Court Opinion

ID: 9528740
Source: CourtListenerOpinion
Date Created: 2023-08-07 03:43:32.963148+00
Date Added: 2024-06-11T13:27:16.396541
License: Public Domain

ERICKSON, Justice,
dissenting:
In my view, the majority opinion improperly imposes restraints on the professional judgment of the supervising authorities at the state hospital and their obligation to treat certified psychiatric patients.
The committed mentally ill had no common law right to refuse drug therapy administered in the institution. Denny v. Tyler, 85 Mass. (3 Allen) 225, 227-29 (1861). Cf. Winters v. Miller, 446 F.2d 65, 74 (2d Cir.), cert. denied, 404 U.S. 985, 92 S.Ct. 450, 30 L.Ed.2d 369 (1971); Howard v. Howard, 87 Ky. 616, 623, 9 S.W. 411, 413 (1888); Price v. Sheppard, 307 Minn. 250, 239 N.W.2d 905 (1976). No court has held that committed mental patients have a specific constitutional right to refuse treatment while institutionalized. Plotkin, Limiting the Therapeutic Orgy: Mental Patients’ Right to Refuse Treatment, 72 Nw. U.L.Rev. 461, 491 (1978).
Colorado does provide that certified mentally ill patients “shall not forfeit any legal right or suffer legal disability” unless specified in a court order. § 27-10-104, 11 C.R.S. (1982). In Goedecke v. Colorado Department of Institutions, 198 Colo. 407, 603 P.2d 123 (1979), we declared that certified patients may refuse the drug Prolixin “in the absence of some finding, reached by a competent tribunal, that the patient’s illness has so impaired his judgment that he is incapable of participating in decisions affecting his health.” Id. at 411, 603 P.2d at 125. Incompetence can be shown by a finding that the patient lacks the capacity to participate in the decision or that the refusal of treatment is irrational or unreasonable. Id.
*976In Goedecke, the patient was able to participate in making the decision to use Prolixin. Medina is not able to cooperate with the mental health experts or his lawyers in making a treatment decision. He has an attention span of approximately thirty seconds, and has not been able to participate in discussions with his psychiatrist regarding drug therapy. Medina possesses the same rights as Goedecke, but the manner in which those rights are to be protected is the issue before us in this case. See In re A. W, 637 P.2d 366 (Colo.1981).
The department of institutions has a legitimate interest in providing treatment to those in its custody and in protecting the patients and personnel at the state hospital from dangerous and destructive conduct by certified patients. See Addington v. Texas, 441 U.S. 418, 99 S.Ct. 1804, 60 L.Ed.2d 323 (1979). The General Assembly, subsequent to the treatment hearing in this ease, created a procedure for a hearing when a mentally ill patient refuses to accept medication. The statute permits the certifying court to consider a petition by the treating physician to have the court enter an order requiring the patient to accept treatment or to have the treatment forcibly administered. § 27-10-111(4.5), 11 C.R.S. (1982).
It is of paramount importance that the treating authorities in the institution be given broad latitude to use their professional training and experience to develop effective therapeutic programs for certified patients. The physician in charge of the patient is clearly best able to diagnose the patient’s illness, prescribe the appropriate treatment (including the use of the antipsy-chotic drugs Prolixin and Thorazine), and monitor and control treatment and medication based on continuing observation of the patient. It is recognized that “[cjourts should tread cautiously in reviewing medical decisions since they lack the competence to prescribe the details of adequate treatment....” Gaughan & LaRue, The Right of a Mental Patient to Refuse Anti-psychotic Drugs in an Institution, 4 Law & Psychology Rev. 43, 45 (1978) (footnote omitted).
The majority opinion and the court of appeals opinion unnecessarily extend the level of judicial review required by Goe-decke. The majority’s four-part test essentially amounts to a substitution of a trial court’s judgment for that of the mental health experts at the state hospital. The majority requires a trial court to determine that drug therapy is necessary to prevent the long-term deterioration of the patient’s condition and that a less intrusive treatment alternative is not available. It is clear that such findings are far beyond the expertise of a trial court, and the court would likely follow the advice of the mental health expert who gave the most convincing testimony at the hearing. The test laid down by the majority will unduly delay and interfere with the orderly administration of the state hospital. Psychiatric hospitals should be administered by mental health professionals and not by the courts. The courts are simply not qualified to prescribe treatment to be given patients at the state hospital in the first instance.
Medina was involuntarily certified by the probate court for psychiatric treatment. The state then petitioned the probate court for an- order allowing treating authorities to medicate the patient despite the patient’s objections. The court determined that respondent was incompetent to participate in the decision to use medication.1 I would hold that once a certified patient is judicially determined to be incompetent to participate in the medication decision (the Goe-decke test), the patient no longer has the right to arbitrarily refuse antipsychotic *977drugs prescribed by state treating authorities in the first instance. Medina was committed to the supervision of mental health experts who were charged with responsibility for his care and treatment.
A certified, incoippetent patient can always seek posttreatment review of the treatment decision under section 27-10-112, 11 C.R.S. (1982).
I would reverse the court of appeals and affirm the probate court’s order directing that the treating physician may administer antipsychotic medications to respondent.

.The probate court treatment order reads, in full:
THIS MATTER having come on for hearing on July 21, 1981 at 10:00 A.M. and the Court having heard the testimony of Kenneth L. Weiner, M.D., as well as arguments of counsel the Court FINDS:
1. The Respondent is mentally ill with a diagnosis of paranoia and the evidence in support thereof was clear and convincing.
2. As a result of the paranoia and delusions suffered by Respondent, the Respondent is not able to participate in a decision concerning treatment with medications.
3. The Court will substitute its judgment for Respondent on the basis that Respondent’s *977refusal to take medications was unreasonable. The evidence suggests that with regular medication Respondent will most probably experience less anxiety resulting in his release to a less restrictive environment and permit Respondent to live a more stable life.
4. The medical chart does not reflect any past major side effects from the use of anti-psychotic medication. The doctor’s testimony also suggests that tardive dyskinesia and other side effects from the use of antipsychotic medications can be properly monitored and controlled.
5. The risk of tardive dyskinesia is not so great so as to preclude the use of antipsy-chotic medications such as Prolixin and Thorazine.
IT IS THEREFORE ORDERED that:
1. The physician attending Respondent may administer antipsychotic medications such as Prolixin and Thorazine, however, without limitations to the two medicines and the attending physician shall use whatever medical procedures good medical practice would direct to properly monitor and control the medications.
2. This Order permitting the use of involuntary medication shall exist so long as the Respondent is under certification.
3. The Clerk of this Court issue copies of this Order, duly certified, to the Respondent, to Respondent’s attorney and to Fort Logan Mental Health Center.