Peo in Int of Cota-Martinez

25CA1233 Peo in Interest of Cota-Martinez 10-30-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1233
Pueblo County District Court No. 24MH30040
Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Alexis Omar Cota-Martinez,

Respondent-Appellant.

ORDER AFFIRMED

Division V
Opinion by JUDGE FREYRE
Pawar and Yun, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced October 30, 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 Alexis Omar Cota-Martinez 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 Cota-Martinez was admitted to the hospital in May 2024 after

being found incompetent to proceed in three criminal cases. He

was diagnosed with an unspecified schizophrenia spectrum and

other psychotic disorder. His symptoms have included auditory

hallucinations, responding to people or voices that are not there,

paranoid ideation, disorganized thought processes, and

disorganized speech. The record indicates that he assaulted jail

guards shortly before his hospital admission and has threatened to

harm staff and peers at the hospital.

¶3 In June 2024 and again in December 2024, the district court

granted the State’s petitions to involuntarily medicate

Cota-Martinez. The December 2024 order authorized the

involuntary administration of three medications: Zyprexa

(olanzapine), Invega (paliperidone), and Depakote (valproic acid).

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¶4 In June 2025, the State filed the petition at issue seeking to

involuntarily medicate Cota-Martinez with the same three

medications.

¶5 At the hearing on the petition, Cota-Martinez’s psychiatrist

and Cota-Martinez testified. The psychiatrist, an expert in clinical

psychiatry, testified that Cota-Martinez’s mental illness constitutes

a substantial disorder that severely impairs his judgment, his

ability to recognize reality, or his capacity to control his behavior.

According to the psychiatrist, Cota-Martinez needs psychiatric

medications and, since taking the medications, his most severe and

distressing symptoms have significantly improved; he has not

exhibited any aggressive behavioral outbursts. The psychiatrist

opined that discontinuing his medications would likely result in a

return of his auditory hallucinations and paranoid delusional

thought processes, increase the risk of harm to others at the

hospital, and cause significant and long-term deterioration in his

mental health. The psychiatrist further testified that Cota-Martinez

lacks any insight into his mental illness, does not recognize that his

symptoms have improved, and believes that his condition would be

unchanged whether or not he takes medication.

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¶6 Cota-Martinez testified that he does not have a mental illness,

and characterized the psychiatrist’s testimony as a “lie.”

Cota-Martinez also testified that he does not need the medications

and that they do not “do anything positive to help [him] in any way.”

He further testified that he does not pose a danger to others.

¶7 The district court found that the psychiatrist had testified

credibly and persuasively, and adopted the psychiatrist’s opinions.

The court then analyzed the four elements of the test from People v.

Medina, 705 P.2d 961, 973 (Colo. 1985), found that the State had

met its burden of proving all four elements by clear and convincing

evidence, and granted the petition.

II. Applicable Law and Standard of Review

¶8 The parties agree that the Medina test applies here. Under

that test, a district court may authorize the involuntary

administration of medication if the State demonstrates 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;

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(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 person in refusing

treatment. Id.1

¶9 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.

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

viewed as a whole and in the light most favorable to the State, is

1 A different test applies to petitions to administer medication

involuntarily for the purpose of restoring competency for a criminal
proceeding. See People in Interest of R.F., 2019 COA 110, ¶¶ 10-15
& n.1 (discussing the test from Sell v. United States, 539 U.S. 166,
180 (2003)). Although Cota-Martinez was admitted to the hospital
for that purpose, the petition’s stated purpose, and the district
court’s basis for granting the petition, was to prevent a significant
and long-term deterioration in his mental condition and to prevent
the likelihood of him causing serious harm to others at the hospital,
which are relevant to the second Medina element. See R.F., ¶ 11
n.1.

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

¶ 11 Cota-Martinez does not contest the district court’s rulings that

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

Medina elements. However, he challenges the sufficiency of the

evidence supporting the first Medina element — that he is

incompetent to effectively participate in the treatment decision.

¶ 12 The district court found Cota-Martinez incompetent to

effectively participate in treatment decisions because he does not

believe he has a mental illness and lacks insight into his mental

illness, and because he does not believe the medications are helping

him, despite the evidence that they are.

¶ 13 Given the district court’s credibility determinations, these

findings by the court are well supported by the record. See

Marquardt, ¶ 8; Ramsey, ¶ 23. By crediting the psychiatrist’s

testimony, the court found that Cota-Martinez suffers from

unspecified schizophrenia spectrum and other psychotic disorder.

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The court also specifically rejected Cota-Martinez’s denial of mental

illness. That supports the psychiatrist’s testimony and the court’s

finding that Cota-Martinez lacks insight into his mental illness,

which prevents him from effectively participating in treatment

decisions. See R.K.L., ¶¶ 6-7, 33 (affirming the probate court’s

finding that the patient was incompetent to effectively participate in

treatment decisions where the patient’s psychiatrist diagnosed the

patient with schizophrenia with possible bipolar disorder, but the

patient denied having a mental illness).

¶ 14 Contrary to Cota-Martinez’s argument, his recognition that he

was previously diagnosed with schizophrenia is irrelevant, given

that he does not believe he has a mental illness.

¶ 15 Similar to the disagreement over Cota-Martinez’s diagnosis,

the psychiatrist testified that Cota-Martinez needs the medications

to continue improving, but Cota-Martinez testified that the

medications provided no benefit. In crediting the psychiatrist’s

testimony, the court found that Cota-Martinez had shown “clear

improvement while he’s on the medications.” Given this finding,

Cota-Martinez’s insistence that he does not need the medications,

coupled with the evidence that he will not take the medications

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voluntarily, further support the court’s finding that he is

incompetent to effectively participate in treatment decisions. See

People in Interest of Strodtman, 293 P.3d 123, 131-32 (Colo. App.

2011) (affirming the magistrate’s finding that the patient was

incompetent to effectively participate in treatment decisions where

she denied having schizophrenia, did not accept the need for

medication, and had a history of noncompliance).

¶ 16 Cota-Martinez argues that (1) “there is objective evidence in

the record that supports his belief that the medications have not

been as effective as the State contends” and (2) the medications are

“clearly not entirely effective.” (Emphasis added.) True, the

psychiatrist testified that although Cota-Martinez’s most impairing

and distressing symptoms have significantly improved, he “does

continue to show some other signs of psychosis.” But

Cota-Martinez testified that the medications do not “do anything

positive to help [him] in any way.” (Emphasis added.) Given the

district court’s credibility determinations, the stark contrast

between the psychiatrist’s testimony and Cota-Martinez’s testimony

supports the finding that he is incompetent to effectively participate

in treatment decisions.

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¶ 17 Finally, Cota-Martinez makes a broader argument that if a

patient can be deemed incompetent to effectively participate in a

treatment decision based solely on the patient’s mere disagreement

with a physician’s diagnosis and planned use of medication, then

the first Medina element will be met in every case involving a

contested petition for involuntary medication, rendering the first

Medina element “meaningless.” We need not address that broader

issue here because this case involved the diametrically opposed

opinions: the psychiatrist’s credited testimony that Cota-Martinez

has a mental illness and needs medication, versus Cota-Martinez’s

testimony that he neither has a mental illness nor requires

medication.

IV. Disposition

¶ 18 The order is affirmed.

JUDGE PAWAR and JUDGE YUN concur.

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