Peo in Interest of Abdurahman

25CA1857 Peo in Interest of Abdurahman 12-18-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1857
City and County of Denver Probate Court No. 25MH266
Honorable Beth A. Tomerlin

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Rior Abdurahman,

Respondent-Appellant.

ORDER AFFIRMED IN PART AND REVERSED IN PART

Division I
Opinion by JUDGE SCHUTZ
J. Jones and Grove, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced December 18, 2025

Miko Brown, City Attorney, Kathleen Bell, Assistant City Attorney, Denver,
Colorado, for Petitioner-Appellee

Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant
¶1 Respondent, Rior Abdurahman, appeals the probate court’s

order authorizing the staff at Denver Health Medical Center

(hospital) to medicate him involuntarily. We reverse the portion of

the order authorizing the involuntary administration of Risperdal

and Invega and remand with directions to vacate that portion of the

order. We otherwise affirm.

I. Background

¶2 Abdurahman was committed to the hospital in February 2025

after being found incompetent to proceed in a criminal case. He

was diagnosed with schizophrenia and exhibited disorganized,

paranoid, and aggressive behavior. The People petitioned the

probate court for authorization to treat Abdurahman with various

antipsychotic, antianxiety, and side effect mitigating medications.

In April, after a hearing, the court granted the petition.

¶3 Four months later, the People filed a petition to renew the

April involuntary treatment order. The People requested

authorization to treat Abdurahman with

• four antipsychotic medications: Haldol (haloperidol),

Invega (paliperidone), Risperdal (risperidone), and

Zyprexa (olanzapine);

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• one antianxiety medication: Ativan (lorazepam); and

• two medications to treat potential side effects: Benadryl

(diphenhydramine) and Cogentin (benztropine).

¶4 The probate court held an evidentiary hearing, at which Dr.

James Haug, Abdurahman’s psychiatrist, and Abdurahman

testified. Dr. Haug described Abdurahman’s disorder and

accompanying symptoms. He also described the requested

medications, explained their possible side effects, and opined that

the medications (apart from Ativan, which he withdrew from his

request) were necessary to treat Abdurahman’s symptoms.

Abdurahman denied having a mental illness and explained that he

was unwilling to take the requested medications, in part because of

his Muslim belief that “[y]ou got [a] right to refuse.” He also

testified that he had experienced various side effects from the

medications, including weight gain, seizures, difficulty breathing,

and difficulty sleeping.

¶5 The probate court found that Dr. Haug’s testimony was

“essentially uncontroverted” and “credible,” and that the People had

proved the criteria set forth in People v. Medina, 705 P.2d 961, 973

(Colo. 1985). Accordingly, the court granted the petition and issued

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an order authorizing the involuntary administration of the

requested medications.

II. Applicable Law and Standard of Review

¶6 A probate 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.

¶7 Application of the Medina test involves mixed questions of fact

and law. People v. Marquardt, 2016 CO 4, ¶ 8. We defer to the

probate court’s factual findings if they have record support and

review its legal conclusions de novo. Id. It is for the probate 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.

¶8 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. Analysis

¶9 Abdurahman challenges the sufficiency of the evidence

supporting the order. In particular, he contends that the evidence

was insufficient to support the probate court’s findings that the

third and fourth Medina elements were met. We address each

contention in turn.

A. Less Intrusive Alternative

¶ 10 First, we address Abdurahman’s contention that the evidence

was insufficient to prove the third Medina element — that a less

intrusive treatment alternative is not available. 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,

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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.” People in Interest of Strodtman, 293 P.3d 123, 133

(Colo. App. 2011).

¶ 11 Abdurahman objects to the probate court’s authorization of

“all of the medications,” but in particular he contends that because

he is being successfully treated with Zyprexa, the evidence does not

support the authorization of Haldol, Risperdal, and Invega as

backup antipsychotics.1 We agree in part.

¶ 12 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

order authorizing backup medications. R.C., ¶ 14. Another division

1 Because Abdurahman does not develop his argument regarding

the side effects of Benadryl and Cogentin we do not address them
further. See Woodbridge Condo. Ass’n v. Lo Viento Blanco, LLC,
2020 COA 34, ¶ 41 n.12 (declining to consider undeveloped
arguments), aff’d, 2021 CO 56.]

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of this court has concluded that to justify an order permitting the

involuntary authorization of a backup medication, there must be a

specific articulable concern that the primary medication could be

ineffective based on the respondent’s medical history. People in

Interest of D.N.W., 2024 COA 129, ¶ 18. And in People in Interest of

Ferguson, 2025 COA 82, ¶ 1, a division concluded that if the

treating physician lacks sufficient knowledge of the patient’s

medical history, articulates a reasonable plan for the sequence in

which the backup medications will be administered, and

demonstrates a need for flexibility in treatment options, the court

may authorize involuntary authorization of backup medications.

¶ 13 After considering these authorities, we conclude that the

evidence in the record was insufficient to support the court’s

determination regarding the involuntary administration of Risperdal

and Invega.

¶ 14 The probate court rested its legal conclusion regarding a less

drastic alternative on its finding that while Abdurahman had been

taking Zyprexa and “ha[d] been doing pretty well on that

medication,” the other medications were needed either to

accommodate a request from Abdurahman if there was “another

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medication from the list that he would like to try,” or “due to

[Abdurahman’s] complaints of experiencing side effects from

Zyprexa.”

¶ 15 We discern no record evidence supporting the probate court’s

finding that Abdurahman would want to try another medication.

Abdurahman unequivocally testified that he did not want to take

any medication and Dr. Haug agreed, testifying that “it has not

been [his] experience that [Abdurahman] will voluntarily take

medications.” More fundamentally, if Abdurahman was willing to

voluntarily take an alternative medication that may be equally as

effective as Zyprexa with less adverse side effects, there would be no

need for a court order permitting the alternative on an involuntary

basis.

¶ 16 Likewise, there is no record support for the court’s finding

that Abdurahman would want to try another medication to relieve

any side effects experienced from Zyprexa. To the contrary, Dr.

Haug testified that “in the past” he discussed with Abdurahman the

possibility of switching medications to relieve certain side effects

Abdurahman was experiencing, but it has been Abdurahman’s

“preference” not to change medication.

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¶ 17 According to Dr. Haug’s testimony, Abdurahman is “doing

pretty well” on Zyprexa and his proposed treatment plan is to

continue treating him with Zyprexa, indicating that Zyprexa is an

effective treatment. Dr. Haug explained his rationale for requesting

backup antipsychotics as follows: “to accommodate [Abdurahman’s]

interests,” “if he has a different medication [that] he’s open to

trying.” We conclude that this nonspecific speculation is

insufficient to justify an order authorizing the involuntary

administration of Risperdal and Invega. See R.C., ¶ 16. Moreover,

Dr. Haug did not explain why Abdurahman’s medical history

justified the requested backup medications under Ferguson. And,

as previously noted, if Abdurahman is ever “open to trying” a

different antipsychotic medication, a court order is not required to

accommodate that request.

¶ 18 We are not persuaded otherwise by the People’s argument that

the probate court’s authority to authorize backup medications is

not restricted solely to the circumstances presented in D.N.W. and

Ferguson. We agree with the People that D.N.W. and Ferguson are

factually distinguishable from this case. But the People do not

provide a compelling reason (nor do we perceive one) why we should

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depart from the established precedent that the Medina elements do

not allow for a backup plan in the absence of a specific articulable

concern that the approved treatment strategy will be ineffective.

See R.C., ¶ 16 (finding that ordering the administration of one

medicine, which would have the desired effect, was a “less intrusive

alternative” than authorizing the administration of six medications,

when the doctor testified that the patient did not need all six at the

time of the hearing, and may not need them in the future); cf.

Marquardt, ¶ 21 (holding that “the abstract possibility that a

patient’s condition may deteriorate in the future is insufficient to

support a Medina order”); R.K.L., ¶ 44 (concluding that “mere

speculation that [the patient] might need these medications in the

future . . . . did not prove that [his] prognosis without treatment by .

. . ten antipsychotic medications” was sufficiently problematic to

satisfy the fourth Medina element).

¶ 19 The record indicates that Abdurahman is being successfully

treated with Zyprexa and that Risperdal and Invega are only being

requested based on the speculative proposition that their

administration may be warranted if his condition changes. But

“mere speculation” that Abdurahman “might need” (or want) the

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additional medications in the future does not show that his

psychiatrist was “currently unable to treat [him] without the

authority to administer them,” especially because Dr. Haug

“testified that [his current medication] was an effective treatment.”

R.K.L., ¶ 44.

¶ 20 We reach a different conclusion regarding Haldol. Dr. Haug

testified that Haldol was necessary in the event Abdurahman

declined to take the oral formulation of Zyprexa and the hospital

did not have the intramuscular formulation of Zyprexa available.

Given Abdurahman’s history of refusing to take medication

voluntarily, this testimony provides a specific articulable concern

sufficient to justify the involuntary treatment with Haldol, under

the narrow circumstances described.

¶ 21 Accordingly, because we conclude that the evidence is not

sufficient to support the probate court’s finding that the third

Medina element is satisfied with respect to Risperdal and Invega, we

reverse this part of the court’s order.

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B. Need for Treatment and Legitimate Interest in Refusing
Treatment

¶ 22 Next, we address Abdurahman’s contention that the evidence

was insufficient to prove the fourth Medina element — that his need

for the requested medications is sufficiently compelling to override

his bona fide and legitimate interest in refusing to take them. 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 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.

¶ 23 Pointing to the side effects he has experienced and his

religious preference not to take medication, Abdurahman

summarily asserts that “[a]ll of these interests combined are not

outweighed by [his] need for treatment.” But Abdurahman does not

address the other side of the equation — his need for the

medications. The probate court accepted Abdurahman’s assertion

that he had bona fide and legitimate reasons for refusing to take the

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requested medications — both based on his avoidance of unwanted

side effects and his religious objection. But it found that

Abdurahman’s need for the medications outweighed those

concerns.

¶ 24 The record supports the probate court’s findings. Dr. Haug

opined that the failure to medicate Abdurahman would be more

harmful than the risks posed by the requested medications. In

support of this opinion, Dr. Haug testified that the gravity of

Abdurahman’s illness is “[p]retty severe,” the requested medications

are “[one] hundred precent” essential to effective treatment, and

without them, Abdurahman “would deteriorate.” Dr. Haug

described Abdurahman’s behavior before he was medicated as

“bizarre” and “threatening,” but once medicated “he stopped being

as aggressive and his discussions were more linear and more

organized.” Because the record supports the court’s findings, we

may not second-guess them. See R.K.L., ¶ 13.

IV. Disposition

¶ 25 The order is reversed to the extent it authorizes the

involuntary administration of Risperdal and Invega, and the matter

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is remanded to the probate court with directions to vacate that part

of the order. In all other respects, the order is affirmed.

JUDGE J. JONES and JUDGE GROVE concur.

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