Peo in Interest of Ramirez Quevado

25CA1503 Peo in Interest of Ramirez Quevado 12-11-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1503
Pueblo County District Court No. 25MH30011
Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Kami Ramirez Quevado,

Respondent-Appellant.

ORDER AFFIRMED

Division II
Opinion by JUDGE BROWN
Fox and Meirink, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced December 11, 2025

Cynthia Mitchell, County Attorney, Kate Shafer, Special Assistant County
Attorney, Pueblo, Colorado, for Petitioner-Appellee

Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant
¶1 Kami Ramirez Quevado appeals the district court’s order

authorizing staff at the Colorado Mental Health Hospital in Pueblo

(the hospital) to medicate her without her consent. We affirm.

I. Background

¶2 Ramirez Quevado was admitted to the hospital in January

2025 after being found incompetent to proceed in a criminal case.

She was diagnosed with schizophrenia and severe post-traumatic

stress disorder. Her symptoms included hearing voices, episodes of

catatonia, intense hypervigilance, and intense discomfort in

situations that remind her of her past, extensive abuse.

¶3 In early February, the district court granted the State’s

petition to involuntarily medicate Ramirez Quevado with three

medications. However, over the next month and a half, Ramirez

Quevado assaulted staff members and fellow patients on nearly

twenty different occasions. In late March, the court granted the

State’s petition to involuntarily medicate her with seven

medications. However, in late March and during the first half of

April, Ramirez Quevado committed six more assaults, as well as an

attempted assault. In late April, the district court granted the

State’s petition to add an eighth medication — clozapine — which

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Ramirez Quevado’s psychiatrist at the hospital described as a “last

resort” medication (the next step being electroconvulsive therapy,

which is much more intrusive).

¶4 Three months later, soon before the April order was set to

expire, the State filed the petition at issue, seeking authorization to

involuntarily medicate Ramirez Quevado with the following six

medications:

• three antipsychotic medications — clozapine, olanzapine

(Zyprexa), and quetiapine (Seroquel);

• two mood-stabilizing medications — valproate (Depakote)

and lithium; and

• propranolol, a blood pressure medication that can be

effective in reducing assaultive behavior.

In an affidavit filed with the petition, Ramirez Quevado’s

psychiatrist at the hospital reported that

• Ramirez Quevado was doing “far better” and hadn’t

committed any assaults since April;

• “we are [now] tapering off as many meds as possible,” with

the goal of eventually treating her solely with clozapine and

lithium;

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• “[w]e need to make sure that she stays on the [other four]

medications while we trim them slowly over the months,

one by one”; and

• “[i]f she stops a medication too soon she will likely relapse

to [become a] danger to others/self.”

¶5 At the hearing on the petition, the psychiatrist and Ramirez

Quevado testified. The psychiatrist, whom the parties stipulated

was an expert in clinical psychiatry, testified that Ramirez

Quevado’s mental illness constitutes a substantial disorder that

grossly impairs her judgment or capacity to recognize reality or to

control her behavior. The psychiatrist reported that Ramirez

Quevado had committed more than forty assaults between January

and April; he explained that this behavior poses a risk of harm not

only to staff members and other patients, but also to Ramirez

Quevado herself because patients “want to fight her.”

¶6 But the psychiatrist testified that, since adding clozapine to

Ramirez Quevado’s medications, she has improved to the point that

she has turned into a “model patient” and a “success story.”

Specifically, she has not committed any more assaults; she has

been “a delight to be with”; she has been participating in group

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therapy; and, although she still hears voices “on and off,” her PTSD

“has virtually disappeared.”

¶7 The psychiatrist explained his plan for tapering Ramirez

Quevado off three of the six medications: first olanzapine (which

was already in progress), then quetiapine, and then propranolol.

He testified that it would take approximately one month to safely

taper off each medication because doing so more quickly would

likely lead to relapse in her condition. He also testified that it was

possible that she could eventually be tapered off valproate and

lithium too.

¶8 Finally, the psychiatrist testified regarding side effects that

Ramirez Quevado had experienced from the medications, including

weight gain, dizziness, and drooling. The psychiatrist explained

that clozapine can lower a patient’s white blood cell count — a

particular concern with Ramirez Quevado because she has a

condition called benign ethnic neutropenia, which causes her to

have a lower-than-average white blood cell count — but he testified

that her white blood cell count has remained within the normal

range. The psychiatrist ultimately opined that Ramirez Quevado’s

need for the medications outweighs the side effects, and that the

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failure to medicate her would be more harmful than the risks posed

by the medications.

¶9 During Ramirez Quevado’s testimony, she said that she has

psychosis and schizophrenia but that she does not need any

medications to treat her conditions. Instead, she testified that she

can treat her symptoms with “[c]oping skills” like reading, writing,

and drawing. She testified that she does not want to take any

medications and will not do so absent a court order. She also

testified about the side effects she had experienced from the

medications, including weight gain, dizziness, and drooling.

¶ 10 Following the testimony, the district court found that the

psychiatrist had testified credibly and persuasively, and it adopted

the psychiatrist’s opinions. The court then examined each of the

four elements of the test from People v. Medina, 705 P.2d 961, 973

(Colo. 1985), concluded that the People had met their burden of

proving all four elements in this case, and granted the petition to

involuntarily medicate Ramirez Quevado.

II. Applicable Law and Standard of Review

¶ 11 Under the Medina test, a district court may authorize the

involuntary administration of medication if the People demonstrate

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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 herself 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.1 Id.

¶ 12 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

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 Ramirez Quevado was admitted to the
hospital for that purpose, the parties agree that the test from People
v. Medina, 705 P.2d 961 (Colo. 1985), applies here. Indeed, the
petition’s stated purposes, and the district court’s bases for
granting the petition, were (1) to prevent a significant and long-term
deterioration in Ramirez Quevado’s mental condition and (2) to
prevent the likelihood of her causing serious harm to others at the
institution. See R.F., ¶ 11 n.1.

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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.

¶ 13 On a challenge to the sufficiency of the evidence, we must

affirm the district court’s ruling if the evidence, viewed as a whole

and in the light most favorable to the prevailing party, is 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

¶ 14 Ramirez Quevado does not contest the district court’s findings

that the People met their burden of proving the first, second, and

third Medina elements. However, she contends that the evidence

was insufficient to establish the fourth Medina element — that her

need for the medications is sufficiently compelling to override any

bona fide and legitimate interest she has in refusing to take them.

¶ 15 In analyzing the fourth Medina element, a court first

determines “whether the patient’s refusal is bona fide and

legitimate.” Medina, 705 P.2d at 974. If it is, the court then

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determines “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.” Id.

¶ 16 The district court found that Ramirez Quevado’s interests in

avoiding the side effects she had been experiencing and the risk of

developing a low white blood cell count were bona fide and

legitimate. However, the court also found that her side effects have

lessened or are expected to lessen in the future, and it noted the

ways in which Ramirez Quevado was, or could be, mitigating the

side effects. The court also found that despite the primary risk with

clozapine — reduced white blood cell count — Ramirez Quevado’s

white blood cell count had remained normal. The court then

balanced that interest against Ramirez Quevado’s need for the

medications, and it found that “her prognosis without treatment is

still so unfavorable, that her personal preference must yield to the

legitimate interest of the State in preserving [her] life and health . . .

[and] protecting the safety of those in the [hospital].”

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¶ 17 The record supports the district court’s findings. To be sure,

the evidence shows that Ramirez Quevado’s interest in avoiding side

effects was bona fide and legitimate. However, the psychiatrist’s

testimony, which the district court credited, shows that her side

effects had either already improved or were expected to improve in

the future:

• In terms of Ramirez Quevado’s weight gain, the psychiatrist

testified that olanzapine and quetiapine are the two

medications she was taking that cause the most weight

gain, but in tapering her off those medications over the next

two months, “it’s possible that the weight gain will go away.”

• In terms of her dizziness, he testified that propranolol was

“probably the main culprit” but that her dizziness had

already gotten “much better.”

• In terms of her drooling, he testified that clozapine was

causing that, but usually “the drooling stops [after] about

six or seven months” on the medication.

¶ 18 The psychiatrist also testified regarding ways to mitigate some

of the side effects:

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• Metformin helps to mitigate weight gain, and although

Ramirez Quevado was taking a minimum dose of that

medication, he was encouraging her to increase the dose.

• Atropine drops, which dry the mouth, can alleviate drooling,

but Ramirez Quevado stopped taking the drops because she

didn’t like how they tasted.

¶ 19 We discern no error in the district court’s finding that Ramirez

Quevado’s interest in avoiding side effects was outweighed by her

compelling need for medication treatment. The record reflects the

gravity of Ramirez Quevado’s condition upon her admission to the

hospital and during the first three months of her hospitalization. It

also reflects her drastic improvement since taking clozapine: the

psychiatrist explained that she had transformed into a “model

patient” who “should skate through this [hospital] quickly . . . once

she gets to a competency exam.” The need for Ramirez Quevado to

take clozapine to continue to improve and stabilize is compelling

and outweighs her interest in avoiding side effects, which either

have already improved or are expected to improve in the future.

¶ 20 In arguing that the district court erred, Ramirez Quevado

highlights the psychiatrist’s testimony describing this as a “record

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case” in terms of the number of medications she had taken. But

the record reflects that the other antipsychotic medications were

tried before clozapine because clozapine is a “last resort”

antipsychotic medication as it can lower white blood cell count and

suppress the immune system. But now that clozapine has proven

effective, the psychiatrist’s focus is on tapering Ramirez Quevado off

as many of the other medications as possible. It is not safe to do

that quickly, however; it must be done one medication at a time,

one month at a time.

¶ 21 Ramirez Quevado also emphasizes that she has benign ethnic

neutropenia, making clozapine particularly dangerous for her to

take since it lowers white blood cell count. However, the

psychiatrist testified that Ramirez Quevado is taking only a

moderate dose of clozapine (525 milligrams, with the maximum

dose being 900 milligrams). Further, lithium, which she is also

taking, helps to maintain white blood cell count. The psychiatrist

testified that Ramirez Quevado’s white blood cell count has

remained within the normal range, making this less of a concern

when balanced against her compelling need for clozapine.

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¶ 22 Finally, Ramirez Quevado suggests that her need for

medication treatment is no longer as compelling because of how

much she has improved and because the assaults she committed at

the hospital were “remote” and “distant” past events. But that

argument ignores the psychiatrist’s testimony and the district

court’s finding that clozapine is the reason she has improved so

significantly. And notably, Ramirez Quevado does not contest the

district court’s finding on the second Medina element that the

medication treatment “is necessary to prevent a significant and

long-term deterioration of [her] mental condition” and “is necessary

to prevent the likelihood of [her] causing serious harm to others in

the [hospital].”

IV. Disposition

¶ 23 The order is affirmed.

JUDGE FOX and JUDGE MEIRINK concur.

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