Peo in Interest of Lozoya

25CA1356 Peo in Interest of Lozoya 10-02-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1356
Pueblo County District Court No. 24MH18
Honorable Amiel Markenson

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Jose Luis Lozoya,

Respondent-Appellant.

ORDER AFFIRMED

Division I
Opinion by JUDGE SCHUTZ
J. Jones and Grove, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced October 2, 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, Jose Luis Lozoya, appeals the district court’s

order authorizing the staff at the Colorado Mental Health Hospital

in Pueblo (the hospital) to medicate him involuntarily. We affirm.

I. Background

¶2 Lozoya was committed to the hospital in October 2023 after

being found incompetent to proceed in a criminal case. This was

his third admission for inpatient competency restoration.

¶3 Shortly after Lozoya’s readmission to the hospital, he was

experiencing auditory and visual hallucinations, disorganized

thinking, poor hygiene, poverty of thought, flat affect and other

significant negative symptoms, including limited speech production

and poor energy to compete daily tasks. He was diagnosed with

schizophrenia. Lozoya developed an extensive rash on his face and

around his eyes, which was caused by his repeated application of

various personal care products, including lotion and hair gel, to his

face. The hospital sought to treat Lozoya with paliperidone (Invega)

and clozapine (Clozaril) — two antipsychotic medications that had

restored Lozoya to competency during his last hospital stay. Lozoya

agreed to take paliperidone but refused to resume treatment with

clozapine.

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¶4 In January 2024 and again in July 2024, the People filed

petitions to authorize the involuntary administration of three

antipsychotic medications to treat Lozoya’s schizophrenia:

clozapine, paliperidone, and olanzapine. Shortly after those

petitions were filed, the parties entered consent orders authorizing

the involuntary administration of all three medications.

¶5 In January 2025, the People again petitioned the district court

for authorization to involuntarily treat Lozoya with clozapine,

paliperidone, and olanzapine. After a hearing, the district court

granted the petition for the scheduled medications, clozapine and

paliperidone, but concluded that the People had not met their

burden of proof to justify involuntary treatment with the as-needed

medication olanzapine, given its infrequent use. Lozoya appealed

the court’s order and a division of this court affirmed. See People in

Interest of Lozoya, (Colo. App. No. 25CA0251, May 8, 2025) (not

published pursuant to C.A.R. 35(e)).

¶6 In July 2025, the People filed the petition at issue, seeking this

time to involuntarily medicate Lozoya with clozapine and

paliperidone. The district court held an evidentiary hearing at

which Lozoya and his treating physician, Dr. Paul Mattox, testified.

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¶7 Dr. Mattox described Lozoya’s schizophrenia disorder and

accompanying symptoms. He also described the requested

medications, explained their possible side effects, and opined that

they are necessary to treat Lozoya’s symptoms. Lozoya testified

that he was not sure if he had a mental illness but was not willing

to take the requested medications because the blood draws required

for clozapine and the monthly paliperidone shots “hurt a lot.”

¶8 The district court found that Dr. Mattox testified “credibly and

persuasively.” The court also found that the People had established

all four elements justifying the involuntary administration of

medication set forth in People v. Medina, 705 P.2d 961, 973 (Colo.

1985). Accordingly, the court granted the petition and authorized

the administration of clozapine and paliperidone to Lozoya against

his will.

II. Applicable Law and Standard of Review

¶9 The parties agree that the district court’s ruling was governed

by the four-part test from Medina. Under the Medina test, a district

court may order the involuntary administration of medication if the

People prove by clear and convincing evidence that (1) the patient is

incompetent to effectively participate in the treatment decision; (2)

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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

himself 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. Id. at 973.

¶ 10 Applying the Medina test presents a mixed question of fact and

law; we defer to the district court’s factual findings if supported by

the record but review its legal conclusions de novo. People in

Interest of R.C., 2019 COA 99M, ¶ 7. It is for the district court, as

the fact finder, to determine the credibility of witnesses; the

sufficiency, probative effect, and weight of the evidence; and the

inferences and conclusions to be drawn from the evidence. Id.

¶ 11 We must affirm the district court’s ruling if 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 criteria. Id. at ¶ 30.

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III. Analysis

¶ 12 Lozoya contends that the evidence was insufficient to prove

the fourth Medina element. We disagree.

¶ 13 In assessing the fourth Medina element — whether the

patient’s need for treatment is sufficiently compelling to override

any legitimate interest in refusing treatment — a court must

consider “whether the patient’s refusal is bona fide and legitimate”

and, if it is, “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.

¶ 14 Lozoya contends that the state’s interest in treating him is

insufficient to overcome his bona fide and legitimate interest in

avoiding painful blood draws and the potentially serious side effects

of the medications. While the district court found that Lozoya has a

bona fide and legitimate interest in avoiding the pain of the blood

draws associated with clozapine monitoring and pain caused by

paliperidone injections, there was no testimony or other evidence

supporting Lozoya’s appellate contention that he also wished to

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avoid side effects associated with the medications. Rather, Dr.

Mattox and Lozoya both testified that Lozoya’s objection to the

requested medications was the “physical discomfort caused” with

“the blood tests required for clozapine administration” as well as

“the monthly injection of [paliperidone].” Moreover, Lozoya testified

that he has not experienced any side effects from the requested

medications. And Dr. Mattox confirmed that Lozoya has no

underlying health conditions that could be affected or worsened by

the requested medications.

¶ 15 As to Lozoya’s stated reasons for avoiding the requested

medications — pain experienced during blood draws and injections

— the district court expressly acknowledged Loyoza’s legitimate

concerns in avoiding the pain associated with the proposed

treatment. However, after weighing Lozoya’s bona fide and

legitimate interests against the state’s interest in preserving his life

and health and protecting the safety of those in the institution, the

court found that the need to administer Lozoya’s medication by

injection — which it allowed only if he refused to take his

medication orally — and the need to monitor the administration of

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clozapine by blood draw is sufficiently compelling to override his

concerns. These findings enjoy record support.

¶ 16 Dr. Mattox opined that the failure to medicate Lozoya would be

more harmful than the risks posed by the requested medication. In

support of this opinion, Dr. Mattox explained that Lozoya has a

“history of deterioration that has resulted in recurrent

hospitalizations,” and during this hospitalization, “his deterioration

led to a significant facial rash, causing him significant risk of harm

to himself.” Dr. Mattox said that, since Lozoya has been on court-

ordered medications, he “is more interactive and more conversant.”

¶ 17 Dr. Mattox also testified that Lozoya has “treatment-resistant

schizophrenia,” — that is, he does “not respond[] well to other

antipsychotic medications.” Thus, Dr. Mattox opined that, if Lozoya

does not continue taking the requested medications, “he’s at risk for

deterioration” and he needs the requested medications “to maintain

his stability.” Indeed, Lozoya was previously stabilized on a

treatment regimen of clozapine and paliperidone. But after he was

discharged from the hospital, he was not taking clozapine and

subsequently deteriorated and had to be readmitted.

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¶ 18 We appreciate Lozoya’s concerns about avoiding pain during

any necessary involuntary paliperidone injections and the blood

draws necessary to monitor the administration of clozapine.

However, because the record supports the district court’s findings,

we conclude that it did not err by finding that Lozoya’s reasons for

refusing the requested medication are overridden by his sufficiently

compelling need for treatment. See R.K.L., ¶¶ 13, 30.

¶ 19 Because Lozoya does not challenge the district court’s findings

concerning the other Medina factors, we conclude the evidence was

sufficient to support the involuntary medication order.

IV. Disposition

¶ 20 The order is affirmed.

JUDGE J. JONES and JUDGE GROVE concur.

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