Certiorari to the Colorado Court of Appeals. Court of Appeals Case No. 14CA105.
In this case, we hold that the rule outlined in People v. Medina, 705 P.2d 961, 973 (Colo. 1985), for determining when patient may be forcibly medicated applies to petitions to increase the dose of a medication over a patient's objection. We also hold that, if the patient is stable, a lack of improvement, without more, does not satisfy Medina's requirement that the patient must be at risk of significant and likely long-term deterioration.
For Petitioner: Special Assistant County Attorney, Douglas A. Gradisar, Pueblo, Colorado.
For Respondent: The Law Firm of John L. Rice, John L. Rice, Pueblo, Colorado.
RICE, CHIEF JUSTICE.
"> [¶1] People v. Medina, 705 P.2d 961, 973 (Colo. 1985), outlined the rule that courts must follow before ordering a patient to be forcibly medicated. In this case, we hold that the Medina rule applies to petitions to increase the dose of a medication over a patient's objection. We also hold that, if the patient is stable, a lack of improvement, without more, does not satisfy Medina's requirement that the patient must be at risk of significant and likely long-term deterioration.
I. Facts and Procedural History
[¶2] Larry Wayne Marquardt was committed to the Colorado Mental Health Institute at Pueblo (CMHIP) in 2013 after having been found not guilty by reason of insanity of charges of criminal attempt to commit murder in the first degree, assault with a deadly weapon, and assault on an at-risk adult. Marquardt was diagnosed with " Schizoaffective Disorder, Bipolar Type, with prominent paranoia." He voluntarily took ten milligrams of Saphris, an antipsychotic medication, once per day, but he refused to consent to more than ten milligrams per day. Marquardt refused to take the higher dose based in part on his fear of side effects, especially tardive dyskinesia. The People petitioned the court to allow them to slowly increase the dosage to a maximum of twenty milligrams per day because Marquardt's psychiatrist felt that the ten-milligram dose was only partially effective.
[¶3] At the hearing, Marquardt and his psychiatrist, Dr. Howard Fisher, testified. Dr. Fisher described Marquardt's condition, stating that Marquardt had been mentally ill for over thirty years, with symptoms such as hallucinations, delusions, and acts of violence. Dr. Fisher testified that Marquardt's hallucinations had subsided on the ten-milligram dose of Saphris, but that Marquardt still suffered from delusions and an inability to connect the need for medication with his mental illness. As a result, Dr. Fisher concluded that Marquardt's condition would not improve without increasing the dose of Saphris. Dr. Fisher also testified that Saphris was a fairly new drug, but most patients showed few adverse side effects from using it, even at twenty milligrams. He stated that Marquardt had not been a management problem on the unit and had not required the use of emergency medication, restraints, or seclusion. Dr. Fisher noted that Marquardt participated in his group and one-on-one sessions but did not appear to be learning as much as he might from those sessions. Without increasing the dosage, Dr. Fisher doubted Marquardt's ability to improve to the point that he could be discharged from the facility. However, Dr. Fisher also testified, " I can't say that he's going to get worse, at this point. He may be able to hold it together."
[¶4] At the conclusion of the hearing, the trial court found that Marquardt was incompetent to participate in treatment decisions. While no recent incidents supported a finding that Marquardt was in danger of causing serious harm to himself or others, the trial court found that " the treatment request
[was] necessary to prevent a significant long-term deterioration in his mental condition." However, it also found that, although Marquardt was not deteriorating from his current level, he would not improve without a higher medication dose. The trial court observed that, because of Marquardt's mental illness and insanity plea, he would never be released from an institution unless his condition improved. The trial court concluded that Marquardt's need for treatment was sufficiently compelling to override " any bona fide and ...