Summary
recognizing that petitioning party must establish factors allowing for forced medication by clear and convincing evidence
Summary of this case from State v. GarciaOpinion
No. 92SA371
Decided February 22, 1993.
Original Proceeding
David F. Vela, Colorado State Public Defender, Robin A. Carey, Deputy State Public Defender, for Petitioner.
Norman S. Early, Jr., District Attorney, Second Judicial District, Nathan B. Coats, Chief Appellate Deputy District Attorney, for Respondents.
In this original proceeding filed pursuant to C.A.R. 21, the petitioner, Freddie B. Donaldson, seeks an order prohibiting the respondent, the District Court in and for the City and County of Denver, from authorizing the administration of the antipsychotic drug prolixin to the petitioner. Having issued a rule to show cause why the requested relief should not be granted, we now discharge the rule.
Prolixin is a trademark for preparations of fluphenazine hydrochloride, a crystalline powder used as a tranquilizer in the treatment of manifestations of mental disorders. Dorland's Illustrated Medical Dictionary 1363 (27th ed. 1988).
I
The petitioner is charged with offenses in two criminal proceedings, one pending in the District Court for Arapahoe County, Colorado, and the other pending in the respondent District Court for the City and County of Denver, Colorado. In March 1992, the trial court in the Arapahoe County District Court proceeding ordered the petitioner, inter alia, to undergo a competency examination at the Colorado Mental Health Institute at Pueblo, Colorado (the Institute). Dr. Jerome Chadwick, one of the petitioner's treating staff psychiatrists, reported that in his opinion the petitioner suffered from chronic, paranoid schizophrenia which rendered him incapable of understanding the charges filed and incompetent to proceed, but that the petitioner could be restored to competency through appropriate treatment.
When addressing questions concerning the competency of a defendant to participate in criminal proceedings, a trial court must initially determine whether the defendant is competent to proceed. § 16-8-111(1), 8A C.R.S. (1986). The court may order a competency examination to assist that determination, pursuant to § 16-8-106(1), 8A C.R.S. (1986 1992 Supp.). If the court ultimately determines that the defendant is incompetent to proceed, the court may commit the defendant to the custody of the Department of Institutions until the defendant has been restored to competency or has been confined for a period of time equal to the maximum term of confinement which would have been imposed upon the defendant for the charged offense. §§ 16-8-112(2), -114.5(1), 8A C.R.S. (1986 1992 Supp.). The Department of Institutions supervises and controls the Institute. § 24-1-118(3)(c), 10A C.R.S. (1988 1992 Supp.). The Arapahoe County District Court also ordered a sanity examination pursuant to § 16-8-106(1), 8A C.R.S. (1986 1992 Supp.). The petitioner's sanity is not at issue in this case.
On July 29, 1992, the respondent trial court found the petitioner incompetent to proceed in this case and ordered the petitioner's commitment to the Institute for treatment. Medical personnel at the Institute determined that prolixin should be administered to the petitioner to prevent long-term deterioration. Although he initially refused to take the medication, the petitioner subsequently agreed to ingest two prolixin pills each day, one in the morning and one in the evening.
The record does not indicate the amount of prolixin contained in the pills administered to the petitioner.
On August 4, 1992, the petitioner ingested one pill. The following day he ingested two pills, as prescribed. On August 6, 1992, the petitioner refused to ingest the medication. That evening his right jaw became distorted, his tongue contracted, and he indicated he could not swallow. The drug cogentin was administered to the petitioner to counteract this reaction. When the petitioner subsequently refused to ingest prolixin, a petition was filed with the trial court requesting an order authorizing the Institute's staff to administer controlled doses of prolixin to treat the petitioner.
Cogentin is a trademark for preparations of benztropine mesylate, a powder having, inter alia, local anesthetic actions. Dorland's Illustrated Medical Dictionary 355 (27th ed. 1988).
The trial court conducted a hearing on the motion. The petitioner, who was present and was represented by counsel, did not offer any evidence on his behalf. The prosecution elicited testimony by telephone from one witness, Dr. Howard W. Fisher, who was at the time the petitioner's treating staff psychiatrist. Dr. Fisher stated that, based on hospital notes, information he received from staff who treated the petitioner on a daily basis, and his own observations of the petitioner, in his opinion the petitioner suffered from paranoid schizophrenia, had a history consistent with an antisocial personality disorder, and was a "very dangerous person." Dr. Fisher testified that while undergoing treatment at a California psychiatric hospital in connection with criminal charges in that state the petitioner had exhibited extreme and violent symptoms of paranoia and had received extraordinary high doses of the drug thorazine; that the petitioner had previously attempted suicide and had experienced a paranoid breakdown while incarcerated in the Colorado Department of Corrections; and that during his confinement at the Institute the petitioner had exhibited extreme anger and hostility, particularly when confronted about the reasons for his confinement.
The petitioner did make a brief statement to the trial court subsequent to the trial court's oral ruling.
Thorazine is a trademark for preparations of chlorpromazine hydrochloride, a powder used as a tranquilizer. Dorland's Illustrated Medical Dictionary 1716 (27th ed. 1988).
Dr. Fisher also noted that the petitioner provided little information about a head injury he had sustained and that the petitioner's attorney refused to release records to the Institute's staff.
Dr. Fisher further testified that fine movements of the tongue may indicate the onset of tardive dyskinesia; that muscle rigidity may suggest the onset of a potentially fatal disorder, neuroleptic malignant syndrome; and that both conditions are potential side effects of the use of prolixin. He stated that the petitioner's behavior was highly suspect because reactions to prolixin ordinarily occur soon after the medication is ingested. Dr. Fisher also testified that although the petitioner has not exhibited any assaultive behavior at the Institute, the petitioner continues to pose a threat to himself and others; that without prolixin the petitioner has made no progress; and that in his opinion it is necessary to administer prolixin to treat the petitioner, that effective less intrusive treatment alternatives are not available, and that reduced dosages of prolixin would minimize the likelihood of adverse reactions.
At the conclusion of the hearing, the trial court found that the petitioner is argumentative and verbally abusive, that he does not follow staff instructions, and that the side effects of prolixin usually occur after high doses have been given during an extended period of time and occur mostly with elderly people. It concluded that the petitioner is incompetent to participate effectively in treatment decisions, that administration of prolixin is necessary to prevent a significant and likely deterioration in the petitioner's mental condition or to prevent the likelihood of the patient causing serious bodily injury to himself or others, that no less intrusive treatment alternatives are available for the petitioner's condition, and that the necessity for effective treatment is sufficiently compelling to override the legitimate interest of the petitioner. The trial court ordered that the petitioner be administered a lesser dose of prolixin than had been prescribed in August of 1992 and that a review hearing be conducted shortly thereafter at which Dr. Fisher would appear and testify with respect to the progress of the petitioner's treatment as well as any side effects that the petitioner might suffer.
II
The petitioner argues that the trial court abused its discretion in ordering the administration of prolixin in the circumstances of this case. We disagree.
The well-established right of a patient involuntarily committed to a mental institution by means of civil adjudicatory proceedings to refuse administration of medication is grounded in constitutional principles, statutory standards and the common law of this state. Such commitment constitutes a severe infringement of the patient's interest in freedom from governmental restraint requiring protection under the Due Process Clauses of the United States and Colorado Constitutions. People v. Medina, 705 P.2d 961, 967 (Colo. 1985). As the United States Supreme Court recently stated, the unconsensual treatment by antipsychotic drugs of a person detained for trial violates federal constitutional due process guarantees "absent a finding of overriding justification and a determination of medical appropriateness." Riggins v. Nevada, ___ U.S. ___, ___, 112 S. Ct. 1810, 1815 (1992). The General Assembly has determined that a patient involuntarily committed for treatment by means of civil adjudication "shall not forfeit any legal right or suffer legal disability," § 27-10-104, 11B C.R.S. (1989), and that a person receiving mental health treatment is entitled to such treatment as will meet that person's needs. § 27-10-116(1)(a), 11B C.R.S. (1989).
In Goedecke v. Department of Institutions, 198 Colo. 407, 411, 603 P.2d 123, 125 (1979), this court held that a patient committed to a mental institution by means of civil adjudication has a qualified common-law right to decline treatment by antipsychotic medication. See also Schloendorff v. Society of New York Hosp., 105 N.E. 92, 93 (1914). In Medina, we reaffirmed this common-law right. 705 P.2d at 971. We also recognized, however, that treatment by antipsychotic medication could be forcibly administered to such patient if in an adversary proceeding the petitioning party establishes the following four factors 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 that the patient will cause serious harm to the patient or to 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 973. In People v. Gilliland, 769 P.2d 477, 483 (Colo. 1989), we found the Medina criteria applicable in a proceeding to determine whether antipsychotic medication should be administered by Colorado State Hospital staff for treatment of a non-consenting defendant involuntarily committed to the Department of Institutions in connection with criminal proceedings.
In this case, the petitioner does not argue that the trial court failed to apply the proper criteria, as articulated in Medina. The petitioner contends, however, that the trial court seriously abused its discretion in concluding that the four factors articulated in Medina were established by clear and convincing evidence. Brewer v. District Court, 655 P.2d 819, 820 (Colo. 1982); see Halaby, McCrea Cross v. Hoffman, 831 P.2d 902, 905 (Colo. 1992). We reject this argument.
The trial court heard uncontradicted testimony from the petitioner's treating staff psychiatrist that the petitioner is incompetent to participate in treatment decisions and has disrupted efforts to provide other treatment alternatives; that in the absence of treatment by reduced doses of prolixin the petitioner will likely continue to constitute a significant danger to himself and others; and that no less intrusive effective means of treating the petitioner are available. The psychiatrist's testimony was neither objected to nor controverted by contrary evidence. In view of the record as a whole, the trial court did not abuse its discretion in concluding that the People had established the first three factors articulated in Medina by clear and convincing evidence. See People v. Stevens, 761 P.2d 768, 775 (Colo. 1988); People v. Lane, 196 Colo. 42, 48, 581 P.2d 719, 723 (1978); People v. Pflugbeil, 834 P.2d 843, 847 (Colo.App. 1992).
With respect to the fourth Medina factor, the petitioner emphasizes that because he suffered serious side effects from ingesting prolixin, the People failed to establish by clear and convincing evidence that his need for effective treatment was sufficiently compelling to override his legitimate interest in refusing treatment. We again disagree.
The trial court found, as Dr. Fisher testified, that the usual side effects of this particular drug most frequently occur soon after the medication is administered, but that the petitioner did not appear to suffer any side effects until some twenty-four hours after the last dosage was ingested. The trial court also found that during the first two days the drug was administered the petitioner did not suffer any side effects and that when the petitioner ultimately exhibited an apparent adverse reaction to the drug, that he was in "good shape" within fifteen to twenty minutes after an antidote was administered. Although Dr. Fisher suggested that the petitioner in fact may not have experienced a serious reaction to the medication, the trial court recognized the potentially serious side effects of use of the drug by ordering that a lower dose of prolixin be administered and requiring that a hearing be conducted soon after such treatment in order to evaluate the petitioner and his treatment.
In our view, the testimony as a whole establishes not only that administration of the drug prolixin is essential for the treatment of the petitioner, but also that the recommended diminished dosage sufficiently reduces the danger of significant adverse reactions to establish by clear and convincing evidence that the need for the drug, administered as ordered by the trial court, outweighs all legitimate interests the petitioner has in refusing such treatment. We therefore conclude that the trial court did not abuse its discretion in determining that the fourth Medina factor was satisfied in this case.
III
For the foregoing reasons, the rule to show cause is discharged.
JUSTICE SCOTT dissents, and JUSTICE LOHR joins in the dissent.