Peo in Interest of Hernandez

24CA2249 Peo in Interest of Hernandez 02-20-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA2249
Arapahoe County District Court No. 24MH761
Honorable H. Clay Hurst, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Erik Mateo Hernandez,

Respondent-Appellant.

ORDER AFFIRMED

Division III
Opinion by JUDGE MEIRINK
Dunn and Tow, JJ., concur

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

Ronald Carl, County Attorney, Meghan Rubincam, Senior Assistant County
Attorney, Aurora, Colorado, for Petitioner-Appellee

Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant
¶1 Erik Mateo Hernandez appeals the district court’s order

authorizing the involuntary administration of medication. We

affirm.

I. Background

¶2 In 2023 Hernandez was committed to the Colorado Mental

Health Institute at Fort Logan after being found incompetent to

proceed in multiple criminal cases. In July 2024, Hernandez was

transferred to the Restoring Individuals Safely and Effectively (RISE)

program at the Arapahoe County Detention Facility for continued

restoration services. Hernandez was diagnosed with schizophrenia

and presented with negative symptoms including flat affect, lack of

emotional expression, and slow movements. When the prior

involuntary medication order expired Hernandez continued to take

his medications voluntarily for about a week. However, as of

December 16, 2024, Hernandez has consistently refused all

medication. At the request of RISE staff psychiatrist Dr. Jonathan

Thiele, the People petitioned the district court to authorize the

involuntary administration of the medications Hernandez was

taking — divalproex (Depakote), olanzapine (Zyprexa), risperidone

(Risperdal), Vistaril, and Benadryl.

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

Thiele and Hernandez testified. Dr. Thiele explained Hernandez’s

disorder and accompanying symptoms. And he described the

requested mediations, their possible side effects, and their necessity

for treating Hernandez’s symptoms. Hernandez denied having a

mental illness, explaining that he does not have “the problems that

they say I have.” Hernandez discussed the side effects he has

experienced since being on the requested medications and he

explained that his preference would be to not take any medication

because he is “worried about [his] health.”

¶4 Finding that Dr. Thiele testified “credibl[y]” the district court

granted the petition in part and entered an order authorizing the

involuntary administration of Risperdal, Zyprexa, and Benadryl.

The court denied the petition as to Depakote and Vistaril.

II. Legal Principles and Standard of Review

¶5 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:

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(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’s causing serious harm to himself or
others in the institution;

(3) a less intrusive treatment alternative is not
available; and

(4) 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.

Id. at 963-64. 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.

¶6 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 is for the district

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

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

inferences and conclusions to be drawn from it. Id.

III. Discussion

¶7 Hernandez does not contest the district court’s finding on the

first and third Medina elements. However, he contends that the

People did not present sufficient evidence to prove the second and

fourth Medina elements. We disagree.

A. The Second Medina Element

¶8 The second Medina element may be satisfied by showing either

a significant and likely long-term deterioration or the likelihood of

serious harm to self or others in the institution. Medina, 705 P.2d

at 973.

¶9 To determine whether a patient is in danger of long-term

deterioration, the court should consider the patient’s need for the

medication, including “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.” Id. To determine whether a patient

is at risk of causing physical harm, the court “should consider

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whether the patient’s mental condition is such that in the absence

of the proposed treatment the patient will likely constitute a

continuing and significant threat to the safety of [them]self or

others in the institution.” Id. at 973-74.

¶ 10 The district court found that the requested treatment was

necessary both to prevent a significant long-term deterioration of

Hernandez’s mental condition and to prevent the likelihood of

Hernandez causing serious harm to himself or others in the

institution. This finding is supported by the record.

¶ 11 Dr. Thiele testified that the primary reason he sought an order

for the involuntary administration of medication was “the concern

for danger to others.” Dr. Thiele explained that “there was some

assaultive behaviors at Fort Logan.” And since Hernandez’s

admission to the RISE program, there have been additional

concerning incidents. During one incident, “staff felt threatened by

[Hernandez]” and afterward the staff member expressed concern

that “if [Hernandez] hadn’t been medicated, she might have been

assaulted.” There was another incident where Hernandez “lunged”

at staff with “balled up” fists and “threw milk” at a patient

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¶ 12 Hernandez argues that this evidence is insufficient because

the safety concerns were based almost entirely on behaviors

occurring before Hernandez’s admission to the RISE program and

since Dr. Thiele became his treating psychiatrist, he has shown

improvement. Thus, he asserts “it is not enough that the patient

may have been violent on some occasion in the past.” Medina, 705

P.2d at 974. But Dr. Thiele did not suggest that Hernandez’s past

violent behavior was isolated. Rather, Dr. Thiele’s testimony

suggests that Hernandez has a history of such behavior and given

the more recent instances of aggression since his admission to the

RISE program, it is likely that such behavior will continue in the

absence of the proposed treatment.

¶ 13 Nor are we persuaded by Hernandez’s assertion that Dr.

Thiele’s testimony “boils down to a general statement about

schizophrenia” and by finding this element was satisfied “by such

sweeping statements” the district court set a precedent that a

schizophrenia diagnosis on its own is clear and convincing evidence

that there is a likelihood of long-term deterioration.

¶ 14 Dr. Thiele opined that, without the requested medications,

there would be significant and likely long-term deterioration in

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Hernandez’s mental condition. Dr. Thiele explained that if

Hernandez stopped taking the requested medications “he would

start to have psychotic symptoms . . . again.” And he testified that

research suggests that untreated schizophrenia can lead to “brain

damage and cognitive issues” and can become “harder . . . to treat

in the future.” The district court expressly credited and adopted Dr.

Thiele’s testimony regarding Hernandez’s mental illness and the

reasons why the requested medications were necessary to prevent

Hernandez from deteriorating finding it “sufficient and convincing.”

Because the record supports the court’s determination, we will not

disturb it and to the extent Hernandez asks us to second-guess

witness credibility or draw different inferences from the testimony,

we decline to do so. See R.C., ¶ 7.

B. The Fourth Medina Element

¶ 15 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

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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.

¶ 16 Hernandez contends that the district court failed to consider

whether his refusal to take the requested medications — to avoid

harmful side effects — is bona fide and legitimate and “applied an

incorrect legal standard by phrasing the inquiry as to which party

was more credible.” We disagree.

¶ 17 The district court expressly acknowledged Hernandez’s

legitimate concern regarding potentially harmful side effects,

including his complaints that the medications were making him

itchy. However, after weighing witness credibility and the court’s

own observations of Hernandez during the hearing, the court was

“not terribly convinced . . . that there is an itching component.”

Even so, the court denied the request to involuntarily administer

Depakote, at least in part, based on evidence presented at the

hearing that it was the likeliest cause of Hernandez’s itchiness.

¶ 18 As to the additional adverse side effects referenced in Dr.

Thiele’s testimony, the district court found that Hernandez’s “need

for treatment by medication is sufficiently compelling to override

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[his] objections.” The record supports these findings. While Dr.

Thiele testified that the requested medications had “hundreds” of

adverse side effects, he also testified that the failure to medicate

Hernandez would be more harmful than the risks that the

medications posed. Moreover, he testified that RISE staff would

monitor Hernandez for any additional side effects with periodic

physical assessments, imaging, lab tests, and additional

medications, if necessary.

¶ 19 We do not doubt that Hernandez’s concerns in avoiding

harmful side effects are bona fide and legitimate. However, because

the record supports the district court’s findings, we conclude it did

not err by finding that any desire Hernandez might have in refusing

the requested medications was overridden by his sufficiently

compelling need for treatment. See R.K.L., ¶¶ 13, 30.

IV. Disposition

¶ 20 The order is affirmed.

JUDGE DUNN and JUDGE TOW concur.

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