Peo in Interest of AC

24CA1912 Peo in Interest of AC 01-09-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA1912
Pueblo County District Court No. 24MH30101
Honorable Timothy O'Shea, Judge

People of the State of Colorado,

Petitioner-Appellee,

In the Interest of A.C.

Respondent-Appellant.

ORDER AFFIRMED

Division V
Opinion by JUDGE SULLIVAN
Freyre and Schock, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced January 9, 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 A.C. appeals the district court’s order authorizing the

involuntary administration of medication. We affirm.

I. Background

¶2 A.C. was committed to the Colorado Mental Health Hospital in

Pueblo (CMHHIP) after being found incompetent to proceed in a

criminal case. He was diagnosed with an unspecified schizophrenia

spectrum and other psychotic disorder and presented with

significant paranoid delusions and auditory hallucinations. Since

his admission to the hospital in January 2021, A.C. had

consistently refused all medication. However, after an incident with

another patient in October, 2024, he was started on an emergency

course of Zyprexa (Olanzapine), an antipsychotic. At the request of

CMHHIP staff psychiatrist Dr. Paul Mattox, the People petitioned

the district court to authorize the involuntary administration of

Zyprexa.

¶3 The district court held an evidentiary hearing at which Dr.

Mattox and A.C. testified. Dr. Mattox explained A.C.’s disorder and

accompanying symptoms. And he described the requested

medication, its side effects, and its necessity for treating A.C.’s

symptoms. A.C. for the most part denied having a mental illness,

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explaining, “If I do, I don’t think it’s that bad.” And while he

testified that he was agreeable to taking Zyprexa, he also testified

that he would stop taking it once he started to develop “a

tolerance.”

¶4 Finding that Dr. Mattox testified “credibly and persuasively,”

the district court granted the petition and entered an order

authorizing the involuntary administration of Zyprexa.

II. Legal Principles and Standard of Review

¶5 An involuntarily committed person retains the right to refuse

treatment. See People v. Medina, 705 P.2d 961, 971 (Colo. 1985).

Even so, a court may authorize the involuntary administration of

medication if the People prove the following elements by clear and

convincing evidence:

(1) the patient is incompetent to effectively
participate in the treatment decision;

(2) treatment by antipsychotic 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’s causing serious harm to himself or
others in the institution;

(3) a less intrusive treatment alternative is not
available; and

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(4) the patient’s need for treatment by
antipsychotic medication is sufficiently
compelling to override any bona fide and
legitimate interest of the patient in refusing
treatment.

Id. at 973.1 We determine whether the evidence, viewed as a whole

and in the light most favorable to the People, is sufficient to support

the court’s order. People in Interest of R.K.L., 2016 COA 84, ¶ 13. A

physician’s testimony alone may suffice to satisfy the Medina test.

Id. at ¶ 30.

¶6 Applying the Medina test presents a mixed question of fact and

law, meaning we defer to the district court’s factual findings if

supported by the record but review its legal conclusions de novo.

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

the district court determines witness credibility; the sufficiency,

probative effect, and weight of the evidence; and the inferences and

conclusions to be drawn from it. Id.

1 A different test applies to petitions to administer involuntary

medication solely to restore competency. Sell v. United States, 539
U.S. 166, 180-81 (2003). But the parties don’t dispute that People
v. Medina, 705 P.2d 961 (Colo. 1985), applies here because the
purpose of the medication is to prevent a significant and long-term
deterioration in A.C.’s mental condition and because he poses a
serious risk of danger to himself or others. See Sell, 539 U.S. at
181-83.

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III. Discussion

¶7 A.C. doesn’t contest the district court’s findings on the first

and third Medina elements. But he contends the People didn’t

present sufficient evidence to prove the second and fourth Medina

elements. We disagree.

A. The Second Medina Element

¶8 The second Medina element may be satisfied by showing either

a significant and likely long-term deterioration or the likelihood of

serious harm to self or others in the institution. Medina, 705 P.2d

at 973. The district court found that the recommended treatment is

necessary both “to prevent a significant and long-term

deterioration” in A.C.’s mental condition and “to prevent the

likelihood of [A.C.] causing serious harm to himself or others in the

institution.”

¶9 As to the district court’s finding that Zyprexa was necessary to

prevent significant and long-term deterioration in A.C.’s mental

condition, the court expressly credited and adopted Dr. Mattox’s

testimony. Dr. Mattox opined that, without the requested

medications, there would be a significant and likely long-term

deterioration in A.C.’s mental condition. He explained that A.C. has

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“gone through extensive deterioration” as his “persistent delusional

beliefs have led him to deteriorating to the point that he’s become

physically aggressive and acted on those beliefs towards a fellow

patient.”

¶ 10 For the same reason the district court credited Dr. Mattox’s

testimony that A.C.’s delusional beliefs have led him to act on those

beliefs in a physically aggressive manner, the court found that the

requested medication was necessary to prevent A.C. from causing

serious harm to himself or others in the institution. The court

credited Dr. Mattox’s testimony that A.C.’s “actions being aggressive

towards another patient” posed a risk to others and “could also put

him at risk for retaliation,” which would pose a risk of harm to

himself.

¶ 11 A.C. argues that Dr. Mattox’s testimony doesn’t support the

district court’s findings because the “single episode” cited by the

doctor was A.C.’s only purportedly aggressive episode over several

years of hospitalization without medication. But Dr. Mattox also

testified that he anticipates that, “if [A.C.] were not to continue

treatment with psychotic medications,” such an episode “would

occur again.” To the extent A.C. asks us to second-guess witness

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credibility or draw different inferences from the testimony, we

decline to do so. See R.C., ¶ 7.

¶ 12 Accordingly, we conclude that sufficient evidence supports the

district court’s finding that the requested medication is necessary to

prevent both a significant and likely long-term deterioration in

A.C.’s mental condition and the likelihood of A.C. causing serious

harm to himself or others in the institution.

B. The Fourth Medina Element

¶ 13 In assessing the fourth Medina element — whether the

patient’s need for treatment is sufficiently compelling to override

any legitimate interest in refusing treatment — a court must

consider “whether the patient’s refusal is bona fide and legitimate”

and, if it is, “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.

¶ 14 A.C. asserts that the state’s interest in treating him is

insufficient to overcome his bona fide and legitimate interest in

avoiding severe side effects by refusing treatment. More specifically,

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he claims that Dr. Mattox testified that potential side effects of

Zyprexa include “putting someone at risk for complications of

diabetes” and A.C. is diabetic and has already suffered a “really bad

diabetic reaction” to antipsychotics in the past.

¶ 15 We acknowledge A.C.’s legitimate concern regarding potentially

harmful side effects, particularly considering his diabetes diagnosis.

But the diabetic reaction A.C. testified to occurred after he took

Seroquel, not Zyprexa. And in the two weeks A.C. has been taking

Zyprexa on an emergency basis, A.C. testified that he hadn’t noticed

any side effects except that it makes him “extremely tired.” Dr.

Mattox’s testimony corroborates A.C.’s. Dr. Mattox explained that

for the most part A.C. “has denied [any] side effects” from the

medication, but recently he reported that it “was causing him to feel

tired.” Dr. Mattox explained that sedation is a side effect of the

medication but “usually it decreases over time.”

¶ 16 Beyond this, Dr. Mattox testified that A.C. “is being monitored

very closely” and there have “not been any signs so far that the

medication is significantly impacting his diabetes management.”

Dr. Mattox testified that A.C. will continue to be monitored by his

medical team through daily visits by nursing staff, frequent

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interviews with Dr. Mattox, and blood work. And he testified that

additional medications are available to neutralize any potential new

side effects should they arise. Further, Dr. Mattox opined that

failing to medicate A.C. would be more harmful than the risk posed

by using the medication.

¶ 17 We therefore conclude that sufficient evidence supports the

district court’s finding that the need to treat A.C.’s mental condition

is sufficiently compelling to override his bona fide and legitimate

interest in refusing treatment.

IV. Disposition

¶ 18 We affirm the order.

JUDGE FREYRE and JUDGE SCHOCK concur.

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