Peo in Interest of Twomey

• Court: Colorado Court of Appeals
• Decided: January 8, 2026
• Docket: 25CA1953
• Status: Unpublished

Opinion

25CA1953 Peo in Interest of Twomey 01-08-2026

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1953 Pueblo County District Court No. 22MH400 Honorable Amiel Markenson, 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 Brown and Meirink, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced January 8, 2026

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 with

schizoaffective disorder, bipolar type. His symptoms include

depression, increased energy, decreased need for sleep, 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 September 2025, the CMHHIP psychiatrist responsible for

Twomey’s care and treatment, Dr. Martin Ahern, sought an order

authorizing involuntary medications. Namely, Dr. Ahern sought the

involuntary administration of Cariprazine (Vraylar), valproic acid

(Depakote), Clozapine, and Haloperidol. Although Twomey

1 expressed a willingness to voluntarily take medication, Dr. Ahern

testified that Twomey had verbally agreed in the past when it was

“clear . . . [his agreement] d[id] not represent a genuine desire to

treat” his symptoms.

¶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 interests he has in refusing

treatment.

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

testimony from Twomey and Dr. Ahern and considered Dr. Ahern’s

affidavit in support of the administration of involuntary medication,

which was admitted into evidence without objection. At the end of

the hearing, the court found that Dr. Ahern testified credibly and

persuasively. The court concluded that the People had proved all

2 four Medina elements and issued an order authorizing hospital staff

to administer the requested medications to Twomey involuntarily.

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 973.1 Twomey does not contest the second or third

Medina elements. However, he contends that the evidence

presented at the hearing was insufficient to prove the first and

fourth element — namely that he is incompetent to effectively

participate in the treatment decision and that his need for

treatment is sufficient to override any bona fide and legitimate

interests he has in refusing treatment. We are not persuaded.

A. Twomey Is Incompetent to Effectively Participate in Treatment Decisions

¶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 testifying

that “it is a little bit confusing because different professionals have

said different things” at CMHHIP. And he denied having religious

1 When the state seeks to administer antipsychotic drugs to a

mentally ill criminal defendant involuntarily so that he can stand trial, a reviewing court applies the Supreme Court’s test in Sell v. United States, 539 U.S. 166, 178 (2003). However, reviewing courts apply state law tests if the state, as here, seeks to administer antipsychotics involuntarily for “a different purpose,” including a purpose “related to the individual’s dangerousness, or . . . the individual’s own interests where refusal to take drugs puts his health gravely at risk.” Id. at 181-82.

4 delusions and paranoia. He also denied that he was moved to a

higher security unit based on those delusions and his disturbing

behavior.

¶9 Dr. Ahern testified that Twomey does not have insight into his

mental illness. He acknowledged that Twomey recognizes he has

been diagnosed with schizoaffective disorder, but upon further

evaluation, Twomey believes he experiences only depression and

lacks insight into any of his delusional beliefs or manic episodes

that cause him to act out in verbally aggressive and physically

intrusive ways. Dr. Ahern explained that when staff reminds

Twomey of his behaviors, he insists that the staff has “lied and . . .

misrepresented” the information. Dr. Ahern testified that Twomey

could participate in treatment decisions “to some degree” as it

relates to his ability to report side effects, but his lack of insight

prevents him from participating in selecting an appropriate

medication regimen.

¶ 10 Nonetheless, Twomey asserts that he is willing to take

medications voluntarily, so the court order is unnecessary. The

court acknowledged Twomey’s testimony that he was willing to take

the prescribed medications but did not find him credible because he

5 had previously agreed to take medications voluntarily and later

changed his mind. The court further noted that Dr. Ahern was

asking for a change in medication to Clozapine. And Dr. Ahern

testified that Twomey had a pattern of refusing medications when

there were changes in the type or dosage. Moreover, Dr. Ahern

explained that a change to Clozapine had to be closely monitored

and required a “high degree of patient compliance” and that he

believed Twomey would not comply to the degree necessary given

his history of noncompliance with voluntary medication.

¶ 11 Given this evidence and the district court’s superior position to

assess credibility, it did not err when it found Twomey incompetent

to effectively participate in his treatment decisions.

B. Twomey’s Need for Treatment Overrides His Bona Fide and Legitimate Interest in Refusing Treatment

¶ 12 The district court found Twomey had bona fide and legitimate

reasons for refusing treatment, including side effects from the

medication in the form of a tremor and sedation. However, it

credited Dr. Ahern’s testimony that Twomey’s need for treatment

outweighed those interests.

6 ¶ 13 The district court found that Twomey continued to have

persistent religious delusions and credited Dr. Ahern’s testimony

that the switch to Clozapine was to address Twomey’s paranoia and

delusions. And it noted that the evidence established that the side

effects have been mitigated somewhat and that Twomey was able to

continue with “day-to-day life.”

¶ 14 The district court found that the involuntary medication order

was necessary to protect the safety of others, noting Twomey’s

preoccupation with “hyper-religious beliefs,” “beliefs that staff and

peers were evil or satanic,” and his “accusatory and threatening

statements.” And the court noted Twomey’s prior violent physical

behavior including an incident where he required a “manual hold

and locked door seclusion.”

¶ 15 On appeal, Twomey does not dispute the district court’s

findings. Rather, he simply lists the potential side effects of the

requested medications and reiterates that he experienced a tremor

and sedation from his current medication regimen. He provides no

explanation, however, why his interests in refusing treatment

outweigh his need for it. See Woodbridge Condo. Ass’n, Inc. v. Lo

7 Viento Blanco, LLC, 2020 COA 34, ¶ 41 n. 12 (declining to consider

undeveloped arguments), aff’d, 2021 CO 56.

¶ 16 Because the record supports a finding that Twomey’s

prognosis without medication is so unfavorable that any bona fide

and legitimate interest in refusal must yield to the People’s

legitimate interests in preserving his health and in protecting the

safety of those at CMHHIP, we will not disturb it. See Uwayezuk,

¶ 57. To the extent Twomey asks us to reweigh the evidence, we

decline to do so. See R.C., ¶ 7.

IV. Disposition

¶ 17 We affirm the order.

JUDGE BROWN and JUDGE MEIRINK concur.