2016 COA 84
Colo. Ct. App.2016Background
- Petition filed to certify R.K.L. (aka A.J.J.) for short-term (≤3 months) involuntary mental-health treatment at CMHI–Fort Logan after a 72-hour hold and transfer from CMHI–Pueblo; petitioner also sought authority to involuntarily administer multiple psychotropic medications.
- Two treating psychiatrists (stipulated experts) testified A.J.J. has schizophrenia (possible bipolar), exhibits grandiose delusions, disorganized thought, poor judgment, history of impulsive/aggressive acts (including a 2014 third-degree assault and threats to staff), and lacks insight; A.J.J. denied having a mental illness and refused medication.
- Probate court upheld the initial certification (Jan 6) and an extended certification (Feb 10), and authorized involuntary administration of Invega plus ten other antipsychotics and several other medications.
- On appeal A.J.J. challenged sufficiency of evidence for both certification and the Medina factors required to involuntarily administer antipsychotics.
- Court of Appeals affirmed certification and extension (danger to others and gravely disabled findings supported by expert testimony and history) but reversed authorization for involuntary administration of ten antipsychotics (other than Invega) for lack of evidence on less-intrusive alternatives and on balancing intrusiveness/side effects vs. need.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Validity of short-term certification/extension | Evidence shows A.J.J. is mentally ill, dangerous to others, and has not accepted voluntary treatment | A.J.J. contends past behavior doesn't prove present danger or grave disability | Affirmed: experts and history supported danger-to-others and gravely-disabled findings by clear and convincing evidence |
| Competency to refuse treatment (Medina prong 1) | A.J.J. is incompetent to participate in treatment decisions due to lack of insight | A.J.J. asserts mental illness alone is insufficient | Affirmed: experts showed lack of insight and impaired judgment beyond mere diagnosis |
| Necessity of antipsychotic treatment to prevent deterioration or harm (Medina prong 2) | Medication is necessary to prevent deterioration and institutional harm | A.J.J. argued stability at hospital undermines necessity | Affirmed for Invega: testimony linked medication to preventing harm/deterioration |
| No less intrusive alternative and overriding patient's refusal (Medina prongs 3 & 4) | Doctors requested multiple antipsychotics to allow flexibility if Invega fails; no viable less-intrusive alternative | A.J.J. argued confinement without forced meds or reliance on current medication is less intrusive | Reversed as to ten non-Invega antipsychotics: psychiatrists failed to provide medication-specific evidence on efficacy and side effects, and speculation about future need cannot override present refusal; affirmed as to Invega |
Key Cases Cited
- People v. Medina, 705 P.2d 961 (Colo. 1985) (establishes four-part test for involuntary antipsychotic medication)
- People v. Pflugbeil, 834 P.2d 843 (Colo.App. 1992) (physician testimony can satisfy Medina factors)
- People v. Marquardt, 364 P.3d 499 (Colo. 2016) (speculation about future deterioration insufficient to support Medina order)
- People in Interest of King, 795 P.2d 273 (Colo.App. 1990) (prior threats and refusal of treatment can support present-danger finding)
- People v. Taylor, 618 P.2d 1127 (Colo. 1980) (statutory requirements for short-term certification)