Peo in Interest of Melrose

24CA1497 Peo in Interest of Melrose 10-24-2024

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA1497
La Plata County District Court No. 24MH34
Honorable A. Nathaniel Baca, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Skyler Melrose,

Respondent-Appellant.

ORDER AFFIRMED IN PART, REVERSED IN PART,
AND CASE REMANDED WITH DIRECTIONS

Division III
Opinion by JUDGE GOMEZ
Dunn and Navarro, JJ., concur

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

Sheryl Rogers, County Attorney, Katie Dittelberger, Assistant County Attorney,
Durango, Colorado, for Petitioner-Appellee

Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant
¶1 Respondent, Skyler Melrose, appeals the district court’s order

(1) certifying him for involuntary short-term treatment and

(2) authorizing the involuntary administration of medications to

him. He contends that the evidence was insufficient to sustain

either ruling. We affirm in part, reverse in part, and remand for

further proceedings.

I. Background

¶2 Melrose drove his car into a lake. When law enforcement

arrived on the scene, Melrose was behaving erratically and was very

disorganized. He was transported to the emergency room and was

later admitted to Highlands Behavioral Health.

¶3 The People filed a notice of certification for short-term

treatment, as well as a motion to authorize the involuntary

administration of medications. According to Melrose’s psychiatrist

at Highlands, Melrose was expressing multiple delusions, was

preoccupied internally, and was responding to internal stimuli. The

psychiatrist diagnosed him as suffering from schizophrenia.

However, Melrose was refusing medical care, including appropriate

medications. The motion requested a court order authorizing the

involuntary administration of

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• five antipsychotic medications — Haldol (haloperidol),

Prolixin (fluphenazine), Zyprexa (olanzapine), Abilify

(aripiprazole), and Invega (paliperidone); and

• three other medications — Benadryl (diphenhydramine),

Cogentin (benztropine), and Ativan (lorazepam) — to treat

any negative side effects.

¶4 At a hearing, the psychiatrist and Melrose both testified. The

psychiatrist testified that this was the second time Melrose had

been admitted to Highlands. During Melrose’s first admission a few

months earlier, he was treated with Haldol, became “much

improved” and “pretty functional,” and was discharged. So, during

this second admission, the psychiatrist planned to treat Melrose

with Haldol “to shorten his stay as soon as possible and discharge

him home in stable condition.” If Haldol was ineffective or caused

negative side effects, the psychiatrist planned to try Prolixin next;

and if that was ineffective or caused negative side effects, he

planned to try Zyprexa. If Melrose improved, the psychiatrist

planned to transition him to Abilify and Invega. According to the

psychiatrist, Melrose would be at risk of significant and long-term

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deterioration of his schizophrenia without an appropriate

antipsychotic medication.

¶5 During Melrose’s testimony, when he was asked whether he

had a mental illness, he responded, “I have a disorder that comes

and goes within the confines of vocabulary.” Melrose testified that

he wasn’t willing to take any antipsychotic medication, and he

denied experiencing any of the symptoms the psychiatrist had

described him as having. He also claimed he didn’t recall having

driven into a lake.

¶6 Following the testimony, the district court issued an order

certifying Melrose for short-term treatment and authorizing the

involuntary administration of the eight medications.

II. Applicable Law and Standards of Review

¶7 On a challenge to the sufficiency of the evidence, we review the

record to determine whether the evidence, viewed as a whole and in

the light most favorable to the People, is sufficient to support the

district court’s order. People in Interest of Ramsey, 2023 COA 95,

¶ 23. We review de novo the court’s conclusions of law and defer to

the court’s findings of fact if sufficient evidence in the record

supports them. Id. The resolution of conflicts in testimony and

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determinations of witness credibility are solely within the province

of the fact finder. Id.

III. Short-Term Treatment

¶8 As pertinent here, to authorize short-term involuntary

treatment, the district court must find by clear and convincing

evidence that the respondent has a mental health disorder and, as

a result of the disorder, is a danger to themself or others or is

gravely disabled. § 27-65-109(1)(a), -113(1), C.R.S. 2024; Ramsey,

¶ 25.

¶9 The district court found that, due to Melrose’s schizophrenia

and resulting symptoms, he was both (1) a danger to himself and

others and (2) gravely disabled.

¶ 10 On appeal, Melrose challenges both of those findings. In doing

so, he first emphasizes the psychiatrist’s testimony that he “has

never exhibited any aggression” at Highlands and “has not been

given any emergency medications.” However, the evidence indicates

that Melrose drove his car into a lake and was suffering significant

effects of his schizophrenia before his admission to Highlands,

which well supports the district court’s finding that he would be a

danger to himself and others without effective medical treatment.

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¶ 11 Melrose also takes issue with the psychiatrist’s explanation for

his opinion that Melrose is gravely disabled. Specifically, the

psychiatrist testified that Melrose “cannot explain and discuss

anything about his mental health treatment” and that he “is not

able to participate in a reasonable discussion of his future and

treatment options.” Melrose argues that these explanations “do not

establish that [he] is incapable of caring for himself.”

¶ 12 The statutory scheme defines “gravely disabled” as “a

condition in which a person, as a result of a mental health disorder,

is incapable of making informed decisions about or providing for the

person’s essential needs without significant supervision and

assistance from other people,” and, as a result, “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.” § 27-65-102(17), C.R.S. 2024.

¶ 13 The record here supports the district court’s finding that

Melrose’s condition satisfied this definition. Indeed, the evidence

indicates that Melrose lacks insight regarding his schizophrenia

and need for treatment, and that without such treatment, he is at

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risk of significant and long-term deterioration of his schizophrenia.

The evidence also suggests that, without appropriate medication,

Melrose would be “incapable of making informed decisions” about

his “essential needs,” resulting in a risk of “significant psychiatric

deterioration” under section 27-65-102(17).

IV. Involuntary Administration of Medication

¶ 14 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

causing serious harm to themself 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

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treatment. People v. Medina, 705 P.2d 961, 973 (Colo. 1985).1 The

testimony of a physician seeking to administer treatment may itself

be sufficient to satisfy the four elements. People in Interest of

R.K.L., 2016 COA 84, ¶ 30.

¶ 15 Melrose doesn’t 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 on the third element — that is, that a

less intrusive treatment alternative wasn’t available.

¶ 16 This third element “encompasses not only the gravity of any

harmful effects from the proposed treatment but also the existence,

feasibility, and efficacy of alternative methods of treating the

patient’s condition or of alleviating the danger created by that

condition.” Medina, 705 P.2d at 974. An alternative treatment is

1 When the state seeks to administer medication involuntarily to

render a criminal defendant competent to stand trial, courts apply
the United States Supreme Court’s test in Sell v. United States, 539
U.S. 166, 180-81 (2003). But state law tests apply when, as here,
the state seeks to administer medication involuntarily for “a
different purpose,” including a purpose “related to the individual’s
dangerousness, or . . . the individual’s own interests where refusal
to take drugs puts [the individual’s] health gravely at risk.” Id. at
182; see also People in Interest of R.F., 2019 COA 110, ¶ 11 n.1.

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considered to be less intrusive if it has fewer harmful side effects

and is at least as effective at treating the patient’s condition as the

proposed treatment. People in Interest of R.C., 2019 COA 99M, ¶ 9.

¶ 17 The district court didn’t make specific findings as to this

element. Instead, in its oral ruling, the court found only that, “[a]s

noted by the doctor, there is not a less intrusive treatment

alternative that’s available at this time and the doctor is

recommending medication”; and in its written order, it made a

similar ruling that there was no less intrusive treatment alternative

than treating Melrose with antipsychotic medications.

¶ 18 Melrose argues that the district court erred in authorizing the

use of so many medications, and that a less intrusive treatment

alternative would be to require the psychiatrist to specify which

medications he believes should be prescribed.

¶ 19 We construe Melrose’s argument on appeal as challenging the

portion of the district court’s order authorizing five antipsychotic

medications (and not the portion of the order authorizing three

medications to treat any negative side effects). That is because the

testimony of the psychiatrist that Melrose relies on in making the

argument is the following explanation from the psychiatrist for why

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he was requesting five antipsychotic medications: “[I]t’s normal

practice to request several medications. If one medication is not

effective or [causes] side effects, we could switch this medication to

[an]other and it could give us some flexibility and prevent us

[having] to go into the court every time we need to switch [to] a new

medication.” The psychiatrist further testified that it is generally

appropriate to treat a patient with only one antipsychotic

medication at any one time.

¶ 20 Here, the psychiatrist’s testimony that any other antipsychotic

medications beyond Haldol might be necessary — despite that

Haldol had been effective for Melrose in the past — was speculative.

And the record indicates that Melrose had never taken any of those

other antipsychotic medications.

¶ 21 That makes this case like R.K.L. and R.C.

¶ 22 In R.K.L., although the patient had responded well in the past

to Invega and his psychiatrists intended to use only that

medication, they added ten other antipsychotic medications to the

authorization request “to allow them the flexibility to treat [the

patient] effectively in case he stopped responding to Invega or

developed an intolerable allergy or side effect.” R.K.L., ¶ 38. The

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division reversed the district court’s ruling that there was no less

intrusive alternative to ordering those ten medications because, in

contrast to the evidence establishing the efficacy of Invega to treat

the patient’s mental illness, there was no evidence regarding the

efficacy or the side effects of the other ten medications. Id. at

¶¶ 39-40.

¶ 23 Similarly, in R.C., although the patient was responding well to

Zyprexa, the People requested — and the district court issued — an

order authorizing the involuntary administration of five other

medications in addition to Zyprexa. R.C., ¶¶ 3-5, 10. The patient’s

psychiatrist testified that although the patient was being treated

effectively with Zyprexa, he was “not sure if that would be the case

over . . . time.” Id. at ¶ 10. The division reversed, concluding that

the evidence showed that the least intrusive option was ordering

only Zyprexa because the mere possibility that the patient might

need any of the other five medications at some unspecified time in

the future didn’t warrant including those medications in the order.

Id. at ¶¶ 12-16.

¶ 24 We are persuaded by these decisions and are unpersuaded by

the People’s reliance on People in Interest of Uwayezuk, 2023 COA

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69. That case involved a patient’s “first break” of schizophrenia

where there was no prescribing history of any antipsychotic

medications and so the psychiatrist didn’t know which of the

requested antipsychotic medications would be effective. Id. at ¶ 61.

Further, the division there was not presented with the issue of

whether ordering all six medications constituted the least intrusive

treatment option. See id. at ¶ 58. Instead, the patient challenged

only the fourth Medina element, arguing — without differentiating

between any of the medications — that his need for them was not

sufficiently compelling to override his bona fide interest in avoiding

the risks of negative side effects. See id. at ¶¶ 60-63. Thus, the

division’s analysis was limited to comparing the patient’s need for

treatment balanced against his interest in refusing medication,

without differentiating between any of the medications. See id.

¶ 25 For these reasons, we conclude that the district court erred in

ordering the involuntary administration of the other antipsychotic

medications beyond Haldol.

V. Disposition

¶ 26 The order is affirmed in part and reversed in part. The portion

of the order certifying Melrose for short-term treatment and

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authorizing the involuntary administration of Haldol (haloperidol),

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

(lorazepam) is affirmed. The portion of the order authorizing the

involuntary administration of Prolixin (fluphenazine), Zyprexa

(olanzapine), Abilify (aripiprazole), and Invega (paliperidone) is

reversed, and the case is remanded for the district court to amend

the order by removing those medications from it.

JUDGE DUNN and JUDGE NAVARRO concur.

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