25CA1443 Peo in Interest of JTR 11-13-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1443 Pueblo County District Court No. 25MH30060 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of J.T.R.,
Respondent-Appellant.
ORDER AFFIRMED
Division VI Opinion by JUDGE BERNARD* Welling and Sullivan, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced November 13, 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
*Sitting by assignment of the Chief Justice under provisions of Colo. Const. art. VI, § 5(3), and § 24-51-1105, C.R.S. 2025. ¶1 Respondent, J.T.R., appeals the district court’s order
authorizing staff at the Colorado Mental Health Hospital in Pueblo,
which we shall call the “state hospital,” to medicate him against his
will. We affirm.
I. Background
¶2 For the fifth time in fewer than three years, the state hospital
admitted J.T.R. in July 2025 after a judge found he was
incompetent to stand trial on criminal charges. He has a long
history of mental illness; according to the affidavit of his treating
physician at the state hospital, he suffers from bipolar disorder.
¶3 The physician’s affidavit described a repeating cycle of events.
Treatment at the state hospital would restore J.T.R. to competency;
he would return to the jail where charges were pending against him;
he would refuse to take his psychiatric medication while in the jail;
his mental condition would deteriorate to the point where he was no
longer competent; and a court order would return him to the state
hospital, where the cycle would begin again.
¶4 During J.T.R.’s most recent stint at the state hospital, he spat
at and tried to punch members of the hospital’s staff; he put one of
his fists in his rectum; and he smeared blood from his injured
1 rectum on his face. In response, staff gave him psychiatric
medication on an emergency basis.
¶5 The government promptly asked the court to issue a six-
month order authorizing the continued involuntary administration
of the medications they had given J.T.R. on an emergency basis:
lithium, Zyprexa, and Haldol. The request stated the staff would
give J.T.R. Haldol if he needed it for episodes of acute agitation, and
the treating physician added Haldol may also be administered if he
refused to take the oral dosage of lithium.
¶6 At an evidentiary hearing to resolve the government’s motion,
the treating physician said the court should allow the state hospital
to treat J.T.R. with medication against his will because (1) he was
incompetent to participate effectively in his treatment decisions;
(2) the requested medications were necessary (a) to prevent a
significant and likely long-term deterioration in his mental health
condition, and (b) to prevent the likelihood he would pose a serious
risk of harm to himself and others; (3) a less intrusive treatment
alternative — specifically, treatment with only lithium — was not
effective; and (4) his need for psychiatric medications outweighed
2 any bona fide interest he had in his refusing to take the
medications. See People v. Medina, 705 P.2d 961, 973 (Colo. 1985).
¶7 The court found the treating physician’s testimony was
credible and persuasive. The court later adopted the physician’s
opinions in its order.
¶8 J.T.R. testified that he objected to taking psychiatric
medications other than lithium because they caused various side
effects and that taking pharmaceuticals was against his religion.
Without deciding whether his testimony about side effects was
credible, the court found the possible side effects and his religious
objection to taking pharmaceuticals were bona fide and legitimate
reasons to refuse medication. But the court also found his
prognosis without treatment was so unfavorable that, despite his
bona fide and legitimate interests in refusing the medication, his
personal preferences must yield to the government’s interests.
¶9 The court ultimately found the government had provided clear
and convincing evidence for each of the four Medina elements listed
above. It issued an order authorizing the state hospital’s staff to
administer all the requested medications.
3 II. Discussion
¶ 10 J.T.R. raises a single issue on appeal. He submits the record
does not contain sufficient evidence to support the court’s findings
and conclusions concerning the fourth Medina element, which was
whether his need for treatment was sufficiently compelling to
override his bona fide and legitimate interests in refusing treatment.
See id. He contends, based on his testimony that the medications
do not actually help him because “on the inside [he is] suffering all
the time,” the government’s interests in treating him did not
outweigh his interests in refusing treatment. We conclude the
record amply supports the court’s determinations concerning the
fourth element.
A. Standard of Review and Legal Authority
¶ 11 When a patient challenges the sufficiency of the evidence
supporting a court’s findings on any of the Medina elements, we
review the record as a whole and, viewing it in the light most
favorable to the government, we decide 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 we defer to its findings of fact if they are
4 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 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).
¶ 12 In assessing the sufficiency of evidence for the fourth Medina
element, 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.
B. Sufficient Evidence of Fourth Medina Element
¶ 13 J.T.R. challenges the court’s determination that his prognosis
without treatment was so unfavorable that his interest in refusing
medication must yield to the government’s interests in preserving
his health and in protecting the safety of others in the state
5 hospital. After examining the record, we conclude the treating
physician’s affidavit and testimony, which the court found credible
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25CA1443 Peo in Interest of JTR 11-13-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1443 Pueblo County District Court No. 25MH30060 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of J.T.R.,
Respondent-Appellant.
ORDER AFFIRMED
Division VI Opinion by JUDGE BERNARD* Welling and Sullivan, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced November 13, 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
*Sitting by assignment of the Chief Justice under provisions of Colo. Const. art. VI, § 5(3), and § 24-51-1105, C.R.S. 2025. ¶1 Respondent, J.T.R., appeals the district court’s order
authorizing staff at the Colorado Mental Health Hospital in Pueblo,
which we shall call the “state hospital,” to medicate him against his
will. We affirm.
I. Background
¶2 For the fifth time in fewer than three years, the state hospital
admitted J.T.R. in July 2025 after a judge found he was
incompetent to stand trial on criminal charges. He has a long
history of mental illness; according to the affidavit of his treating
physician at the state hospital, he suffers from bipolar disorder.
¶3 The physician’s affidavit described a repeating cycle of events.
Treatment at the state hospital would restore J.T.R. to competency;
he would return to the jail where charges were pending against him;
he would refuse to take his psychiatric medication while in the jail;
his mental condition would deteriorate to the point where he was no
longer competent; and a court order would return him to the state
hospital, where the cycle would begin again.
¶4 During J.T.R.’s most recent stint at the state hospital, he spat
at and tried to punch members of the hospital’s staff; he put one of
his fists in his rectum; and he smeared blood from his injured
1 rectum on his face. In response, staff gave him psychiatric
medication on an emergency basis.
¶5 The government promptly asked the court to issue a six-
month order authorizing the continued involuntary administration
of the medications they had given J.T.R. on an emergency basis:
lithium, Zyprexa, and Haldol. The request stated the staff would
give J.T.R. Haldol if he needed it for episodes of acute agitation, and
the treating physician added Haldol may also be administered if he
refused to take the oral dosage of lithium.
¶6 At an evidentiary hearing to resolve the government’s motion,
the treating physician said the court should allow the state hospital
to treat J.T.R. with medication against his will because (1) he was
incompetent to participate effectively in his treatment decisions;
(2) the requested medications were necessary (a) to prevent a
significant and likely long-term deterioration in his mental health
condition, and (b) to prevent the likelihood he would pose a serious
risk of harm to himself and others; (3) a less intrusive treatment
alternative — specifically, treatment with only lithium — was not
effective; and (4) his need for psychiatric medications outweighed
2 any bona fide interest he had in his refusing to take the
medications. See People v. Medina, 705 P.2d 961, 973 (Colo. 1985).
¶7 The court found the treating physician’s testimony was
credible and persuasive. The court later adopted the physician’s
opinions in its order.
¶8 J.T.R. testified that he objected to taking psychiatric
medications other than lithium because they caused various side
effects and that taking pharmaceuticals was against his religion.
Without deciding whether his testimony about side effects was
credible, the court found the possible side effects and his religious
objection to taking pharmaceuticals were bona fide and legitimate
reasons to refuse medication. But the court also found his
prognosis without treatment was so unfavorable that, despite his
bona fide and legitimate interests in refusing the medication, his
personal preferences must yield to the government’s interests.
¶9 The court ultimately found the government had provided clear
and convincing evidence for each of the four Medina elements listed
above. It issued an order authorizing the state hospital’s staff to
administer all the requested medications.
3 II. Discussion
¶ 10 J.T.R. raises a single issue on appeal. He submits the record
does not contain sufficient evidence to support the court’s findings
and conclusions concerning the fourth Medina element, which was
whether his need for treatment was sufficiently compelling to
override his bona fide and legitimate interests in refusing treatment.
See id. He contends, based on his testimony that the medications
do not actually help him because “on the inside [he is] suffering all
the time,” the government’s interests in treating him did not
outweigh his interests in refusing treatment. We conclude the
record amply supports the court’s determinations concerning the
fourth element.
A. Standard of Review and Legal Authority
¶ 11 When a patient challenges the sufficiency of the evidence
supporting a court’s findings on any of the Medina elements, we
review the record as a whole and, viewing it in the light most
favorable to the government, we decide 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 we defer to its findings of fact if they are
4 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 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).
¶ 12 In assessing the sufficiency of evidence for the fourth Medina
element, 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.
B. Sufficient Evidence of Fourth Medina Element
¶ 13 J.T.R. challenges the court’s determination that his prognosis
without treatment was so unfavorable that his interest in refusing
medication must yield to the government’s interests in preserving
his health and in protecting the safety of others in the state
5 hospital. After examining the record, we conclude the treating
physician’s affidavit and testimony, which the court found credible
and incorporated into its order, support this finding.
¶ 14 The treating physician testified he had treated J.T.R. during
each of J.T.R.’s five hospitalizations since 2022. Based on his
contact with J.T.R. during those times, he thought, without
treatment with the proposed medications, J.T.R. would suffer
multiple symptoms of mania, including delusions, paranoia, and
impulsivity; he would be suicidal; and he would hurt himself.
¶ 15 On the one hand, the physician described several incidents
when J.T.R. was insufficiently medicated. He had engaged in
aggressive or self-harming behavior, including spitting at hospital
staff, making explicit threats of violence, attempting to punch and
kick staff, attempting to eat his own flesh, and lighting his own
beard on fire.
¶ 16 On the other hand, when J.T.R. was appropriately medicated
— as he had been with lithium and Zyprexa in at least three of his
four prior hospitalizations — his symptoms improved and
stabilized, and he was restored to competency. The treating
6 physician added there was no record of him suffering significant
side effects from either of those medications.
¶ 17 To the extent J.T.R.’s testimony conflicts with the treating
physician’s testimony and affidavit, we defer to the court’s
resolution of the conflicts. See R.C., ¶ 7. And, because ample
evidence supports the court’s decision that J.T.R.’s need for
treatment was sufficiently compelling to override concerns about
the medication’s side effects and the treatment’s intrusion on his
religious rights, we conclude the fourth Medina element was
satisfied. See Marquardt, ¶ 8.
¶ 18 The order is affirmed.
JUDGE WELLING and JUDGE SULLIVAN concur.