Peo in Interest of Powell

25CA0990 Peo in Interest of Powell 08-14-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA0990
Arapahoe County District Court No. 25MH149
Honorable H. Clay Hurst, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Monique Powell,

Respondent-Appellant.

ORDER AFFIRMED IN PART AND REVERSED IN PART

Division IV
Opinion by JUDGE MEIRINK
Freyre and Gomez, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced August 14, 2025

Ron Carl, County Attorney, Meghan Rubincam, Senior Assistant County
Attorney, Aurora, Colorado, for Petitioner-Appellee

Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant
¶1 Monique Powell appeals the district court’s order authorizing

an additional three months of short-term care and treatment under

section 27-65-109, C.R.S. 2024, and the involuntary administration

of the antipsychotic medication Prolixin. We reverse the portion of

the order authorizing the involuntary administration of Prolixin,

and we otherwise affirm.

I. Background

¶2 Following an evidentiary hearing in March 2025, the district

court authorized three months of involuntary treatment and

medication of Powell, a respondent with about eight years of history

with mental health issues and “several previous visits to the

emergency room based on various mental health concerns.” People

in Interest of Powell, slip op. at ¶ 12 (Colo. App. No. 25CA0504, May

8, 2025) (not published pursuant to C.A.R. 35(e)). This initial order

— set to expire on May 27, 2025 — was affirmed on appeal. See id.,

slip. op. at ¶ 25.

¶3 Powell remained hospitalized for a few weeks after the initial

order, then she was discharged to outpatient care at Aurora Mental

Health & Recovery (AMHR), where she was diagnosed with

schizoaffective disorder, bipolar type. Dr. Janet Dodd, a

1
psychologist at AMHR, petitioned to extend Powell’s certification for

short-term treatment for an additional three months. Dr. Erin

Smith, a staff psychiatrist at AMHR, petitioned to continue Powell’s

involuntary medication and requested four antipsychotic

medications: Abilify, Prolixin, Thorazine, and Haldol.

¶4 Powell requested a hearing on the petitions. At the time of the

hearing, Powell had been voluntarily taking Abilify for three weeks,

and Dr. Smith rescinded the Haldol request because Powell was

tolerating Abilify well and didn’t like Haldol.

¶5 Following the evidentiary hearing, at which Dr. Smith and

Powell testified, the district court found that the People had

established, by clear and convincing evidence, the criteria for short-

term certification under section 27-65-109, and each of the four

Medina elements for involuntary administration of medication. See

People v. Medina, 705 P.2d 961, 973 (Colo. 1985). It issued an

order (1) extending Powell’s certification until August 27, 2025, and

(2) authorizing treatment with Abilify, which Powell was currently

taking, and Prolixin — one backup antipsychotic.

2
II. Discussion

¶6 Powell challenges the sufficiency of the evidence supporting

the order. Specifically, she contends that the evidence was

insufficient to support the district court’s findings that (1) she was

gravely disabled and (2) the People had established the third Medina

element for Prolixin as a backup antipsychotic. We address each

contention in turn.

A. Standard of Review

¶7 When a respondent challenges the sufficiency of the evidence

supporting the district court’s findings, we review the court’s

conclusions of law de novo and defer to its findings of fact if

supported by evidence in the record. People v. Marquardt, 2016 CO

4, ¶ 8. We review the record as a whole and in the light most

favorable to the People, and we defer to the fact finder to resolve any

conflicts in the testimony and determine the credibility of witnesses.

See People in Interest of Ramsey, 2023 COA 95, ¶ 23. “The district

court, as fact finder, ‘has discretion to determine the credibility of

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

evidence; and the inferences and conclusions to be drawn from it.’”

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

3
Interest of S.M.A.M.A., 172 P.3d 958, 962 (Colo. App. 2007)). A

treating physician’s testimony alone may constitute clear and

convincing evidence. See People v. Pflugbeil, 834 P.2d 843, 846-47

(Colo. App. 1992).

B. Certification for Short-Term Treatment

¶8 To authorize short-term treatment, the district court must

find, by clear and convincing evidence, that the respondent has a

mental health disorder and, as a result of the mental health

disorder, is a danger to herself or others or is gravely disabled.

§ 27-65-109(1)(a); § 27-65-113(1), C.R.S. 2024.

¶9 Powell challenges the district court’s finding that she is gravely

disabled. As relevant here, a person is “gravely disabled” when, as

a result of a mental health disorder, they are “incapable of making

informed decisions about or providing for [their] essential needs

without significant supervision and assistance from other people.”

§ 27-65-102(17), C.R.S. 2024. And because they are incapable of

making informed decisions, the gravely disabled person “is at risk of

. . . significant psychiatric deterioration, or mismanagement of

[their] essential needs that could result in substantial bodily harm.”

Id. Essential needs include medical care. See People v. Taylor, 618

4
P.2d 1127, 1134 (Colo. 1980) (a person’s basic personal needs

include “food, shelter, clothing, and medical care”).

¶ 10 The district court found that Powell is gravely disabled based

on its findings that (1) as a result of Powell’s schizoaffective bipolar

type disorder, she was unable to make informed decisions about

her health; and (2) Powell didn’t believe she needed treatment, and

without medication, she would not be able to manage daily

activities and would suffer brain damage. The record supports

these findings.

¶ 11 Dr. Smith — who the court found to be “quite credible” —

testified that Powell was not competent to participate in her

treatment decisions because she didn’t understand her diagnosis or

the benefits of medication. Dr. Smith further testified that Powell

lived with her mother and described how Powell’s mother had

directed Powell’s treatment decisions, including the decision to

medicate with Abilify. Both Powell and Dr. Smith testified that

although Powell had recently accepted a one-month Abilify

injection, she didn’t believe she had a mental health disorder and

would not continue medication without a court order. Dr. Smith

5
opined that without antipsychotic medication, Powell’s prognosis

was poor, and psychotic episodes would damage her brain.

¶ 12 We conclude that this testimony sufficiently supports the

district court’s finding of grave disability. Specifically, Dr. Smith’s

testimony supports a finding that because Powell is incapable of

making informed decisions about her mental health without

assistance, she is at risk of significant psychiatric deterioration or

mismanagement of her essential needs that could result in brain

damage. See Pflugbeil, 834 P.2d at 846-47; see also

§ 27-65-102(17).

¶ 13 We are not persuaded otherwise by Powell’s argument that

under People v. Bucholz, 778 P.2d 300, 302 (Colo. App. 1989), Dr.

Smith’s testimony that Powell was currently attending to her needs

— with her mother’s support and the assistance of medication —

establishes that Powell is not gravely disabled. See id. (holding that

a medicated respondent’s prospective inability to provide for their

basic personal needs when unmedicated is insufficient to support a

finding of grave disability). Bucholz is inapposite because (1) its

holdings interpret a different statutory definition of “gravely

disabled” than the one that applies to Powell; and (2) here, the

6
district court properly found that Powell’s existing condition meets

the applicable definition of “gravely disabled.”

¶ 14 Accordingly, we conclude that the district court properly

extended Powell’s certification for short-term treatment.

C. Involuntary Administration of Medication

¶ 15 A district court may authorize the involuntary administration

of medication to a patient only if the People establish each of the

following elements by clear and convincing evidence: (1) the patient

is incompetent to participate effectively in the treatment decision;

(2) treatment by medication is necessary either to prevent a

significant and likely long-term deterioration in the patient’s mental

condition or to prevent the likelihood of the patient causing serious

harm to themself or others in the institution; (3) a less intrusive

treatment alternative isn’t available; and (4) the patient’s need for

treatment with medication is sufficiently compelling to override

their bona fide and legitimate interest in refusing medication.

Medina, 705 P.2d at 973; see People in Interest of Strodtman, 293

P.3d 123, 131 (Colo. App. 2011).

¶ 16 Powell challenges the sufficiency of the evidence for the third

Medina element. This element “encompasses not only the gravity of

7
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.” Medina, 705 P.2d 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.

¶ 17 Powell does not object to the authorization of Prolixin because

of its potential side effects. Rather, citing R.C., ¶ 13, and People in

Interest of R.K.L., 2016 COA 84, ¶ 44, she argues that because she

is being successfully treated with Abilify, the evidence does not

support authorization of Prolixin as a backup antipsychotic. We

agree.

¶ 18 For purposes of our analysis, we define “primary medication”

as one that the petitioner seeks to immediately administer to a

respondent. And a “backup medication” is (1) of the same class as

a primary medication and (2) one that the petitioner seeks to

administer only if certain conditions arise.

¶ 19 In R.C., a division of this court concluded that “[t]he possibility

that that [a primary medication] may no longer be an effective

8
treatment . . . at some unspecified time in the future, is insufficient

to justify” an order authorizing backup medications. R.C., ¶ 14. In

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

concluded that to justify an order authorizing the involuntary

administration 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. Following

these authorities, we do not perceive sufficient evidence that Abilify

alone is not a less intrusive treatment than Abilify and Prolixin.

¶ 20 The district court rested its legal conclusion as to the third

Medina element on a finding that in case a dangerous side effect

arose from treatment with Abilify, it was “necessary to have an

alternative to prevent [brain] damage.” But we discern no record

evidence supporting the court’s premise that Powell may suffer a

dangerous side effect from Abilify — possibly rendering it an

ineffective treatment at some time in the future. See R.C., ¶ 14. Dr.

Smith did not articulate such a concern. To the contrary, she

testified that Powell was tolerating Abilify well without side effects,

and she planned to keep Powell on long-acting injections of Abilify.

9
Moreover, the district court found that Powell “had not had any

serious side effects.” (Emphasis added.)

¶ 21 According to Dr. Smith’s testimony, Powell had not displayed

symptoms of psychosis since April 10, indicating that Abilify is an

effective treatment. Dr. Smith explained her sole rationale for

requesting backup antipsychotics as follows: so she would have

options available “should the Abilify not to be a good fit for [Powell]

down the line.” Applying R.C. and D.N.W., we conclude that this

nonspecific speculation is insufficient to justify an order authorizing

the involuntary administration of Prolixin.

III. Disposition

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

involuntary administration of Prolixin. In all other respects, the

order is affirmed.

JUDGE FREYRE and JUDGE GOMEZ concur.

10