Peo in Interest of Sweeney

25CA0505 Peo in Interest of Sweeney 05-15-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA0505
Arapahoe County District Court No. 25MH133
Honorable H. Clay Hurst, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Alissa Jordan Sweeney,

Respondent-Appellant.

ORDER AFFIRMED

Division II
Opinion by JUDGE SCHUTZ
Fox and Harris, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced May 15, 2025

Ronald Carl, County Attorney, Meghan K. Rubincam, Senior Assistant County
Attorney, Aurora, Colorado for Petitioner-Appellee

Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant
¶1 Respondent, Alissa Jordan Sweeney, appeals the district court

order authorizing the involuntary administration of olanzapine

(Zyprexa), an antipsychotic, and valproic acid (Depakote), a mood-

stabilizing medication. We affirm.

I. Background

¶2 Sweeney was admitted to the Colorado Mental Health Hospital

in Pueblo (CMHHIP) after being found incompetent to proceed to

trial on criminal charges. She was placed on emergency

medications after “she became assaultive toward staff members and

bit one nurse multiple times.” The People then dismissed the

charges against Sweeney and petitioned for short-term certification

and involuntary treatment pursuant to section 27-65-109, C.R.S.

2024. Specifically, they requested authorization to treat her with

Zyprexa, fluphenazine (a second antipsychotic), and Depakote. The

physician’s affidavit accompanying the petition asserted that

despite a short period of involuntary treatment with Zyprexa,

Sweeney continued to exhibit acute symptoms of unspecified

schizophrenia, unspecified psychotic disorder, and mania.

¶3 Consistent with People v. Medina, 705 P.2d 961 (Colo. 1985),

the physician’s affidavit also asserted that (1) Sweeney is incapable

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of participating in decisions affecting her health and treatment; (2)

the requested treatment is necessary to prevent a significant and

likely long-term deterioration in her mental health condition or to

prevent the likelihood of her causing serious harm to herself or

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

and (4) Sweeney’s need for treatment is sufficient to override any

bona fide and legitimate interest she has in refusing treatment.1

¶4 Sweeney did not challenge her short-term certification, but she

requested a hearing on the involuntary medication order. At the

hearing, the testifying physician, Dr. Hareesh Pillai, rescinded the

request for fluphenazine and requested an order authorizing

treatment with only (1) Zyprexa, orally and if declined, by

intramuscular injection; and (2) the Depakote, orally or via a

nasogastric (NG) tube. Sweeney testified that she preferred to be

1 When the state seeks to administer antipsychotic drugs to a

mentally ill criminal defendant involuntarily so that she 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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treated with Benadryl, melatonin, Vicodin, and antibiotics. Her

testimony also revealed delusional thoughts consistent with those

alleged by CMHHIP. Sweeney’s attorney argued that, considering

her alleged side effects from Zyprexa (including that she had once

been poisoned by Zyprexa “and it took four different hospitals to

put a blocker in”), the People had not set forth clear and convincing

evidence for the fourth Medina element.

¶5 The district court found that Dr. Pillai’s testimony was

credible, and Sweeney’s was not. It found that the People had

presented clear and convincing evidence for each of the Medina

elements. As relevant to this appeal, the court found that Dr.

Pillai’s testimony supported its finding as to the third Medina

element, and no alternative treatment had been proposed. It issued

an order authorizing CMHHIP staff to involuntarily administer the

requested medications for a period of two months. The court

specified that Zyprexa was to be offered orally, and if Sweeney

refused, it could be administered by intramuscular injection. For

the Depakote, the court ordered that it was to be offered orally, and

if rejected, it could be administered by intravenous injection (if

available) or by NG tube. For the NG tube, the court further

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required that its placement be accompanied by litmus paper or X-

ray precautions to ensure that the tube was not erroneously placed

in Sweeney’s lung.

II. Discussion

¶6 On appeal, Sweeney challenges the sufficiency of the evidence

only for the third Medina element. As we understand her argument,

she contends that treating her with Zyprexa alone is an available

less intrusive alternative, and Dr. Pillai’s testimony was insufficient

to establish her need for Depakote.

A. Legal Authority and Standard of Review

¶7 A district court may authorize the involuntary administration

of medication to a patient only if the People establish each of the

Medina elements by clear and convincing evidence. Medina, 705

P.2d at 973; see People in Interest of Strodtman, 293 P.3d 123, 131

(Colo. App. 2011). A physician’s testimony alone may constitute

clear and convincing evidence. See People v. Pflugbeil, 834 P.2d

843, 846-47 (Colo. App. 1992).

¶8 When, as here, a patient challenges the sufficiency of the

evidence supporting the district court’s findings on any of these

elements, we review the court’s conclusions of law de novo and

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defer to its findings of fact if supported by evidence in the record.

People v. Marquardt, 2016 CO 4, ¶ 8. We view the record as a whole

and in the light most favorable to the People, and we defer to the

fact finder to resolve any conflicts in the testimony and determine

the credibility of witnesses. See People in Interest of Ramsey, 2023

COA 95, ¶ 23; see also Strodtman, 293 P.3d at 130.

¶9 The third Medina element requires a court to determine that

no less intrusive alternative to the proposed medication is available.

Medina, 705 P.2d at 973. 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.” Id. 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.

B. Sufficient Evidence Presented

¶ 10 Viewing the record in the light most favorable to the People, we

conclude that Dr. Pillai’s testimony provides clear and convincing

evidence of the third Medina element. Pflugbeil, 834 P.2d at 846-

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47. As relevant here, Pillai directly testified that there is no less

intrusive treatment alternative to the requested medications. He

also testified that:

• Because Sweeney is suffering from acute mania, a mood

stabilizer and an antipsychotic are the “first line of

treatment.” (Emphasis added).

• Based on the severity of Sweeney’s symptoms, “she would

require a mood stabilizing agent along with Zyprexa to

return to her normal baseline.” (Emphasis added.)

• Depakote would treat Sweeney’s mania and target her

symptoms of irritability, mood lability, and impulsivity.

¶ 11 This evidence demonstrates that Zyprexa alone is not a less

intrusive treatment alternative, because it would not be at least as

effective at alleviating Sweeney’s condition as the proposed

treatment. See Strodtman, 293 P.3d at 133. That is, Zyprexa alone

would not treat Sweeney’s mania, irritability, mood lability, and

impulsivity.

¶ 12 To the extent Sweeney also argues that treatment with

Depakote is not the least intrusive alternative because the backup

version requires NG tube administration, we conclude that the

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district court properly considered “the gravity of any harmful effects

from the proposed treatment” and weighed that in view of Sweeney’s

serious symptoms and need for treatment. We also note that the

court ordered CMHHIP to offer oral and intravenous injection (if

available) of Depakote before resorting to the NG version. Thus, the

court adequately considered the existence of alternative methods of

treating Sweeney’s condition and the least restrictive means by

which to administer the requested medications when it issued its

order. See Medina, 705 P.2d at 974.

III. Disposition

¶ 13 The order authorizing the involuntary administration of

medication is affirmed.

JUDGE FOX and JUDGE HARRIS concur.

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