25CA1233 Peo in Interest of Cota-Martinez 10-30-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1233 Pueblo County District Court No. 24MH30040 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Alexis Omar Cota-Martinez,
Respondent-Appellant.
ORDER AFFIRMED
Division V Opinion by JUDGE FREYRE Pawar and Yun, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced October 30, 2025
Cynthia Mitchell, County Attorney, Kate H. Shafer, Special Assistant County Attorney, Pueblo, Colorado, for Petitioner-Appellee
Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant ¶1 Alexis Omar Cota-Martinez appeals the district court’s order
authorizing staff at the Colorado Mental Health Hospital in Pueblo
(the hospital) to medicate him without his consent. We affirm.
I. Background
¶2 Cota-Martinez was admitted to the hospital in May 2024 after
being found incompetent to proceed in three criminal cases. He
was diagnosed with an unspecified schizophrenia spectrum and
other psychotic disorder. His symptoms have included auditory
hallucinations, responding to people or voices that are not there,
paranoid ideation, disorganized thought processes, and
disorganized speech. The record indicates that he assaulted jail
guards shortly before his hospital admission and has threatened to
harm staff and peers at the hospital.
¶3 In June 2024 and again in December 2024, the district court
granted the State’s petitions to involuntarily medicate
Cota-Martinez. The December 2024 order authorized the
involuntary administration of three medications: Zyprexa
(olanzapine), Invega (paliperidone), and Depakote (valproic acid).
1 ¶4 In June 2025, the State filed the petition at issue seeking to
involuntarily medicate Cota-Martinez with the same three
medications.
¶5 At the hearing on the petition, Cota-Martinez’s psychiatrist
and Cota-Martinez testified. The psychiatrist, an expert in clinical
psychiatry, testified that Cota-Martinez’s mental illness constitutes
a substantial disorder that severely impairs his judgment, his
ability to recognize reality, or his capacity to control his behavior.
According to the psychiatrist, Cota-Martinez needs psychiatric
medications and, since taking the medications, his most severe and
distressing symptoms have significantly improved; he has not
exhibited any aggressive behavioral outbursts. The psychiatrist
opined that discontinuing his medications would likely result in a
return of his auditory hallucinations and paranoid delusional
thought processes, increase the risk of harm to others at the
hospital, and cause significant and long-term deterioration in his
mental health. The psychiatrist further testified that Cota-Martinez
lacks any insight into his mental illness, does not recognize that his
symptoms have improved, and believes that his condition would be
unchanged whether or not he takes medication.
2 ¶6 Cota-Martinez testified that he does not have a mental illness,
and characterized the psychiatrist’s testimony as a “lie.”
Cota-Martinez also testified that he does not need the medications
and that they do not “do anything positive to help [him] in any way.”
He further testified that he does not pose a danger to others.
¶7 The district court found that the psychiatrist had testified
credibly and persuasively, and adopted the psychiatrist’s opinions.
The court then analyzed the four elements of the test from People v.
Medina, 705 P.2d 961, 973 (Colo. 1985), found that the State had
met its burden of proving all four elements by clear and convincing
evidence, and granted the petition.
II. Applicable Law and Standard of Review
¶8 The parties agree that the Medina test applies here. Under
that test, a district court may authorize the involuntary
administration of medication if the State demonstrates by clear and
convincing evidence that (1) the patient is incompetent to effectively
participate in the treatment decision; (2) the treatment is necessary
to prevent a significant and likely long-term deterioration in the
patient’s mental health condition or to prevent the likelihood of the
patient causing serious harm to himself or others at the institution;
3 (3) a less intrusive treatment alternative is not available; and (4) the
patient’s need for treatment is sufficiently compelling to override
any bona fide and legitimate interest of the person in refusing
treatment. Id.1
¶9 Application of the Medina test involves mixed questions of fact
and law. People v. Marquardt, 2016 CO 4, ¶ 8. We defer to the
district court’s factual findings if they have record support, while we
review the court’s legal conclusions de novo. Id. Resolving conflicts
in testimony and determining the credibility of the witnesses are
matters solely within the province of the district court. People in
Interest of Ramsey, 2023 COA 95, ¶ 23.
¶ 10 We must affirm the district court’s ruling if the evidence,
viewed as a whole and in the light most favorable to the State, is
1 A different test applies to petitions to administer medication
involuntarily for the purpose of restoring competency for a criminal proceeding. See People in Interest of R.F., 2019 COA 110, ¶¶ 10-15 & n.1 (discussing the test from Sell v. United States, 539 U.S. 166, 180 (2003)). Although Cota-Martinez was admitted to the hospital for that purpose, the petition’s stated purpose, and the district court’s basis for granting the petition, was to prevent a significant and long-term deterioration in his mental condition and to prevent the likelihood of him causing serious harm to others at the hospital, which are relevant to the second Medina element. See R.F., ¶ 11 n.1.
4 sufficient to support the court’s order. People in Interest of R.K.L.,
2016 COA 84, ¶ 13. The testimony of the physician seeking to
administer treatment may be sufficient, without more, to satisfy the
Medina test. Id. at ¶ 30.
III. Analysis
¶ 11 Cota-Martinez does not contest the district court’s rulings that
the People met their burden of proving the second, third, and fourth
Medina elements. However, he challenges the sufficiency of the
evidence supporting the first Medina element — that he is
incompetent to effectively participate in the treatment decision.
¶ 12 The district court found Cota-Martinez incompetent to
effectively participate in treatment decisions because he does not
believe he has a mental illness and lacks insight into his mental
illness, and because he does not believe the medications are helping
him, despite the evidence that they are.
¶ 13 Given the district court’s credibility determinations, these
findings by the court are well supported by the record. See
Marquardt, ¶ 8; Ramsey, ¶ 23. By crediting the psychiatrist’s
testimony, the court found that Cota-Martinez suffers from
unspecified schizophrenia spectrum and other psychotic disorder.
5 The court also specifically rejected Cota-Martinez’s denial of mental
illness. That supports the psychiatrist’s testimony and the court’s
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25CA1233 Peo in Interest of Cota-Martinez 10-30-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1233 Pueblo County District Court No. 24MH30040 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Alexis Omar Cota-Martinez,
Respondent-Appellant.
ORDER AFFIRMED
Division V Opinion by JUDGE FREYRE Pawar and Yun, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced October 30, 2025
Cynthia Mitchell, County Attorney, Kate H. Shafer, Special Assistant County Attorney, Pueblo, Colorado, for Petitioner-Appellee
Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant ¶1 Alexis Omar Cota-Martinez appeals the district court’s order
authorizing staff at the Colorado Mental Health Hospital in Pueblo
(the hospital) to medicate him without his consent. We affirm.
I. Background
¶2 Cota-Martinez was admitted to the hospital in May 2024 after
being found incompetent to proceed in three criminal cases. He
was diagnosed with an unspecified schizophrenia spectrum and
other psychotic disorder. His symptoms have included auditory
hallucinations, responding to people or voices that are not there,
paranoid ideation, disorganized thought processes, and
disorganized speech. The record indicates that he assaulted jail
guards shortly before his hospital admission and has threatened to
harm staff and peers at the hospital.
¶3 In June 2024 and again in December 2024, the district court
granted the State’s petitions to involuntarily medicate
Cota-Martinez. The December 2024 order authorized the
involuntary administration of three medications: Zyprexa
(olanzapine), Invega (paliperidone), and Depakote (valproic acid).
1 ¶4 In June 2025, the State filed the petition at issue seeking to
involuntarily medicate Cota-Martinez with the same three
medications.
¶5 At the hearing on the petition, Cota-Martinez’s psychiatrist
and Cota-Martinez testified. The psychiatrist, an expert in clinical
psychiatry, testified that Cota-Martinez’s mental illness constitutes
a substantial disorder that severely impairs his judgment, his
ability to recognize reality, or his capacity to control his behavior.
According to the psychiatrist, Cota-Martinez needs psychiatric
medications and, since taking the medications, his most severe and
distressing symptoms have significantly improved; he has not
exhibited any aggressive behavioral outbursts. The psychiatrist
opined that discontinuing his medications would likely result in a
return of his auditory hallucinations and paranoid delusional
thought processes, increase the risk of harm to others at the
hospital, and cause significant and long-term deterioration in his
mental health. The psychiatrist further testified that Cota-Martinez
lacks any insight into his mental illness, does not recognize that his
symptoms have improved, and believes that his condition would be
unchanged whether or not he takes medication.
2 ¶6 Cota-Martinez testified that he does not have a mental illness,
and characterized the psychiatrist’s testimony as a “lie.”
Cota-Martinez also testified that he does not need the medications
and that they do not “do anything positive to help [him] in any way.”
He further testified that he does not pose a danger to others.
¶7 The district court found that the psychiatrist had testified
credibly and persuasively, and adopted the psychiatrist’s opinions.
The court then analyzed the four elements of the test from People v.
Medina, 705 P.2d 961, 973 (Colo. 1985), found that the State had
met its burden of proving all four elements by clear and convincing
evidence, and granted the petition.
II. Applicable Law and Standard of Review
¶8 The parties agree that the Medina test applies here. Under
that test, a district court may authorize the involuntary
administration of medication if the State demonstrates by clear and
convincing evidence that (1) the patient is incompetent to effectively
participate in the treatment decision; (2) the treatment is necessary
to prevent a significant and likely long-term deterioration in the
patient’s mental health condition or to prevent the likelihood of the
patient causing serious harm to himself or others at the institution;
3 (3) a less intrusive treatment alternative is not available; and (4) the
patient’s need for treatment is sufficiently compelling to override
any bona fide and legitimate interest of the person in refusing
treatment. Id.1
¶9 Application of the Medina test involves mixed questions of fact
and law. People v. Marquardt, 2016 CO 4, ¶ 8. We defer to the
district court’s factual findings if they have record support, while we
review the court’s legal conclusions de novo. Id. Resolving conflicts
in testimony and determining the credibility of the witnesses are
matters solely within the province of the district court. People in
Interest of Ramsey, 2023 COA 95, ¶ 23.
¶ 10 We must affirm the district court’s ruling if the evidence,
viewed as a whole and in the light most favorable to the State, is
1 A different test applies to petitions to administer medication
involuntarily for the purpose of restoring competency for a criminal proceeding. See People in Interest of R.F., 2019 COA 110, ¶¶ 10-15 & n.1 (discussing the test from Sell v. United States, 539 U.S. 166, 180 (2003)). Although Cota-Martinez was admitted to the hospital for that purpose, the petition’s stated purpose, and the district court’s basis for granting the petition, was to prevent a significant and long-term deterioration in his mental condition and to prevent the likelihood of him causing serious harm to others at the hospital, which are relevant to the second Medina element. See R.F., ¶ 11 n.1.
4 sufficient to support the court’s order. People in Interest of R.K.L.,
2016 COA 84, ¶ 13. The testimony of the physician seeking to
administer treatment may be sufficient, without more, to satisfy the
Medina test. Id. at ¶ 30.
III. Analysis
¶ 11 Cota-Martinez does not contest the district court’s rulings that
the People met their burden of proving the second, third, and fourth
Medina elements. However, he challenges the sufficiency of the
evidence supporting the first Medina element — that he is
incompetent to effectively participate in the treatment decision.
¶ 12 The district court found Cota-Martinez incompetent to
effectively participate in treatment decisions because he does not
believe he has a mental illness and lacks insight into his mental
illness, and because he does not believe the medications are helping
him, despite the evidence that they are.
¶ 13 Given the district court’s credibility determinations, these
findings by the court are well supported by the record. See
Marquardt, ¶ 8; Ramsey, ¶ 23. By crediting the psychiatrist’s
testimony, the court found that Cota-Martinez suffers from
unspecified schizophrenia spectrum and other psychotic disorder.
5 The court also specifically rejected Cota-Martinez’s denial of mental
illness. That supports the psychiatrist’s testimony and the court’s
finding that Cota-Martinez lacks insight into his mental illness,
which prevents him from effectively participating in treatment
decisions. See R.K.L., ¶¶ 6-7, 33 (affirming the probate court’s
finding that the patient was incompetent to effectively participate in
treatment decisions where the patient’s psychiatrist diagnosed the
patient with schizophrenia with possible bipolar disorder, but the
patient denied having a mental illness).
¶ 14 Contrary to Cota-Martinez’s argument, his recognition that he
was previously diagnosed with schizophrenia is irrelevant, given
that he does not believe he has a mental illness.
¶ 15 Similar to the disagreement over Cota-Martinez’s diagnosis,
the psychiatrist testified that Cota-Martinez needs the medications
to continue improving, but Cota-Martinez testified that the
medications provided no benefit. In crediting the psychiatrist’s
testimony, the court found that Cota-Martinez had shown “clear
improvement while he’s on the medications.” Given this finding,
Cota-Martinez’s insistence that he does not need the medications,
coupled with the evidence that he will not take the medications
6 voluntarily, further support the court’s finding that he is
incompetent to effectively participate in treatment decisions. See
People in Interest of Strodtman, 293 P.3d 123, 131-32 (Colo. App.
2011) (affirming the magistrate’s finding that the patient was
incompetent to effectively participate in treatment decisions where
she denied having schizophrenia, did not accept the need for
medication, and had a history of noncompliance).
¶ 16 Cota-Martinez argues that (1) “there is objective evidence in
the record that supports his belief that the medications have not
been as effective as the State contends” and (2) the medications are
“clearly not entirely effective.” (Emphasis added.) True, the
psychiatrist testified that although Cota-Martinez’s most impairing
and distressing symptoms have significantly improved, he “does
continue to show some other signs of psychosis.” But
Cota-Martinez testified that the medications do not “do anything
positive to help [him] in any way.” (Emphasis added.) Given the
district court’s credibility determinations, the stark contrast
between the psychiatrist’s testimony and Cota-Martinez’s testimony
supports the finding that he is incompetent to effectively participate
in treatment decisions.
7 ¶ 17 Finally, Cota-Martinez makes a broader argument that if a
patient can be deemed incompetent to effectively participate in a
treatment decision based solely on the patient’s mere disagreement
with a physician’s diagnosis and planned use of medication, then
the first Medina element will be met in every case involving a
contested petition for involuntary medication, rendering the first
Medina element “meaningless.” We need not address that broader
issue here because this case involved the diametrically opposed
opinions: the psychiatrist’s credited testimony that Cota-Martinez
has a mental illness and needs medication, versus Cota-Martinez’s
testimony that he neither has a mental illness nor requires
medication.
IV. Disposition
¶ 18 The order is affirmed.
JUDGE PAWAR and JUDGE YUN concur.