Opinion
Court of Appeals No. 16CA0795
08-04-2016
The People of the State of Colorado, Petitioner-Appellee, In the Interest of Charles Arthur Murray, Respondent-Appellant.
Gregory J. Styduhar, County Attorney, David A. Roth, Special Assistant County Attorney, Pueblo, Colorado, for Petitioner-Appellee The Law Firm of John L. Rice, John L. Rice, Pueblo, Colorado, for Respondent-Appellant
Pueblo County District Court No. 16MH107
Honorable William D. Alexander, Judge ORDER AFFIRMED Division IV
Opinion by JUDGE HAWTHORNE
Terry and Fox, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Gregory J. Styduhar, County Attorney, David A. Roth, 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 Charles Arthur Murray appeals the district court's order authorizing mental health personnel to involuntarily medicate him. We affirm.
I. Background
¶ 2 Mr. Murray has been diagnosed with bipolar disorder with manic and psychotic features. In March 2016, he was admitted to the Colorado Mental Health Institute at Pueblo (CMHIP) after he was found incompetent to proceed in three criminal cases filed against him. ¶ 3 Following Mr. Murray's threats to harm others, CMHIP mental health personnel administered emergency medication to him for ten days. He refused to voluntarily accept the medication after the emergency period ended, with the exception of Haldol. The People then filed a petition to involuntarily medicate him. After a hearing, the district court granted the People's petition to medicate Mr. Murray until October 27, 2016. Mr. Murray appeals that order.
II. Involuntary Medication
¶ 4 Mr. Murray contends that the district court erred in granting the petition for involuntary medication. Specifically, he asserts that the evidence was insufficient to support the court's order. We are not persuaded.
A. Standard of Review
¶ 5 Determining whether a patient may be involuntarily medicated presents a mixed legal and factual question. People in Interest of Strodtman, 293 P.3d 123, 131 (Colo. App. 2011). We review de novo the court's legal conclusions and defer to its factual findings if evidence in the record supports them. Id.
B. The Medina Factors
¶ 6 To obtain the authority to involuntarily administer antipsychotic medication without violating a patient's due process rights, a health care provider must prove by clear and convincing evidence the four factors established in People v. Medina, 705 P.2d 961, 973 (Colo. 1985). See, e.g., Donaldson v. Dist. Court, 847 P.2d 632, 634 (Colo. 1993); People in Interest of Marquardt, 2014 COA 57, ¶ 13, aff'd, 2016 CO 4. The Medina factors are:
(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.Medina, 705 P.2d at 973. ¶ 7 The treating physician's testimony can be sufficient to satisfy the criteria for administering involuntary medication. See People v. Pflugbeil, 834 P.2d 843, 847 (Colo. App. 1992). ¶ 8 Mr. Murray concedes that the evidence supported the second and fourth prongs of the Medina test. We reject his assertions of error as to the other two prongs and address them in turn.
1. Competency to Effectively Participate in Treatment Decisions
¶ 9 "[A] court is prohibited from ordering the forced medication of an involuntarily committed . . . patient unless the court is satisfied that the patient's mental illness has so impaired his judgment as to render him 'incapable of participating in decisions affecting his health.'" Medina, 705 P.2d at 973 (quoting Goedecke v. State Dep't of Insts., 198 Colo. 407, 411, 603 P.2d 123, 125 (1979)) ¶ 10 Dr. Cheney, Mr. Murray's treating psychiatrist, testified that Mr. Murray was incapable of effectively participating in decisions that affect his health. When asked whether Mr. Murray was incompetent to effectively participate in deciding whether he needed antipsychotic medication Dr. Cheney responded, "Yes." Although Dr. Cheney noted that Mr. Murray's mania and delusions had gradually decreased since he started taking medications, she also stated that Mr. Murray "still doesn't have real insight." Dr. Cheney was further convinced Mr. Murray lacked insight into his condition when he was not receptive to the suggestion that he needed to take a mood stabilizer and that Haldol was not a good long-term medication because of its side effects. ¶ 11 Additionally, until the day before the hearing, Mr. Murry did not want any medications. Dr. Cheney testified that, "[Mr. Murray] didn't think there was anything wrong with him. He was the maker of the universe, he took care of everything and didn't need medication." Dr. Cheney also testified that Mr. Murray mistakenly believed that the medications he was receiving were rat poison and that he had been the King of Persia. Mr. Murray did not recant those beliefs at the hearing, but instead argued that he was the King of Persia and that the medications were rat poison. ¶ 12 Considering this evidence, the district court found that Mr. Murray "doesn't have any insight into the mental illness and he's incapable of making informed treatment decisions and incompetent to effectively participate in treatment decisions." The district court also concluded that the "refusal to accept the treatment is in itself irrational and unreasonable under the circumstances." We conclude that Dr. Cheney's and Mr. Murray's testimony were sufficient to support the court's finding that Mr. Murray was incompetent to effectively participate in his treatment decisions.
2. No Less Intrusive Alternative
¶ 13 A petitioner must also show that a less intrusive alternative treatment is not available. Medina, 705 P.2d at 974. 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 the proposed treatment. Strodtman, 293 P.3d at 133 (citing Medina, 705 P.2d at 974). ¶ 14 When asked whether there was an alternative method of treating Mr. Murray that would be as effective and less intrusive, Dr. Cheney answered, "No." Dr. Cheney's affidavit noted that there was "no less intrusive treatment available" and that, without proper medications, it was "impossible to treat [Mr. Murry] so as to eventually place him in a less restrictive environment." Her testimony also confirmed that the failure to medicate Mr. Murray would be more harmful than the risks posed by the recommended medications. ¶ 15 Mr. Murray asserts that continued treatment with Haldol would be a less intrusive alternative. Specifically, Mr. Murray insists that taking Haldol alone is a less intrusive alternative. However, Dr. Cheney explained that while Haldol is an acceptable short-term medication, in the long term Haldol was not a good medication for Mr. Murray because of the high risk of tardive dyskinesia in older individuals. In fact, Mr. Murray admitted at the hearing that he was worried about the long-term side effects of Haldol. ¶ 16 In addition, Dr. Cheney stated that newer medications modeled after Haldol treat bipolar disorder with fewer side effects. Furthermore, Dr. Cheney emphasized that Mr. Murray also needed a mood stabilizer because his primary diagnosis was bipolar disorder. And Dr. Cheney testified that antipsychotic and other medications were needed for Mr. Murray's treatment. Accordingly, the record supports the court's finding that there was no less intrusive method of treatment.
III. Conclusion
¶ 17 The order is affirmed.
JUDGE TERRY and JUDGE FOX concur.