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People in the Interest of Ramsey.

2023 COA 95. No. 23CA1100. Treatment of Persons With Mental Health Disorders—Involuntary Medication Administration—Certification for Short-Term Treatment—Hearing Procedures—Medina Factors.

October 12, 2023

Ramsey was arrested for trespassing at an encampment. The jail’s psychiatric team suspected that she was suffering from significant paranoia and delusions, so they placed her on a mental health hold. Ramsey was transported to Denver Health Medical Center (DHMC), which admitted her into an inpatient unit, and her treating psychiatrist diagnosed her with delusional disorder. DHMC filed a notice of certification for short-term treatment and moved for involuntary medication administration authority in the probate court. The court appointed counsel for Ramsey, who filed a motion to dismiss on statutory grounds and a motion to continue and for discovery, arguing that more time was required to obtain and review Ramsey’s medical records and for her to undergo a medical examination. The probate court denied both motions and, after a hearing, it granted the People’s motion for involuntary medication administration.

On appeal, Ramsey argued that the probate court violated her due process rights by denying her continuance motion because her counsel was appointed late in the afternoon on a Friday and the hearing was held the following Tuesday. She maintained that the probate court was required to reschedule the hearing to a later date within the 10-day statutory period because her counsel had insufficient time to obtain and review the documents necessary to prepare for the hearing. Under CRS § 27-65-113(5)(a), when the probate court receives a petition for a short-term involuntary treatment certification and authorization to involuntarily administer medication, it must appoint an attorney to represent the respondent and hear the matter within 10 days. Here, the probate court followed these statutory procedures, so no statutory deviation prejudiced Ramsey’s procedural due process rights. The record also shows that Ramsey had the opportunity to meet with her counsel, and counsel was offered access to the medical records in DHMC’s possession. Further, the probate court properly weighed Ramsey’s counsel’s ability to prepare, his experience, and his familiarity with these types of cases against the severity of Ramsey’s present need for treatment. Accordingly, the probate court did not abuse its discretion by denying Ramsey’s continuance motion.

Ramsey also contended that there was insufficient evidence to support the probate court’s conclusion that she has a mental health disorder that causes her to be gravely disabled. To authorize short-term treatment, the probate court must find, by clear and convincing evidence, that the respondent has a mental health disorder that results in the respondent posing a danger to herself or others or being gravely disabled. Here, the probate court credited the treating psychiatrist’s testimony and not Ramsey’s testimony to find, based on clear and convincing evidence, that Ramsey had a delusional disorder that impaired her judgment and that she was gravely disabled. The court properly weighed the conflicting evidence, which sufficiently supported its order.

Ramsey further argued that the probate court erred in ordering involuntary medication administration because insufficient evidence supported its findings under People v. Medina, 705 P.2d 961 (Colo. 1985). Under Medina, an involuntary medication administration order must be supported by clear and convincing evidence that (1) the patient is incompetent to effectively participate in the treatment decision; (2) antipsychotic medication is necessary to prevent a likely long-term deterioration of the patient’s mental condition or to prevent the likelihood of the patient causing serious self-harm or harm to others; (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 the patient’s legitimate interest in refusing treatment. Here, the court’s factual findings on all of the Medina factors are supported by sufficient record evidence and are thus entitled to deference. Accordingly, the order authorizing involuntary medication administration was properly entered.

The order was affirmed.

Official Colorado Court of Appeals proceedings can be found at the Colorado Court of Appeals website.

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