25CA0251 Peo in Interest of Lozoya 05-08-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA0251 Pueblo County District Court No. 24MH18 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Jose Luis Lozoya,
Respondent-Appellant.
ORDER AFFIRMED
Division I Opinion by JUDGE BROWN J. Jones and Yun, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced May 8, 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 Jose Luis Lozoya 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 This case pertains to the psychiatric treatment of Lozoya’s
schizophrenia during his third hospital stay, beginning in December
2023, after he was found incompetent to proceed in a criminal case.
¶3 Lozoya was last discharged from the hospital in October 2022
after being restored to competency (the record suggests that the
same criminal case was pending against him between his discharge
in October 2022 and his readmission in December 2023). During
that previous hospital stay, several antipsychotic medications were
ineffective in treating Lozoya. However, he ultimately showed
significant improvement on the antipsychotic medication clozapine,
a medication for treatment-resistant patients with schizophrenia.
He was restored to competency on a regimen of clozapine and the
antipsychotic medication paliperidone.
¶4 However, when Lozoya was discharged from the hospital and
sent back to jail in October 2022, clozapine was not prescribed for
him at the jail due to an administrative error. As a result, his
1 condition deteriorated, and he was once again found incompetent to
proceed. Upon his readmission to the hospital in December 2023,
Lozoya was experiencing auditory and visual hallucinations,
disorganized thinking, and other significant negative symptoms,
including limited speech production and poor energy to complete
daily tasks. He agreed to take paliperidone but refused clozapine.
¶5 In January 2024, and again in July 2024, the People filed
petitions to authorize the involuntary administration of three
medications to treat Lozoya’s schizophrenia: clozapine,
paliperidone, and the antipsychotic medication olanzapine. Shortly
after those petitions were filed, the parties entered into consent
orders authorizing the involuntary administration of all three
medications.
¶6 In January 2025, the People filed the petition at issue, again
seeking authorization to medicate Lozoya involuntarily with
clozapine, paliperidone, and olanzapine. At the hearing on the
petition, Lozoya’s clinical psychiatrist testified that Lozoya was
taking clozapine and paliperidone on a scheduled basis, and
olanzapine solely on an as-needed basis for acute agitation. The
psychiatrist reported that Lozoya had again “improved significantly”
2 taking clozapine. The psychiatrist opined that, without the
requested medications, Lozoya would likely suffer a significant and
long-term deterioration of his mental condition and would pose a
serious risk of harm to himself.
¶7 Lozoya testified that he did not have a mental illness and that
he did not want to take any of the medications. The sole reason he
gave for avoiding the medications was the pain he experienced from
needle sticks — clozapine required a blood draw every two weeks for
testing and monitoring, and paliperidone was administered through
a monthly injection.
¶8 The district court found the psychiatrist’s testimony to be
credible and persuasive. The court granted the People’s petition for
the scheduled medications, clozapine and paliperidone. But it
concluded that the People had not met their burden of proof to
justify the involuntary treatment with the as-needed medication
olanzapine, given its infrequent use.
II. Applicable Law and Standard of Review
¶9 The parties agree that the district court’s ruling was governed
by the four-element test from People v. Medina, 705 P.2d 961, 973
(Colo. 1985). Under the Medina test, a district court may authorize
3 the involuntary administration of medication if the People
demonstrate by clear and convincing evidence that (1) the person 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 person’s mental health condition or
to prevent the likelihood of the patient causing serious harm to
himself or others at the institution; (3) a less intrusive treatment
alternative is not available; and (4) the person’s need for treatment
is sufficiently compelling to override any bona fide and legitimate
interest of the person in refusing treatment. Id.
¶ 10 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.
¶ 11 We must affirm the district court’s ruling if the evidence,
viewed as a whole and in the light most favorable to the prevailing
party, is sufficient to support the court’s order. People in Interest of
4 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
¶ 12 Lozoya does not contest the district court’s ruling that the
People met their burden of proving the first, second, and fourth
elements of the Medina test. He challenges only the sufficiency of
the evidence supporting the third Medina element — that a less
intrusive treatment alternative was not available.
¶ 13 In finding that the third Medina element was satisfied, the
court first noted the psychiatrist’s testimony that electroconvulsive
therapy (ECT) was the only alternative treatment. Consistent with
the psychiatrist’s testimony, the court found that ECT would be
more invasive than administering clozapine and paliperidone, and
Lozoya does not suggest otherwise on appeal.
¶ 14 Instead, Lozoya contends that the People failed to prove that
he could not be effectively treated “with different medications
altogether.” But the district court found that Lozoya had previously
been prescribed several other antipsychotic medications, all of
which had proven ineffective in treating him, and that the
5 combination of clozapine and paliperidone had proven to be
effective. The psychiatrist’s testimony supports both findings.
Thus, the record undermines Lozoya’s claim that “different
medications” were a less intrusive but equally effective alternative.
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25CA0251 Peo in Interest of Lozoya 05-08-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA0251 Pueblo County District Court No. 24MH18 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Jose Luis Lozoya,
Respondent-Appellant.
ORDER AFFIRMED
Division I Opinion by JUDGE BROWN J. Jones and Yun, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced May 8, 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 Jose Luis Lozoya 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 This case pertains to the psychiatric treatment of Lozoya’s
schizophrenia during his third hospital stay, beginning in December
2023, after he was found incompetent to proceed in a criminal case.
¶3 Lozoya was last discharged from the hospital in October 2022
after being restored to competency (the record suggests that the
same criminal case was pending against him between his discharge
in October 2022 and his readmission in December 2023). During
that previous hospital stay, several antipsychotic medications were
ineffective in treating Lozoya. However, he ultimately showed
significant improvement on the antipsychotic medication clozapine,
a medication for treatment-resistant patients with schizophrenia.
He was restored to competency on a regimen of clozapine and the
antipsychotic medication paliperidone.
¶4 However, when Lozoya was discharged from the hospital and
sent back to jail in October 2022, clozapine was not prescribed for
him at the jail due to an administrative error. As a result, his
1 condition deteriorated, and he was once again found incompetent to
proceed. Upon his readmission to the hospital in December 2023,
Lozoya was experiencing auditory and visual hallucinations,
disorganized thinking, and other significant negative symptoms,
including limited speech production and poor energy to complete
daily tasks. He agreed to take paliperidone but refused clozapine.
¶5 In January 2024, and again in July 2024, the People filed
petitions to authorize the involuntary administration of three
medications to treat Lozoya’s schizophrenia: clozapine,
paliperidone, and the antipsychotic medication olanzapine. Shortly
after those petitions were filed, the parties entered into consent
orders authorizing the involuntary administration of all three
medications.
¶6 In January 2025, the People filed the petition at issue, again
seeking authorization to medicate Lozoya involuntarily with
clozapine, paliperidone, and olanzapine. At the hearing on the
petition, Lozoya’s clinical psychiatrist testified that Lozoya was
taking clozapine and paliperidone on a scheduled basis, and
olanzapine solely on an as-needed basis for acute agitation. The
psychiatrist reported that Lozoya had again “improved significantly”
2 taking clozapine. The psychiatrist opined that, without the
requested medications, Lozoya would likely suffer a significant and
long-term deterioration of his mental condition and would pose a
serious risk of harm to himself.
¶7 Lozoya testified that he did not have a mental illness and that
he did not want to take any of the medications. The sole reason he
gave for avoiding the medications was the pain he experienced from
needle sticks — clozapine required a blood draw every two weeks for
testing and monitoring, and paliperidone was administered through
a monthly injection.
¶8 The district court found the psychiatrist’s testimony to be
credible and persuasive. The court granted the People’s petition for
the scheduled medications, clozapine and paliperidone. But it
concluded that the People had not met their burden of proof to
justify the involuntary treatment with the as-needed medication
olanzapine, given its infrequent use.
II. Applicable Law and Standard of Review
¶9 The parties agree that the district court’s ruling was governed
by the four-element test from People v. Medina, 705 P.2d 961, 973
(Colo. 1985). Under the Medina test, a district court may authorize
3 the involuntary administration of medication if the People
demonstrate by clear and convincing evidence that (1) the person 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 person’s mental health condition or
to prevent the likelihood of the patient causing serious harm to
himself or others at the institution; (3) a less intrusive treatment
alternative is not available; and (4) the person’s need for treatment
is sufficiently compelling to override any bona fide and legitimate
interest of the person in refusing treatment. Id.
¶ 10 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.
¶ 11 We must affirm the district court’s ruling if the evidence,
viewed as a whole and in the light most favorable to the prevailing
party, is sufficient to support the court’s order. People in Interest of
4 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
¶ 12 Lozoya does not contest the district court’s ruling that the
People met their burden of proving the first, second, and fourth
elements of the Medina test. He challenges only the sufficiency of
the evidence supporting the third Medina element — that a less
intrusive treatment alternative was not available.
¶ 13 In finding that the third Medina element was satisfied, the
court first noted the psychiatrist’s testimony that electroconvulsive
therapy (ECT) was the only alternative treatment. Consistent with
the psychiatrist’s testimony, the court found that ECT would be
more invasive than administering clozapine and paliperidone, and
Lozoya does not suggest otherwise on appeal.
¶ 14 Instead, Lozoya contends that the People failed to prove that
he could not be effectively treated “with different medications
altogether.” But the district court found that Lozoya had previously
been prescribed several other antipsychotic medications, all of
which had proven ineffective in treating him, and that the
5 combination of clozapine and paliperidone had proven to be
effective. The psychiatrist’s testimony supports both findings.
Thus, the record undermines Lozoya’s claim that “different
medications” were a less intrusive but equally effective alternative.
See People in Interest of Strodtman, 293 P.3d 123, 133 (Colo. App.
2011) (“Under Medina, a ‘less intrusive alternative’ constitutes an
available treatment that has less harmful side effects and is at least
as effective at alleviating a patient’s condition as the proposed
treatment.” (quoting Medina, 705 P.2d at 974)).
¶ 15 Lozoya also contends that the People failed to offer any
explanation or evidence showing that he could not be treated “with
alternative versions of [clozapine and paliperidone] . . . that would
not require him to be stuck with a needle.” With respect to the
actual administration of clozapine, however, the record indicates
that it was being given daily either orally or via nasogastric tube
(not by injection). So Lozoya’s complaint must be that treatment
with clozapine requires a blood draw every two weeks for testing
and monitoring. The psychiatrist testified that treatment with
clozapine required blood draws for testing and monitoring. Thus,
6 the record reflects that there was no less intrusive way to treat
Lozoya with clozapine.
¶ 16 With respect to paliperidone, we recognize that the psychiatrist
did not testify about whether the amount of paliperidone Lozoya
was taking could be administered without using needles. But
according to the psychiatrist’s affidavit and testimony, he was
seeking to administer paliperidone to Lozoya both by mouth daily
(up to twelve milligrams) and by monthly injection (up to 234
milligrams). The psychiatrist also testified generally that there was
no “alternative method of treating [Lozoya] that would be both
effective and less intrusive.” Given the district court’s credibility
finding and adoption of the psychiatrist’s opinions, we conclude
that the evidence was sufficient for the court to conclude that there
was no less intrusive alternative to administering paliperidone as
requested.
IV. Disposition
¶ 17 The order is affirmed.
JUDGE J. JONES and JUDGE YUN concur.