Goedecke v. State, Dept. of Institutions
| Decision Date | 10 October 1979 |
| Docket Number | No. 28179,28179 |
| Citation | 603 P.2d 123,198 Colo. 407 |
| Parties | Ralph GOEDECKE, Appellant, v. STATE of Colorado, DEPARTMENT OF INSTITUTIONS, Appellee. |
| Court | Colorado Supreme Court |
David E. Skaggs, Skaggs, Stone & Sheehy, Boulder, for appellant.
J. D. MacFarlane, Atty. Gen., Joseph N. de Raismes, First Asst. Atty. Gen., Human Resources Section, Dennis J. Sousa, Edward R. Martinez, Asst. Attys. Gen., Denver, for appellee.
James W. Dean, Denver, for amicus curiae Legal Aid Soc. of Metropolitan Denver, Inc.
Lynn K. Daily, Boulder, for amicus curiae Boulder County Legal Services.
Marianne Wesson, Boulder, for amicus curiae American Civil Liberties Union of Colo.
Betty L. Nordwind, Denver, for amicus curiae Colo. Bar Ass'n, Office for the Mentally Disabled.
The district court held that the Mental Health Center of Boulder County, Inc. (MHC) could administer to the appellant Goedecke, in spite of his objections, an antipsychotic drug (prolixin decanoate). Goedecke appealed directly to this Court pursuant to section 13-4-102(1)(b), C.R.S.1973. The State of Colorado, Department of Institutions (State) became a party appellee in this Court in order to defend the regulations put in issue by the appellant. We reverse the order of the district court, and hold that appellant is entitled to a trial transcript at state expense.
Goedecke underwent a court-requested psychiatric evaluation and was diagnosed as a paranoid schizophrenic. The examining psychiatrist determined that he was dangerous and gravely disabled. 1 Goedecke then was certified and detained for short-term mental treatment. 2
At the certification hearing, a psychiatrist testified that Goedecke would be confined for treatment for up to three weeks at a psychiatric hospital, and would be treated with prolixin thereafter on an outpatient basis. Prolixin had been selected to alter his psychotic thought patterns and to minimize his dangerousness.
Testimony at the hearing adduced that, aside from its behavior-modifying capacity, prolixin can generate such short-term side effects as stiffness, shakiness, restlessness and dizziness. Moreover, it was established that prolixin therapy can produce a long-term neurological condition called tardive dyskinesia. This condition initially causes involuntary tongue and lip movement. It may progress to involuntary movement of other muscles such as arm, shoulder and trunk muscles, and may cause permanent disability. Indeed, Goedecke's reason for refusing prolixin treatment was that he had previously been treated with the drug and had experienced some of its short-term adverse side effects, including passing out, falling down, loss of breath, stiff tongue, disordered thinking and a feeling like being "half dead."
The appellant's expert medical witness, a psychiatrist, testified that prolixin causes severe side effects in half of the patients treated with it. 3 He also suggested that "milieu therapy" 4 and psychotherapy are available as alternative and preferred methods of treating paranoid schizophrenia.
In spite of the appellant's persistent protestations, based on his prior experience of adverse side effects, prolixin medication was continued. In fact, because of his resistance, it was given in long-lasting injections. These injections, which transmit the drug's effects for up to eight weeks, were continued even after a written notice refusing such treatments, signed by the appellant, was placed in the hospital chart and brought to the treating psychiatrist's attention.
The issue is whether the appellant must submit to prolixin therapy without his consent and over his objection. Appellant asserts that forcing this drug on him violated his legal and constitutional rights. Since we agree with his contention that Colorado law protects one in his situation from being forced to undergo treatment with drugs having serious deleterious side effects, we need not reach the constitutional issues raised. 5 Times Call Publishing Co. v. Wingfield, 159 Colo. 172, 176-177, 410 P.2d 511, 513 (1966).
Goedecke was certified for short-term treatment under section 27-10-107, C.R.S.1973 (and 1978 Cum.Supp.). The entire tenor of the Article in which that section appears is to recognize and protect the dignity and legal rights 6 of patients treated pursuant to its provisions. Among the purposes of Article 27-10 declared by the General Assembly are:
(c) To provide the fullest possible measure of privacy, dignity, and other rights to persons undergoing care and treatment for mental illness;
(d) To encourage the use of voluntary rather than coercive measures to secure treatment and care for mental illness.
Section 27-10-101(1), C.R.S.1973.
Moreover, the legislature has directed that this statute is to be "liberally construed" to carry out these purposes. Section 27-10-101(2), C.R.S.1973.
Section 27-10-104 declares that: "Unless specifically stated in an order by the court, a respondent shall not forfeit any legal right or suffer legal disability by reason of the provisions of this article." There is no provision, in any court order in the record before us, declaring the appellant legally disabled from exercising whatever legal right a medical patient normally has to decline treatment with a dangerous or obnoxious drug.
The courts of this state have long acknowledged the physician's obligation to obtain the patient's informed consent not only for surgery, 7 but also for treatment with drugs having possible harmful side effects. 8 As Justice Cardozo declared in Schloendorff v. Society of New York Hospitals, 211 N.Y. 125, 105 N.E. 92, 93 (1914), "(e)very human being of adult years and sound mind has a right to determine what shall be done with his own body." The above cited statutory provisions recognize that mental and emotional illnesses are not crimes and that hospitalization for their treatment is not to be confused with incarceration for punishment. It would be inconsistent with the statutes' spirit and purpose to insist that a patient's common law right to decline medical treatment is abrogated by short-term certification alone. Instead we conclude that this right is to be numbered among those protected by C.R.S.1973, 27-10-104 and is therefore preserved intact 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.
The record in this case contains no finding that appellant lacked the capacity to participate in such decisions or that his refusal to submit to treatment with prolixin was itself irrational or unreasonable. Lacking such findings, we conclude that the statutory and common law of this state afford the appellant a right to withhold consent to the administration of prolixin in non-emergency circumstances.
After the certification hearing, appellant petitioned the trial court for permission to proceed with the appeal 9 In forma pauperis and for provision, at state expense, of a transcript of the hearing. The court allowed the appellant to proceed In forma pauperis, but denied the transcript at state expense on the basis that a mental health proceeding is a civil matter. 10
Mental commitment proceedings technically are civil, but the procedures 11 and resulting deprivation of liberty are more akin to the criminal process. It has long been the rule that an indigent criminal appellant is entitled constitutionally to a trial transcript at state expense. Griffin v. Illinois, 351 U.S. 12, 76 S.Ct. 585, 100 L.Ed. 891 (1956); In re Patterson's Petition, 136 Colo. 401, 317 P.2d 1041 (1957).
This Court allowed a transcript at state expense in Habeas corpus proceedings, labelled as "civil", because a transcript was necessary to challenge a criminal conviction. Williams v. District Court, 160 Colo. 348, 417 P.2d 496 (1966). However, a transcript at state expense was not required in civil proceedings involving rescission of a contract. Almarez v. Carpenter, 173 Colo. 284, 477 P.2d 792 (1970).
Mental commitment proceedings, however, concern questions of personal liberty and due process protection. The U.S. Court of Appeals for the Tenth Circuit, requiring a right to counsel in mental commitment proceedings, described the strict due process requirements necessary when a serious deprivation of liberty may result:
Heryford v. Parker, 396 F.2d 393, 396 (10th Cir. 1968).
This Court has affirmed the high due process standard required for mental commitment:
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