Background
G.S. was admitted to Denver Health in June 2026 after his mother brought him to the hospital. His treating psychiatrist testified that G.S., who had schizophrenia and recurrent catatonia, was largely mute, intermittently followed commands, had a low body mass index, and showed signs of malnutrition. G.S. had previously responded favorably to ECT.
The Denver City Attorney sought short-term certification and authorization to administer ECT without G.S.’s consent. The psychiatrist testified that G.S.’s catatonia was worsening despite Ativan, that a recently administered long-acting antipsychotic could worsen catatonia, and that without ECT G.S. faced minimal food and fluid intake, malnutrition, renal failure, and other physical deterioration. G.S. opposed ECT, denied that he had catatonia, preferred a lower Ativan dose, and cited memory problems from prior ECT.
The Court’s Holding
The Colorado Court of Appeals affirmed the magistrate’s order authorizing involuntary ECT. G.S. challenged only the fourth requirement under People v. Medina: whether his need for treatment was sufficiently compelling to override his bona fide and legitimate interests in refusing it.
The court held that the record supported that finding by clear and convincing evidence. The magistrate considered G.S.’s objections, found his concerns about his preferred Ativan dose and memory effects from ECT bona fide and legitimate, and nonetheless credited the psychiatrist’s testimony that ECT was vital, had helped G.S. before, and was less harmful than the consequences of leaving his catatonia untreated.
Key Takeaways
- An involuntary ECT order may be upheld when clear and convincing evidence shows the need for treatment outweighs the patient’s legitimate refusal interests.
- The fact finder may credit a treating psychiatrist’s testimony over a patient’s contrary account of symptoms and treatment need.
- Memory loss and anesthesia risks did not preclude ECT where evidence showed serious risks from untreated catatonia and a favorable prior response to ECT.
Why It Matters
The decision applies Colorado’s Medina framework to involuntary ECT and emphasizes that the fourth element requires consideration of the patient’s actual objections, not simply a determination that ECT is medically preferred. Here, the magistrate satisfied that requirement by recognizing G.S.’s legitimate concerns and weighing them against evidence of substantial psychiatric and physical danger without treatment.