Peo in Interest of Dudley

25CA1394 Peo In Interest of Dudley 10-16-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1394
Arapahoe County District Court No. 25MH259
Honorable H. Clay Hurst, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Michelle Dudley,

Respondent-Appellant.

ORDER AFFIRMED

Division IV
Opinion by JUDGE SCHOCK
Harris and Johnson, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced October 16, 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 Michelle Dudley appeals the district court’s order certifying

her for short-term treatment under section 27-65-109, C.R.S. 2025,

and authorizing the involuntary administration of aripiprazole

(Abilify), an antipsychotic medication. We affirm.

I. Background

¶2 Dudley has been hospitalized multiple times over the past five

years due to recurring psychosis. Most recently, Dudley’s neighbor

reported concerns about Dudley’s mental health, including that she

had been yelling at people in her apartment complex and seeing

and hearing people in the elevator shaft. The neighbor also

reported that Dudley had recently been observed abusing her dog.

¶3 Dudley was involuntarily admitted to Porter Hospital and

presented with psychosis, disorganized thought, and delusions.

She was diagnosed with schizoaffective disorder, bipolar type.

¶4 Dudley’s treating physician requested that Dudley be certified

for short-term mental health treatment under section 27-65-109

and sought an order authorizing the involuntary administration of

Abilify to her. Dudley, through counsel, stipulated to short-term

certification and to treatment with Abilify. The stipulation provided

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that Abilify would be offered to Dudley on a voluntary basis and

only administered involuntarily if Dudley refused to take it.

¶5 Before the short-term certification order expired, Dudley’s

psychiatrist, Dr. Colon-Sanchez, and psychologist, Dr. Zott,

petitioned the district court to extend the certification and

involuntary medication order. This time, Dudley objected.

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

Colon-Sanchez, Dr. Zott, and Dudley testified. After the hearing,

the district court entered an order extending Dudley’s certification

for short-term mental health treatment. The court found by clear

and convincing evidence that Dudley had a mental health disorder,

was gravely disabled, and had refused voluntary treatment. The

court also authorized the involuntary administration of Abilify to

Dudley, finding that the People had proved all four elements of the

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

II. Short-Term Certification

¶7 Dudley first argues that the evidence was insufficient to

support the district court’s finding that she was gravely disabled, as

necessary to sustain the short-term treatment certification order.

Because the district court’s finding has record support, we disagree.

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A. Applicable Law and Standard of Review

¶8 The district court may certify a person for involuntary short-

term treatment if it finds, by clear and convincing evidence, that the

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

health disorder, is a danger to themselves or others or is gravely

disabled. § 27-65-109(1)(a); § 27-65-113(1), C.R.S. 2025.

¶9 As relevant in this case, a person is “gravely disabled” when

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. 2025. As a

result of the inability to make informed decisions, a gravely disabled

person is at risk of, among other things, “significant psychiatric

deterioration, or mismanagement of [their] essential needs that

could result in substantial bodily harm.” Id.; see also People v.

Taylor, 618 P.2d 1127, 1134 (Colo. 1980) (noting that “basic

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

¶ 10 Whether a person is gravely disabled is a fact-specific

determination that depends on the person’s condition at the time

the finding is made. People in Interest of Vivekanathan, 2013 COA

143M, ¶ 14. We review the record as a whole and in the light most

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favorable to the People to determine whether the evidence is

sufficient to support the district court’s decision. People in Interest

of Ramsey, 2023 COA 95, ¶ 23. We defer to the court’s factual

findings if sufficient evidence in the record supports them. Id.

B. Analysis

¶ 11 The district court found that Dudley was gravely disabled

because, without treatment, she “cannot make rational decisions”

or “care for herself.” The court noted that, before her most recent

certification, Dudley “was failing to meet her essential needs” and

“was in a crisis mode” that “put her at risk of harm to herself.” The

court acknowledged that Dudley was doing “remarkably well” while

the certification was in effect. But it found that she remained

gravely disabled because she lacked insight into her condition and

had not agreed “to receive the treatment that she so clearly needs.”

¶ 12 The record supports the district court’s findings. Both Dr.

Colon-Sanchez and Dr. Zott testified that Dudley lacks insight into

her diagnosis and her need for medication to maintain her long-

term stability. They further explained that this lack of insight has

resulted in repeated involuntary hospitalizations and mental health

certifications in recent years. Dr. Colon-Sanchez testified that

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when Dudley is taking medication, she “is able to organize herself,

maintain her job and functions very well in society.” But when not

hospitalized or certified, Dudley has historically stopped taking

medication, causing her to revert to the delusions, psychosis, and

hallucinations that interfere with her ability to care for herself.

¶ 13 Dr. Zott opined that Dudley is gravely disabled because

“without the stability of treatment and medications,” Dudley is

unable to meet her daily needs, maintain sanitary living conditions,

and care for her dog. She testified that Dudley becomes “extremely

psychotic” and engages in “behaviors that put herself at risk.” Dr.

Colon-Sanchez described one instance when Dudley, while off her

medication, “wasn’t eating” and her house was in “disarray.”

¶ 14 This testimony is sufficient to support the district court’s

finding that Dudley’s mental health disorder — and her

unwillingness to voluntarily engage in necessary treatment — made

her “incapable of making informed decisions about or providing for

[her] essential needs without significant supervision and

assistance.” § 27-65-102(17). It also supports a finding that,

without certification, Dudley was at risk of “significant psychiatric

deterioration[] or mismanagement of [Dudley’s] essential needs.” Id.

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¶ 15 Dudley asserts that the district court’s reliance on her

psychiatric history and prior certifications when unmedicated

means that she can only avoid certification by voluntarily

consenting to treatment. But while Dudley’s psychiatric history

may have informed the district court’s decision, the court did not

find Dudley gravely disabled based on her psychiatric past. It

found her gravely disabled based on her existing condition.

Specifically, Dudley was currently refusing treatment, without which

she was currently unable to provide for her own essential needs.

¶ 16 Thus, because the record supports the district court’s finding

that Dudley was gravely disabled, the district court did not err by

extending Dudley’s certification for short-term treatment.

III. Involuntary Administration of Medication

¶ 17 Dudley next contends that the evidence was insufficient to

support the district court’s order authorizing the involuntary

administration of Abilify to her. Specifically, she argues that the

evidence was insufficient to establish that (1) she was incompetent

to participate effectively in her treatment decisions; and (2) her need

for the medication was sufficiently compelling to override her bona

fide and legitimate interest in refusing to take it. We again disagree.

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A. Applicable Law and Standard of Review

¶ 18 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 himself 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.

Medina, 705 P.2d at 973.

¶ 19 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. 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

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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.

B. Incompetent to Effectively Participate

¶ 20 The first Medina element requires a finding that the patient is

incompetent to effectively participate in the relevant treatment

decision. Medina, 705 P.2d at 973. A court may not order the

involuntary administration of medication unless the patient’s

mental illness has so impaired their judgment as to render them

incapable of participating in decisions affecting their health. Id.

¶ 21 Dr. Colon-Sanchez opined that Dudley’s lack of insight into

her mental illness and need for medication makes her incapable of

effectively participating in decisions about her health, including as

to her need for psychiatric medications. Dr. Colon-Sanchez testified

that Dudley “doesn’t believe that she has a schizoaffective disorder,”

but instead “thinks it’s mostly PTSD that is affecting her.” Dr.

Colon-Sanchez explained, however, that Dudley’s delusions and

disorganized thought process are not symptoms of PTSD. Dr. Zott

agreed, opining that Dudley does not have insight into her diagnosis

or her need to stay on medications for her long-term stability.

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¶ 22 The district court credited Dr. Colon-Sanchez’s and Dr. Zott’s

testimony and adopted Dr. Colon-Sanchez’s opinion that Dudley

was not capable of effectively participating in her treatment because

she does not believe she has schizoaffective disorder. This

testimony was sufficient to support the district court’s finding. See

People v. Pflugbeil, 834 P.2d 843, 847 (Colo. App. 1992).

¶ 23 Dudley asserts that the district court’s encouragement for her

to work with her treatment team to identify alternative treatments is

inconsistent with its finding that she was incompetent to effectively

participate in her treatment decisions. But read in context, the

district court was simply acknowledging Dudley’s concern about the

side effects and urging her treatment team to consider whether

there was any alternative. It was not retracting its immediately

preceding finding that Dudley was “pretty clearly” unable to

participate competently in her treatment. Indeed, right after the

court’s suggestion that Dudley “work[] with her treatment team,”

the court reiterated its finding that she did not have “the insight to

effectively participate, because if there was no certification, she

would not take her mental health medicine, because she does not

believe she has a mental health disorder.”

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¶ 24 Given the ample evidence of Dudley’s lack of insight into the

severity of her illness and her need for the requested medication,

and the weight the district court placed on her treating physicians’

credibility, we conclude the evidence was sufficient to support the

district court’s finding that the first Medina element was satisfied.

C. Need for Treatment and Legitimate Interest in Refusing
Treatment

¶ 25 In assessing the fourth Medina element — whether the

patient’s need for the requested medication is sufficiently

compelling to override a bona fide and legitimate interest in refusing

it — 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.

¶ 26 The district court acknowledged that Dudley had legitimate

concerns about the side effects of the medication. In particular,

Dudley has endometriosis and believes that the Abilify is increasing

her pain and causing irregular menstrual cycles. But in weighing

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those legitimate concerns against the risk of “another psychotic

episode, where her body and her mind is put at danger, where her

dog cannot be cared for, where she can’t care for herself,” the court

found the latter sufficiently compelling to override the former.

¶ 27 The district court’s finding has record support. Dr. Colon-

Sanchez testified that Dudley’s prognosis without medication would

mirror what has happened in the past when she stops taking the

needed medication. Dr. Colon-Sanchez explained that if Dudley

were to stop taking her medication, she would “start experiencing

delusions, psychosis, hallucinations, and will become gravely

disabled . . . possibly requiring inpatient hospitalization.” Dr.

Colon-Sanchez also testified that when Dudley was not taking her

medication in the past, she “wasn’t eating,” she “wasn’t taking care

of her environment,” and “[h]er house was in . . . disarray.” Dr.

Colon-Sanchez added that treatment with Abilify is necessary to

prevent a significant and likely long-term deterioration of Dudley’s

mental condition and prevent “further episodes of decompensation

in psychosis.” On the other hand, Dr. Colon-Sanchez explained

that Dudley is “very eloquent and organized” when taking Abilify.

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¶ 28 Dudley contends that the state’s interest in treating her is

insufficient to overcome her bona fide and legitimate interest in

avoiding side effects, including irregular menstrual cycles, weight

gain, and anxiety.1 But Dr. Colon-Sanchez addressed each of these

potential side effects, and the district court considered them.

¶ 29 As to the irregular menstrual cycles, Dr. Colon-Sanchez

acknowledged that Abilify can affect prolactin levels, which can

affect menstrual cycles. But she explained that Dudley’s prolactin

level is within normal limits. Moreover, Dr. Colon-Sanchez testified

that Dudley’s irregular menstrual cycles could be caused by her

endometriosis and noted that Dudley is following up with a

gynecologist. Dr. Colon-Sanchez also acknowledged that the

requested medication could cause weight gain but testified that she

did not recall Dudley expressing this as a concern when they met.

¶ 30 As to Dudley’s anxiety, Dr. Colon-Sanchez testified that

anxiety is not a typical side effect of Abilify and was not something

Dudley had previously mentioned to her. Dr. Colon-Sanchez also

1 Dudley also asserts, and testified in the district court, that the

certification order “makes her feel stigmatized and unheard.” But
she does not tie that concern to the requested medication.

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testified that Abilify generally reduces manic episodes that may be

associated with impulsive behavior. And Dr. Zott testified that

Dudley seemed less distressed and anxious after taking the

medication than she did when she was first hospitalized.

¶ 31 In the end, the district court recognized that Dudley had some

legitimate concerns with taking the medication. It even urged her

treatment team to continue to consider whether there was any other

effective alternative. But it found that Dudley’s dire need for the

medication outweighed her concerns. Because the record supports

the district court’s finding, we may not disturb it. See R.K.L., ¶ 13.

IV. Disposition

¶ 32 The order is affirmed.

JUDGE HARRIS and JUDGE JOHNSON concur.

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