24CA1082 Peo in Interest of Hayes 09-19-2024
COLORADO COURT OF APPEALS
Court of Appeals No. 24CA1082 Pueblo County District Court No. 24MH30033 Honorable Timothy O’Shea, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Armound De Shaun Hayes,
Defendant-Appellant.
ORDER AFFIRMED
Division II Opinion by JUDGE JOHNSON Fox and Schock, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced September 19, 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 Defendant-Appellant ¶1 Respondent, Armound De Shaun Hayes (Hayes), appeals the
district court’s order authorizing the involuntary administration of
medication to him. We affirm.
I. Background
¶2 Hayes was committed to the Colorado Mental Health Hospital
in Pueblo (CMHHIP) for restoration to competency in a criminal
case. He was diagnosed with unspecified mood disorder and
presented with symptoms including agitation, irritability,
impulsivity, and physically aggressive behavior.
¶3 When Hayes was admitted to CMHHIP, he voluntarily agreed
to take Depakote (Depakene/Valproic Acid) but refused to take
Zyprexa (Olanzapine). Two days later, he assaulted two staff
members and was administered emergency medications to stabilize
him.
¶4 The State filed a petition for a court order authorizing the
involuntary administration of medication to Hayes. The district
court held a hearing, at which Hayes and Dr. Mattox, a psychiatrist
at CMHHIP and a supervisor of Hayes’s psychiatric provider,
testified. Dr. Mattox was qualified as an expert in the field of
1 clinical psychiatry. At the conclusion of that hearing, the court
found that Dr. Mattox had “testified credibly and persuasively,” and
it concluded that the State 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 Zyprexa (Olanzapine)
and Depakote (Depakene/Valproic Acid), “as scheduled
medications” in the dosages requested by Dr. Mattox, as well as
Chlorpromazine (Thorazine), Hydroxyzine (Vistaril), and Ativan
(Lorazepam) “as needed for severe levels of agitation and
aggression,” and the lab work necessary to monitor the
administration of these medications.
II. Standard of Review
¶5 An involuntarily committed individual retains the right to
refuse medical treatment, including the administration of
antipsychotic medications. Medina, 705 P.2d at 973. Under
Medina, a court may order that such a person be medicated over
his objection only when (1) the person is not competent to
participate in the treatment decision; (2) treatment by antipsychotic
medication is necessary to prevent significant and likely long-term
2 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) no less intrusive treatment option is available;
and (4) the person’s need for treatment with antipsychotic
medication is sufficiently compelling to outweigh his bona fide and
legitimate interest in refusing the medication. Id. The State bears
the burden of proving each of the Medina factors by clear and
convincing evidence. Id.1 A psychiatrist’s testimony may suffice to
meet this burden. People v. Pflugbeil, 834 P.2d 843, 847 (Colo. App.
1992).
¶6 When challenging the sufficiency of the evidence, we review
the record de novo, viewing the evidence in the light most favorable
to the State, as the prevailing party. See Clark v. People, 232 P.3d
1287, 1291 (Colo. 2010); People v. Fuentes, 258 P.3d 320, 326
1 When the State seeks to administer antipsychotic drugs to a
mentally ill criminal defendant involuntarily so that the individual can stand trial, a reviewing court applies the Supreme Court’s test in Sell v. United States, 539 U.S. 166, 178 (2003). But reviewing courts apply state law tests if the state, as here, seeks to administer antipsychotics 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 his health gravely at risk.” Id. at 181-82. 3 (Colo. App. 2011). As the fact finder, the district court “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.” People in Interest
of R.C., 2019 COA 99M, ¶ 7 (quoting People in Interest of
S.M.A.M.A., 172 P.3d 958, 962 (Colo. App. 2007)). Where there is
“ample evidence in the record to support the trial court’s findings
and conclusion[s], based on clear and convincing evidence,” we may
not “substitute[] [our] judgment for that of the trial court.” People in
Interest of A.J.L., 243 P.3d 244, 255 (Colo. 2010).
III. Analysis
¶7 Hayes contends that the evidence was insufficient to prove the
first Medina factor: that he is incompetent to effectively participate
in the treatment decision. We are not persuaded.
¶8 The record supports the district court’s finding that Hayes was
incompetent to effectively participate in his treatment decisions.
Dr. Mattox testified that Hayes has no insight into his mental
illness. This opinion was based on Dr. Mattox’s experience with the
patient during this and two prior visits to CMHHIP. Dr. Mattox
4 further testified that Hayes is incompetent to effectively participate
in decisions affecting his health, including the decision as to
whether psychiatric medications are needed, because Hayes “does
not believe he has a mental illness” and does not believe that he
“need[s] treatment with psychiatric medications.” And Dr. Mattox
testified that when he discussed with Hayes the possibility of taking
the requested medications voluntarily, Hayes refused.
¶9 We are not persuaded otherwise by the assertion that Hayes is
competent to effectively participate in the treatment decision
because he “did not deny that he had any mental illness” and
“stated a willingness to take both Depakote and Zyprexa, the two
primary medications” requested by Dr. Mattox. Nothing in Hayes’s
testimony evidences a belief that he has a mental illness. Indeed,
when Hayes was asked if he believed that he had a mental illness,
he responded only, “They diagnosed me with ADHD, anxiety, and
depression.” And while Hayes did testify, somewhat conflictingly,
that he was agreeable to taking Depakote and Zyprexa, he also
testified that he would not willingly take the other requested
medications. Iin response to Hayes’s testimony, Dr. Mattox opined,
5 “I don’t believe his consent [to taking Depakote and Zyprexa] would
be maintained.” Dr. Mattox explained, “[Hayes] has refused those
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24CA1082 Peo in Interest of Hayes 09-19-2024
COLORADO COURT OF APPEALS
Court of Appeals No. 24CA1082 Pueblo County District Court No. 24MH30033 Honorable Timothy O’Shea, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Armound De Shaun Hayes,
Defendant-Appellant.
ORDER AFFIRMED
Division II Opinion by JUDGE JOHNSON Fox and Schock, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced September 19, 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 Defendant-Appellant ¶1 Respondent, Armound De Shaun Hayes (Hayes), appeals the
district court’s order authorizing the involuntary administration of
medication to him. We affirm.
I. Background
¶2 Hayes was committed to the Colorado Mental Health Hospital
in Pueblo (CMHHIP) for restoration to competency in a criminal
case. He was diagnosed with unspecified mood disorder and
presented with symptoms including agitation, irritability,
impulsivity, and physically aggressive behavior.
¶3 When Hayes was admitted to CMHHIP, he voluntarily agreed
to take Depakote (Depakene/Valproic Acid) but refused to take
Zyprexa (Olanzapine). Two days later, he assaulted two staff
members and was administered emergency medications to stabilize
him.
¶4 The State filed a petition for a court order authorizing the
involuntary administration of medication to Hayes. The district
court held a hearing, at which Hayes and Dr. Mattox, a psychiatrist
at CMHHIP and a supervisor of Hayes’s psychiatric provider,
testified. Dr. Mattox was qualified as an expert in the field of
1 clinical psychiatry. At the conclusion of that hearing, the court
found that Dr. Mattox had “testified credibly and persuasively,” and
it concluded that the State 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 Zyprexa (Olanzapine)
and Depakote (Depakene/Valproic Acid), “as scheduled
medications” in the dosages requested by Dr. Mattox, as well as
Chlorpromazine (Thorazine), Hydroxyzine (Vistaril), and Ativan
(Lorazepam) “as needed for severe levels of agitation and
aggression,” and the lab work necessary to monitor the
administration of these medications.
II. Standard of Review
¶5 An involuntarily committed individual retains the right to
refuse medical treatment, including the administration of
antipsychotic medications. Medina, 705 P.2d at 973. Under
Medina, a court may order that such a person be medicated over
his objection only when (1) the person is not competent to
participate in the treatment decision; (2) treatment by antipsychotic
medication is necessary to prevent significant and likely long-term
2 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) no less intrusive treatment option is available;
and (4) the person’s need for treatment with antipsychotic
medication is sufficiently compelling to outweigh his bona fide and
legitimate interest in refusing the medication. Id. The State bears
the burden of proving each of the Medina factors by clear and
convincing evidence. Id.1 A psychiatrist’s testimony may suffice to
meet this burden. People v. Pflugbeil, 834 P.2d 843, 847 (Colo. App.
1992).
¶6 When challenging the sufficiency of the evidence, we review
the record de novo, viewing the evidence in the light most favorable
to the State, as the prevailing party. See Clark v. People, 232 P.3d
1287, 1291 (Colo. 2010); People v. Fuentes, 258 P.3d 320, 326
1 When the State seeks to administer antipsychotic drugs to a
mentally ill criminal defendant involuntarily so that the individual can stand trial, a reviewing court applies the Supreme Court’s test in Sell v. United States, 539 U.S. 166, 178 (2003). But reviewing courts apply state law tests if the state, as here, seeks to administer antipsychotics 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 his health gravely at risk.” Id. at 181-82. 3 (Colo. App. 2011). As the fact finder, the district court “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.” People in Interest
of R.C., 2019 COA 99M, ¶ 7 (quoting People in Interest of
S.M.A.M.A., 172 P.3d 958, 962 (Colo. App. 2007)). Where there is
“ample evidence in the record to support the trial court’s findings
and conclusion[s], based on clear and convincing evidence,” we may
not “substitute[] [our] judgment for that of the trial court.” People in
Interest of A.J.L., 243 P.3d 244, 255 (Colo. 2010).
III. Analysis
¶7 Hayes contends that the evidence was insufficient to prove the
first Medina factor: that he is incompetent to effectively participate
in the treatment decision. We are not persuaded.
¶8 The record supports the district court’s finding that Hayes was
incompetent to effectively participate in his treatment decisions.
Dr. Mattox testified that Hayes has no insight into his mental
illness. This opinion was based on Dr. Mattox’s experience with the
patient during this and two prior visits to CMHHIP. Dr. Mattox
4 further testified that Hayes is incompetent to effectively participate
in decisions affecting his health, including the decision as to
whether psychiatric medications are needed, because Hayes “does
not believe he has a mental illness” and does not believe that he
“need[s] treatment with psychiatric medications.” And Dr. Mattox
testified that when he discussed with Hayes the possibility of taking
the requested medications voluntarily, Hayes refused.
¶9 We are not persuaded otherwise by the assertion that Hayes is
competent to effectively participate in the treatment decision
because he “did not deny that he had any mental illness” and
“stated a willingness to take both Depakote and Zyprexa, the two
primary medications” requested by Dr. Mattox. Nothing in Hayes’s
testimony evidences a belief that he has a mental illness. Indeed,
when Hayes was asked if he believed that he had a mental illness,
he responded only, “They diagnosed me with ADHD, anxiety, and
depression.” And while Hayes did testify, somewhat conflictingly,
that he was agreeable to taking Depakote and Zyprexa, he also
testified that he would not willingly take the other requested
medications. Iin response to Hayes’s testimony, Dr. Mattox opined,
5 “I don’t believe his consent [to taking Depakote and Zyprexa] would
be maintained.” Dr. Mattox explained, “[Hayes] has refused those
medications in the past,” and when Dr. Mattox spoke to him in the
past about voluntarily taking these medications, “similar to . . . his
testimony today, he gave very inconsistent answers saying first that
he would prefer to take the Valproic Acid [Depakote] and not the
Zyprexa and then stating he would prefer to take the Zyprexa and
not the Valproic Acid [Depakote].” Weighing this conflicting
evidence, the court credited Dr. Mattox’s testimony, finding it both
credible and persuasive, and found Hayes’s testimony on this point
to be incredible. We are bound by those findings. See People in
Interest of Strodtman, 293 P.3d 123, 132 (Colo. App. 2011); People
in Interest of Ramsey, 2023 COA 95, ¶ 30.
¶ 10 We likewise reject Hayes’s assertion that his ability to testify
about his symptoms, side effects, and past experiences with
medication demonstrate that he is competent to effectively
participate in the treatment decisions. The first Medina factor does
not ask simply whether a patient has the ability to “articulate his or
her preferences” in regard to treatment. Strodtman, 293 P.3d at
6 132. It asks whether the patient is competent to effectively
participate in the treatment decision. Medina, 705 P.2d at 973. “To
participate effectively contemplates action in addition to words.”
Strodtman, 293 P.3d at 132. And for the reasons above, Dr.
Mattox’s testimony is sufficient to support the district court’s
finding that Hayes was not competent to effectively participate in
the treatment decision.
¶ 11 And to the extent Hayes asserts that the district court’s
statement, “it just comes down to a disagreement over which . . .
class of medications to take” evidences an error in the court’s
judgment concerning Hayes’s competence to effectively participate
in the treatment decision, we disagree. This statement was in
reference to the court’s finding that Hayes’s refusal to take the
requested medications was not bona fide and legitimate — a Medina
factor Hayes does not contest on appeal.
¶ 12 Because Hayes does not challenge the district court’s findings
concerning the other Medina factors, we conclude the evidence was
sufficient to support the involuntary medication order.
7 IV. Conclusion
¶ 13 The order is affirmed.
JUDGE FOX and JUDGE SCHOCK concur.