People v. Marquardt, 2016 CO 4

Larry Marquardt was committed to the Colorado Mental Health Institute at Pueblo after a not-guilty-by-reason-of-insanity verdict for violent offenses and diagnosed with schizoaffective disorder, bipolar type with paranoia.
He voluntarily accepted 10 mg/day of Saphris (antipsychotic) but refused higher doses due to fear of side effects (e.g., tardive dyskinesia).
The State petitioned to increase his dose to up to 20 mg/day because his psychiatrist believed 10 mg was only partially effective and that a higher dose was necessary for improvement and potential eventual discharge.
The trial court found Marquardt incompetent to make treatment decisions and ordered the higher dose, reasoning the increase was necessary to prevent long-term deterioration and to improve his condition.
The court of appeals reversed, holding the Medina framework applies to dose-increase orders and that lack of improvement (in a stable patient) does not meet Medina’s deterioration requirement.
The Colorado Supreme Court granted certiorari to decide (1) whether Medina applies to forced dose increases and (2) whether the trial court applied the correct Medina standard.

Issue	Plaintiff's Argument (People)	Defendant's Argument (Marquardt)	Held
Does Medina apply to court-ordered increases in medication dose?	Medina need not apply to dose-increase decisions because the patient is already medicated at a lower dose.	Medina applies to any forced medication decision, including dose increases.	Medina applies to orders increasing medication dose over a patient’s objection.
Did the trial court correctly apply Medina’s “deterioration” element?	Risk of future deterioration and lack of improvement on a lower dose support a Medina order; full Medina factors allow consideration of lack of improvement.	The State must show significant and likely long-term deterioration; a stable patient’s lack of improvement is insufficient.	The trial court misapplied Medina. Lack of improvement in a patient who is stable does not satisfy the requirement of significant and likely long-term deterioration.

People v. Medina, 705 P.2d 961 (Colo. 1985) (establishes four-part test for court-ordered antipsychotic medication)
People v. Bonilla-Barraza, 209 P.3d 1090 (Colo. 2009) (standard for mixed questions of law and fact; deference to trial court findings)
People ex rel. Strodtman, 293 P.3d 123 (Colo. App. 2011) (application of Medina involves mixed questions)
Bloskas v. Murray, 646 P.2d 907 (Colo. 1982) (informed consent and battery principles underpin right to bodily integrity)