Peo in Interest of Powell

26CA0345 Peo in Interest of Powell 05-14-2026

COLORADO COURT OF APPEALS

Court of Appeals No. 26CA0345
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

Division IV
Opinion by JUDGE SCHUTZ
Freyre and Brown, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced May 14, 2026

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) a six-month extension of her certification for long-term care and

treatment under section 27-65-110(5), C.R.S. 2025; and (2) the

involuntary administration of medication. We affirm.

I. Background

¶2 Powell has a ten-year history of mental illness and psychiatric

hospitalizations. Since February 2025, she has been receiving care

and treatment for a mental health diagnosis of schizoaffective

disorder, bipolar type. She has been an outpatient client of Aurora

Mental Health & Recovery (AMHR) since April 2025 and subject to

various court orders, most recently an August 2025 order granting

long-term certification of Powell and the involuntary administration

of her medications.

¶3 In January 2026, Powell’s treatment providers at AMHR

sought an extension of Powell’s long-term certification along with an

extension of the order authorizing medical personnel to

involuntarily administer her medication. As pertinent to this

appeal, the certification petition alleged that Powell is gravely

disabled because of her mental illness. The petition seeking an

order authorizing the involuntary administration of medications

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asked the court to permit, as relevant here, the involuntary

administration of Abilify, an antipsychotic medication, and three

other drugs to address potential side effects.

¶4 Following an evidentiary hearing, at which the district court

heard testimony from both Powell and one of her treating

psychiatrists, Dr. Erin Smith, the court entered an order extending

Powell’s long-term care certification for six months and authorizing

the involuntary administration of Abilify but denying the request for

authorization to administer the remaining medications

involuntarily.

¶5 The court found by clear and convincing evidence that Powell

has a mental health disorder and is gravely disabled. And the court

found that the People had clearly and convincingly established all

four elements necessary for the involuntary administration of

Abilify: (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

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compelling to override any bona fide and legitimate interest she has

in refusing treatment. See People v. Medina, 705 P.2d 961, 973

(Colo. 1985).

II. Discussion

¶6 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. Standard of Review

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

review the record as a whole — viewing it in the light most favorable

to the People — to 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 its findings of fact, including the weight and credibility

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

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B. Extension of Long-Term Certification Order

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

professional in charge of a patient’s long-term care and treatment to

seek an extension of the order certifying such care and treatment.

See § 27-65-110(5). To grant the extension, 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),

(5), 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)).

¶9 “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

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

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.

¶ 10 Powell maintains that the evidence does not support the

district court’s finding that she is gravely disabled because the

record establishes that she “has made substantial and sustained

progress in her mental health, functioning, and independence” and

demonstrates “stability, insight[,] and a commitment to continued

treatment,” all of which “support[s] a determination that she is

capable of managing her affairs and meeting her essential needs

without involuntary intervention.” She specifically points to Dr.

Smith’s testimony that she “looks terrific”; appears well-dressed

and appropriately groomed; “look[ed] the best she’s ever looked” at

an appointment two weeks before the hearing; and has improved in

the areas of speech, eye contact, motor activity, anxiety, irritability,

memory, attention, and insight.

¶ 11 True, Dr. Smith so testified. And the district court

acknowledged that Powell “seems like she’s proceeding forward,

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doing a little better than she was even last time that we met.”

However, Dr. Smith testified that, although she was seeing

improvements, she wanted to see consistency over time, “not one

visit,” particularly as to Powell’s insight into her mental health

condition and her judgment. Dr. Smith further testified that, in the

year she had known Powell, “the majority of her responses have

shown poor insight into her illness and her need for medicating that

illness.” Thus, Dr. Smith “worr[ied] that [Powell] would not be able

to take care of herself if given total independence right now.”

¶ 12 The court credited Dr. Smith’s testimony, finding that, “in her

medical expertise,” she “just does not believe . . . that [Powell is]

there yet.” Because the court’s finding is supported by the record,

we cannot conclude that Powell’s progress is, as she asserts,

sustained and substantial. See Ramsey, ¶¶ 32-38 (deferring to trial

court’s “gravely disabled” findings because they were supported by

the record).

¶ 13 In determining that Powell “is and continues to be gravely

disabled,” the court noted that she continues to be “in need of

help.” The court found that she relies on her mother to assist her

with housing and is “not providing housing for herself at this time.”

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The court also noted that, while testifying, Powell appeared to defer

to her mother’s opinion when asked certain questions. And the

court simply did not “believe” that Powell would continue to take

her medicine or seek therapy for her mental health disorder absent

a certification order.

¶ 14 The record supports these findings and therefore the court’s

conclusion that Powell is gravely disabled. See id. Powell herself

testified that she relies on her mother to provide housing and that

she works with an AMHR caseworker, who helps with finding

employment and vocational rehabilitation. Asked a question about

whether her mental health had improved, Powell deferred to her

mother’s judgment, saying, “I wish my mom was here, because she

can help out a lot more if she came before.” Powell further testified

that the Colorado Coalition for the Homeless is assisting her with

“look[ing] for jobs and get[ting] a place [in] the program.” Although

the record contains indications of Powell’s aforementioned progress

and increasing ability to care for herself and her son, it nonetheless

supports the court’s grave disability determination because it

reflects that Powell still needs significant supervision and

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assistance from other people to make informed decisions about and

provide for her essential needs.

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

¶ 15 Under the first Medina element, the district 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 her judgment as to render her incapable of participating in

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

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

first Medina element was supported by clear and convincing

evidence because, among other things, her testimony established a

“demonstrated understanding of her condition,” along with a

willingness to voluntarily take Abilify.

¶ 17 But the district court disbelieved Powell’s testimony that she

would continue to take Abilify on a voluntary basis, and we are not

free to disregard this credibility determination. See R.C., ¶ 7 (“The

district court, as fact finder, has discretion to determine the

credibility of the witnesses; the sufficiency, probative effect, and

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weight of the evidence; and the inferences and conclusions to be

drawn from it.” (citation modified)).

¶ 18 Likewise, the court found that there wasn’t a clear indication

that Powell understood why she needed to take Abilify. She was

unable to clearly express that she has a mental illness for which

she needs medication. Asked whether she has a mental health

disorder, Powell testified, “Sometimes.” Questioned about whether

she believes she has schizoaffective disorder, she answered, “I don’t

know. I’m still learning that.” Similarly, when asked whether she

thought she would “get bad without taking Abilify,” she responded,

“No.” She also testified that she did not believe that taking Abilify

would help her remain in the community and take care of herself

and her son.

¶ 19 Dr. Smith, whose testimony the court found credible, testified

to the contrary — namely, that without medication, Powell would

suffer a significant and long-term deterioration with degeneration of

the brain and symptoms akin to dementia.

¶ 20 Given the evidence supporting the district court’s concerns

with Powell’s lack of insight into both her need for treatment and

the severity of her illness, along with the weight the court placed on

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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).

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

¶ 21 We likewise reject Powell’s assertion that there was insufficient

evidence to support 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

at 974.

¶ 22 Powell asserts that her “willingness to engage in voluntary

treatment presents a viable and less intrusive alternative to a court-

ordered mandate.” But, as noted, the district court rejected, as not

credible, Powell’s testimony that she would continue to voluntarily

take her medication in the absence of a court order. Thus, the

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record does not support her claim; instead, it supports the court’s

determination that there isn’t any less intrusive treatment

alternative available. Dr. Smith, whose testimony the court

credited, so testified, and we may not disturb the court’s credibility

determination. D.N.W., ¶ 20.

III. Disposition

¶ 23 The order is affirmed.

JUDGE FREYRE and JUDGE BROWN concur.

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