People in Interest of Jordan

24CA2073 Peo in Interest of Jordan 02-13-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA2073
Pueblo County District Court No. 24MH30116
Honorable Timothy O’Shea, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Charles Arthur Thomas Jordan,

Respondent-Appellant.

ORDER AFFIRMED

Division V
Opinion by JUDGE SULLIVAN
Freyre and Schock, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced February 13, 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 Respondent, Charles Arthur Thomas Jordan, appeals the

district court’s order authorizing the involuntary administration of

olanzapine (Zyprexa) and chlorpromazine (Thorazine) —

antipsychotic medications — as well as valproic acid (Depakote) — a

mood-stabilizing medication. We affirm the order.

I. Background

¶2 Jordan was admitted to the Colorado Mental Health Hospital

in Pueblo (CMHHIP) after being found incompetent to proceed to

trial on criminal charges. According to the affidavit of his treating

physician, Dr. Hareesh Pillai, Jordan has been diagnosed with an

unspecified mood disorder. His illness is a “substantial disorder . .

. that grossly impairs judgment or capacity to recognize reality or to

control behavior.”

¶3 Jordan was prescribed Zyprexa and Depakote on an

involuntary and emergency basis after he smeared feces on walls

and floors, threw books at security, threatened staff with violence

and death, and attempted to punch, kick, and spit at them. Jordan

initially refused the emergency medications, “then ran across the

hall and kicked a staff member in the face.” He denied that he

suffered from a mental illness and needed medication, and he asked

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for information about a medication hearing. The People petitioned

for a hearing and an order authorizing the involuntary

administration of Zyprexa and Depakote, plus Thorazine as needed

for episodes of acute agitation.

¶4 Both Dr. Pillai and Jordan testified at the hearing. Dr. Pillai

testified about each of the four elements required for involuntary

administration of medication under People v. Medina, 705 P.2d 961,

973 (Colo. 1985). In general, he described Jordan’s symptoms,

statements, and behaviors, as well as the benefits and potential

side effects of treatment with Zyprexa, Thorazine, and Depakote.

Jordan testified that he didn’t have a mental illness and that he

wouldn’t take medications without a court order. He complained

that the medications caused flushing and headaches, although he

said that he receives Tylenol to treat the headaches. He expressed

a preference to be treated with marijuana or, alternatively, with an

antianxiety drug and an antidepressant.

¶5 At the conclusion of the testimony, the district court found Dr.

Pillai’s opinions to be credible and persuasive and adopted them. It

found that the People had established each of the Medina elements

by clear and convincing evidence, and it issued an order authorizing

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CMHHIP staff to administer all of the requested medications for a

period of six months. While the court was delivering its findings,

Jordan “stormed out” and began “fighting with staff.”

¶6 On appeal, Jordan challenges the sufficiency of the evidence

supporting the court’s order.

II. Legal Authority and Standard of Review

¶7 A district court may authorize the involuntary administration

of medication to a patient if the treating facility establishes each of

the following Medina elements by clear and convincing evidence: (1)

the patient is incompetent to participate effectively in the treatment

decision; (2) treatment by medication is necessary either 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 themself or others in the institution; (3) a less

intrusive treatment alternative isn’t available; and (4) the patient’s

need for treatment with medication is sufficiently compelling to

override their bona fide and legitimate interest in refusing

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medication.1 Id.; see People in Interest of Strodtman, 293 P.3d 123,

131 (Colo. App. 2011). A physician’s testimony alone may

constitute clear and convincing evidence. See People v. Pflugbeil,

834 P.2d 843, 846-47 (Colo. App. 1992).

¶8 When, as here, a patient challenges the sufficiency of the

evidence supporting the district court’s findings on any of these

elements, we review the court’s conclusions of law de novo and

defer to its findings of fact if supported by evidence in the record.

People v. Marquardt, 2016 CO 4, ¶ 8. We view the record as a whole

and in the light most favorable to the People, and we defer to the

fact finder to resolve any conflicts in the testimony and determine

the credibility of witnesses. See People in Interest of Ramsey, 2023

COA 95, ¶ 23; see also Strodtman, 293 P.3d at 130.

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 Jordan from causing
serious harm to others in the institution. See Sell, 539 U.S. at 181-
83.
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III. Analysis

¶9 Jordan challenges the sufficiency of the evidence only for the

first and fourth Medina elements. He argues that Dr. Pillai’s

testimony failed to show (1) that he was incapable of participating

in treatment decisions; or (2) a sufficiently compelling need to

override his interest in avoiding side effects from the requested

medications. See Medina, 705 P.2d at 973-74. We conclude that

the record provides ample support for the court’s findings.

A. First Medina Element

¶ 10 A patient is incompetent to participate effectively in treatment

decisions when his “mental illness has so impaired his judgment as

to render him ‘incapable of participating in decisions affecting his

health.’” Id. at 973 (citation omitted). When a patient’s failure to

recognize that he has a mental illness interferes with his ability to

effectively participate in treatment decisions, the first Medina

element is “easily” satisfied. People in Interest of C.J.R., 2016 COA

133, ¶ 32.

¶ 11 The district court found that Jordan “has no or limited insight

into his mental illness” and is thus “incapable of making informed

treatment decisions.” Dr. Pillai testified that he didn’t believe

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Jordan had any insight into his mental illness and that Jordan was

incompetent to effectively participate in decisions affecting his

health, including medication decisions. He asserted that Jordan (1)

“frequently exhibited disorganized thinking and prominent

delusions” such as hearing “CIA mind control,” in addition to

agitation; (2) denied suffering from any type of psychiatric illness

and denied needing medication; (3) thought he was put on

emergency medications “for critical resistance exercising”; and (4)

had punched himself in the neck “to try and improve circulation

and blood flow.” Jordan testified that Dr. Pillai “said many lies,”

but as a whole his testimony substantially corroborated Dr. Pillai’s

assertions.

¶ 12 Viewing this testimony in the light most favorable to the

People, we conclude that the record amply supports the district

court’s findings as to the first Medina element. See C.J.R., ¶ 32; see

also Ramsey, ¶ 23.

B. Fourth Medina Element

¶ 13 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

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determine (1) “whether the patient’s refusal is bona fide and

legitimate” and, if so, (2) “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.

¶ 14 As to the first question, Jordan told the district court that he

wished to refuse treatment on religious grounds. He asserted that

taking medications was against his beliefs because, among other

things, “Religion, anything bible.” Dr. Pillai testified that he knew of

no bona fide reason for Jordan to refuse treatment and that he

considered Jordan’s refusal irrational and unreasonable. Giving

Jordan the benefit of the doubt, the court found that Jordan’s

religious preference was a bona fide and legitimate reason for

refusing medication.

¶ 15 Turning to the second question, Dr. Pillai testified that Jordan

had engaged in the impulsive and assaultive behaviors described

above in Part I, in addition to throwing feces at staff. He further

testified that Jordan’s delusions, disorganized thinking, and his

ability to be redirected had improved on the emergency medications

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and that his agitation would worsen without the medication. In Dr.

Pillai’s opinion, the failure to medicate Jordan would make him a

danger to others — causing more harm than the risks posed by the

medication. Based on this testimony, the district court found that

Jordan’s prognosis without medication was so unfavorable that his

personal preference must yield to the state’s legitimate interests in

preserving his health and protecting the safety of those in CMHHIP.

¶ 16 Viewing Dr. Pillai’s testimony in the light most favorable to the

People, we conclude that the record supports the district court’s

findings as to the fourth Medina element. In sum, we perceive clear

and convincing evidence of a compelling need for involuntary

administration of medications. See Pflugbeil, 834 P.2d at 846-47.

¶ 17 Our conclusion is unaffected by Jordan’s appellate argument

that he seeks to refuse medication due to two side effects:

headaches and suicidal thoughts. While actual side effects can be a

legitimate reason for refusing treatment, Jordan’s alleged side

effects are either relatively minor — his headaches are treatable

with Tylenol — or not attributable to the medications — as Dr. Pillai

testified to regarding Jordan’s suicidal thoughts. Moreover, Dr.

Pillai testified that Jordan doesn’t have any known underlying

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health conditions that could be worsened by the medications and

that CMHHIP monitors for any negative side effects.

¶ 18 Our conclusion is similarly unaffected by Jordan’s belated

argument that the state has demonstrated a lack of interest in

treating him by failing to treat his self-diagnosed depression. Dr.

Pillai testified that Jordan hadn’t exhibited depression during this

hospitalization and that antidepressant medications weren’t

appropriate treatments for Jordan’s symptoms. See Ramsey, ¶ 23.

Moreover, Jordan didn’t present this argument to the district court.

See Estate of Stevenson v. Hollywood Bar & Cafe, Inc., 832 P.2d

718, 721 n.5 (Colo. 1992) (“Arguments never presented to,

considered or ruled upon by a trial court may not be raised for the

first time on appeal.”).

IV. Disposition

¶ 19 We affirm the order.

JUDGE FREYRE and JUDGE SCHOCK concur.

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