July 19, 2018

Colorado Court of Appeals: Probate Court Lacked Authority to Order “Chemical Castration”

The Colorado Court of Appeals issued its opinion in People in Interest of C.J.R. on Thursday, September 8, 2016.

Probate Court Authority—Chemical Castration—Medina Factors.

C.J.R. is a long-term patient at a state hospital, where he is treated for a form of psychosis. He has also engaged in “sexually inappropriate behavior” for some time. C.J.R. was treated for years with antipsychotic drugs. After a change in his drug therapy, his sexually inappropriate behavior worsened. As a result, a psychiatrist prescribed Depo-Provera by injection every 90 days. The use of Depo-Provera for this purpose is commonly called chemical castration. C.J.R. refused to take the drug voluntarily, and the People sought authorization from the Denver Probate Court to administer it involuntarily. The probate court authorized the involuntary administration of Depo-Provera and use of a nasogastric tube to administer other drugs. C.J.R. appealed.

In People v. Medina, the Colorado Supreme Court formulated a four-factor test that the People must satisfy before a court may order a patient to be forcibly medicated. Medina dealt with antipsychotic drugs. The court of appeals held that it does not apply to a request to involuntarily administer the synthetic equivalent of progesterone as part of the treatment for a mentally ill male patient at a state hospital for the express purpose of controlling his sexually inappropriate behavior.

In addition, the court found that even if the Medina test were applicable here, the People did not prove by clear and convincing evidence that the requirements of Medina were established because (1) there was not record support that there were no less intrusive alternative treatments available, and (2) C.J.R.’s need for treatment with medication was not sufficiently compelling to override “any bona fide and legitimate interest of the patient in refusing treatment.”

The part of the probate court’s order authorizing involuntary administration of Depo-Provera was reversed. That part of the order authorizing the use of a nasogastric tube to administer other medications was affirmed.

Summary provided courtesy of The Colorado Lawyer.

Colorado Court of Appeals: Evidence Insufficient to Support Involuntary Administration of Medication

The Colorado Court of Appeals issued its opinion in People in Interest of R.K.L. on Thursday, May 19, 2016.

Involuntary Administration of Medication—Due Process—Clear and Convincing Evidence.

On request of the People, R.K.L., a/k/a A.J.J., was found to be mentally ill and a danger to others and gravely disabled, and was certified to Colorado Mental Health Institute at Fort Logan for short-term treatment for a period not to exceed three months. The probate court also authorized involuntary administration for 11 requested antipsychotic medications. Before the expiration of that order, the People filed a notice extending the certification for treatment for an additional three months and a motion to extend the involuntary medication order. The probate court, following a hearing, extended the certification for short-term treatment and granted the motion for continued involuntary administration authority for the requested medications.

A.J.J. appealed both orders. He conceded that the People had established by clear and convincing evidence that he has a mental illness and that he has not voluntarily accepted treatment. He argued that the court erred in finding that the People proved by clear and convincing evidence that he is a danger to others or gravely disabled. The Court of Appeals held that the probate court’s finding that A.J.J. is a danger to others was supported by evidence in the record. Alternatively, the Court found sufficient evidence in the record to support the probate court’s findings by clear and convincing evidence that A.J.J was gravely disabled as a result of his mental illness. Sufficient evidence supports the probate court’s orders upholding the certification and extended certification of A.J.J. for short-term treatment.

To involuntarily administer antipsychotic medication without violating a patient’s due process rights, all four elements set forth in People v. Medina, 705 P.2d 961, 973 (Colo. 1985), must be proven by clear and convincing evidence. The Court found that the evidence did not support the probate court’s findings as to two of these elements regarding involuntary administration of 10 of the medications, but the evidence was sufficient to support the administration of one medication. The Court agreed with A.J.J. that the evidence did not support the court’s findings that (1) the People had established by clear and convincing evidence that there was no less intrusive alternative than administering the 10 antipsychotics and (2) A.J.J.’s need for treatment with the 10 antipsychotic medications overrode his bona fide and legitimate interest in refusing this treatment.

The orders were reversed to the extent that they authorized involuntary administration of 10 antipsychotics and affirmed in all other respects.

Summary provided courtesy of The Colorado Lawyer.

Colorado Supreme Court: Showing of Deterioration of Condition Required for Involuntary Increase of Psychiatric Medication

The Colorado Supreme Court issued its opinion in People v. Marquardt on Tuesday, January 19, 2016.

Marquardt was committed to the Colorado Mental Health Institute in Pueblo after a plea of not guilty by reason of insanity. While there, he voluntarily took 10 mg per day of Saphris, an anti-psychotic medication that kept his mental condition stable, but refused to increase his dose because of concerns of potentially permanent side effects. The People petitioned the court to allow them to slowly increase Marquardt’s dose of Saphris to 20 mg, arguing that although he was stable on 10 mg, 20 mg could potentially allow him to return to society. The trial court applied the test articulated in People v. Medina, 705 P.2d 961, 973 (Colo. 1985), and determined that Marquardt’s failure to improve justified increasing the dose of Saphris.

On appeal, the Colorado Court of Appeals found the trial court had incorrectly applied the Medina test because the People had not shown that Marquardt’s mental condition was deteriorating. The court of appeals found that Medina permitted court-ordered medication increases to prevent deterioration but not solely for the purpose of expediting a patient’s treatment. The People appealed, and the Colorado Supreme Court agreed with the court of appeals, finding the Medina test was the proper analysis for determining whether a court should order forcible medication increases over a patient’s right to bodily integrity. In this case, the supreme court held the court of appeals correctly determined that the trial court had incorrectly applied the test where there was no deterioration of condition shown.

The supreme court affirmed the court of appeals.

Colorado Court of Appeals: Involuntary Medication Administration Necessary to Render Defendant Competent to Stand Trial

The Colorado Court of Appeals issued its opinion in People in Interest of Hardesty on Thursday, October 9, 2014.

Involuntary Administration of Medication to Render Defendant Competent to Stand Trial.

Hardesty was sent to the Colorado Mental Health Institute in Pueblo (CMHIP) after he was found incompetent to proceed in two criminal cases filed against him. While at CMHIP, Hardesty refused to take antipsychotic medications. The People petitioned to have the medications involuntarily administered to render him competent to proceed in the criminal cases. The district court granted the People’s petition following a hearing in which it made a number of findings by clear and convincing evidence.

On appeal, Hardesty argued that the People failed to establish the legal requirements for administration of medications under Sell v. United States, 539 U.S. 166 (2003).The Court of Appeals disagreed.

Under Sell, a court must find the defendant: (1) is facing “serious criminal charges”; (2) the involuntary medication will significantly further the state’s interest in prosecution; (3) administration of the drugs is substantially likely to render the defendant competent to stand trial; (4) administration of the drugs is substantially unlikely to have side effects that will interfere significantly with the defendant’s ability to assist counsel in conducting a trial defense; (5) involuntary medication is necessary to further the identified governmental interests; (6) less intrusive means for administering the drugs must be considered; (7) any alternative, less intrusive treatments are unlikely to achieve substantially the same results; and (8) administration of the drugs is medically appropriate.

Hardesty challenged the first, second, and fifth factors listed above. On the first issue, Hardesty was charged with “[s]hoplifting that resulted in an assault and as a result then [became] a [r]obbery.” The Court held that robbery, as charged here, was a “serious” crime. The Court further concluded that, given the seriousness of the robbery charge, the government had a significant interest in restoring Hardesty to competency so that he could be tried.

Hardesty also argued that no evidence was presented to prove that ordering involuntary medication was necessary to further the state’s interest in prosecution. The lower court found by clear and convincing evidence that Hardesty was unlikely to be restored to competency without the medications. This finding was not clearly erroneous. The order was affirmed.

Summary and full case available here, courtesy of The Colorado Lawyer.

Tenth Circuit: Specific Treatment Plan Required Before Court can Order Involuntary Medication of Incompetent Defendant

The Tenth Circuit Court of Appeals published its opinion in United States v. Chavez on Wednesday, November 13, 2013.

Reydecel Chavez was charged with being a felon in possession of a firearm, being an illegal alien in possession of a firearm, and reentry of a removed alien. Chavez was found incompetent to stand trial and he refused antipsychotic medication that would render him competent. The district court ordered Chavez to be involuntarily medicated.

Under United States v. Sell, “the government may involuntarily administer drugs to a mentally ill, non-dangerous defendant in order to render him competent to stand trial only upon a four-part showing. The government must establish that: (1) “important governmental interests are at stake;” (2) the “involuntary medication will significantly further” those interests; (3) the “involuntary medication is necessary to further those interests,” e.g., less intrusive alternative treatments are unlikely to be effective; and (4) the administration of the medication is “medically appropriate” and in the defendant’s best medical interests.”

Chavez argued that the lack of an individualized treatment plan could not satisfy the requirements of Sell. The Tenth Circuit agreed and held that “an order to involuntarily medicate a non-dangerous defendant solely in order to render him competent to stand trial must specify which medications might be administered and their maximum dosages.” Without this information, a court could not be sure any side effects would be unlikely to significantly interfere with the defendant’s ability to assist in his trial defense, or that the medication is medically appropriate. The court held that a list of possible medications and their maximum dosages was adequate because medical staff require flexibility to provide effective treatment.

The court vacated the district court’s order and remanded for further proceedings.