Peo in Interest of Carr

25CA1214 Peo in Interest of Carr 09-18-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1214
Pueblo County District Court No. 24MH30035
Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Michael Allen Carr,

Respondent-Appellant.

ORDER AFFIRMED

Division A
Opinion by JUSTICE MARTINEZ*
Román, C.J., and Hawthorne*, J., concur

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

*Sitting by assignment of the Chief Justice under provisions of Colo. Const. art.
VI, § 5(3), and § 24-51-1105, C.R.S. 2025.
¶1 Respondent, Michael Allen Carr, appeals the district court’s

order authorizing the staff at the Colorado Mental Health Hospital

in Pueblo (the hospital) to medicate him involuntarily. Carr

contends that his need for treatment was not sufficiently compelling

to override his legitimate interest in refusing treatment. We affirm.

I. Background

¶2 Carr was committed to the hospital in April 2024 after being

found incompetent to proceed in two criminal cases. This was

Carr’s fourth recent admission for mental health treatment, with

two previous admissions to the hospital in 2019 and 2020, along

with an admission to the Colorado Mental Health Hospital in Fort

Logan in 2023. He was diagnosed with unspecified schizophrenia

spectrum and other psychotic disorder and presented with

symptoms including disorganized thinking, thought blocking,

auditory hallucinations, delusional beliefs, and paranoia. Shortly

after Carr’s admission to the hospital, in May 2024, he became

aggressive and threatening toward peers and was started on

emergency medication. In June 2024, the district court granted the

People’s petition for the involuntary administration of various

antipsychotic and mood stabilizing medications.

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¶3 Over the course of the following six months, Carr remained

psychotic and continued to lack insight into his mental illness,

however, he was no longer a behavioral problem. He was diagnosed

with schizoaffective disorder bipolar type. In December 2024, at the

request of the hospital, the People requested a new involuntary

treatment order. Following a hearing, the district court granted the

People’s petition, and a division of this court affirmed. See People in

Interest of Carr, (Colo. App. No. 24CA2167, Feb. 20, 2025) (not

published pursuant to C.A.R. 35(e)).

¶4 In June 2025, at the request of Dr. Elisabeth Cheney, Carr’s

psychiatrist at the hospital, the People petitioned the district court

to review its prior involuntary treatment order. In particular, the

People requested authorization to continue treatment with the only

medication Carr was currently taking, olanzapine (Zyprexa).

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

Cheney and Carr testified. Dr. Cheney described Carr’s disorder

and accompanying symptoms. She also described the requested

medication, explained its possible side effects, and opined that it

was necessary to treat Carr’s symptoms.

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¶6 Carr testified that he had a mental illness but was not willing

to take the requested medication because he believed that his

“coping skills” and “family support system” were sufficient to treat

his symptoms. He also testified about the various side effects he

has experienced including “jolting pains in [his] legs and arms” and

weight gain.

¶7 The district court found that Dr. Cheney testified “credibly and

persuasively.” The court also found that the People had established

all four elements for the involuntary administration of medication

set forth in People v. Medina, 705 P.2d 961, 973 (Colo. 1985), and,

accordingly, granted the petition and authorized the administration

of Zyprexa to Carr against his will.

II. Legal Principles and Standard of Review

¶8 An involuntarily committed person retains the right to refuse

treatment. See id. at 971. Even so, a court may authorize the

involuntary administration of medication if the People prove the

following elements by clear and convincing evidence:

(1) the patient is incompetent to effectively
participate in the treatment decision;

(2) treatment by antipsychotic medication is
necessary to prevent a significant and likely

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long-term deterioration in the patient’s mental
condition or to prevent the likelihood of the
patient’s causing serious harm to himself or
others in the institution;

(3) a less intrusive treatment alternative is not
available; and

(4) the patient’s need for treatment by
antipsychotic medication is sufficiently
compelling to override any bona fide and
legitimate interest of the patient in refusing
treatment.

Id. at 973.

¶9 We determine whether the evidence, viewed as a whole and in

the light most favorable to the People, is sufficient to support the

court’s order. People in Interest of R.K.L., 2016 COA 84, ¶ 13. A

physician’s testimony alone may be sufficient to satisfy the Medina

test. Id. at ¶ 30.

¶ 10 Applying the Medina test presents a mixed question of fact and

law, meaning we defer to the district court’s factual findings if

supported by the record but review its legal conclusions de novo.

People in Interest of R.C., 2019 COA 99M, ¶ 7. It is for the district

court, as the fact finder, to determine witness credibility; the

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

inferences and conclusions to be drawn from it. Id.

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III. Analysis

¶ 11 Carr concedes that the first three Medina elements were

proven and only challenges whether the evidence was sufficient to

prove the fourth Medina element.

¶ 12 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.

¶ 13 Carr specifically contends he has a bona fide and legitimate

interest in avoiding serious side effects and his need for treatment

is insufficient to overcome this interest. Carr also argues that

because Dr. Cheney “expects him to be discharged in the near

future” and expects he “will cease taking Zyprexa once his is

discharged,” the need to treat him is “greatly diminished” due to the

short-term nature of the treatment.

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¶ 14 The district court expressly acknowledged Carr’s legitimate

concern about the harmful side effects he has experienced,

including “weight gain” and “jolting pains.” However, after weighing

Carr’s bona fide and legitimate interests against the state’s interest

in preserving his life and health and protecting the safety of those

in the institution the court found that “the need for treatment is

sufficiently compelling and overrides any bona fide and legitimate

interest of [Carr’s in] refusing the treatment.” The record supports

this determination.

¶ 15 Dr. Cheney opined that the failure to medicate Carr would be

more harmful than the risks posed by the requested medication. In

support of this opinion, Dr. Cheney testified that when Carr is “off

medications” he is “quite dangerous.” Dr. Cheney explained that

when Carr first arrived at the hospital, “he was very paranoid, very

thought disordered, [and] he couldn’t make meaningful

conversation.” When staff would try to “redirect him,” he “was

combative” and “very guarded.”

¶ 16 However, Dr. Cheney testified that since Carr has been on

court-ordered medications, apart from “one breakthrough episode,”

his symptoms have improved. She explained that he “still has poor

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insight” but “he’s improved behaviorally and is very . . .

manageable.” Dr. Cheney also testified that she was able to get him

off two other medications, so that he is currently only taking

Zyprexa.

¶ 17 Dr. Cheney acknowledged that Zyprexa has some potential

adverse side effects. But Dr. Cheney explained that they would

monitor for any new side effects, and that additional medications

were available to neutralize some of those side effects should they

arise. Despite Carr’s complaints of current side effects, Dr. Cheney

testified that his need for Zyprexa outweighs those side effects and

there is not another medication available that “would not have

those side effects or worse.”

¶ 18 As to Carr’s complaint of weight gain, Dr. Cheney agreed that

weight gain is “a common [side] effect” of Zyprexa and Carr “has

had some weight gain” since his admission to the hospital.

However, she explained that while his weight gain is “likely due to

the sedentary lifestyle here,” it was also “certainly possible” that

Depakote, which he is no longer taking, “was a culprit in his initial

weight gain.” She said that while he gained seventy pounds by the

time he came to her unit at the end of October 2025, as of January

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2025, his weight had stabilized. She added that to help prevent

weight gain, his treatment team has “encouraged him not to

overeat” and “to exercise when he is able [and] to go to the

recreation center.”

¶ 19 Concerning Carr’s complaint of “jolting pains” in his arms and

legs, Dr. Cheney testified that she could not recall Carr complaining

of arm and leg pain, but agreed that such complaints, while “less

common,” are “possible.” For his part, Carr testified that the

hospital staff gave him Tylenol every night to help with the pain,

and that helps “[a] little bit.” Dr. Cheney also testified that there

are additional medications they could try to treat his arm and leg

pain.

¶ 20 We disagree with Carr’s assertion that the state’s interest in

treating him is “greatly diminished” by his pending release. Dr.

Cheney testified that one of Carr’s two criminal cases was

dismissed, but not both. While she testified that she expected that

his charges in the other case would be dismissed as well, she

provided no assurance, nor could she, that this would in fact be the

case. Further, based on our review of the record, the charges that

were dismissed were less serious than those in the current pending

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case. Accordingly, absent evidence of the dismissal of both of Carr’s

criminal cases along with a scheduled pending release date, the

state’s interests in preserving Carr’s life and health and protecting

the safety of those in the institution with him have not greatly

diminished.

¶ 21 We do not doubt that Carr’s concerns in avoiding harmful side

effects are bona fide and legitimate. However, because the record

supports the district court’s findings, we conclude it did not err by

finding that Carr’s reasons for refusing the requested medication

are overridden by his sufficiently compelling need for treatment.

See R.K.L., ¶¶ 13, 30.

IV. Disposition

¶ 22 The order is affirmed.

CHIEF JUDGE ROMÁN and JUDGE HAWTHORNE concur.

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