Peo in Interest of Twomey

• Court: Colorado Court of Appeals
• Decided: July 3, 2025
• Docket: 25CA0534
• Status: Unpublished

Opinion

25CA0534 Peo in Interest of Twomey 07-03-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA0534 Pueblo County District Court No. 22MH400 Honorable Allison P. Ernst, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Richard Hugh Twomey,

Respondent-Appellant.

ORDER AFFIRMED

Division II Opinion by JUDGE FOX Harris and Schutz, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced July 3, 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 Richard Hugh Twomey appeals the district court’s order

authorizing staff at the Colorado Mental Health Hospital in Pueblo

(CMHHIP) to involuntarily administer medication to him. He

contests the sufficiency of the evidence supporting the order. We

affirm.

I. Background

¶2 Twomey was committed to CMHHIP in 2022 after he was

found not guilty by reason of insanity in a criminal case. He is

currently confined there and has been diagnosed as suffering from

schizoaffective disorder, bipolar type. His symptoms include

depression; increased energy; decreased need for sleep;

intrusiveness; auditory hallucinations; and grandiose, paranoid,

and religious delusional beliefs. He has a history of refusing

medications and when untreated or undertreated, his mental health

significantly deteriorates.

¶3 In March 2025, the CMHHIP psychiatrist responsible for

Twomey’s care and treatment, Dr. Paul Mattox, M.D., sought an

order authorizing involuntary medications. Namely, Dr. Mattox

sought the involuntary administration of quetiapine (Seroquel),

valproic acid (Depakote/Depakene), and chlorpromazine

1 (Thorazine). Although Twomey had expressed a willingness to

voluntarily take medication when he met with Dr. Mattox, Dr.

Mattox represented that “it is unlikely his consent will be

maintained given his history of refusing medications, especially

when he decompensates.”

¶4 Consistent with People v. Medina, 705 P.2d 961 (Colo. 1985),

the People filed a petition asserting that (1) Twomey is incapable of

effectively participating in decisions affecting his health and

treatment; (2) the requested treatment is necessary to prevent a

significant and likely long-term deterioration in his mental health

condition or to prevent the likelihood of him causing serious harm

to himself or others; (3) a less intrusive treatment alternative is not

available; and (4) Twomey’s need for treatment is sufficient to

override any bona fide and legitimate interest he has in refusing

treatment.

¶5 At a hearing on the People’s petition, the district court heard

testimony from Twomey and Dr. Mattox and considered Dr.

Mattox’s affidavit in support of involuntary medications, which was

admitted into evidence without objection. At the end of the hearing,

the court found that Dr. Mattox testified credibly and persuasively.

2 The court concluded that the People had proved all four Medina

elements and issued an order authorizing the hospital staff to

administer the requested medications to Twomey against his will.

II. Standard of Review

¶6 When, as here, a patient challenges the sufficiency of the

evidence supporting an involuntary medication order, we review the

district court’s legal conclusions de novo but defer to its factual

findings if they have record support. People v. Marquardt, 2016 CO

4, ¶ 8. We view the evidence as a whole and in the light most

favorable to the petitioning party, leaving the resolution of

testimonial conflicts and the determination of witness credibility

solely to the fact finder. People in Interest of Uwayezuk, 2023 COA

69, ¶ 57; People in Interest of R.C., 2019 COA 99M, ¶ 7. As the fact

finder, the district court determines the sufficiency, probative effect,

and weight of the evidence, along with the inferences and

conclusions to be drawn therefrom. R.C., ¶ 7.

III. Discussion

¶7 A district court may order the involuntary administration of

medication to a patient only if the People prove, by clear and

convincing evidence, each of the four elements outlined in Medina.

3 705 P.2d at 973. Twomey does not contest the second, third, or

fourth Medina elements. He contends only that the evidence

presented at the hearing was insufficient to prove the first element

— namely, that he is incompetent to effectively participate in the

treatment decision. We are not persuaded.

¶8 At the hearing, Twomey testified that he was willing to take the

requested medications as needed. However, he did not

acknowledge the severity of his mental illness, instead indicating

that he was “severely misdiagnosed” and asserting that he just has

“some depression.” He denied ever having a manic episode,

psychotic symptoms such as paranoia or auditory hallucinations, or

any religious delusional beliefs. When asked if he ever believed

satanists were after him or if people were stealing from him, he

said, “Well, that kind of thing has been going around for years. It’s

like, I think, the, the staff members are pretty dirty around here.

They’re not, they’re not doing the right and rejecting the

wrong . . . .”

¶9 Dr. Mattox testified that Twomey has only “partial insight” into

his mental illness. When he is stable and well, he acknowledges

that he has a mental illness, needs medication treatment, and will

4 continue to take medications. However, when he becomes ill, he

often refuses medications, whether increased dosages or the

addition of new medications required to keep him stable. Dr.

Mattox testified that he has known Twomey for many years since he

was admitted to CMHHIP. In that time, Dr. Mattox has observed a

pattern where Twomey’s mental health improves and stabilizes, but

then he regresses, refusing medication adjustments and displaying

significant symptoms of his mental illness. Consequently, Dr.

Mattox opined, Twomey is incompetent to effectively participate in

decisions affecting his health, including the decision of whether

psychiatric medications are required.

¶ 10 The court credited Dr. Mattox’s testimony; thus the record

supports the court’s finding that Twomey is incompetent to

effectively participate in decisions regarding his treatment. R.C.,

¶ 7; see People v. Pflugbeil, 834 P.2d 843, 846-47 (Colo. App. 1992)

(physician’s testimony alone may constitute clear and convincing

evidence).

¶ 11 Nonetheless, Twomey asserts that his “history is irrelevant to

his current ability to participate in treatment decisions.” But Dr.

Mattox testified that recently, Twomey had begun to display

5 behaviors that concerned Dr. Mattox and made him think Twomey’s

medication would need adjustment. In particular, Dr. Mattox

testified that Twomey was displaying early signs that his psychotic

symptoms might be returning or might not be fully treated.

Twomey grabbed an orange juice and drank it, notwithstanding a

listed allergy to oranges; when staff attempted to redirect him, he

became paranoid, accusing them of violating his HIPAA rights.

¶ 12 Under these circumstances, and given the district court’s

superior position to assess credibility, we will not disturb the

court’s order.

IV. Disposition

¶ 13 The order is affirmed.

JUDGE HARRIS and JUDGE SCHUTZ concur.