Peo in Interest of EME

25CA0370 Peo in Interest of EME 05-22-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA0370
Pueblo County District Court No. 24MH30074
Honorable Scott B. Epstein, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of E.M.E.,

Respondent-Appellant.

ORDER AFFIRMED

Division VII
Opinion by JUDGE LUM
Lipinsky and Pawar, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced May 22, 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
¶1 Respondent, E.M.E., appeals the district court order

authorizing the involuntary administration of two antipsychotic

medications — olanzapine (Zyprexa) and haloperidol (Haldol) — as

well as valproic acid (Depakote), a mood-stabilizing medication. We

affirm the order.

I. Background

¶2 E.M.E. was admitted to the Colorado Mental Health Hospital

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

trial on criminal charges. According to the affidavits of two treating

physicians and the testimony of Dr. Paul Mattox, his current

treating physician, E.M.E.’s condition significantly deteriorated

when he refused psychiatric medication in jail. As a result, six

officers had to transport him to CMHHIP in a “cocoon suit” due to

his extremely aggressive conduct. At CMHHIP, he required

seclusion and restraint because, among other threatening

behaviors, he attempted to bite, strike, pinch, and kick staff. He

also hit his head against the walls, held his breath, and elbowed a

door.

¶3 In August 2024, the district court entered an order permitting

the involuntary administration of Zyprexa, Haldol, Depakote, and

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Thorazine (an antipsychotic) for six months. The order was updated

to include a fifth medication — an additional antipsychotic — when

E.M.E. continued to exhibit symptoms requiring severe assault

precautions. E.M.E. appealed the updated order, and a division of

this court affirmed. People in Interest of E.M.E., (Colo. App. No.

24CA1914, Dec. 26, 2024) (not published pursuant to C.AR. 35(e)).

¶4 In February 2025, the People petitioned for a six-month order

permitting the involuntary administration of Zyprexa, Haldol, and

Depakote. They argued that, although E.M.E. had significantly

improved during the first six months of involuntary treatment, he

continued to believe that he did not have a mental illness and did

not benefit from medication. After conducting an evidentiary

hearing at which E.M.E. and Dr. Mattox testified, the court issued

an order authorizing CMHHIP staff to involuntarily administer the

requested medications for six months.

¶5 On appeal, E.M.E. challenges the sufficiency of the evidence

supporting the court’s order.

II. Legal Authority and Standard of Review

¶6 A district court may authorize the involuntary administration

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

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following elements by clear and convincing evidence: (1) the patient

is incompetent to participate effectively in the treatment decision;

(2) treatment by medication is necessary to prevent a significant

and likely long-term deterioration in the patient’s mental condition

or to prevent the likelihood of the patient causing serious harm to

themself or others in the institution; (3) a less intrusive treatment

alternative isn’t available; and (4) the patient’s need for treatment

with medication is sufficiently compelling to override their bona fide

and legitimate interest in refusing medication. People v. Medina,

705 P.2d 961, 973 (Colo. 1985); see People in Interest of Strodtman,

293 P.3d 123, 131 (Colo. App. 2011).

¶7 When a patient challenges the sufficiency of the evidence

supporting the district court’s findings on any of these elements, we

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

favorable to the People, determine 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 defer to its findings of fact if supported by evidence in the

record. People v. Marquardt, 2016 CO 4, ¶ 8. We also defer to the

district court’s resolution of evidentiary conflicts and its

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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).

III. The Fourth Medina Element

¶8 E.M.E. challenges the sufficiency of the evidence only for the

fourth Medina element. He argues that the court erred by finding

that he did not have a legitimate reason to refuse medication. We

conclude that the record provides ample support for the court’s

ultimate finding on this element.

¶9 In assessing whether the patient’s need for treatment is

sufficiently compelling to override any legitimate interest in refusing

treatment, 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.

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A. Testimony and Findings

¶ 10 At the evidentiary hearing, E.M.E. testified that, without a

court order to take the requested medications, he would try to

“wean himself off” them. In addition to his general desire to avoid

medications, he complained of several side effects, including weight

gain, lethargy, sedation, muscle and joint pain, numbness, dry

mouth, and tremors.1 He also said that his sedation and pain

symptoms had improved since the CMHHIP staff began giving him

his medication at night.

¶ 11 As relevant here, Dr. Mattox testified that E.M.E.’s side effects

were minimal, and if he discontinued medication, he would

deteriorate significantly and become a danger to himself or others.

Dr. Mattox verified that E.M.E.’s reported side effects could be

caused by the medications and said that he was previously aware of

some, but not all, of E.M.E.’s complaints. He explained that he

would continue to monitor E.M.E.’s side effects and make any

necessary treatment adjustments. Even in light of E.M.E.’s newly

1 E.M.E. testified that he weighed 138 pounds when he arrived at

CMHHIP and 178 pounds at the time of the hearing (approximately
six months after his arrival). (TR p. 20:1-3.)

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reported side effects, Dr. Mattox testified, E.M.E.’s deterioration

when unmedicated was so concerning that his need for treatment

outweighed any risks from the reported side effects.

¶ 12 At the conclusion of the testimony, the district court found Dr.

Mattox’s opinions to be credible and persuasive, and it adopted

them. The court found that each of the Medina elements had been

established by clear and convincing evidence. As relevant to the

fourth Medina element, the court found that

• E.M.E.’s past behavior was very concerning;

• if E.M.E. discontinued his medication, there was a

significant likelihood that he would harm himself and

others;

• a failure to medicate E.M.E. would be more harmful than

the risks posed by the medications; and

• E.M.E.’s liberty interest in refusing medication is

outweighed by his need for treatment and the state’s

interest in treating him.

¶ 13 The court expressed concern about E.M.E.’s forty-pound

weight gain, considering that E.M.E.’s mother had been recently

diagnosed with diabetes, and it ordered CMHHIP to speak with him

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about alternatives to address that side effect. In its written order,

the court added a finding that E.M.E. did not have a legitimate

reason to refuse medication.

B. Analysis

¶ 14 We agree with E.M.E. that the record does not support a

finding that he had no legitimate reason to refuse medication. Dr.

Mattox testified that E.M.E.’s reported side effects could be caused

by his medications and that he had observed at least some of the

reported effects, including weight gain. And the court implicitly

found that, under the circumstances, E.M.E.’s weight gain was a

significant adverse effect. The desire to avoid significant adverse

effects can constitute a bona fide and legitimate reason to refuse

medication. See People in Interest of Uwayezuk, 2023 COA 69, ¶

62.

¶ 15 Nonetheless, we conclude that ample evidence supports the

district court’s finding that the state’s interest in treating E.M.E.

outweighed his objection. Multiple physician affidavits and Dr.

Mattox’s testimony establish that, without treatment, E.M.E.’s

condition would significantly deteriorate, and he would become a

danger to himself and others. We conclude that this evidence

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clearly and convincingly supports the court’s finding that E.M.E.’s

legitimate interest in refusing medication must yield to the state’s

legitimate interests in preserving his health and protecting the

safety of those in CMHHIP. See Medina, 705 P.2d at 974; Pflugbeil,

834 P.2d at 846-47.

IV. Disposition

¶ 16 The order authorizing the involuntary administration of

medication is affirmed.

JUDGE LIPINSKY and JUDGE PAWAR concur.

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