Peo in Interest of Thomas

24CA2111 Peo in Interest of Thomas 02-20-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA2111
Pueblo County District Court No. 24MH30119
Honorable Timothy O’Shea, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Antonious W. Thomas,

Respondent-Appellant.

ORDER AFFIRMED

Division III
Opinion by JUDGE DUNN
Tow and Meirink, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced February 20, 2025

Cynthia Mitchell, County Attorney, Kate H. Shafer, Special Assistant County
Attorney, Pueblo, Colorado, for Petitioner-Appellee

Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant
¶1 Antonious W. Thomas appeals the district court’s order

authorizing the involuntary administration of antipsychotic and

mood-stabilizing medications. We affirm.

I. Background

¶2 Thomas was committed to the Colorado Mental Health

Hospital in Pueblo (CMHHIP) after being found incompetent to

proceed in a criminal case. He was diagnosed with an unspecified

mood disorder marked by erratic behavior, impulsivity, aggression,

pressured speech, and irritability. Thomas refused all medications,

but after multiple incidents of threatening and assaulting staff and

peers, staff started Thomas on an emergency course of Zyprexa, an

antipsychotic, and Depakote, a mood stabilizer. At the request of

CMHHIP staff psychiatrist Dr. Hareesh Pillai, the People then

petitioned the district court to authorize the involuntary

administration of Zyprexa and Depakote.

¶3 The district court held an evidentiary hearing at which Dr.

Pillai and Thomas testified. Dr. Pillai explained Thomas’s disorder

and accompanying symptoms. And he described the requested

medications, their possible side effects, and their necessity in

treating Thomas’s symptoms.

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¶4 Thomas denied having a mental illness. He also described the

side effects he had experienced since taking the requested

medications and his general preference not to take any medication.

¶5 Finding that Dr. Pillai testified “credibly and persuasively,” the

court granted the petition and entered an order authorizing the

involuntary administration of Zyprexa and Depakote.

II. Legal Principles and Standard of Review

¶6 An involuntarily committed person retains the right to refuse

treatment. See People v. Medina, 705 P.2d 961, 971 (Colo. 1985).

Even so, a court may authorize the involuntary administration of

medication if the People prove the following elements by clear and

convincing evidence:

(1) the patient is incompetent to effectively participate in the

treatment decision;

(2) 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 causing serious harm to himself or others in the

institution;

(3) no less intrusive treatment alternative is available; and

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(4) the patient’s need for treatment by antipsychotic

medication is sufficiently compelling to override his bona fide

and legitimate interest in refusing treatment.

Id. at 973.1 We determine whether the evidence, viewed as a whole

and in the light most favorable to the People, is sufficient to support

the court’s order. People in Interest of R.K.L., 2016 COA 84, ¶ 13. A

physician’s testimony alone may be sufficient to satisfy the Medina

test. Id. at ¶ 30.

¶7 Applying the Medina test presents a mixed question of fact and

law, meaning we defer to the district court’s factual findings if

supported by the record but review its legal conclusions de novo.

People in Interest of R.C., 2019 COA 99M, ¶ 7. It’s for the district

court, as the fact finder, to determine witness credibility; the

sufficiency, probative effect, and weight of the evidence; and the

inferences and conclusions to be drawn from it. Id.

1 A different test applies to petitions to administer involuntary

medication solely to restore competency. Sell v. United States, 539
U.S. 166, 180-81 (2003). But the parties don’t dispute that People
v. Medina, 705 P.2d 961 (Colo. 1985), applies here because the
purpose of the medications is to prevent Thomas from harming
others and to prevent a significant and long-term deterioration in
his mental condition. See Sell, 539 U.S. at 181-83.

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III. Discussion

¶8 Thomas doesn’t contest the district court’s findings on the first

and second Medina elements. But he contends that the People

didn’t present sufficient evidence to prove the third and fourth

Medina elements. We disagree.

A. The Third Medina Element

¶9 The third Medina element requires a court to determine that

no less intrusive alternative to the proposed medication is available.

Medina, 705 P.2d at 973. This element “encompasses not only the

gravity of any harmful effects from the proposed treatment but also

the existence, feasibility, and efficacy of alternative methods of

treating the patient’s condition or of alleviating the danger created

by that condition.” Id. at 974. A less intrusive alternative is “an

available treatment that has less harmful side effects and is at least

as effective at alleviating a patient’s condition as the proposed

treatment.” People in Interest of Strodtman, 293 P.3d 123, 133

(Colo. App. 2011).

¶ 10 Thomas contends that there is a less intrusive alternative to

the proposed treatment because he had previously and successfully

been treated with Zyprexa alone and the proposed addition of

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Depakote was based on “physician speculation” instead of his

“treatment history.”

¶ 11 True, Dr. Pillai testified that during a previous hospitalization,

Thomas was treated with just Zyprexa. But Dr. Pillai also testified

that during the present hospitalization, Thomas’s behaviors were

“much more severe” and “unmanageable by staff members,” which

is why “both a[n] antipsychotic and mood-stabilizing agent are

necessary.” Particularly, Dr. Pillai described “repeated incidents

where [Thomas] required assault precautions and severe assault

precautions” and “engag[ed] in activities like threatening staff,

throwing urine at staff, and assaulting others.”2

¶ 12 Crediting this testimony, the district court found that while

Thomas had been successfully treated in the past by Zyprexa alone,

his “severe behaviors warrant Depakote in addition to the Zyprexa.”

Therefore, the court found that “a less intrusive treatment

alternative is not available.”

2 Dr. Pillai indicated that Zyprexa and Depakote were currently

necessary to treat Thomas, but if he showed improvement on “any”
of the medications, Dr. Pillai would “try to decrease either
[medication] and try him on monotherapy with one of the two.”

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¶ 13 Thus, we conclude that sufficient evidence supports the

court’s finding on the third Medina element.

B. The Fourth Medina Element

¶ 14 In assessing the fourth Medina element — whether the

patient’s need for treatment is sufficiently compelling to override

any legitimate interest in refusing treatment — a court must

consider “whether the patient’s refusal is bona fide and legitimate”

and, if it is, “whether the prognosis without treatment is so

unfavorable that the patient’s personal preference must yield to the

legitimate interests of the state in preserving the life and health of

the patient placed in its charge and in protecting the safety of those

in the institution.” Medina, 705 P.2d at 974.

¶ 15 Thomas contends that the state’s interest in treating him is

insufficient to overcome his bona fide and legitimate interest in

avoiding severe side effects by refusing treatment. More specifically,

he claims that the district court didn’t properly weigh his interests

against the state’s because it didn’t consider his underlying

respiratory condition (COPD) and “minimized” his side effects.

¶ 16 We acknowledge Thomas’s legitimate concern regarding

potentially harmful side effects. But the district court plainly found

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that, given “his belief system,” Thomas had a bona fide and

legitimate interest in refusing treatment because he “does not

believe in taking prescription medications” and “there’s a price to

pay on the other end” in that “you may suffer some side effect that’s

undesirable.” And the court acknowledged Thomas’s testimony

“about being sluggish,” which the court recognized was “a side

effect of [the] medications he’s taking.” Thus, though the court

didn’t specifically mention Thomas’s COPD or all his stated side

effects, the court implicitly considered this evidence.

¶ 17 But even if we assume the court’s findings could have been

more robust, the record nevertheless supports the court’s

conclusion. Concerning his COPD, Thomas testified that the

requested medications caused him “breathing” problems and

“fatigue[].” However, Dr. Pillai testified that “Zyprexa and Depakote

would be unlikely to worsen” his COPD. And in the two weeks

Thomas had been taking Zyprexa and Depakote on an emergency

basis, despite falling once “due to the acute sedative properties of

the immediate intramuscular injection,” Dr. Pillai testified that

Thomas had “tolerated [the medications] relatively well without

overt side effects.” Dr. Pillai explained that Thomas’s vital signs

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had “not shown any discrepancies in his respiratory rate or his

oxygen saturation” and that the doctor expected any dizziness or

sluggishness Thomas had experienced to improve as Thomas’s

“body develops a tolerance to that aspect of the medications.”

¶ 18 Beyond this, Dr. Pillai testified that Thomas’s medical team

would closely monitor his COPD and side effects by patient

observation, lab work, vital signs, and physical examinations. He

testified that additional medications were available to neutralize

some of the side effects. And Dr. Pillai opined that (1) the need to

treat Thomas with the requested medications outweighed the risk of

side effects, even considering his underlying medical condition;

(2) no alternative treatment would be both as effective and less

intrusive than the requested medications; (3) without the

medications, there would be a significant and long-term

deterioration in Thomas’s mental condition; (4) without the

medications, Thomas poses a serious risk of harm to others (and

had already repeatedly “required assault precautions and severe

assault precautions” at the hospital); and (5) Thomas had no insight

into his mental condition, and his refusal to take the medications

was irrational and unreasonable.

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¶ 19 We therefore conclude that sufficient evidence supports the

court’s finding that the need to treat Thomas and protect others is

sufficiently compelling to override his bona fide and legitimate

interest in refusing treatment.

IV. Disposition

¶ 20 The order is affirmed.

JUDGE TOW and JUDGE MEIRINK concur.

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