The summaries of the Colorado Court of Appeals published opinions constitute no part of the opinion of the division but have been prepared by the division for the convenience of the reader. The summaries may not be cited or relied upon as they are not the official language of the division. Any discrepancy between the language in the summary and in the opinion should be resolved in favor of the language in the opinion.
SUMMARY June 27, 2019
2019COA99
No. 19CA0647, People in Interest of R.C. — Health and Welfare — Care and Treatment of Persons with Mental Health Disorders — Involuntary Administration of Medication
This is the first reported Colorado decision that addresses a
situation where the People seek the involuntary administration of
medications that the treating physician believes may need to be
given at a later date, if the patient’s current medication stops being
efficacious, but that do not currently need to be administered.
Nonetheless, the lower court granted the physician immediate
authorization to administer the additional medications. In addition,
the People did not seek an order for the involuntary administration
of the patient’s current medication, despite the psychiatrist’s
concern that the patient may stop taking it voluntarily. A division
of the court of appeals concludes that the People did not carry their burden under People v. Medina, 705 P.2d 961 (Colo. 1985), to prove
that the involuntary administration of the additional medications
was the less intrusive alternative. COLORADO COURT OF APPEALS 2019COA99
Court of Appeals No. 19CA0647 Pueblo County District Court No. 19MH81 Honorable Jill S. Mattoon, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of R.C.,
Respondent-Appellant.
ORDER REVERSED
Division IV Opinion by JUDGE LIPINSKY Román and J. Jones, JJ., concur
Announced June 27, 2019
Cynthia Mitchell, County Attorney, Kate H. Shafer, Special Assistant County Attorney, Pueblo, Colorado, for Petitioner-Appellee
The Law Firm of John L. Rice, John L. Rice, Pueblo, Colorado, for Respondent- Appellant ¶1 Appellant, R.C., appeals the district court’s order authorizing
mental health personnel to medicate him involuntarily. We reverse.
I. Background
¶2 R.C. was committed to the Colorado Mental Health Institute at
Pueblo (CMHIP) after being found incompetent to proceed in a
criminal case. A CMHIP staff psychiatrist, Dr. Lennart Abel,
diagnosed R.C. with bipolar disorder mania with psychosis.
¶3 Following R.C.’s assault of a staff member at CMHIP, the
People filed a petition seeking a court order authorizing the
administration of involuntary medication. At a hearing on the
petition, Dr. Abel testified that R.C. was voluntarily taking Zyprexa.
Dr. Abel opined that R.C. would not continue to take this drug
voluntarily because he had previously refused to take medication.
¶4 The People did not seek an order allowing R.C. to be
involuntarily medicated with Zyprexa, however. Rather, the People
sought authorization to medicate R.C. involuntarily with six other
drugs: Olanzapine, Haldol, Abilify, Lithium, Depakote, and
Clozapine (the Six Medications). Dr. Abel testified that R.C. “can be
treated with Zyprexa but I’m not sure if that would be the case over
the time. Therefore, I have the other medications on the petition.”
1 ¶5 The district court granted the People’s petition and entered an
order authorizing the involuntary administration of the Six
Medications, effective immediately. On appeal, R.C. contends that
insufficient evidence supported the order. We agree and, therefore,
reverse.
II. Involuntary Administration of Medication
¶6 An order for involuntary administration of medications must
be supported by clear and convincing evidence
(1) that the patient is incompetent to effectively participate in the treatment decision; (2) that 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) that a less intrusive treatment alternative is not available; and (4) that 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.
People v. Medina, 705 P.2d 961, 973 (Colo. 1985). The People bear
the burden to prove each element. People in Interest of Strodtman,
293 P.3d 123, 131 (Colo. App. 2011).
2 ¶7 “Applying the Medina test involves mixed questions of law and
fact.” People v. Marquardt, 2016 CO 4, ¶ 8, 364 P.3d 499, 502. We
defer to the district court’s factual findings if they are supported by
the record and review its legal conclusions de novo. Id. The district
court, as fact finder, “has discretion to determine the credibility of
the witnesses; the sufficiency, probative effect, and weight of the
evidence; and the inferences and conclusions to be drawn from it.
If supported by the record, a trial court’s findings and conclusions
. . . will not be disturbed on review.” People in Interest of
S.M.A.M.A., 172 P.3d 958, 962 (Colo. App. 2007); accord People in
Interest of C.A.K., 652 P.2d 603, 613 (Colo. 1982).
¶8 R.C. contests only the third element of the Medina test,
asserting that the district court erred in finding that no less
intrusive treatment alternative was available. He argues that his
voluntarily taking Zyprexa at the time of the hearing clearly showed
that a less intrusive treatment option was available. We conclude
that the record does not support the district court’s finding that the
People met their burden on this element of Medina.
¶9 A treatment is less intrusive when it has fewer harmful side
effects and is at least as effective at treating a patient’s condition as
3 the proposed treatment. Strodtman, 293 P.3d at 133 (citing Medina,
705 P.2d at 974). This 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.
¶ 10 Dr. Abel testified that R.C. had been taking Zyprexa
voluntarily for ten days before the hearing. Dr. Abel agreed that
R.C.’s behavior had improved since he began taking Zyprexa,
testifying that R.C. is “not as manic as he was before.” He also
stated that, even if the court authorized the administration of the
Six Medications, he would “keep [R.C.] on Zyprexa” because, “for
the time being, [R.C.] can be treated with Zyprexa.” He was,
however, “not sure if that would be the case over . . . time.”
¶ 11 Thus, Dr. Abel did not testify that R.C. needed to receive the
Six Medications at the time of the hearing and, moreover, did not
state unconditionally that R.C. would need to take the Six
Medications in the future.
Free access — add to your briefcase to read the full text and ask questions with AI
The summaries of the Colorado Court of Appeals published opinions constitute no part of the opinion of the division but have been prepared by the division for the convenience of the reader. The summaries may not be cited or relied upon as they are not the official language of the division. Any discrepancy between the language in the summary and in the opinion should be resolved in favor of the language in the opinion.
SUMMARY June 27, 2019
2019COA99
No. 19CA0647, People in Interest of R.C. — Health and Welfare — Care and Treatment of Persons with Mental Health Disorders — Involuntary Administration of Medication
This is the first reported Colorado decision that addresses a
situation where the People seek the involuntary administration of
medications that the treating physician believes may need to be
given at a later date, if the patient’s current medication stops being
efficacious, but that do not currently need to be administered.
Nonetheless, the lower court granted the physician immediate
authorization to administer the additional medications. In addition,
the People did not seek an order for the involuntary administration
of the patient’s current medication, despite the psychiatrist’s
concern that the patient may stop taking it voluntarily. A division
of the court of appeals concludes that the People did not carry their burden under People v. Medina, 705 P.2d 961 (Colo. 1985), to prove
that the involuntary administration of the additional medications
was the less intrusive alternative. COLORADO COURT OF APPEALS 2019COA99
Court of Appeals No. 19CA0647 Pueblo County District Court No. 19MH81 Honorable Jill S. Mattoon, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of R.C.,
Respondent-Appellant.
ORDER REVERSED
Division IV Opinion by JUDGE LIPINSKY Román and J. Jones, JJ., concur
Announced June 27, 2019
Cynthia Mitchell, County Attorney, Kate H. Shafer, Special Assistant County Attorney, Pueblo, Colorado, for Petitioner-Appellee
The Law Firm of John L. Rice, John L. Rice, Pueblo, Colorado, for Respondent- Appellant ¶1 Appellant, R.C., appeals the district court’s order authorizing
mental health personnel to medicate him involuntarily. We reverse.
I. Background
¶2 R.C. was committed to the Colorado Mental Health Institute at
Pueblo (CMHIP) after being found incompetent to proceed in a
criminal case. A CMHIP staff psychiatrist, Dr. Lennart Abel,
diagnosed R.C. with bipolar disorder mania with psychosis.
¶3 Following R.C.’s assault of a staff member at CMHIP, the
People filed a petition seeking a court order authorizing the
administration of involuntary medication. At a hearing on the
petition, Dr. Abel testified that R.C. was voluntarily taking Zyprexa.
Dr. Abel opined that R.C. would not continue to take this drug
voluntarily because he had previously refused to take medication.
¶4 The People did not seek an order allowing R.C. to be
involuntarily medicated with Zyprexa, however. Rather, the People
sought authorization to medicate R.C. involuntarily with six other
drugs: Olanzapine, Haldol, Abilify, Lithium, Depakote, and
Clozapine (the Six Medications). Dr. Abel testified that R.C. “can be
treated with Zyprexa but I’m not sure if that would be the case over
the time. Therefore, I have the other medications on the petition.”
1 ¶5 The district court granted the People’s petition and entered an
order authorizing the involuntary administration of the Six
Medications, effective immediately. On appeal, R.C. contends that
insufficient evidence supported the order. We agree and, therefore,
reverse.
II. Involuntary Administration of Medication
¶6 An order for involuntary administration of medications must
be supported by clear and convincing evidence
(1) that the patient is incompetent to effectively participate in the treatment decision; (2) that 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) that a less intrusive treatment alternative is not available; and (4) that 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.
People v. Medina, 705 P.2d 961, 973 (Colo. 1985). The People bear
the burden to prove each element. People in Interest of Strodtman,
293 P.3d 123, 131 (Colo. App. 2011).
2 ¶7 “Applying the Medina test involves mixed questions of law and
fact.” People v. Marquardt, 2016 CO 4, ¶ 8, 364 P.3d 499, 502. We
defer to the district court’s factual findings if they are supported by
the record and review its legal conclusions de novo. Id. The district
court, as fact finder, “has discretion to determine the credibility of
the witnesses; the sufficiency, probative effect, and weight of the
evidence; and the inferences and conclusions to be drawn from it.
If supported by the record, a trial court’s findings and conclusions
. . . will not be disturbed on review.” People in Interest of
S.M.A.M.A., 172 P.3d 958, 962 (Colo. App. 2007); accord People in
Interest of C.A.K., 652 P.2d 603, 613 (Colo. 1982).
¶8 R.C. contests only the third element of the Medina test,
asserting that the district court erred in finding that no less
intrusive treatment alternative was available. He argues that his
voluntarily taking Zyprexa at the time of the hearing clearly showed
that a less intrusive treatment option was available. We conclude
that the record does not support the district court’s finding that the
People met their burden on this element of Medina.
¶9 A treatment is less intrusive when it has fewer harmful side
effects and is at least as effective at treating a patient’s condition as
3 the proposed treatment. Strodtman, 293 P.3d at 133 (citing Medina,
705 P.2d at 974). This 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.
¶ 10 Dr. Abel testified that R.C. had been taking Zyprexa
voluntarily for ten days before the hearing. Dr. Abel agreed that
R.C.’s behavior had improved since he began taking Zyprexa,
testifying that R.C. is “not as manic as he was before.” He also
stated that, even if the court authorized the administration of the
Six Medications, he would “keep [R.C.] on Zyprexa” because, “for
the time being, [R.C.] can be treated with Zyprexa.” He was,
however, “not sure if that would be the case over . . . time.”
¶ 11 Thus, Dr. Abel did not testify that R.C. needed to receive the
Six Medications at the time of the hearing and, moreover, did not
state unconditionally that R.C. would need to take the Six
Medications in the future.
¶ 12 Based on this record, we agree with R.C. that insufficient
evidence supports the district court’s finding that no less intrusive
4 treatment alterative than Zyprexa is available. To the contrary, Dr.
Abel’s testimony establishes that continued administration of
Zyprexa is a less intrusive treatment alternative than
administration of the Six Medications.
¶ 13 Not only does this conclusion follow logically from Dr. Abel’s
testimony, but it finds support in People in Interest of R.K.L., 2016
COA 84, 412 P.3d 827. In R.K.L., a division of this court concluded
that “mere speculation” that a patient “might need [the specified]
medications in the future” was insufficient to establish that his
psychiatrists were currently unable to provide effective treatment.
Id. at ¶ 44, 412 P.3d at 837. This was especially true because the
psychiatrists were successfully treating the patient with only one of
the medications listed in their petition. Id.
¶ 14 While the R.K.L. division reached that conclusion in the
context of the fourth Medina factor, we consider this reasoning
relevant to our analysis of the third factor. The possibility that
Zyprexa may no longer be an effective treatment for R.C., at some
unspecified time in the future, is insufficient to justify the entry of
an order authorizing the immediate administration of the Six
Medications. See id. Moreover, the trial court’s order authorizing
5 the immediate involuntary administration of the Six Medications
cannot be squared with Dr. Abel’s testimony that R.C. does not
need the Six Medications now and may never need them.
¶ 15 Further, Dr. Abel did not testify that the Six Medications
would be more effective in treating R.C. than is Zyprexa. Dr. Abel’s
general concern that R.C. had previously refused to take prescribed
medications does not address why the People needed an order for
the involuntary administration of the Six Medications while R.C.
was voluntarily taking Zyprexa.
¶ 16 For these reasons, we conclude that the People did not carry
their burden of proving the lack of a less intrusive alternative than
administration of the Six Medications. See Medina, 705 P.2d at
973. The record evidence establishes that the continued
administration of Zyprexa is a less intrusive treatment alternative
than administering the Six Medications. We also therefore conclude
that the record does not support the district court’s determination
of the third Medina factor. See R.K.L., ¶ 44, 412 P.3d at 837.
III. Conclusion
¶ 17 The order is reversed.
JUDGE ROMÁN and JUDGE J. JONES concur.