Background
Chaz Dillinger McGee was found incompetent to proceed on criminal charges while in jail. After jail staff treated his psychiatric symptoms with the antipsychotic Zyprexa and mood stabilizer Depakote for about three months, McGee stopped taking the medications. Following his admission to the Colorado Mental Health Hospital in Pueblo, staff observed worsening delusions, responses to internal stimuli, bizarre behavior, disorganized thinking, and emerging paranoia.
The People sought authorization to administer Risperdal, Zyprexa, and Depakote involuntarily. After hearing testimony from McGee and his treating psychiatrist, Dr. Hareesh Pillai, the district court found all four requirements for involuntary medication under Colorado law satisfied by clear and convincing evidence. It authorized treatment and necessary monitoring tests for six months. McGee appealed, challenging the findings that no less intrusive treatment was available, that his need for medication outweighed his legitimate interests in refusing it, and that the court made sufficiently individualized findings.
The Court’s Holding
The Colorado Court of Appeals affirmed. It held that sufficient evidence supported the finding that the requested medications were the least intrusive effective treatment available. McGee’s testimony reflected, at most, an uncertain willingness to take unspecified alternatives, while Dr. Pillai explained that an antipsychotic and mood stabilizer were the first-line treatment, that medication had previously reduced McGee’s symptoms, and that his condition continued to deteriorate despite group treatment. The proposed use of Risperdal in place of Zyprexa also addressed McGee’s reported side effects, with Zyprexa reserved for situations in which he refused oral medication.
The court also upheld the finding that McGee’s need for treatment outweighed his bona fide interests in avoiding tiredness and conflict with his family. Credited testimony showed that without medication his condition would continue deteriorating, could become more resistant to treatment, and might not return to baseline. Finally, the district court’s findings were individualized rather than conclusory: they addressed McGee’s illness, symptoms, treatment needs, reported side effects, and reasons for refusing medication. The district court was permitted to credit and adopt the psychiatrist’s expert opinions.
Key Takeaways
- A treating physician’s credited testimony may supply clear and convincing evidence supporting involuntary medication.
- A patient’s vague or inconsistent willingness to consider unspecified medications does not establish an available, equally effective, and less harmful treatment alternative.
- A court may override legitimate medication-refusal interests when the evidence shows an unfavorable prognosis without treatment, including continuing deterioration and increasing treatment resistance.
Why It Matters
The decision illustrates the evidence needed to sustain an involuntary-medication order under Colorado’s four-part Medina test when treatment is sought to protect a patient’s health rather than solely to restore competency for trial. Prior treatment results, ongoing deterioration, efforts to reduce side effects, and the patient’s stated reasons for refusal can collectively support the required findings.
The unpublished opinion also confirms that individualized findings may rest substantially on a credited psychiatrist’s testimony, provided the court applies that evidence to the particular patient rather than merely reciting the governing legal test.