Peo in Interest of Walsh

• Court: Colorado Court of Appeals
• Decided: February 6, 2025
• Docket: 24CA2074
• Status: Unpublished

Opinion

24CA2074 Peo in Interest of Walsh 02-06-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA2074 City and County of Broomfield District Court No. 24MH55 Honorable Mark D. Warner, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Christine Walsh,

Respondent-Appellant.

ORDER AFFIRMED

Division VI Opinion by JUDGE SCHUTZ Welling and Kuhn, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced February 6, 2025

Nancy D. Rodgers, City & County Attorney, Courtney Thiemann, Senior Assistant City & County Attorney, Broomfield, Colorado, for Petitioner-Appellee

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

(1) her certification for short-term mental health treatment and

(2) the involuntarily administration of medication. We affirm.

I. Background

¶2 In November 2024, passersby observed that Walsh had been

standing in the same outdoor location for several hours. One of

them sought a welfare check, and local law enforcement responded.

Walsh indicated that she was waiting for her husband, Frank; in

fact, she is not known to be married, but her outpatient psychiatrist

is named Frank. Concerned that Walsh was mentally unwell, the

responders took her to the hospital emergency department where

emergency room physicians surmised that she had developed a

psychosis due to her “disengagement from outpatient mental

healthcare and nonadherence to pharmacotherapy.” Walsh

presented in a catatonic state — she was mute, rigid, and prone to

staring.

¶3 Walsh was involuntarily admitted to AdventHealth Porter

Hospital (Porter) for psychiatric care. According to her treating

psychiatrist, Dr. Shujah Choudhry, Walsh appeared to have

developed “some system of psychosis” and has a “psychiatric

1 history notable for bipolar disorder (type 1).” When her treatment

team attempted to explore her mental health condition and history

with her and discuss treatment, Walsh was unwilling to engage on

the topic, instead “claim[ing] to be a citizen of France, Ireland[,] and

Saudi Arabia,” and saying “that the government has retained sole

[authority] over her medical decision making, hence why she is

incapable of adhering to treatment within [the] hospital.”

¶4 Pursuant to section 27-65-109, C.R.S. 2024, Dr. Choudhry

certified Walsh for short-term mental health treatment. He also

wanted authorization to involuntarily administer Walsh four

medications — namely, haloperidol (Haldol); paliperidone (Invega);

lorazepam (Ativan); and lithium. The City and County of Broomfield

Attorney filed a motion seeking such an order.

¶5 After a hearing, the district court entered an order confirming

the short-term certification for treatment and granting the

involuntary administration of three of the four requested

medications. The court found, by clear and convincing evidence,

that the requirements for short-term certification had been

established. Likewise, the court ordered the involuntary

administration of Haldol, Invega, and lithium, but not Ativan.

2 II. Legal Principles and Standard of Review

¶6 To authorize short-term certification for mental health

treatment, a court must find that the patient has a mental health

disorder and, as a result, is gravely disabled or a danger to herself

or others. People in Interest of Ramsey, 2023 COA 95, ¶ 25;

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

¶7 A court may authorize the involuntary administration of

medication to a patient if the petitioning party establishes each of

the elements set forth in People v. Medina, 705 P.2d 961 (Colo.

1985): (1) the patient 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 herself 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.

at 973.

¶8 Both an order of short-term certification and an order

authorizing the involuntary administration of medications must be

3 supported by clear and convincing evidence. Ramsey, ¶ 39;

Medina, 705 P.2d at 971. Clear and convincing evidence is

“evidence that is highly probable and free from serious or

substantial doubt.” Destination Maternity v. Burren, 2020 CO 41,

¶ 10 (citation omitted).

¶9 In performing our review, we determine whether the evidence,

viewed as a whole and in the light most favorable to the petitioning

party, is sufficient to support the court’s order. People in Interest of

R.K.L., 2016 COA 84, ¶ 13. We defer to the court’s factual findings

if there is evidence supporting them, but we review the court’s legal

conclusions de novo. People in Interest of Strodtman, 293 P.3d 123,

131 (Colo. App. 2011).

¶ 10 Discussion

¶ 11 As to the short-term certification order, Walsh asserts that

insufficient evidence supports a conclusion that she is either

gravely disabled or a danger to herself or others. And as to the

involuntary administration of medications, she does not contest the

third and fourth Medina elements but asserts that insufficient

evidence supports the first and second. We discern no error.

4 A. Gravely Disabled

¶ 12 “Gravely disabled” means that, due to a mental health

disorder, a person is incapable of making informed decisions about

or providing for her essential needs without significant supervision

and assistance from other people. § 27-65-102(17), C.R.S. 2024.

As a result, such a person “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.” Id.

¶ 13 A person is “gravely disabled” if she is “unable to take care of

basic personal needs.” People v. Taylor, 618 P.2d 1127, 1134 (Colo.

1980). Basic personal needs means “those fundamental necessities

of human existence, such as food, shelter, clothing, and medical

care, which an individual must obtain and maintain in order to live

safely.” Id.

¶ 14 At the hearing, Dr. Choudhry offered his expert opinion that

Walsh is gravely disabled as a result of her mental illness. He noted

that, while in the emergency department, Walsh was catatonic,

mute, rigid, and prone to staring, and was either unable or

5 unwilling to communicate with treatment providers, instead

indicating that her information was “confidential.” She

“demonstrated an inability to care for herself” and “had an episode

of urinary incontinence where she wet herself” and “was physically

incapable” of “ventur[ing] to a bathroom” or “clean[ing] up after

her[self].” Similarly, Dr. Choudhry testified, “during her

hospitalization at Porter, as well as during her time in the

emergency room, she demonstrated an inability” to adequately

nourish or hydrate herself, which can lead to physical instability

and enhanced heart rate and blood pressure. And when Walsh’s

treatment team attempted to discuss her condition with her, she

claimed to be a citizen of other countries, which controlled her

medical decision-making, and refused to provide her mental health

and related medical history

¶ 15 This testimony supports the district court’s finding that Walsh

is gravely disabled.

¶ 16 Nonetheless, Walsh asserts, Dr. Choudhry testified that (1) he

had not observed any other behaviors that demonstrated she was

unable to care for herself and (2) “she has been caring for herself to

a larger degree th[a]n she had in the [emergency department].” But

6 the definition of “gravely disabled” does not require any threshold

number of behaviors indicative of an inability to care for oneself.

Nor do incremental improvements in one’s abilities to do so mean

that a person is not gravely disabled. Rather, a finding that a

person is gravely disabled requires only that a person is “unable to

take care of basic personal needs.” Id. And Dr. Choudhry testified

that, during Walsh’s (at the time) six-day hospitalization, “her

nutrition and her hydration [were at times] sparse to a point where

[he would] ask staff to try and log and keep records as to how much

nourishment she [wa]s getting” and monitor her vital signs.

However, Walsh “refused to allow staff to get those tests for reasons

that she [would] not elaborate on.” Likewise, she refused to provide

her mental health history1 or permit the treatment team to

communicate with her outpatient provider and loved ones to assist

in coordinating her care.

1 In her reply brief, Walsh argues that the refusal to provide her

mental health history is of no consequence because she did not have the burden to prove she was gravely disabled. This observation misses the mark. Walsh’s failure to provide this information is relevant because it interfered with the ability of her providers to fully address her existing conditions, including her inability to take care of her basic human needs.

7 ¶ 17 Under these circumstances, and notwithstanding the district

court’s observation that “the evidence was somewhat equivocal with

respect to” grave disability, we cannot conclude that the evidence

was insufficient to support the court’s finding that Walsh is gravely

disabled. And because the statute requires a showing of grave

disability or dangerousness, § 27-65-109(1)(a), we need not reach

the issue of Walsh’s dangerousness to herself or others. See

Lombard v. Colo. Outdoor Educ. Ctr., Inc., 187 P.3d 565, 571 (Colo.

2008) (“Generally, we presume the disjunctive use of the word ‘or’

marks distinctive categories.”).

B. The First Medina Element: Incompetency to Participate in Treatment Decision

¶ 18 To lawfully administer medication on an involuntary basis, the

petitioner must show “the patient’s incompetency to make

treatment decisions.” Medina, 705 P.2d at 973. A court may not

order the forced medication of an involuntarily committed patient

unless it is satisfied that the patient’s mental illness has so

impaired her judgment as to render her “incapable of participating

in decisions affecting [her] health.” Id. (citation omitted).

8 ¶ 19 At the hearing, the district court did not make an express

determination that Walsh was incompetent to effectively participate

in the treatment decisions. Instead, after indicating that it was

turning to the subject of forced administration of medications, the

court stated that it was required to find that Walsh was “incapable

of making informed decisions about providing for that person’s

essential needs without significant supervision and assistance from

other people.” Although it bears on the question of Walsh’s ability

to participate in decisions affecting her treatment, this is not,

strictly speaking, the test for a finding of incompetency under

Medina. Rather, the court’s articulation of the legal standard more

accurately tracks the inquiry into whether the patient is gravely

disabled such that short-term certification is warranted.

¶ 20 Nonetheless, the court’s written order appropriately articulates

— and the evidence is sufficient to establish — the first Medina

element. True, Walsh testified that she is “competent to effectively

participate in the decisions regarding medications” because she

“know[s] [her] own body, [her] own strength, and [her] own mind.”

But she also testified that (1) she shares a “medical power of

attorney” with three lawyers; (2) she has physicians in Ireland

9 whose treatment “supersede[s]” the care she might receive in the

United States; and (3) all of her health information is “protected and

confidential” because she is a “confidential citizen.”

¶ 21 Dr. Choudhry testified that, when he has attempted to discuss

Walsh’s mental health condition and the importance of treatment

with her, she is “unwilling to explore [the topics]” with her

treatment team, is “mute and refuses to converse,” “segue[s] the

conversation away” from discussion of her mental health, and says

that such information is “confidential” or that she is a “protected

individual” and thus “cannot disclose” information. And as noted,

when Dr. Choudhry has further attempted to engage her, “she

claims to be a citizen of France, Ireland and Saudi Arabia, and tells

[him] that the government has retained sole [authority] over her

medical decision making, hence why she is incapable of adhering to

treatment within [the] hospital.” Moreover, Walsh denies having

ever been diagnosed with a mental illness or previously hospitalized

for mental health treatment, which her medical records refute.

Thus, in Dr. Choudhry’s opinion, her refusal of treatment and

treatment discussions is not “reality based” and is “wholly illogical.”

10 ¶ 22 Notwithstanding conflicts in the evidence, this record is

sufficient to show that Walsh lacks insight into her mental health

condition, does not or cannot acknowledge its severity, and

equivocates on her own authorization to make decisions regarding

her care. Thus, we conclude the record evidence satisfies the first

Medina element.

C. The Second Medina Element: Deterioration

¶ 23 The district court also concluded that the second Medina

element was satisfied — namely, that the requested medications are

necessary to prevent a significant and likely long-term deterioration

in Walsh’s mental health. The record supports this conclusion. Dr.

Choudhry specifically testified that if Walsh was left untreated and

unmedicated, she would be at risk of significant psychiatric

deterioration. In addition, he noted that “the longer her symptoms

go untreated, the less responsive they may be to intervention.”

III. Disposition

¶ 24 The order is affirmed.

JUDGE WELLING and JUDGE KUHN concur.