Peo in Interest of DeHerrera

25CA1581 Peo in Interest of DeHerrera 11-06-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1581
Pueblo County District Court No. 24MH183
Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Chanel DeHerrera,

Respondent-Appellant.

ORDER AFFIRMED

Division IV
Opinion by JUDGE HARRIS
Johnson and Schock, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced November 6, 2025

Cynthia Mitchell, County Attorney, Kate H. Schafer, Special Assistant County
Attorney, Pueblo, Colorado, for Petitioner-Appellee

Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant
¶1 Respondent, Chanel DeHerrera, appeals the district court’s

order authorizing the staff at Health Solutions to medicate her

involuntarily. We affirm.

I. Background

¶2 DeHerrera has a long history of psychosis, including multiple

hospitalizations over the last twenty years. She was diagnosed with

schizoaffective disorder, bipolar type, and has experienced

psychotic symptoms including hallucinations and delusions —

believing at times that she was pregnant (when she was not) or that

her family members were trying to kill her.

¶3 Based on the district court’s findings that DeHerrera is

mentally ill, gravely disabled, and in need of extended long-term

care and treatment, she was certified for long-term mental health

treatment under section 27-65-110, C.R.S. 2025. Later, DeHerrera

was certified for long-term mental health treatment on an

outpatient basis under section 27-65-111, C.R.S. 2025. DeHerrera,

with the assistance of counsel, also consented to court-ordered

treatment with various antipsychotic and mood stabilizing

medications.

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¶4 In August 2025, before the previous medication order expired,

DeHerrera’s psychiatrist, Dr. Arlene Shanklin, petitioned the

district court to review DeHerrera’s refusal of treatment. This time,

DeHerrera objected.

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

Shanklin and DeHerrera testified. Dr. Shanklin described

DeHerrera’s disorder and accompanying symptoms. She also

described the requested medications, explained their possible side

effects, and opined that they were necessary to treat DeHerrera’s

symptoms. DeHerrera testified that she believes she has a mental

illness but provided conflicting testimony as to whether she was

willing to take the requested medications. DeHerrera also testified

about the side effects she has experienced from the requested

medications.

¶6 The district court found that Dr. Shanklin had testified

“credibly and persuasively,” and that the People had proved all four

elements of the test set forth in People v. Medina, 705 P.2d 961, 973

(Colo. 1985), for each of the requested medications except

olanzapine and atropine sulfate. Accordingly, the court granted the

petition in part and authorized the involuntary administration of

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Invega Sustenna, Trileptal, clozapine (both the 100mg tablet and

the 200mg tablet), and risperidone to DeHerrera against her will.

II. Applicable Law and Standard of Review

¶7 A district court may order the involuntary administration of

medication if the People prove 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

serious harm to themself 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.

¶8 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 and

review its legal conclusions de novo. Id. It is for the district court,

as the fact finder, to determine the credibility of witnesses; the

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

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inferences and conclusions to be drawn from the evidence. People

in Interest of R.C., 2019 COA 99M, ¶ 7.

¶9 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

People, is sufficient to support the order. People in Interest of

R.K.L., 2016 COA 84, ¶ 13. The testimony of the treating

psychiatrist alone may suffice. Id. at ¶ 30.

III. Need for Treatment and Legitimate Interest in Refusing
Treatment

¶ 10 DeHerrera contends that the evidence was insufficient to prove

the fourth Medina element — that her need for the requested

medications is sufficiently compelling to override her bona fide and

legitimate interest in refusing to take them. We disagree.

¶ 11 In assessing this element, a court must first determine

“whether the patient’s refusal is bona fide and legitimate.” Medina,

705 P.2d at 974. If it is, the court must then determine “whether

the prognosis without treatment is so unfavorable that the patient’s

personal preference must yield to the legitimate interests of the

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state in preserving the life and health of the patient placed in its

charge and in protecting the safety of those in the institution.” Id.

¶ 12 The district court acknowledged that DeHerrera had bona fide

and legitimate concerns about the side effects of the medications.

DeHerrera has experienced excessive drooling and sedation from

the medication, and she believes risperidone is causing her hair to

fall out. But the court found that these concerns were outweighed

by the state’s legitimate interest in “preserving her life and health.”

In making this determination, the court cited DeHerrera’s history of

decompensation when not taking the requested medications.

¶ 13 The record supports the district court’s findings. Dr. Shanklin

opined that the failure to medicate DeHerrera would be more

harmful than the risks posed by the requested medications. In

support of this opinion, Dr. Shanklin testified that, without the

requested medications, “historically, [DeHerrera] would

decompensate” — she would “return to a florid psychosis,” making

her “more vulnerable in terms of people out in the community.”

Further, Dr. Shanklin expected that such decompensation would

cause DeHerrera to “be a danger to herself by not caring for herself,

and then a danger eventually to other people.” Dr. Shanklin

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explained that DeHerrera has had multiple hospitalizations because

“she decompensates without the medication,” and when this

happens “she cannot function in the community.” However, Dr.

Shanklin testified that since DeHerrera has been on court-ordered

medications, she has improved.

¶ 14 Dr. Shanklin acknowledged that the requested medications

have potential adverse side effects. But Dr. Shanklin testified that

while DeHerrera has experienced side effects, including excessive

drooling and sedation, some of the most serious possible side

effects have not been an issue for her. Regarding DeHerrera’s

complaint of hair loss, Dr. Shanklin disagreed that risperidone was

the cause because DeHerrera raised this concern when she was not

taking risperidone and hair loss is a side effect that has not been

“directly pinned” to antipsychotic medication. Even still, Dr.

Shanklin explained that she agreed to reduce DeHerrera’s dose of

risperidone to address this possible side effect. As to any possible

new side effects, Dr. Shanklin explained that DeHerrera’s care team

would continue to monitor her, and that additional medications

were available to treat any new side effects should they arise.

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¶ 15 On appeal, DeHerrera maintains that the state’s interest in

treating her is “greatly diminished,” based, in part, on the district

court’s finding that she is not a danger to herself or others. True,

the court found that DeHerrera did not meet the statutory definition

for danger to self or others under section 27-65-102(10)(a) and (b),

C.R.S. 2025. But the court’s findings in this regard pertained to the

second Medina element, an element that DeHerrera does not

contest on appeal. Moreover, as explained in Medina, while the

dangerousness of the patient, as defined by statute, is “similar” to

the considerations relevant in resolving the second Medina element,

“[t]he dangerousness of the patient to himself or others is a matter

for consideration in the initial certification determination.” Medina,

705 P.2d at 973; see §§ 27-65-102, -109, -110, C.R.S. 2025. And

DeHerrera’s initial certification determination is not at issue in this

appeal.

¶ 16 Nor are we persuaded by DeHerrera’s argument that the

state’s interest in treating her is “greatly diminished” because she is

being treated on an outpatient basis, and therefore, the safety of the

institution is not a concern. The fourth Medina element requires a

court to weigh the state’s interests against the patient’s interest in

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refusing the medication. Medina, 705 P.2d at 974. And while

Medina discusses the legitimate interests of the state both in

preserving the life and health of the patient placed in its charge and

in protecting the safety of those in the institution, it does not

mandate that both interests be applicable. See id. Rather, Medina

recognizes that “the resolution of the treatment decision will vary

with the circumstances of the case and that the particular weight to

be accorded the competing interests involved is impossible to

predetermine.” Id.

¶ 17 Furthermore, unlike DeHerrera, the respondent in Medina was

involuntarily committed to an inpatient facility. Id. at 963. Thus,

for Medina, and respondents like him, the state’s interest in

protecting the safety of those in the institution is paramount. For

respondents like DeHerrera, who are being involuntarily treated on

an outpatient basis, the state’s interests are distinct but not

diminished. See id. at 974. In this case, the state has a legitimate

interest in preserving DeHerrera’s life and health and protecting the

community. And given the very real concerns expressed by Dr.

Shanklin that DeHerrera’s health will decompensate without

treatment with the requested medications, and that she could

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eventually become a danger to others, the court found that her need

for treatment was sufficiently compelling to override her bona fide

and legitimate interest in avoiding the side effects she was

experiencing. Because there is sufficient evidence in the record to

support that finding, we must uphold it. See R.K.L., ¶ 13.

¶ 18 Because DeHerrera does not challenge the district court’s

findings concerning the other Medina factors, we conclude the

evidence was sufficient to support the involuntary medication order.

IV. Disposition

¶ 19 The order is affirmed.

JUDGE JOHNSON and JUDGE SCHOCK concur.

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