the

psychiatrist testified that (1) given the severity of E.M.E.’s initial

presentation, he would experience a significant and likely long-term

deterioration of his mental condition without the medications; (2)

E.M.E. would be monitored for side effects, and medications were

available to “neutralize” some of the side effects; and (3) failure to

medicate E.M.E. would be more harmful than the risks posed by

the medications.

IV. Disposition

¶ 16 The order is affirmed.

JUDGE FREYRE and JUDGE GROVE concur.

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