Peo in Interest of Danford

24CA2273 Peo in Interest of Danford 05-01-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA2273
City and County of Denver Probate Court No. 24MH1290
Honorable Beth A. Tomerlin, Magistrate

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Caley Danford,

Respondent-Appellant.

ORDER AFFIRMED

Division VII
Opinion by JUDGE LIPINSKY
Johnson and Moultrie, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced May 1, 2025

Katie McLoughlin, Acting City Attorney, Kathleen Bell, Assistant City Attorney,
Denver, Colorado, for Petitioner-Appellee

The Mental Health Law Firm, Jonathan B. Culwell, Denver, Colorado, for
Respondent-Appellant
¶1 Caley Danford appeals a magistrate’s order authorizing the

staff at the Colorado Mental Health Hospital in Fort Logan (the

hospital) to involuntarily administer medication to her. We affirm.

I. Background

¶2 In February 2024, Danford was committed to the custody of

the Colorado Department of Human Services for competency

restoration after having been found incompetent to proceed in her

criminal cases. She was admitted to the hospital for competency

restoration services eight months later. Dr. W. John Porter, a staff

psychiatrist at the hospital, was her treating physician.

¶3 Danford was previously diagnosed with bipolar disorder. After

Danford’s admission to the hospital, however, Dr. Porter

provisionally diagnosed her with schizophrenia and noted that he

was “still sifting through [her] symptoms, trying to get a precise

diagnosis.” Dr. Porter reported that Danford exhibited symptoms of

magical thinking, irritability, agitation, possible auditory

hallucinations, delusional thought content, mood lability (prone to

fluctuation), and impaired judgment. In addition, Dr. Porter said

that Danford had substantial disorders of her cognitive, volitional,

and emotional processes.

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¶4 In December 2024, Dr. Porter sought authorization to

involuntarily treat Danford with several antipsychotic, mood

stabilizing, and antianxiety medications, as well as medications to

treat those drugs’ possible side effects. Dr. Porter said the

involuntary treatment was necessary to prevent a significant and

likely long-term deterioration of Danford’s mental condition. The

magistrate appointed counsel for Danford and set the matter for an

evidentiary hearing.

¶5 Following the hearing, at which both Dr. Porter and Danford

testified, the magistrate issued an order finding that the People had

proved all four elements of the test outlined in People v. Medina,

705 P.2d 961, 973 (Colo. 1985), for determining whether medication

may be involuntarily administrated to a mentally ill patient,

consistent with the patient’s constitutional rights. The order

authorized the hospital staff to administer the requested

medications — Haldol, Invega, Prolixin, Risperdal, Zyprexa,

Depakote, lithium, Ativan, Benadryl, and Cogentin — to Danford

against her will. The court also found that the hospital’s requested

physical assessments and labs were necessary to monitor the

medications’ effectiveness and safety to Danford.

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II. Discussion

¶6 Danford argues that the magistrate applied an incorrect legal

standard when the magistrate entered the involuntary medication

order. In particular, she argues that, when a court considers a

petition to authorize the involuntary medication of a criminal

defendant who is undergoing competency restoration and is not a

danger to herself or others, due process requires that the court find

evidence of “grave health concerns” before it can apply the Medina

factors. Danford argues that, in her case, the magistrate erred by

ordering the involuntary administration of medication in the

absence of a finding of “grave health concerns.” Because we

conclude the magistrate applied the correct legal standard, we

affirm the involuntary medication order.

¶7 “Whether a court applied the correct legal standard presents a

question of law that we review de novo.” People v. Vigil, 2021 CO

46, ¶ 17, 488 P.3d 1150, 1154.

¶8 A person has a significant constitutionally protected liberty

interest in avoiding the unwanted administration of antipsychotic

medications. Sell v. United States, 539 U.S. 166, 178 (2003);

Washington v. Harper, 494 U.S. 210, 221 (1990). Nonetheless, the

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government may involuntarily administer medication to a mentally

ill person under limited circumstances.

¶9 For example, when a criminal defendant is committed to a

mental health facility to restore her competency, and the facility

seeks authorization to involuntarily administer medication, a court

generally must apply the test in Sell, 539 U.S. at 180-81, to

determine whether the state’s important governmental interest in

bringing the defendant to trial for a serious crime outweighs the

defendant’s interest in refusing the medication.

¶ 10 The Sell Court, however, recognized that, “if forced medication

is warranted for a different purpose” than competency restoration,

“such as the purposes set out in Harper related to the individual’s

dangerousness, or purposes related to the individual’s own interests

where refusal to take drugs puts [the person’s] health gravely at

risk,” then courts should apply the applicable state law test that

accounts for those different purposes. Sell, 539 U.S. at 181-83. In

Harper, the Court analyzed the due process protections afforded to

mentally ill prisoners who refuse to take prescribed psychotropic

medications and concluded that a state may administer medication

to such individuals involuntarily “if the inmate is dangerous to

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himself or others and the treatment is in the inmate’s medical

interest.” Harper, 494 U.S. at 227.

¶ 11 Relying on this language in Sell and Harper, Danford argues

that, absent a finding that the person is “dangerous” or has “grave

health concerns,” a court must apply the Sell test, and not the

Medina test, to determine whether forced medication is warranted.

But while Sell recognized two alternative purposes for the

involuntary administration of medication — a person’s

dangerousness or purposes related to the person’s own interests

when their refusal to take medication puts the person’s health

gravely at risk — they are not the only purposes that can justify the

forced administration of medication under a state law test, as the

Supreme Court’s use of “such as” demonstrates. See Sell, 539 U.S.

at 182; see League of Women Voters of Colo. v. Davidson, 23 P.3d

1266, 1277 (Colo. App. 2001) (Use of the words “such as” implies

“an exemplary, not exclusive, list.”). Moreover, a division of this

court recognized that “the test established in [Medina] controls”

when the government seeks to involuntarily administer medications

to further purposes other than rendering a defendant competent to

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stand trial. People in Interest of R.F., 2019 COA 110, ¶ 11 n.1, 451

P.3d 1238, 1241 n.1.

¶ 12 But even if the Sell Court had limited the purposes sufficient

to justify an order for the involuntary administration of medication,

we conclude that a person’s significant and likely long-term

psychiatric deterioration would fall within “purposes related to the

individual’s own interests where refusal to take drugs puts [the

individual’s] health gravely at risk.” Sell, 539 U.S. at 182. In

Colorado, a person is “gravely disabled” when, “as a result of a

mental health disorder,” the person is at risk, of, among other

things, “significant psychiatric deterioration.” § 27-65-102(17),

C.R.S. 2024. Thus, we disagree with Danford to the extent she

argues that a person’s significant psychiatric deterioration is

neither a legitimate government interest sufficient to justify an

order compelling the involuntary administration of medication, nor

evidence related to the person’s own interests when the refusal to

take medications puts the person’s health gravely at risk as Sell

contemplated.

¶ 13 The State alleged in its petition that the involuntary

administration of medication was necessary because Danford was

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“at risk of a significant and likely long-term deterioration of [her]

mental condition.” Thus, the petition demonstrates that the

administration of the medications was not intended to restore

Danford’s competency but rather to address an alternative purpose

— the risk of a significant and likely long-term deterioration of her

mental condition. To determine whether a patient is in danger of

such long-term deterioration, a court should consider the patient’s

need for the medication based on “the nature and gravity of the

patient’s illness, the extent to which the medication is essential to

effective treatment, the prognosis without the medication, and

whether the failure to medicate will be more harmful to the patient

than any risks posed by the medication.” Medina, 705 P.2d at 973;

see People v. Marquardt, 2016 CO 4, ¶ 23, 364 P.3d 499, 505

(discussing “[t]he factors that make up the full test for determining

whether a patient is at risk of a significant and likely long-term

deterioration”).

¶ 14 Dr. Porter testified at the hearing that Danford was at risk of

significant and likely long-term deterioration of her mental

condition without the requested treatment. He explained that

Danford had a “pretty severe illness” and that medications were

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“completely essential” to treat her effectively. Further, Dr. Porter

opined that, without administration of the requested medications,

Danford’s prognosis would be “quite poor” and the failure to

medicate her would be more harmful than the risk of possible side

effects from the medications.

¶ 15 The magistrate found that Dr. Porter’s testimony on these

points was “credible” and “essentially uncontroverted.” See People

in Interest of R.C., 2019 COA 99M, ¶ 7, 451 P.3d 1229, 1231 (“The

[probate] court, as fact finder, ‘has discretion to determine the

credibility of the witnesses; the sufficiency, probative effect, and

weight of the evidence; and the inferences and conclusions to be

drawn from it.’” (quoting People in Interest of S.M.A.M.A., 172 P.3d

958, 962 (Colo. App. 2007))).

¶ 16 Under these circumstances, the magistrate correctly applied

the Medina test in determining that the involuntarily administration

of antipsychotic medications was consistent with Colorado law and

Danford’s constitutional rights. And because Danford does not

contest the sufficiency of the evidence supporting the magistrate’s

findings that all four Medina elements were met, we affirm the

order.

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III. Disposition

¶ 17 The order is affirmed.

JUDGE JOHNSON and JUDGE MOULTRIE concur.

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