Peo in Interest of Powell

25CA1488 Peo in Interest of Powell 11-06-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1488
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 JOHNSON
Harris and Schock, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced November 6, 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

(1) her certification for long-term care and treatment under section

27-65-110, C.R.S. 2025; and (2) the involuntary administration of

medications. We affirm in part and reverse in part.

I. Background

¶2 Powell has a history of mental illness and psychiatric

hospitalizations spanning nearly a decade. In February 2025, she

was certified for short-term mental health treatment after she

brought her five-year-old son to the hospital, believing that he

needed oral surgery. Several doctors at the hospital observed

disorganization in Powell’s thought process, and she was placed on

a mental health hold. During her hospitalization, a doctor

diagnosed her with schizophrenia. The short-term certification

treatment included an order authorizing the involuntary

administration of Haldol, Prolixin, and Thorazine as primary

medications with Benadryl, Cogentin, and Ativan as side-effect

medications.

¶3 She appealed the short-term certification order on grounds

that the State had not proved by clear and convincing evidence that

she was gravely disabled or that the State had proved the fourth

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

973 (Colo. 1985). A division of this court affirmed the short-term

certification order involving all medications in People in Interest of

Powell, (Colo. App. No. 25CA0504, May 8, 2025) (not published

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

¶4 In March, Powell’s short-term certification was extended for

another three months, which authorized treatment with Abilify (as

Powell had complained of side effects to Haldol and her treating

physician discontinued it) with Prolixin as a backup medication.

Powell appealed the extension of the short-term certification order;

a division of this court affirmed the extension and continued

treatment with Abilify but reversed the portion of the order

authorizing the involuntary administration of Prolixin as a backup

medication. The division reasoned that the doctor’s nonspecific

speculation that Abilify may not be effective treatment for Powell in

the future was insufficient grounds to order Prolixin as a backup

medication. See People in Interest of Powell, (Colo. App. No.

25CA0990, Aug. 14, 2025) (not published pursuant to C.A.R. 35(e))

(Powell II).

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¶5 Powell currently has been receiving outpatient treatment at

Aurora Mental Health & Recovery (the clinic), where her treating

psychiatrist, Dr. Erin Smith (Dr. Smith), diagnosed her with

schizoaffective disorder – bipolar type.

¶6 In July, Powell’s treatment providers at the clinic filed

petitions for long-term certification and the involuntary

administration of medications. The long-term certification petition

alleged that Powell is gravely disabled as a result of her mental

illness and that she stated she will not take the prescribed

medications absent a court order. The petition seeking the

involuntary administration of medications asked the court to order

two antipsychotic medications, Abilify and Prolixin; and three other

medications — Ativan, Benadryl, and Cogentin — in the event of

side effects.

¶7 Following an evidentiary hearing in August, at which the

district court heard testimony from both Powell and Dr. Smith, the

court entered an order certifying Powell for long-term care and

authorizing the involuntary administration of the requested

medications. As pertinent here, the court found by clear and

convincing evidence that Powell has a mental health disorder and is

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gravely disabled. The court also found that the State had clearly

and convincingly established all four Medina elements — namely,

that (1) Powell is incompetent to effectively participate in the

treatment decision; (2) the treatment is necessary to prevent a

significant and likely long-term deterioration in her mental health

condition or to prevent the likelihood that she will cause serious

harm to herself or others; (3) a less intrusive treatment alternative

is not available; and (4) Powell’s need for treatment is sufficiently

compelling to override any bona fide and legitimate interest she has

in refusing treatment. Medina, 705 P.2d at 973. Powell now

appeals the long-term certification treatment order and the order

authorizing the involuntary administration of medication.

II. Standard of Review

¶8 When a party challenges the sufficiency of the evidence, we

review the record as a whole and, viewing it in the light most

favorable to the People, determine whether the evidence is sufficient

to support the court’s decision. People in Interest of Ramsey, 2023

COA 95, ¶ 23. We review de novo the court’s conclusions of law but

defer to the court’s findings of fact, including the weight and

credibility afforded to witness testimony, if supported by the record.

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

2011); People in Interest of C.A.K., 652 P.2d 603, 613 (Colo. 1982);

see People in Interest of R.C., 2019 COA 99M, ¶ 7 (“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.’”

(citation omitted)).

III. Analysis

¶9 Powell challenges the sufficiency of the evidence supporting

the district court’s order. In particular, she contends that the

evidence was insufficient to support (1) a finding that she is gravely

disabled and (2) the first and third Medina elements. We address

each contention in turn.

A. Certification for Long-Term Treatment

¶ 10 Under specified circumstances, section 27-65-110 permits the

professional in charge of a patient’s short-term certification and

treatment to file a petition to certify the patient for long-term care

and treatment. See § 27-65-110(1); see generally Perreira v. State,

768 P.2d 1198 (Colo. 1989) (providing an overview of the

certification process). As relevant here, to authorize long-term

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certification for mental health treatment, a court must find by clear

and convincing evidence that the patient has a mental health

disorder and, as a result, is gravely disabled. §§ 27-65-110(1)(a),

27-65-113(1), C.R.S. 2025. Evidence is clear and convincing when

it “persuades the trier of fact that the truth of the contention is

‘highly probable.’” People v. Taylor, 618 P.2d 1127, 1136 (Colo.

1980) (quoting Page v. Clark, 592 P.2d 792, 800 (Colo. 1979)).

¶ 11 Powell asserts that the evidence does not support a finding

that she is gravely disabled because it did not establish that she is

unable to meet her own basic needs.

¶ 12 “Gravely disabled” means that, due to a mental health

disorder, a person is incapable of making informed decisions about

or providing for her essential needs without significant supervision

and assistance from other people. § 27-65-102(17), C.R.S. 2025.

As a result, such a person “is at risk of substantial bodily harm,

dangerous worsening of any concomitant serious physical illness,

significant psychiatric deterioration, or mismanagement of the

person’s essential needs that could result in substantial bodily

harm.” Id. The supreme court has explained that a person is

gravely disabled if she is “unable to take care of basic personal

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needs.” Taylor, 618 P.2d at 1134. Basic personal needs means

“those fundamental necessities of human existence, such as food,

shelter, clothing, and medical care, which an individual must

obtain and maintain in order to live safely.” Id.

¶ 13 Dr. Smith testified that Powell needs assistance from others in

meeting her essential needs. In particular, Dr. Smith noted that

Powell lives with her mother, who holds a power of attorney and

provides support and structure to Powell. Without her mother’s

assistance and prompting, Dr. Smith testified, Powell would not

take her psychiatric medications, her psychosis would increase,

and she would be unable to take care of herself and her child.

Thus, in Dr. Smith’s expert opinion, Powell is gravely disabled.

¶ 14 The district court found Dr. Smith credible. And Dr. Smith’s

testimony supports the court’s finding that Powell is gravely

disabled because, without help, she cannot meet her essential

needs — in particular, her medical needs related to her psychiatric

illness. Likewise, Dr. Smith’s testimony supports the court’s

determination that Powell is unable to understand or make

important medical decisions on her own, and, without the help her

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mother provides, she will face significant deterioration in her mental

health disorder.

¶ 15 Powell nonetheless challenges the order because, in her view,

the record supports that she is taking care of herself and her child.

The district court acknowledged that Powell appeared to have more

linear responses to her counsel’s questioning at the August hearing

as compared to previous hearings. And at the same August

hearing, Dr. Smith praised Powell for wanting to obtain

employment. But Dr. Smith testified, and the court agreed, that

Powell’s improvements were only possible because Powell was on

medications and that Powell did not appreciate the extent to which

her mother and the clinic provided structure to ensure Powell

stayed medicated.

¶ 16 Thus, notwithstanding Powell’s assertions to the contrary, we

conclude that sufficient evidence supports the court’s determination

that she is gravely disabled.

B. The First Medina Element: Incompetent to Participate in the
Treatment Decision

¶ 17 Under the first Medina element, the district court may not

order the forced medication of an involuntarily committed patient

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unless it is satisfied that the patient’s mental illness has so

impaired her judgment as to render her incapable of participating in

decisions affecting her health. Medina, 705 P.2d at 973.

¶ 18 Powell contends that the court erred in determining that the

first Medina element was supported by clear and convincing

evidence because Dr. Smith’s testimony on this topic was “scant”

and did not suggest that Powell’s judgment was impaired. Rather,

she claims, the testimony established only that she disagrees with

Dr. Smith’s assessment that she has a mental health disorder in

need of medication.

¶ 19 But Dr. Smith detailed that, untreated, Powell’s schizoaffective

disorder would “build[] on itself, essentially causing brain damage

over time, leading to early dementia.” Yet Powell lacks “any insight

into her mental illness and what it requires to be stable and take

care of herself.” Thus, the doctor opined, she is not competent to

effectively participate in treatment decisions.

¶ 20 The court expressly credited Dr. Smith’s testimony that Powell

indeed has schizoaffective disorder and rejected Powell’s contrary

testimony as “biased” by her desire to simply be “left alone.”

Likewise, the court credited Dr. Smith’s testimony that Powell has

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no insight into the fact that she has a mental health disorder

requiring treatment and does not understand the consequences of

failing to treat it. Thus, the court concluded, she is unable to

competently and effectively participate in her treatment.

¶ 21 Given the evidence supporting Powell’s lack of insight into her

need for treatment or the severity of her illness, in combination with

the weight the district court placed on Dr. Smith’s testimony, we

cannot conclude that the evidence was insufficient to support the

determination that Powell is incompetent to effectively participate in

the relevant treatment decision. See People in Interest of D.N.W.,

2024 COA 129, ¶ 20 (deferring to the court’s determination of

witness credibility and the weight afforded that testimony).

C. The Third Medina Element: No Less Intrusive Treatment
Alternative

¶ 22 Powell also challenges the sufficiency of the evidence

supporting the third Medina element. This element “encompasses

not only the gravity of 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

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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.

¶ 23 As she did in Powell II, Powell objects to the district court’s

authorization of Prolixin as a backup to Abilify. She also objects to

the authorization of Ativan, Cogentin, and Benadryl, which, the

testimony established, are medications aimed at alleviating

potential side effects from Prolixin. We agree that the record does

not support the authorization of Prolixin and these side-effect

medications as a backup to Abilify.

¶ 24 Like the Powell II division, we define “primary medication” as

one that the petitioner seeks to immediately administer to a

respondent. Powell II, ¶ 18. 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. Id. We add

that side-effect medications aimed only at treating potential side

effects of a backup medication are also in the category of “backup

medication.”

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

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

. . . at some unspecified time in the future, is insufficient to justify”

an order authorizing backup medications. R.C., ¶ 14. Although

there are circumstances under which a backup medication might

be warranted — for example, when there is a specific and

articulable concern that the primary medication could be

ineffective, based on the respondent’s particular medical history,

D.N.W., ¶ 18 — we perceive no such circumstances here. Another

circumstance may arise when the treating physician does not have

knowledge as to which array of medications will most effectively

treat the patient’s symptoms; in that scenario, an order

involuntarily administering a primary and backup medication may

be justified. See People In Interest of Ferguson, 2025 COA 82, ¶ 28.

But that circumstance is also not present here.

¶ 26 At the August hearing, Dr. Smith testified that Powell has been

taking Abilify every four weeks. The doctor indicated that Powell

“has not complained of any side effects” from Abilify but said that “if

she were to have major side effects” — such as certain known

metabolic side effects — or “she just could not tolerate [Abilify], I

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would ask to have the option of [Prolixin as] a backup.” Dr. Smith

further testified that Ativan, Cogentin, and Benadryl would only be

needed to manage potential side effects from Prolixin, stating that

she did not foresee a need for those three medications “while

[Powell] is taking Abilify.”

¶ 27 With this in mind, the district court authorized Prolixin,

finding that, “if [Abilify] becomes ineffective” or “some side effects

appear,” Prolixin “is a reasonable alternative.” It further found that,

although Powell “is doing great on” Abilify, the three requested side-

effect medications were appropriate in case “she does not” and “has

one of these acute side effects that needs emergent treatment.”

¶ 28 This record is analogous to R.C. because it contains only

speculation that Abilify might become ineffective “at some

unspecified time in the future.” R.C., ¶ 14. And this is insufficient

to justify an order authorizing backup medications.

¶ 29 We acknowledge that Dr. Smith testified she had been told by

Powell’s mother that the mother noticed Powell was displaying more

irritability and less grooming during the last week before her Abilify

injection. But Dr. Smith did not opine that this meant a switch to

Prolixin was imminent or necessary; rather, she noted that “we can

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increase the frequency of the [Abilify] shot to every three weeks”

instead of every four. Likewise, although Powell testified that she

was feeling more drowsy on Abilify than she initially had, the

district court did not credit this as a reason for authorizing Prolixin

as a backup medication. Instead, the court identified drowsiness as

an acceptable side effect of Abilify as compared to the likely brain

damage that would occur if Powell were to remain untreated.

¶ 30 Accordingly, we conclude that insufficient evidence supports a

conclusion that Abilify alone is not a less intrusive treatment than

Abilify and Prolixin. And because the testimony establishes that

the three side-effect medications are aimed only at treating the

potential side effects of Prolixin, we likewise conclude that their

authorization rests on insufficient evidence.

IV. Conclusion

¶ 31 The order is affirmed as to the long-term certification and the

involuntary administration of Abilify. It is reversed, however,

insofar as it authorizes Prolixin and the three side-effect

medications as “backup” medications.

JUDGE HARRIS and JUDGE SCHOCK concur.

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