25CA0872 Peo in Interest of Clave 07-24-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA0872 Pueblo County District Court No. 25MH30040 Honorable Kelle Thomas, Magistrate
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Daniel Boaz Clave,
Respondent-Appellant.
ORDER AFFIRMED
Division VI Opinion by JUDGE SULLIVAN Tow and Yun, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced July 24, 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 Respondent, Daniel Boaz Clave, appeals a magistrate’s order
authorizing the involuntary administration of two antipsychotic
medications: paliperidone (Invega) and olanzapine (Zyprexa). We
affirm the order.
I. Background
¶2 According to the affidavit and testimony of his treating
physician, Dr. Paul Mattox, Clave is fifty-four years old and has a
long history of refusing medication to treat his schizophrenia. Clave
was first hospitalized and diagnosed in 1992. In 2005, Clave was
committed to the Colorado Mental Health Hospital in Pueblo
(CMHHIP) after he was found not guilty by reason of insanity on
charges of second degree assault and resisting arrest — offenses
that occurred after he had stopped taking his psychiatric
medications. Clave was granted conditional release in 2016, but in
2024, he again refused treatment, his condition deteriorated, his
release was revoked, and he was readmitted to CMHHIP.
¶3 At CMHHIP, Clave displayed symptoms including paranoia,
delusional beliefs, agitation, and thought disorganization, but he
refused medication. When he became severely agitated and lunged
at his medical provider, CMHHIP staff involuntarily medicated Clave
1 on an emergency basis with Zyprexa. Once the ten-day course of
emergency medications ended, Clave began voluntarily taking daily
oral doses of Invega. The People petitioned for a six-month order
permitting the involuntary administration of Invega — either as
daily oral doses or monthly injections — and Zyprexa — either as a
backup daily oral or injectable medication.
¶4 After the parties consented to magistrate jurisdiction, see
C.R.M. 6(e)(2)(B), a magistrate conducted an evidentiary hearing
and issued an order granting the People’s petition. On appeal,
Clave challenges the sufficiency of the evidence supporting the
court’s order.
II. Legal Authority and Standard of Review
¶5 A court may authorize the involuntary administration of
medication to a patient only if the People establish each of the
following elements by clear and convincing evidence: (1) the patient
is incompetent to participate effectively in the treatment decision;
(2) treatment by 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 causing serious harm to
themself or others in the institution; (3) a less intrusive treatment
2 alternative isn’t available; and (4) the patient’s need for treatment
with medication is sufficiently compelling to override their bona fide
and legitimate interest in refusing medication. People v. Medina,
705 P.2d 961, 973 (Colo. 1985); see People in Interest of Strodtman,
293 P.3d 123, 131 (Colo. App. 2011).
¶6 When a patient challenges the sufficiency of the evidence
supporting the court’s findings on any of these elements, we review
the record as a whole and, viewing it in the light most favorable to
the People, determine whether the evidence is sufficient to support
the court’s decision. People in Interest of Ramsey, 2023 COA 95,
¶ 23. We review the court’s conclusions of law de novo and defer to
its findings of fact if supported by evidence in the record. People v.
Marquardt, 2016 CO 4, ¶ 8. We also defer to the court’s resolution
of evidentiary conflicts and its determinations of witness credibility,
the weight of the evidence, and the inferences to be drawn from the
evidence. See People in Interest of R.C., 2019 COA 99M, ¶ 7. A
physician’s testimony alone may constitute clear and convincing
evidence. See People v. Pflugbeil, 834 P.2d 843, 846-47 (Colo. App.
1992).
3 III. The Fourth Medina Element
¶7 Clave challenges the sufficiency of the evidence only for the
fourth Medina element. He argues that his desire to refuse
medication is based on bona fide and legitimate interests in bodily
autonomy and in avoiding potential adverse side effects including
anxiety, blood clots, and pain from injections. We conclude that the
record provides ample support for the court’s findings on this
element.
¶8 In assessing whether the patient’s need for treatment is
sufficiently compelling to override any legitimate interest in refusing
treatment, a court must determine (1) “whether the patient’s refusal
is bona fide and legitimate” and, if so, (2) “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.
A. Testimony and Findings
¶9 At the evidentiary hearing, Clave described several side effects,
including a blood clot, that motivated him to stop taking a previous
4 antipsychotic medication (risperidone). Clave testified that despite
Invega’s similar potential side effects, there was no need for court-
ordered treatment because he had voluntarily taken Invega for six
days and would continue to do so. But Clave also testified that he
has a history of refusing to take unnecessary psychiatric
medication, and he believes the doctors at CMHHIP are
experimenting on him. He expressed two objections to involuntary
medication: he wished to have a say in his treatment, and he
wished to avoid treatment by injections because they can be
painful.
¶ 10 Even though Clave didn’t object to taking Invega or Zyprexa
based on their potential adverse effects, Dr. Mattox addressed those
effects in his testimony. Regarding potential adverse effects from
Invega, Dr. Mattox testified that among Clave’s reported effects of
risperidone, Invega could cause only a remote risk of deep vein
thrombosis and two other treatable conditions: dry skin and
constipation. Regarding Zyprexa, Dr. Mattox explained that
although Clave had told him the medication caused anxiety and an
increased heart rate, those symptoms were caused by Clave’s
feelings about taking the medication — they weren’t side effects of
5 the medication itself. Dr. Mattox also testified that unless Clave
refused to take oral medication or was released from the hospital,
there was no need to administer any medication by injection.
¶ 11 Dr. Mattox specifically testified that he knew of no bona fide
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25CA0872 Peo in Interest of Clave 07-24-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA0872 Pueblo County District Court No. 25MH30040 Honorable Kelle Thomas, Magistrate
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Daniel Boaz Clave,
Respondent-Appellant.
ORDER AFFIRMED
Division VI Opinion by JUDGE SULLIVAN Tow and Yun, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced July 24, 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 Respondent, Daniel Boaz Clave, appeals a magistrate’s order
authorizing the involuntary administration of two antipsychotic
medications: paliperidone (Invega) and olanzapine (Zyprexa). We
affirm the order.
I. Background
¶2 According to the affidavit and testimony of his treating
physician, Dr. Paul Mattox, Clave is fifty-four years old and has a
long history of refusing medication to treat his schizophrenia. Clave
was first hospitalized and diagnosed in 1992. In 2005, Clave was
committed to the Colorado Mental Health Hospital in Pueblo
(CMHHIP) after he was found not guilty by reason of insanity on
charges of second degree assault and resisting arrest — offenses
that occurred after he had stopped taking his psychiatric
medications. Clave was granted conditional release in 2016, but in
2024, he again refused treatment, his condition deteriorated, his
release was revoked, and he was readmitted to CMHHIP.
¶3 At CMHHIP, Clave displayed symptoms including paranoia,
delusional beliefs, agitation, and thought disorganization, but he
refused medication. When he became severely agitated and lunged
at his medical provider, CMHHIP staff involuntarily medicated Clave
1 on an emergency basis with Zyprexa. Once the ten-day course of
emergency medications ended, Clave began voluntarily taking daily
oral doses of Invega. The People petitioned for a six-month order
permitting the involuntary administration of Invega — either as
daily oral doses or monthly injections — and Zyprexa — either as a
backup daily oral or injectable medication.
¶4 After the parties consented to magistrate jurisdiction, see
C.R.M. 6(e)(2)(B), a magistrate conducted an evidentiary hearing
and issued an order granting the People’s petition. On appeal,
Clave challenges the sufficiency of the evidence supporting the
court’s order.
II. Legal Authority and Standard of Review
¶5 A court may authorize the involuntary administration of
medication to a patient only if the People establish each of the
following elements by clear and convincing evidence: (1) the patient
is incompetent to participate effectively in the treatment decision;
(2) treatment by 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 causing serious harm to
themself or others in the institution; (3) a less intrusive treatment
2 alternative isn’t available; and (4) the patient’s need for treatment
with medication is sufficiently compelling to override their bona fide
and legitimate interest in refusing medication. People v. Medina,
705 P.2d 961, 973 (Colo. 1985); see People in Interest of Strodtman,
293 P.3d 123, 131 (Colo. App. 2011).
¶6 When a patient challenges the sufficiency of the evidence
supporting the court’s findings on any of these elements, we review
the record as a whole and, viewing it in the light most favorable to
the People, determine whether the evidence is sufficient to support
the court’s decision. People in Interest of Ramsey, 2023 COA 95,
¶ 23. We review the court’s conclusions of law de novo and defer to
its findings of fact if supported by evidence in the record. People v.
Marquardt, 2016 CO 4, ¶ 8. We also defer to the court’s resolution
of evidentiary conflicts and its determinations of witness credibility,
the weight of the evidence, and the inferences to be drawn from the
evidence. See People in Interest of R.C., 2019 COA 99M, ¶ 7. A
physician’s testimony alone may constitute clear and convincing
evidence. See People v. Pflugbeil, 834 P.2d 843, 846-47 (Colo. App.
1992).
3 III. The Fourth Medina Element
¶7 Clave challenges the sufficiency of the evidence only for the
fourth Medina element. He argues that his desire to refuse
medication is based on bona fide and legitimate interests in bodily
autonomy and in avoiding potential adverse side effects including
anxiety, blood clots, and pain from injections. We conclude that the
record provides ample support for the court’s findings on this
element.
¶8 In assessing whether the patient’s need for treatment is
sufficiently compelling to override any legitimate interest in refusing
treatment, a court must determine (1) “whether the patient’s refusal
is bona fide and legitimate” and, if so, (2) “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.
A. Testimony and Findings
¶9 At the evidentiary hearing, Clave described several side effects,
including a blood clot, that motivated him to stop taking a previous
4 antipsychotic medication (risperidone). Clave testified that despite
Invega’s similar potential side effects, there was no need for court-
ordered treatment because he had voluntarily taken Invega for six
days and would continue to do so. But Clave also testified that he
has a history of refusing to take unnecessary psychiatric
medication, and he believes the doctors at CMHHIP are
experimenting on him. He expressed two objections to involuntary
medication: he wished to have a say in his treatment, and he
wished to avoid treatment by injections because they can be
painful.
¶ 10 Even though Clave didn’t object to taking Invega or Zyprexa
based on their potential adverse effects, Dr. Mattox addressed those
effects in his testimony. Regarding potential adverse effects from
Invega, Dr. Mattox testified that among Clave’s reported effects of
risperidone, Invega could cause only a remote risk of deep vein
thrombosis and two other treatable conditions: dry skin and
constipation. Regarding Zyprexa, Dr. Mattox explained that
although Clave had told him the medication caused anxiety and an
increased heart rate, those symptoms were caused by Clave’s
feelings about taking the medication — they weren’t side effects of
5 the medication itself. Dr. Mattox also testified that unless Clave
refused to take oral medication or was released from the hospital,
there was no need to administer any medication by injection.
¶ 11 Dr. Mattox specifically testified that he knew of no bona fide
and legitimate reason for Clave to refuse Invega or Zyprexa. And he
opined that without the requested medications, Clave would (1)
experience a significant and likely long-term deterioration in his
psychiatric condition and (2) pose a serious risk of harm to others.
¶ 12 At the conclusion of the testimony, the court found Dr.
Mattox’s opinions to be credible and persuasive. It therefore
adopted them as its own. The court found that the People had
established each of the Medina elements by clear and convincing
evidence. As relevant to the fourth Medina element, the court found
that Clave had expressed a bona fide and legitimate interest in
refusing injections, but his need for treatment was sufficiently
compelling to override that interest.
B. Analysis
¶ 13 Clave argues that he expressed bona fide and legitimate
interests in refusing medication. The court agreed, and so do we.
See People in Interest of Uwayezuk, 2023 COA 69, ¶ 62 (a desire to
6 avoid adverse effects can constitute a bona fide and legitimate
reason to refuse medication). But he doesn’t present any specific
argument regarding the court’s consideration of his and the State’s
interests; instead, he simply asserts that the court “erred in finding
that his interests were outweighed by those of the State.”
¶ 14 Reviewing the record as a whole in the light most favorable to
the People, and deferring to the court’s finding that Dr. Mattox is a
credible witness, we conclude that ample evidence supports the
court’s finding that the State’s interest in treating Clave outweighed
his objections. See Ramsey, ¶ 23; R.C., ¶ 7. Dr. Mattox’s affidavit
and testimony established that (1) Clave’s risks of adverse side
effects from Invega and Zyprexa are treatable or minimal; and (2)
without treatment, Clave’s condition will significantly deteriorate,
and he will become a danger to others. We conclude that this
evidence clearly and convincingly supports the court’s finding that
Clave’s legitimate interest in refusing medication must yield to the
state’s legitimate interests in preserving his health and protecting
the safety of those in CMHHIP. See Medina, 705 P.2d at 974;
Pflugbeil, 834 P.2d at 846-47.
7 IV. Disposition
¶ 15 We affirm the order authorizing the involuntary administration
of medication.
JUDGE TOW and JUDGE YUN concur.