Peo in Interest of Lozoya

25CA0251 Peo in Interest of Lozoya 05-08-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA0251
Pueblo County District Court No. 24MH18
Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Jose Luis Lozoya,

Respondent-Appellant.

ORDER AFFIRMED

Division I
Opinion by JUDGE BROWN
J. Jones and Yun, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced May 8, 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 Jose Luis Lozoya appeals the district court’s order authorizing

staff at the Colorado Mental Health Hospital in Pueblo (the hospital)

to medicate him without his consent. We affirm.

I. Background

¶2 This case pertains to the psychiatric treatment of Lozoya’s

schizophrenia during his third hospital stay, beginning in December

2023, after he was found incompetent to proceed in a criminal case.

¶3 Lozoya was last discharged from the hospital in October 2022

after being restored to competency (the record suggests that the

same criminal case was pending against him between his discharge

in October 2022 and his readmission in December 2023). During

that previous hospital stay, several antipsychotic medications were

ineffective in treating Lozoya. However, he ultimately showed

significant improvement on the antipsychotic medication clozapine,

a medication for treatment-resistant patients with schizophrenia.

He was restored to competency on a regimen of clozapine and the

antipsychotic medication paliperidone.

¶4 However, when Lozoya was discharged from the hospital and

sent back to jail in October 2022, clozapine was not prescribed for

him at the jail due to an administrative error. As a result, his

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condition deteriorated, and he was once again found incompetent to

proceed. Upon his readmission to the hospital in December 2023,

Lozoya was experiencing auditory and visual hallucinations,

disorganized thinking, and other significant negative symptoms,

including limited speech production and poor energy to complete

daily tasks. He agreed to take paliperidone but refused clozapine.

¶5 In January 2024, and again in July 2024, the People filed

petitions to authorize the involuntary administration of three

medications to treat Lozoya’s schizophrenia: clozapine,

paliperidone, and the antipsychotic medication olanzapine. Shortly

after those petitions were filed, the parties entered into consent

orders authorizing the involuntary administration of all three

medications.

¶6 In January 2025, the People filed the petition at issue, again

seeking authorization to medicate Lozoya involuntarily with

clozapine, paliperidone, and olanzapine. At the hearing on the

petition, Lozoya’s clinical psychiatrist testified that Lozoya was

taking clozapine and paliperidone on a scheduled basis, and

olanzapine solely on an as-needed basis for acute agitation. The

psychiatrist reported that Lozoya had again “improved significantly”

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taking clozapine. The psychiatrist opined that, without the

requested medications, Lozoya would likely suffer a significant and

long-term deterioration of his mental condition and would pose a

serious risk of harm to himself.

¶7 Lozoya testified that he did not have a mental illness and that

he did not want to take any of the medications. The sole reason he

gave for avoiding the medications was the pain he experienced from

needle sticks — clozapine required a blood draw every two weeks for

testing and monitoring, and paliperidone was administered through

a monthly injection.

¶8 The district court found the psychiatrist’s testimony to be

credible and persuasive. The court granted the People’s petition for

the scheduled medications, clozapine and paliperidone. But it

concluded that the People had not met their burden of proof to

justify the involuntary treatment with the as-needed medication

olanzapine, given its infrequent use.

II. Applicable Law and Standard of Review

¶9 The parties agree that the district court’s ruling was governed

by the four-element test from People v. Medina, 705 P.2d 961, 973

(Colo. 1985). Under the Medina test, a district court may authorize

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the involuntary administration of medication if the People

demonstrate by clear and convincing evidence that (1) the person 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 person’s mental health condition or

to prevent the likelihood of the patient causing serious harm to

himself or others at the institution; (3) a less intrusive treatment

alternative is not available; and (4) the person’s need for treatment

is sufficiently compelling to override any bona fide and legitimate

interest of the person in refusing treatment. Id.

¶ 10 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, while we

review the court’s legal conclusions de novo. Id. Resolving conflicts

in testimony and determining the credibility of the witnesses are

matters solely within the province of the district court. People in

Interest of Ramsey, 2023 COA 95, ¶ 23.

¶ 11 We must affirm the district court’s ruling if the evidence,

viewed as a whole and in the light most favorable to the prevailing

party, is sufficient to support the court’s order. People in Interest of

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

to administer treatment may be sufficient, without more, to satisfy

the Medina test. Id. at ¶ 30.

III. Analysis

¶ 12 Lozoya does not contest the district court’s ruling that the

People met their burden of proving the first, second, and fourth

elements of the Medina test. He challenges only the sufficiency of

the evidence supporting the third Medina element — that a less

intrusive treatment alternative was not available.

¶ 13 In finding that the third Medina element was satisfied, the

court first noted the psychiatrist’s testimony that electroconvulsive

therapy (ECT) was the only alternative treatment. Consistent with

the psychiatrist’s testimony, the court found that ECT would be

more invasive than administering clozapine and paliperidone, and

Lozoya does not suggest otherwise on appeal.

¶ 14 Instead, Lozoya contends that the People failed to prove that

he could not be effectively treated “with different medications

altogether.” But the district court found that Lozoya had previously

been prescribed several other antipsychotic medications, all of

which had proven ineffective in treating him, and that the

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combination of clozapine and paliperidone had proven to be

effective. The psychiatrist’s testimony supports both findings.

Thus, the record undermines Lozoya’s claim that “different

medications” were a less intrusive but equally effective alternative.

See People in Interest of Strodtman, 293 P.3d 123, 133 (Colo. App.

2011) (“Under Medina, a ‘less intrusive alternative’ constitutes 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.” (quoting Medina, 705 P.2d at 974)).

¶ 15 Lozoya also contends that the People failed to offer any

explanation or evidence showing that he could not be treated “with

alternative versions of [clozapine and paliperidone] . . . that would

not require him to be stuck with a needle.” With respect to the

actual administration of clozapine, however, the record indicates

that it was being given daily either orally or via nasogastric tube

(not by injection). So Lozoya’s complaint must be that treatment

with clozapine requires a blood draw every two weeks for testing

and monitoring. The psychiatrist testified that treatment with

clozapine required blood draws for testing and monitoring. Thus,

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the record reflects that there was no less intrusive way to treat

Lozoya with clozapine.

¶ 16 With respect to paliperidone, we recognize that the psychiatrist

did not testify about whether the amount of paliperidone Lozoya

was taking could be administered without using needles. But

according to the psychiatrist’s affidavit and testimony, he was

seeking to administer paliperidone to Lozoya both by mouth daily

(up to twelve milligrams) and by monthly injection (up to 234

milligrams). The psychiatrist also testified generally that there was

no “alternative method of treating [Lozoya] that would be both

effective and less intrusive.” Given the district court’s credibility

finding and adoption of the psychiatrist’s opinions, we conclude

that the evidence was sufficient for the court to conclude that there

was no less intrusive alternative to administering paliperidone as

requested.

IV. Disposition

¶ 17 The order is affirmed.

JUDGE J. JONES and JUDGE YUN concur.

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