24CA1912 Peo in Interest of AC 01-09-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 24CA1912 Pueblo County District Court No. 24MH30101 Honorable Timothy O'Shea, Judge
People of the State of Colorado,
Petitioner-Appellee,
In the Interest of A.C.
Respondent-Appellant.
ORDER AFFIRMED
Division V Opinion by JUDGE SULLIVAN Freyre and Schock, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced January 9, 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 A.C. appeals the district court’s order authorizing the
involuntary administration of medication. We affirm.
I. Background
¶2 A.C. was committed to the Colorado Mental Health Hospital in
Pueblo (CMHHIP) after being found incompetent to proceed in a
criminal case. He was diagnosed with an unspecified schizophrenia
spectrum and other psychotic disorder and presented with
significant paranoid delusions and auditory hallucinations. Since
his admission to the hospital in January 2021, A.C. had
consistently refused all medication. However, after an incident with
another patient in October, 2024, he was started on an emergency
course of Zyprexa (Olanzapine), an antipsychotic. At the request of
CMHHIP staff psychiatrist Dr. Paul Mattox, the People petitioned
the district court to authorize the involuntary administration of
Zyprexa.
¶3 The district court held an evidentiary hearing at which Dr.
Mattox and A.C. testified. Dr. Mattox explained A.C.’s disorder and
accompanying symptoms. And he described the requested
medication, its side effects, and its necessity for treating A.C.’s
symptoms. A.C. for the most part denied having a mental illness,
1 explaining, “If I do, I don’t think it’s that bad.” And while he
testified that he was agreeable to taking Zyprexa, he also testified
that he would stop taking it once he started to develop “a
tolerance.”
¶4 Finding that Dr. Mattox testified “credibly and persuasively,”
the district court granted the petition and entered an order
authorizing the involuntary administration of Zyprexa.
II. Legal Principles and Standard of Review
¶5 An involuntarily committed person retains the right to refuse
treatment. See People v. Medina, 705 P.2d 961, 971 (Colo. 1985).
Even so, a court may authorize the involuntary administration of
medication if the People prove the following elements by clear and
convincing evidence:
(1) the patient is incompetent to effectively participate in the treatment decision;
(2) treatment by antipsychotic medication is necessary to prevent a significant and likely long-term deterioration in the patient’s mental condition or to prevent the likelihood of the patient’s causing serious harm to himself or others in the institution;
(3) a less intrusive treatment alternative is not available; and
2 (4) the patient’s need for treatment by antipsychotic medication is sufficiently compelling to override any bona fide and legitimate interest of the patient in refusing treatment.
Id. at 973.1 We determine whether the evidence, viewed as a whole
and in the light most favorable to the People, is sufficient to support
the court’s order. People in Interest of R.K.L., 2016 COA 84, ¶ 13. A
physician’s testimony alone may suffice to satisfy the Medina test.
Id. at ¶ 30.
¶6 Applying the Medina test presents a mixed question of fact and
law, meaning we defer to the district court’s factual findings if
supported by the record but review its legal conclusions de novo.
People in Interest of R.C., 2019 COA 99M, ¶ 7. As the fact finder,
the district court determines witness credibility; the sufficiency,
probative effect, and weight of the evidence; and the inferences and
conclusions to be drawn from it. Id.
1 A different test applies to petitions to administer involuntary
medication solely to restore competency. Sell v. United States, 539 U.S. 166, 180-81 (2003). But the parties don’t dispute that People v. Medina, 705 P.2d 961 (Colo. 1985), applies here because the purpose of the medication is to prevent a significant and long-term deterioration in A.C.’s mental condition and because he poses a serious risk of danger to himself or others. See Sell, 539 U.S. at 181-83.
3 III. Discussion
¶7 A.C. doesn’t contest the district court’s findings on the first
and third Medina elements. But he contends the People didn’t
present sufficient evidence to prove the second and fourth Medina
elements. We disagree.
A. The Second Medina Element
¶8 The second Medina element may be satisfied by showing either
a significant and likely long-term deterioration or the likelihood of
serious harm to self or others in the institution. Medina, 705 P.2d
at 973. The district court found that the recommended treatment is
necessary both “to prevent a significant and long-term
deterioration” in A.C.’s mental condition and “to prevent the
likelihood of [A.C.] causing serious harm to himself or others in the
institution.”
¶9 As to the district court’s finding that Zyprexa was necessary to
prevent significant and long-term deterioration in A.C.’s mental
condition, the court expressly credited and adopted Dr. Mattox’s
testimony. Dr. Mattox opined that, without the requested
medications, there would be a significant and likely long-term
deterioration in A.C.’s mental condition. He explained that A.C. has
4 “gone through extensive deterioration” as his “persistent delusional
beliefs have led him to deteriorating to the point that he’s become
physically aggressive and acted on those beliefs towards a fellow
patient.”
¶ 10 For the same reason the district court credited Dr. Mattox’s
testimony that A.C.’s delusional beliefs have led him to act on those
beliefs in a physically aggressive manner, the court found that the
requested medication was necessary to prevent A.C. from causing
serious harm to himself or others in the institution. The court
credited Dr. Mattox’s testimony that A.C.’s “actions being aggressive
towards another patient” posed a risk to others and “could also put
him at risk for retaliation,” which would pose a risk of harm to
himself.
¶ 11 A.C. argues that Dr. Mattox’s testimony doesn’t support the
district court’s findings because the “single episode” cited by the
doctor was A.C.’s only purportedly aggressive episode over several
years of hospitalization without medication. But Dr. Mattox also
testified that he anticipates that, “if [A.C.] were not to continue
treatment with psychotic medications,” such an episode “would
occur again.” To the extent A.C. asks us to second-guess witness
5 credibility or draw different inferences from the testimony, we
decline to do so. See R.C., ¶ 7.
¶ 12 Accordingly, we conclude that sufficient evidence supports the
district court’s finding that the requested medication is necessary to
prevent both a significant and likely long-term deterioration in
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24CA1912 Peo in Interest of AC 01-09-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 24CA1912 Pueblo County District Court No. 24MH30101 Honorable Timothy O'Shea, Judge
People of the State of Colorado,
Petitioner-Appellee,
In the Interest of A.C.
Respondent-Appellant.
ORDER AFFIRMED
Division V Opinion by JUDGE SULLIVAN Freyre and Schock, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced January 9, 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 A.C. appeals the district court’s order authorizing the
involuntary administration of medication. We affirm.
I. Background
¶2 A.C. was committed to the Colorado Mental Health Hospital in
Pueblo (CMHHIP) after being found incompetent to proceed in a
criminal case. He was diagnosed with an unspecified schizophrenia
spectrum and other psychotic disorder and presented with
significant paranoid delusions and auditory hallucinations. Since
his admission to the hospital in January 2021, A.C. had
consistently refused all medication. However, after an incident with
another patient in October, 2024, he was started on an emergency
course of Zyprexa (Olanzapine), an antipsychotic. At the request of
CMHHIP staff psychiatrist Dr. Paul Mattox, the People petitioned
the district court to authorize the involuntary administration of
Zyprexa.
¶3 The district court held an evidentiary hearing at which Dr.
Mattox and A.C. testified. Dr. Mattox explained A.C.’s disorder and
accompanying symptoms. And he described the requested
medication, its side effects, and its necessity for treating A.C.’s
symptoms. A.C. for the most part denied having a mental illness,
1 explaining, “If I do, I don’t think it’s that bad.” And while he
testified that he was agreeable to taking Zyprexa, he also testified
that he would stop taking it once he started to develop “a
tolerance.”
¶4 Finding that Dr. Mattox testified “credibly and persuasively,”
the district court granted the petition and entered an order
authorizing the involuntary administration of Zyprexa.
II. Legal Principles and Standard of Review
¶5 An involuntarily committed person retains the right to refuse
treatment. See People v. Medina, 705 P.2d 961, 971 (Colo. 1985).
Even so, a court may authorize the involuntary administration of
medication if the People prove the following elements by clear and
convincing evidence:
(1) the patient is incompetent to effectively participate in the treatment decision;
(2) treatment by antipsychotic medication is necessary to prevent a significant and likely long-term deterioration in the patient’s mental condition or to prevent the likelihood of the patient’s causing serious harm to himself or others in the institution;
(3) a less intrusive treatment alternative is not available; and
2 (4) the patient’s need for treatment by antipsychotic medication is sufficiently compelling to override any bona fide and legitimate interest of the patient in refusing treatment.
Id. at 973.1 We determine whether the evidence, viewed as a whole
and in the light most favorable to the People, is sufficient to support
the court’s order. People in Interest of R.K.L., 2016 COA 84, ¶ 13. A
physician’s testimony alone may suffice to satisfy the Medina test.
Id. at ¶ 30.
¶6 Applying the Medina test presents a mixed question of fact and
law, meaning we defer to the district court’s factual findings if
supported by the record but review its legal conclusions de novo.
People in Interest of R.C., 2019 COA 99M, ¶ 7. As the fact finder,
the district court determines witness credibility; the sufficiency,
probative effect, and weight of the evidence; and the inferences and
conclusions to be drawn from it. Id.
1 A different test applies to petitions to administer involuntary
medication solely to restore competency. Sell v. United States, 539 U.S. 166, 180-81 (2003). But the parties don’t dispute that People v. Medina, 705 P.2d 961 (Colo. 1985), applies here because the purpose of the medication is to prevent a significant and long-term deterioration in A.C.’s mental condition and because he poses a serious risk of danger to himself or others. See Sell, 539 U.S. at 181-83.
3 III. Discussion
¶7 A.C. doesn’t contest the district court’s findings on the first
and third Medina elements. But he contends the People didn’t
present sufficient evidence to prove the second and fourth Medina
elements. We disagree.
A. The Second Medina Element
¶8 The second Medina element may be satisfied by showing either
a significant and likely long-term deterioration or the likelihood of
serious harm to self or others in the institution. Medina, 705 P.2d
at 973. The district court found that the recommended treatment is
necessary both “to prevent a significant and long-term
deterioration” in A.C.’s mental condition and “to prevent the
likelihood of [A.C.] causing serious harm to himself or others in the
institution.”
¶9 As to the district court’s finding that Zyprexa was necessary to
prevent significant and long-term deterioration in A.C.’s mental
condition, the court expressly credited and adopted Dr. Mattox’s
testimony. Dr. Mattox opined that, without the requested
medications, there would be a significant and likely long-term
deterioration in A.C.’s mental condition. He explained that A.C. has
4 “gone through extensive deterioration” as his “persistent delusional
beliefs have led him to deteriorating to the point that he’s become
physically aggressive and acted on those beliefs towards a fellow
patient.”
¶ 10 For the same reason the district court credited Dr. Mattox’s
testimony that A.C.’s delusional beliefs have led him to act on those
beliefs in a physically aggressive manner, the court found that the
requested medication was necessary to prevent A.C. from causing
serious harm to himself or others in the institution. The court
credited Dr. Mattox’s testimony that A.C.’s “actions being aggressive
towards another patient” posed a risk to others and “could also put
him at risk for retaliation,” which would pose a risk of harm to
himself.
¶ 11 A.C. argues that Dr. Mattox’s testimony doesn’t support the
district court’s findings because the “single episode” cited by the
doctor was A.C.’s only purportedly aggressive episode over several
years of hospitalization without medication. But Dr. Mattox also
testified that he anticipates that, “if [A.C.] were not to continue
treatment with psychotic medications,” such an episode “would
occur again.” To the extent A.C. asks us to second-guess witness
5 credibility or draw different inferences from the testimony, we
decline to do so. See R.C., ¶ 7.
¶ 12 Accordingly, we conclude that sufficient evidence supports the
district court’s finding that the requested medication is necessary to
prevent both a significant and likely long-term deterioration in
A.C.’s mental condition and the likelihood of A.C. causing serious
harm to himself or others in the institution.
B. The Fourth Medina Element
¶ 13 In assessing the fourth Medina element — whether the
patient’s need for treatment is sufficiently compelling to override
any legitimate interest in refusing treatment — a court must
consider “whether the patient’s refusal is bona fide and legitimate”
and, if it is, “whether the prognosis without treatment is so
unfavorable that the patient’s personal preference must yield to the
legitimate interests of the state in preserving the life and health of
the patient placed in its charge and in protecting the safety of those
in the institution.” Medina, 705 P.2d at 974.
¶ 14 A.C. asserts that the state’s interest in treating him is
insufficient to overcome his bona fide and legitimate interest in
avoiding severe side effects by refusing treatment. More specifically,
6 he claims that Dr. Mattox testified that potential side effects of
Zyprexa include “putting someone at risk for complications of
diabetes” and A.C. is diabetic and has already suffered a “really bad
diabetic reaction” to antipsychotics in the past.
¶ 15 We acknowledge A.C.’s legitimate concern regarding potentially
harmful side effects, particularly considering his diabetes diagnosis.
But the diabetic reaction A.C. testified to occurred after he took
Seroquel, not Zyprexa. And in the two weeks A.C. has been taking
Zyprexa on an emergency basis, A.C. testified that he hadn’t noticed
any side effects except that it makes him “extremely tired.” Dr.
Mattox’s testimony corroborates A.C.’s. Dr. Mattox explained that
for the most part A.C. “has denied [any] side effects” from the
medication, but recently he reported that it “was causing him to feel
tired.” Dr. Mattox explained that sedation is a side effect of the
medication but “usually it decreases over time.”
¶ 16 Beyond this, Dr. Mattox testified that A.C. “is being monitored
very closely” and there have “not been any signs so far that the
medication is significantly impacting his diabetes management.”
Dr. Mattox testified that A.C. will continue to be monitored by his
medical team through daily visits by nursing staff, frequent
7 interviews with Dr. Mattox, and blood work. And he testified that
additional medications are available to neutralize any potential new
side effects should they arise. Further, Dr. Mattox opined that
failing to medicate A.C. would be more harmful than the risk posed
by using the medication.
¶ 17 We therefore conclude that sufficient evidence supports the
district court’s finding that the need to treat A.C.’s mental condition
is sufficiently compelling to override his bona fide and legitimate
interest in refusing treatment.
IV. Disposition
¶ 18 We affirm the order.
JUDGE FREYRE and JUDGE SCHOCK concur.