Peo in Interest of JTR

25CA1443 Peo in Interest of JTR 11-13-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1443
Pueblo County District Court No. 25MH30060
Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of J.T.R.,

Respondent-Appellant.

ORDER AFFIRMED

Division VI
Opinion by JUDGE BERNARD*
Welling and Sullivan, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced November 13, 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, J.T.R., appeals the district court’s order

authorizing staff at the Colorado Mental Health Hospital in Pueblo,

which we shall call the “state hospital,” to medicate him against his

will. We affirm.

I. Background

¶2 For the fifth time in fewer than three years, the state hospital

admitted J.T.R. in July 2025 after a judge found he was

incompetent to stand trial on criminal charges. He has a long

history of mental illness; according to the affidavit of his treating

physician at the state hospital, he suffers from bipolar disorder.

¶3 The physician’s affidavit described a repeating cycle of events.

Treatment at the state hospital would restore J.T.R. to competency;

he would return to the jail where charges were pending against him;

he would refuse to take his psychiatric medication while in the jail;

his mental condition would deteriorate to the point where he was no

longer competent; and a court order would return him to the state

hospital, where the cycle would begin again.

¶4 During J.T.R.’s most recent stint at the state hospital, he spat

at and tried to punch members of the hospital’s staff; he put one of

his fists in his rectum; and he smeared blood from his injured

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rectum on his face. In response, staff gave him psychiatric

medication on an emergency basis.

¶5 The government promptly asked the court to issue a six-

month order authorizing the continued involuntary administration

of the medications they had given J.T.R. on an emergency basis:

lithium, Zyprexa, and Haldol. The request stated the staff would

give J.T.R. Haldol if he needed it for episodes of acute agitation, and

the treating physician added Haldol may also be administered if he

refused to take the oral dosage of lithium.

¶6 At an evidentiary hearing to resolve the government’s motion,

the treating physician said the court should allow the state hospital

to treat J.T.R. with medication against his will because (1) he was

incompetent to participate effectively in his treatment decisions;

(2) the requested medications were necessary (a) to prevent a

significant and likely long-term deterioration in his mental health

condition, and (b) to prevent the likelihood he would pose a serious

risk of harm to himself and others; (3) a less intrusive treatment

alternative — specifically, treatment with only lithium — was not

effective; and (4) his need for psychiatric medications outweighed

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any bona fide interest he had in his refusing to take the

medications. See People v. Medina, 705 P.2d 961, 973 (Colo. 1985).

¶7 The court found the treating physician’s testimony was

credible and persuasive. The court later adopted the physician’s

opinions in its order.

¶8 J.T.R. testified that he objected to taking psychiatric

medications other than lithium because they caused various side

effects and that taking pharmaceuticals was against his religion.

Without deciding whether his testimony about side effects was

credible, the court found the possible side effects and his religious

objection to taking pharmaceuticals were bona fide and legitimate

reasons to refuse medication. But the court also found his

prognosis without treatment was so unfavorable that, despite his

bona fide and legitimate interests in refusing the medication, his

personal preferences must yield to the government’s interests.

¶9 The court ultimately found the government had provided clear

and convincing evidence for each of the four Medina elements listed

above. It issued an order authorizing the state hospital’s staff to

administer all the requested medications.

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II. Discussion

¶ 10 J.T.R. raises a single issue on appeal. He submits the record

does not contain sufficient evidence to support the court’s findings

and conclusions concerning the fourth Medina element, which was

whether his need for treatment was sufficiently compelling to

override his bona fide and legitimate interests in refusing treatment.

See id. He contends, based on his testimony that the medications

do not actually help him because “on the inside [he is] suffering all

the time,” the government’s interests in treating him did not

outweigh his interests in refusing treatment. We conclude the

record amply supports the court’s determinations concerning the

fourth element.

A. Standard of Review and Legal Authority

¶ 11 When a patient challenges the sufficiency of the evidence

supporting a court’s findings on any of the Medina elements, we

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

favorable to the government, we decide whether the evidence is

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

Ramsey, 2023 COA 95, ¶ 23. We review the court’s conclusions of

law de novo, and we defer to its findings of fact if they are

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

CO 4, ¶ 8. We also defer to the court’s resolution of evidentiary

conflicts and its determinations of witness credibility, the weight of

the evidence, and the inferences to be drawn from it. See People in

Interest of R.C., 2019 COA 99M, ¶ 7. A physician’s testimony alone

may constitute clear and convincing evidence. See People v.

Pflugbeil, 834 P.2d 843, 846-47 (Colo. App. 1992).

¶ 12 In assessing the sufficiency of evidence for the fourth Medina

element, a court must determine (1) “whether the patient’s refusal

is bona fide and legitimate” and, if so, (2) “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.

B. Sufficient Evidence of Fourth Medina Element

¶ 13 J.T.R. challenges the court’s determination that his prognosis

without treatment was so unfavorable that his interest in refusing

medication must yield to the government’s interests in preserving

his health and in protecting the safety of others in the state

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hospital. After examining the record, we conclude the treating

physician’s affidavit and testimony, which the court found credible

and incorporated into its order, support this finding.

¶ 14 The treating physician testified he had treated J.T.R. during

each of J.T.R.’s five hospitalizations since 2022. Based on his

contact with J.T.R. during those times, he thought, without

treatment with the proposed medications, J.T.R. would suffer

multiple symptoms of mania, including delusions, paranoia, and

impulsivity; he would be suicidal; and he would hurt himself.

¶ 15 On the one hand, the physician described several incidents

when J.T.R. was insufficiently medicated. He had engaged in

aggressive or self-harming behavior, including spitting at hospital

staff, making explicit threats of violence, attempting to punch and

kick staff, attempting to eat his own flesh, and lighting his own

beard on fire.

¶ 16 On the other hand, when J.T.R. was appropriately medicated

— as he had been with lithium and Zyprexa in at least three of his

four prior hospitalizations — his symptoms improved and

stabilized, and he was restored to competency. The treating

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physician added there was no record of him suffering significant

side effects from either of those medications.

¶ 17 To the extent J.T.R.’s testimony conflicts with the treating

physician’s testimony and affidavit, we defer to the court’s

resolution of the conflicts. See R.C., ¶ 7. And, because ample

evidence supports the court’s decision that J.T.R.’s need for

treatment was sufficiently compelling to override concerns about

the medication’s side effects and the treatment’s intrusion on his

religious rights, we conclude the fourth Medina element was

satisfied. See Marquardt, ¶ 8.

¶ 18 The order is affirmed.

JUDGE WELLING and JUDGE SULLIVAN concur.

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