25CA0370 Peo in Interest of EME 05-22-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA0370 Pueblo County District Court No. 24MH30074 Honorable Scott B. Epstein, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of E.M.E.,
Respondent-Appellant.
ORDER AFFIRMED
Division VII Opinion by JUDGE LUM Lipinsky and Pawar, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced May 22, 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, E.M.E., appeals the district court order
authorizing the involuntary administration of two antipsychotic
medications — olanzapine (Zyprexa) and haloperidol (Haldol) — as
well as valproic acid (Depakote), a mood-stabilizing medication. We
affirm the order.
I. Background
¶2 E.M.E. was admitted to the Colorado Mental Health Hospital
in Pueblo (CMHHIP) after being found incompetent to proceed to
trial on criminal charges. According to the affidavits of two treating
physicians and the testimony of Dr. Paul Mattox, his current
treating physician, E.M.E.’s condition significantly deteriorated
when he refused psychiatric medication in jail. As a result, six
officers had to transport him to CMHHIP in a “cocoon suit” due to
his extremely aggressive conduct. At CMHHIP, he required
seclusion and restraint because, among other threatening
behaviors, he attempted to bite, strike, pinch, and kick staff. He
also hit his head against the walls, held his breath, and elbowed a
door.
¶3 In August 2024, the district court entered an order permitting
the involuntary administration of Zyprexa, Haldol, Depakote, and
1 Thorazine (an antipsychotic) for six months. The order was updated
to include a fifth medication — an additional antipsychotic — when
E.M.E. continued to exhibit symptoms requiring severe assault
precautions. E.M.E. appealed the updated order, and a division of
this court affirmed. People in Interest of E.M.E., (Colo. App. No.
24CA1914, Dec. 26, 2024) (not published pursuant to C.AR. 35(e)).
¶4 In February 2025, the People petitioned for a six-month order
permitting the involuntary administration of Zyprexa, Haldol, and
Depakote. They argued that, although E.M.E. had significantly
improved during the first six months of involuntary treatment, he
continued to believe that he did not have a mental illness and did
not benefit from medication. After conducting an evidentiary
hearing at which E.M.E. and Dr. Mattox testified, the court issued
an order authorizing CMHHIP staff to involuntarily administer the
requested medications for six months.
¶5 On appeal, E.M.E. challenges the sufficiency of the evidence
supporting the court’s order.
II. Legal Authority and Standard of Review
¶6 A district court may authorize the involuntary administration
of medication to a patient only if the People establish each of the
2 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
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).
¶7 When a patient challenges the sufficiency of the evidence
supporting the district 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
district court’s resolution of evidentiary conflicts and its
3 determinations of witness credibility, the weight of the evidence,
and the inferences to be drawn from it. 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).
III. The Fourth Medina Element
¶8 E.M.E. challenges the sufficiency of the evidence only for the
fourth Medina element. He argues that the court erred by finding
that he did not have a legitimate reason to refuse medication. We
conclude that the record provides ample support for the court’s
ultimate finding on this element.
¶9 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.
4 A. Testimony and Findings
¶ 10 At the evidentiary hearing, E.M.E. testified that, without a
court order to take the requested medications, he would try to
“wean himself off” them. In addition to his general desire to avoid
medications, he complained of several side effects, including weight
gain, lethargy, sedation, muscle and joint pain, numbness, dry
mouth, and tremors.1 He also said that his sedation and pain
symptoms had improved since the CMHHIP staff began giving him
his medication at night.
¶ 11 As relevant here, Dr. Mattox testified that E.M.E.’s side effects
were minimal, and if he discontinued medication, he would
deteriorate significantly and become a danger to himself or others.
Dr. Mattox verified that E.M.E.’s reported side effects could be
caused by the medications and said that he was previously aware of
some, but not all, of E.M.E.’s complaints. He explained that he
would continue to monitor E.M.E.’s side effects and make any
necessary treatment adjustments. Even in light of E.M.E.’s newly
1 E.M.E. testified that he weighed 138 pounds when he arrived at
CMHHIP and 178 pounds at the time of the hearing (approximately six months after his arrival). (TR p. 20:1-3.)
5 reported side effects, Dr. Mattox testified, E.M.E.’s deterioration
when unmedicated was so concerning that his need for treatment
outweighed any risks from the reported side effects.
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25CA0370 Peo in Interest of EME 05-22-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA0370 Pueblo County District Court No. 24MH30074 Honorable Scott B. Epstein, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of E.M.E.,
Respondent-Appellant.
ORDER AFFIRMED
Division VII Opinion by JUDGE LUM Lipinsky and Pawar, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced May 22, 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, E.M.E., appeals the district court order
authorizing the involuntary administration of two antipsychotic
medications — olanzapine (Zyprexa) and haloperidol (Haldol) — as
well as valproic acid (Depakote), a mood-stabilizing medication. We
affirm the order.
I. Background
¶2 E.M.E. was admitted to the Colorado Mental Health Hospital
in Pueblo (CMHHIP) after being found incompetent to proceed to
trial on criminal charges. According to the affidavits of two treating
physicians and the testimony of Dr. Paul Mattox, his current
treating physician, E.M.E.’s condition significantly deteriorated
when he refused psychiatric medication in jail. As a result, six
officers had to transport him to CMHHIP in a “cocoon suit” due to
his extremely aggressive conduct. At CMHHIP, he required
seclusion and restraint because, among other threatening
behaviors, he attempted to bite, strike, pinch, and kick staff. He
also hit his head against the walls, held his breath, and elbowed a
door.
¶3 In August 2024, the district court entered an order permitting
the involuntary administration of Zyprexa, Haldol, Depakote, and
1 Thorazine (an antipsychotic) for six months. The order was updated
to include a fifth medication — an additional antipsychotic — when
E.M.E. continued to exhibit symptoms requiring severe assault
precautions. E.M.E. appealed the updated order, and a division of
this court affirmed. People in Interest of E.M.E., (Colo. App. No.
24CA1914, Dec. 26, 2024) (not published pursuant to C.AR. 35(e)).
¶4 In February 2025, the People petitioned for a six-month order
permitting the involuntary administration of Zyprexa, Haldol, and
Depakote. They argued that, although E.M.E. had significantly
improved during the first six months of involuntary treatment, he
continued to believe that he did not have a mental illness and did
not benefit from medication. After conducting an evidentiary
hearing at which E.M.E. and Dr. Mattox testified, the court issued
an order authorizing CMHHIP staff to involuntarily administer the
requested medications for six months.
¶5 On appeal, E.M.E. challenges the sufficiency of the evidence
supporting the court’s order.
II. Legal Authority and Standard of Review
¶6 A district court may authorize the involuntary administration
of medication to a patient only if the People establish each of the
2 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
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).
¶7 When a patient challenges the sufficiency of the evidence
supporting the district 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
district court’s resolution of evidentiary conflicts and its
3 determinations of witness credibility, the weight of the evidence,
and the inferences to be drawn from it. 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).
III. The Fourth Medina Element
¶8 E.M.E. challenges the sufficiency of the evidence only for the
fourth Medina element. He argues that the court erred by finding
that he did not have a legitimate reason to refuse medication. We
conclude that the record provides ample support for the court’s
ultimate finding on this element.
¶9 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.
4 A. Testimony and Findings
¶ 10 At the evidentiary hearing, E.M.E. testified that, without a
court order to take the requested medications, he would try to
“wean himself off” them. In addition to his general desire to avoid
medications, he complained of several side effects, including weight
gain, lethargy, sedation, muscle and joint pain, numbness, dry
mouth, and tremors.1 He also said that his sedation and pain
symptoms had improved since the CMHHIP staff began giving him
his medication at night.
¶ 11 As relevant here, Dr. Mattox testified that E.M.E.’s side effects
were minimal, and if he discontinued medication, he would
deteriorate significantly and become a danger to himself or others.
Dr. Mattox verified that E.M.E.’s reported side effects could be
caused by the medications and said that he was previously aware of
some, but not all, of E.M.E.’s complaints. He explained that he
would continue to monitor E.M.E.’s side effects and make any
necessary treatment adjustments. Even in light of E.M.E.’s newly
1 E.M.E. testified that he weighed 138 pounds when he arrived at
CMHHIP and 178 pounds at the time of the hearing (approximately six months after his arrival). (TR p. 20:1-3.)
5 reported side effects, Dr. Mattox testified, E.M.E.’s deterioration
when unmedicated was so concerning that his need for treatment
outweighed any risks from the reported side effects.
¶ 12 At the conclusion of the testimony, the district court found Dr.
Mattox’s opinions to be credible and persuasive, and it adopted
them. The court found that each of the Medina elements had been
established by clear and convincing evidence. As relevant to the
fourth Medina element, the court found that
• E.M.E.’s past behavior was very concerning;
• if E.M.E. discontinued his medication, there was a
significant likelihood that he would harm himself and
others;
• a failure to medicate E.M.E. would be more harmful than
the risks posed by the medications; and
• E.M.E.’s liberty interest in refusing medication is
outweighed by his need for treatment and the state’s
interest in treating him.
¶ 13 The court expressed concern about E.M.E.’s forty-pound
weight gain, considering that E.M.E.’s mother had been recently
diagnosed with diabetes, and it ordered CMHHIP to speak with him
6 about alternatives to address that side effect. In its written order,
the court added a finding that E.M.E. did not have a legitimate
reason to refuse medication.
B. Analysis
¶ 14 We agree with E.M.E. that the record does not support a
finding that he had no legitimate reason to refuse medication. Dr.
Mattox testified that E.M.E.’s reported side effects could be caused
by his medications and that he had observed at least some of the
reported effects, including weight gain. And the court implicitly
found that, under the circumstances, E.M.E.’s weight gain was a
significant adverse effect. The desire to avoid significant adverse
effects can constitute a bona fide and legitimate reason to refuse
medication. See People in Interest of Uwayezuk, 2023 COA 69, ¶
62.
¶ 15 Nonetheless, we conclude that ample evidence supports the
district court’s finding that the state’s interest in treating E.M.E.
outweighed his objection. Multiple physician affidavits and Dr.
Mattox’s testimony establish that, without treatment, E.M.E.’s
condition would significantly deteriorate, and he would become a
danger to himself and others. We conclude that this evidence
7 clearly and convincingly supports the court’s finding that E.M.E.’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.
IV. Disposition
¶ 16 The order authorizing the involuntary administration of
medication is affirmed.
JUDGE LIPINSKY and JUDGE PAWAR concur.