Peo in Interest of Lujan

26CA1489 Peo in Interest of Lujan 10-15-2026
COLORADO COURT OF APPEALS
Court of Appeals No. 26CA1489
Pueblo County District Court No. 26MH30076
Honorable Gregory J. Styduhar, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Danny Ray Lujan,
Respondent-Appellant.
ORDER AFFIRMED
Division IV
Opinion by JUDGE LIPINSKY
Harris and Gomez, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced October 15, 2026
Brendan Hursh, Interim 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

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¶ 1 Danny Ray Lujan appeals the district court’s order authorizing
the staff at the Colorado Mental Health Hospital in Pueblo (the
hospital) to medicate him without his consent. We affirm.
I. Background
¶ 2 Lujan was committed to the hospital after being found
incompetent to proceed in three criminal cases. He was diagnosed
with unspecified schizophrenia spectrum disorder marked by
paranoid delusions, delusional beliefs, auditory hallucinations, and
anger. Throughout Lujan’s hospitalization, he endorsed delusional
ideas about being surveilled by his family, including being watched
through hospital cameras and televisions, and about being
“stalked” by his previous probation officer and other correctional
officers.
¶ 3 When Lujan arrived at the hospital, he declined to take any
antipsychotic medications, although he voluntarily took an
antidepressant for sleep. However, after multiple escalating
incidents in which Lujan threatened and assaulted staff members,
the hospital staff started Lujan on an emergency course of Zyprexa
(an antipsychotic) and Depakote (a mood stabilizer). At the request
of a hospital staff psychiatrist, the State petitioned the district court

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to authorize the involuntary administration of Zyprexa (olanzapine),
Depakote/Depakene (valproic acid), Risperdal (risperidone), and
Haldol (haloperidol).
¶ 4 On July 20, 2026, the district court conducted an evidentiary
hearing at which the psychiatrist and Lujan testified. The
psychiatrist explained Lujan’s disorder and accompanying
symptoms and described the requested medications, their possible
side effects, and their necessity to treat Lujan’s symptoms.
¶ 5 Lujan denied having a mental illness. He described the side
effects he had experienced since taking the emergency course of
medications and his general preference not to take any medication.
¶ 6 Following Lujan’s testimony, the district court credited the
psychiatrist’s testimony; examined each of the four elements of the
test from People v. Medina, 705 P.2d 961, 973 (Colo. 1985);
concluded that the State had met their burden of proving all four
elements; and granted the petition.
¶ 7 Following the hearing, the district court entered a written
order authorizing the hospital staff to administer the following
medications to Lujan:

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• OLANZAPINE/ZYPREXA up to 40mg orally or
intramuscularly daily.
• RISPERIDONE/RISPERDAL up to 8mg orally or
long-acting intramuscular injectable formulation of
risperidone within FDA-approved dose ranges.
• HALOPERIDOL/HALDOL up to 40mg orally or
intramuscularly daily.
• VALPROIC ACID/DEPAKOTE/DEPAKENE up to 4000mg
orally or by [nasogastric tube] daily.
In addition, the court ordered that the hospital staff perform “[a]ll
laboratory work, physical assessments, and appropriate testing
necessary to monitor the safe administration of these medications,
including any potential side effects.”
II. Applicable Law and Standard of Review
¶ 8 A district court may order the involuntary administration of
medication if the State proves by clear and convincing evidence that
(1) the patient 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 patient’s mental
health condition or to prevent the likelihood of the patient causing

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serious harm to himself or others at the institution; (3) a less
intrusive treatment alternative is not available; and (4) the patient’s
need for treatment is sufficiently compelling to override any bona
fide and legitimate interest of the patient in refusing treatment. Id.
(The test from Sell v. United States, 539 U.S. 166, 180-81 (2003),
applies to petitions to administer medication involuntarily for the
purpose of rendering a defendant competent to stand trial. See
People in Interest of R.F., 2019 COA 110, ¶¶ 10-15, ¶ 11 n.1, 451
P.3d 1238, 1241-42, 1241 n.1. Although Lujan was initially
admitted to the hospital for that purpose, the State filed the petition
at issue to prevent a significant and long-term deterioration in his
mental condition and to prevent the likelihood that he would cause
serious harm to others at the hospital. These considerations are
relevant to the second Medina element. See id. at ¶ 11 n.1, 451
P.3d at 1241 n.1.)
¶ 9 Application of the Medina test involves mixed questions of fact
and law. People v. Marquardt, 2016 CO 4, ¶ 8, 364 P.3d 499, 502.
We defer to the district court’s factual findings if they have record
support and review its legal conclusions de novo. Id. It is for the
district court, as the fact finder, to determine the credibility of

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witnesses; the sufficiency, probative effect, and weight of the
evidence; and the inferences and conclusions to be drawn from the
evidence. People in Interest of R.C., 2019 COA 99M, ¶ 7, 451 P.3d
1229, 1231.
¶ 10 When a patient challenges the sufficiency of the evidence
supporting an involuntary medication order, we must affirm if the
evidence, viewed as a whole and in the light most favorable to the
State, is sufficient to support the order. People in Interest of R.K.L.,
2016 COA 84, ¶ 13, 412 P.3d 827, 832. The testimony of the
treating psychiatrist alone may suffice. Id. at ¶ 30, 412 P.3d at
834.
III. Discussion
¶ 11 Lujan contends that insufficient evidence supports the district
court’s findings concerning the second, third, and fourth Medina
elements. We address each element in turn and reject Lujan’s
contentions.
A. Long-Term Deterioration and Harm to Others
¶ 12 The second Medina element may be satisfied by showing that
the proposed treatment is necessary to prevent (1) a significant and
likely long-term deterioration in the patient’s mental condition or

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(2) the likelihood of the patient causing serious harm to himself or
others in the institution. Medina, 705 P.2d at 973. To determine
whether a patient is in danger of long-term deterioration, the court
should consider the patient’s need for the medication, including
“the nature and gravity of the patient’s illness, the extent to which
the medication is essential to effective treatment, the prognosis
without the medication, and whether the failure to medicate will be
more harmful to the patient than any risks posed by the
medication.” Id. To determine whether a patient is at risk of
causing physical harm, the court “should consider whether the
patient’s mental condition is such that in the absence of the
proposed treatment the patient will likely constitute a continuing
and significant threat to the safety of himself or others in the
institution.” Id. at 973-74.
¶ 13 The district court found that the requested treatment was
necessary both to prevent a significant long-term deterioration of
Lujan’s mental condition and to prevent the likelihood that Lujan
would cause serious harm to others in the hospital. These findings
are supported by the record.

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¶ 14 The psychiatrist’s testimony supports the district court’s
finding that the treatment was necessary to prevent a significant
long-term deterioration of Lujan’s mental condition. The
psychiatrist explained that, when Lujan arrived at the hospital, the
hospital staff was concerned that some of his symptoms could stem
from his recent use of substances such as methamphetamine “in
the community.” However, because Lujan’s symptoms continued to
persist in the controlled hospital environment, the psychiatrist
opined it was “increasingly likely” that his symptoms were caused
by a “primary psychotic disorder” that, if left untreated, could
“worsen over time and become harder to treat.”
¶ 15 The psychiatrist also testified about his “major concerns about
[Lujan’s] risk to others.” The psychiatrist explained that Lujan
“engaged in aggressive and assaultive behavior in a number of
instances” and “represents a . . . major threat to others at the
[hospital] at this time.” The psychiatrist described an incident two
months earlier in which Lujan had a “loud and argumentative”
altercation with staff. Then, fifteen days before the hearing, Lujan
approached a hospital police officer, “yelled at him[,]” and “punched
him in the jaw.” Seven days later, he “attempted to punch a male

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staff member.” Two days after that, Lujan “began to scream and
yell loudly” when staff approached him, “very quickly ran” toward a
psychiatric nurse practitioner and had a physical altercation with
eight to ten staff members in which he attempted to “hurt . . . ,
punch, [and] headbutt” them and had to be put in restraints.
During this altercation, Lujan hit a psychiatric nurse practitioner
student in the jaw and “headbutted” a member of the security staff
in the nose.
¶ 16 Lujan argues that this evidence is insufficient to establish that
the requested treatment was necessary to prevent a long-term
deterioration in his mental condition and to prevent the likelihood
that he would cause serious harm to others at the hospital. Lujan
points to the psychiatrist’s testimony that he believed there “could
be” significant long-term deterioration and acknowledged that
Lujan’s “clinical picture remained ‘a little unclear.” We disagree.
¶ 17 The psychiatrist unequivocally testified that, without the
requested medications, Lujan “risks long-term deterioration.” The
psychiatrist noted that it was “a little unclear” why Lujan’s
“psychotic symptoms and associated mood symptoms are
consistent with [an] unspecified schizophrenia spectrum disorder.”

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The psychiatrist said that “[d]elusional disorder may be
appropriate” but “it also may be possible that [Lujan] does suffer
from schizophrenia, and additional time will help determine that.”
¶ 18 Regardless of Lujan’s precise diagnosis, the psychiatrist
expressed no uncertainty that, without the requested medications,
there would be significant and likely long-term deterioration in
Lujan’s mental condition. The district court expressly credited and
adopted the psychiatrist’s testimony regarding Lujan’s mental
illness and the reasons why the medications were necessary to
prevent him from deteriorating.
¶ 19 Because the record supports the court’s determination, we will
not disturb it. And to the extent Lujan asks us to second-guess
credibility or draw different inferences from the testimony, we
decline to do so. See R.C., ¶ 7, 451 P.3d at 1231.
¶ 20 Nor are we persuaded by Lujan’s assertion that his recent
increased aggression at the hospital was insufficient to establish
the likelihood of serious future harm to others in the hospital. The
second Medina element does not speak of certainties; it is framed as
a likelihood. See Medina, 705 P.2d at 973. The psychiatrist did not
suggest that Lujan’s recent aggressive behavior was isolated —

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Lujan suggested that it was attributable to the unusually difficult
period surrounding the anniversary of his teenaged daughter’s
death. Rather, the psychiatrist opined that Lujan’s aggressive
behavior would likely continue in the absence of the proposed
treatment. Indeed, according to the psychiatrist, in the short time
Lujan had been taking the emergency medication, he had not had
“any recurrence of aggression or assertiveness, which is positive.”
See People in Interest of Strodtman, 293 P.3d 123, 132-33 (Colo.
App. 2001) (stating that evidence that the patient was “functioning
poorly upon admission” but “improved dramatically with
administration” of medication supported the court’s finding that the
State had proved the second Medina element).
¶ 21 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
Lujan’s mental condition and the likelihood of Lujan causing
serious harm to others in the hospital.
B. Less Intrusive Treatment Alternative
¶ 22 The third Medina element requires a court to determine that
no less intrusive alternative to the proposed medication is available.

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Medina, 705 P.2d at 973. This element “encompasses not only the
gravity of any harmful effects from the proposed treatment but also
the existence, feasibility, and efficacy of alternative methods of
treating the patient’s condition or of alleviating the danger created
by that condition.” Id. at 974. A less intrusive alternative is “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.” Strodtman, 293 P.3d at 133.
¶ 23 Lujan objects to the district court’s authorization of all the
medications, but he singles out risperidone and Haldol because
they were not part of the treatment plan in place at the time of the
hearing. In his view, the evidence presented was insufficient to
show that the addition of risperidone and Haldol to his treatment
plan was “presently the least intrusive treatment,” and the
psychiatrist’s testimony concerning his desire for “flexibility” in
treatment options was inadequate to justify the “breadth” of the
order. We are not persuaded.
¶ 24 In R.C., a division of this court concluded that “[t]he possibility
that [a medication] may no longer be an effective treatment . . . at
some unspecified time in the future, is insufficient to justify” an

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order authorizing backup medication. R.C., ¶ 14, 451 P.3d at 1232.
However, there are circumstances under which a backup
medication might be warranted — for example, when, as here, the
treating psychiatrist does not yet know which medications would
most effectively treat the patient’s symptoms. See People in Interest
of Ferguson, 2025 COA 82, ¶ 28, 580 P.3d 1183, 1190.
¶ 25 At the hearing, the psychiatrist testified that Lujan was placed
on emergency medications (Zyprexa and Depakote) following his
most recent “assaultive incident against staff.” At the time of the
hearing, Lujan had been taking these medications for six days. The
psychiatrist testified that the treatment plan “for the foreseeable
future” would be to continue those two medications. However, he
also testified that, because Lujan only had “limited” exposure to
“antipsychotic medications and psychiatric treatment in general,”
his treatment team was “not sure what will work best for him to
treat his symptoms or what might best be tolerated.”
¶ 26 As a result, the psychiatrist explained that he was requesting
authorization to administer Zyprexa and risperidone as “two options
for the primary antipsychotic,” “Haldol would only be used as a
backup medication . . . in the case of acute agitation or refusal of

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risperidone,” and Depakote would be administered “for the purpose
of mood stabilization.” The psychiatrist added that “flexibility” was
important under the circumstances so it would be possible to
“quickly and seamlessly” switch to a different medication for
“symptom control” and to “better accommodate[] . . . our ability to
accommodate his report of side effects” if Lujan did not respond to
Zyprexa and risperidone or if he experienced “a genuine side effect.”
In addition, the psychiatrist testified that waiting a week for a new
court order to authorize a change in medication “would increase the
risk of recurrent episodes of agitation and assertiveness” and
thereby jeopardize the safety of hospital staff.
¶ 27 Based on this testimony, the district court found that, given
Lujan’s “particular history,” his treatment team was unsure exactly
which medications “would work best.” The court credited the
psychiatrist’s testimony concerning the hospital’s proposed plan,
noted the treatment team’s need for “flexibility,” and authorized the
requested medications.
¶ 28 Under the circumstances, we conclude that this case is
analogous to Ferguson, in which the treating psychiatrist (1) lacked
sufficient knowledge of the patient’s medical history to know which

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medication would best address the circumstances requiring
involuntary medication; (2) developed a reasonable plan for the
sequence in which the psychiatrist would try a reasonable number
of alternatives; and (3) identified a need for flexibility in treatment
options without having to return to court each time he sought to try
a new medication. Id. at ¶¶ 31-32, 580 P.3d at 1190-91. Therefore,
we reject Lujan’s assertion that the district court erred by including
all the requested medication options in its order.
C. Need Overrides Interest
¶ 29 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.
¶ 30 Lujan contends that the state’s interest in treating him is
insufficient to overcome his bona fide and legitimate interest in

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avoiding adverse side effects — sleeping extensively, feeling “wobbly
on his feet,” constipation, increased drooling, blurry vision, and
dizziness.
¶ 31 The district court found at the hearing that Lujan’s reason for
refusing the requested medications — avoiding adverse side effects
— “might” be bona fide and legitimate. However, in its written
order, the court found that that Lujan did not have “a legitimate
reason for refusing medications.”
¶ 32 Avoiding unwanted or harmful side effects from medications is
a bona fide and legitimate reason for refusing treatment. See People
in Interest of Uwayezuk, 2023 COA 69, ¶ 62, 537 P.3d 377, 391.
Indeed, Lujan testified that, since taking Zyprexa and Depakote, he
has “been sleeping,” felt “kinda wobbly on [his] feet,” and
constipated. He also described having “more drool in [his] mouth,”
blurred vision, and feelings of “dizz[iness].” The psychiatrist
explained that many of these side effects are “common” and “within
the range of normal.” He also explained that the medical staff
would continue to monitor Lujan’s side effects and, if they
continued, or if vital sign abnormalities or lab abnormalities

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occurred, the staff would consider switching to a different
medication.
¶ 33 Therefore, to the extent the district court found that Lujan’s
reasons for refusing the requested medications were not bona fide
and legitimate, the court erred. However, the court went on to say
that, based on the “persistence and continuance” of Lujan’s illness,
his prognosis without treatment is “so unfavorable” that his
“personal preference” or “desire to refuse [the] medications” is
outweighed by “the legitimate interests of the State in preserving
[Lujan’s] health and life.” The record supports this determination.
¶ 34 The psychiatrist opined that, given “the persistence and
chronicity of [Lujan’s] symptoms,” the failure to medicate him would
be more harmful than the risk posed by the requested medications.
In support of this opinion, the psychiatrist testified that, despite
“less intrusive methods of treating him,” Lujan’s symptoms and
“associated aggression and assertiveness ha[d] worsened.” The
psychiatrist said he “fear[ed]” that gaps in treatment would
“increase the risk of recurrent episodes of agitation and
assaultiveness” and lead to “a concomitant increase in danger to
staff members.”

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¶ 35 The psychiatrist acknowledged the requested medications’
potential adverse side effects. But he explained that the medical
staff would continue to monitor Lujan for side effects and could
administer additional medications to neutralize some of them. The
psychiatrist opined that (1) the need to treat Lujan with the
requested medications outweighed the risk of adverse side effects;
(2) no alternative treatment would be both as effective and less
intrusive than the requested medications; (3) without the
medications, there would be significant and long-term deterioration
in Lujan’s mental condition; (4) without the medications, Lujan
poses a serious risk of harm to others; and (5) Lujan had no insight
into his mental condition, and his refusal to take the medications
was irrational and unreasonable.
¶ 36 We therefore conclude that sufficient evidence supports the
court’s finding that Lujan’s prognosis without the requested
medications is so unfavorable that his personal preference must
yield to the state’s legitimate interests in preserving his life and
health and protecting the safety of those in the hospital. See People
in Interest of Ramsey, 2023 COA 95, ¶ 23, 541 P.3d 1198, 1204.

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And to the extent Lujan asks us to reweigh the evidence, we decline
to do so. See R.C., ¶ 7, 451 P.3d 1229, 1231.
IV. Disposition
¶ 37 The order is affirmed.
JUDGE HARRIS and JUDGE GOMEZ concur.