Peo in Interest of Camack

25CA2189 Peo in Interest of Camack 01-08-2026

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA2189
Pueblo County District Court No. 25MH30111
Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Sean Camack,

Respondent-Appellant.

ORDER AFFIRMED

Division II
Opinion by JUDGE MEIRINK
Fox and Brown, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced January 8, 2026

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 Sean Camack appeals the district court’s order authorizing the

involuntary administration of medications under the four-part test

found in People v. Medina, 705 P.2d 961 (Colo. 1985). We affirm

the order.

I. Background

¶2 Camack was admitted to the Colorado Mental Health Hospital

in Pueblo in February 2024 after he was found not guilty by reason

of insanity in a first degree murder case. He has been diagnosed

with unspecified schizophrenia spectrum and other psychotic

disorder, and he presents with symptoms including paranoia,

disorganized thinking and speech, auditory and visual

hallucinations, severe agitation, and a decreased need for sleep.

¶3 In November 2025, believing that Camack would not maintain

consent to treatment, his treating psychiatrist, Dr. Paul Mattox,

sought an order authorizing the involuntary administration of

Zyprexa (olanzapine), lithium, and Thorazine (chlorpromazine).

¶4 Following a hearing — at which both Dr. Mattox and Camack

testified — the district court issued an order authorizing the

requested involuntary treatment, finding that the People had met

their burden to prove all four Medina elements.

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II. Discussion

¶5 Camack contests the sufficiency of the evidence as to the first

and third Medina elements. We conclude that sufficient evidence

supports these elements.

A. Legal Principles and Standard of Review

¶6 A district court may authorize the involuntary administration

of medication if the People establish each of the following elements

by clear and convincing evidence: (1) the person 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 person’s mental health condition or to prevent the likelihood

of the patient causing serious harm to himself or others in the

institution; (3) a less intrusive treatment alternative is not available;

and (4) the person’s need for treatment is sufficiently compelling to

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override any bona fide and legitimate interest of the person in

refusing treatment.1 Id. at 973.

¶7 We determine whether the evidence, viewed as a whole and in

the light most favorable to the People, 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.

¶8 Application of the Medina test is a mixed question of fact and

law. People v. Marquardt, 2016 CO 4, ¶ 8. We defer to the district

court’s factual findings if they are supported by the record but

review the court’s legal conclusions de novo. Id. Both the

resolution of testimonial conflicts and the determination of witness

credibility are solely within the province of the fact finder. People in

Interest of Ramsey, 2023 COA 95, ¶ 23. Where the evidence

1 When the state seeks to administer antipsychotic drugs to a

mentally ill criminal defendant involuntarily so that they can stand
trial, a reviewing court applies the Supreme Court’s test in Sell v.
United States, 539 U.S. 166, 178 (2003). However, reviewing courts
apply state law tests if the state, as here, seeks to administer
antipsychotics involuntarily for “a different purpose,” including a
purpose “related to the individual’s dangerousness, or . . .the
individual’s own interests where refusal to take drugs puts his
health gravely at risk.” Id. at 181-82.

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supports the district court’s findings and conclusions, we may not

substitute our judgment for that of the district court. People in

Interest of A.J.L., 243 P.3d 244, 255 (Colo. 2010).

B. The First Medina Element

¶9 The first Medina element requires a court to determine

whether the patient is incompetent to effectively participate in the

relevant treatment decision. Medina, 705 P.2d at 973. A court may

not order the forced medication of an involuntarily committed

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

impaired their judgment as to render them incapable of

participating in decisions affecting their health. Id.

¶ 10 At the hearing, Dr. Mattox testified that Camack has “[v]ery

little” insight into his mental illness and does not believe that he

“ha[s] the major psychotic illness that he” indeed “suffer[s] from.”

Instead, he believes “he primarily has a trauma spectrum illness”

and wishes to take medications only “for a short period of time.”

However, Dr. Mattox said Camack’s primary mental health issue is

his psychotic symptoms, which are not related to trauma and will

not resolve without treatment. Consequently, in Dr. Mattox’s expert

opinion, Camack is incapable of effectively participating in decisions

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affecting his health, including the decision on whether psychiatric

medications are needed.

¶ 11 The district court credited Dr. Mattox’s testimony, adopting

the doctor’s opinions as its own. As noted, the testimony of the

physician seeking to administer treatment may be sufficient,

without more, to satisfy the Medina test. R.K.L., ¶ 30.

¶ 12 Nonetheless, Camack asserts that his own testimony reflects

that his judgment is not impaired and demonstrates that he is

capable of actively participating in his mental health treatment and

contributing constructively to his care. But the district court

expressed “severe concerns regarding [Camack’s] credibility,”

stating that “frankly, the [c]ourt just does not find him credible”

based on the court’s view that he is simply unwilling to be “truthful

when he has something to gain, which here would be no court

order” requiring involuntary medication.

¶ 13 Because determinations of witness credibility are solely within

the province of the fact finder, we are not free to disturb them. See

Ramsey, ¶ 23. In any event, as the district court found, Camack’s

own testimony reflected a lack of insight into his mental illness. He

denied the severity of his mental illness, claiming that its “root

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cause” “stem[med] from post-traumatic stress disorder,” not a

psychotic disorder. And when asked by his lawyer if he had any of

the symptoms described by Dr. Mattox — namely, paranoia,

hallucinations, and delusions — he answered, “No, ma’am,” and

attributed “what [he] was going through” to “reliving traumatic

experiences.”

¶ 14 Under these circumstances, we cannot conclude that the

evidence was insufficient to support the district court’s

determination that Camack is incompetent to effectively participate

in the relevant treatment decision.

C. The Third Medina Element

¶ 15 The third Medina element — that a less intrusive treatment

alternative is not available — “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 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

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treatment.” People in Interest of Strodtman, 293 P.3d 123, 133

(Colo. App. 2011).

¶ 16 As we understand him, Camack asserts that permitting him to

voluntarily resume a regimen of Abilify — which he has previously

taken and which has fewer side effects than Zyprexa — constitutes

a less restrictive alternative. Further, he argues, because he has

expressed a willingness to comply voluntarily with prescribed

medication, there is no demonstrated need for court-ordered

treatment. That is, in his view, his “voluntary participation is

substantially likely to achieve the same therapeutic results as an

involuntary order.”

¶ 17 Although Camack stated that he was willing to take

medications voluntarily, the district court rejected this testimony as

not credible, and we are not free to second-guess this credibility

determination. See Ramsey, ¶ 23. Further, though Dr. Mattox

acknowledged that Abilify “could be” sufficient to treat Camack in

the long term once he is stabilized, he testified that Zyprexa is “a

good, if not one of the best antipsychotic medications for [the] acute

stabilization” phase of Camack’s treatment plan. He stated that,

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thereafter, he would “[a]bsolutely” look at different alternatives,

such as Abilify.

¶ 18 This testimony supports the district court’s determination

that, at the time of the hearing, there was no alternative as effective

and less intrusive than the requested medications. In particular,

the court credited Dr. Mattox’s testimony that Zyprexa was

necessary to get Camack “out of his acute state,” but that Abilify

could be an alternative in the future. This evidence amply supports

a conclusion that, at the time of the hearing, Abilify was not a less

intrusive alternative to the requested medications.

III. Disposition

¶ 19 The order is affirmed.

JUDGE FOX and JUDGE BROWN concur.

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