People in Interest of Ferguson

The summaries of the Colorado Court of Appeals published opinions
constitute no part of the opinion of the division but have been prepared by
the division for the convenience of the reader. The summaries may not be
cited or relied upon as they are not the official language of the division.
Any discrepancy between the language in the summary and in the opinion
should be resolved in favor of the language in the opinion.

SUMMARY
October 9, 2025

2025COA82

No. 25CA0905, People in Interest of Ferguson — Health and
Welfare — Care and Treatment of Persons with Mental Health
Disorders — Involuntary Administration of Medication

A division of the court of appeals expands on People in Interest

of D.N.W., 2024 COA 129, by holding that, when authorizing the

involuntary administration of medication, a court can authorize a

reasonable set of options when a treating physician (1) lacks

sufficient knowledge of the patient’s medical history to know which

medication will be most effective in treating the patient;

(2) articulates a reasonable plan for the sequence in which the

alternatives will be administered; and (3) demonstrates a need for

flexibility in treatment options.
COLORADO COURT OF APPEALS 2025COA82

Court of Appeals No. 25CA0905
City and County of Denver Probate Court No. 25MH313
Honorable Beth A. Tomerlin, Magistrate

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Theodore Ferguson,

Respondent-Appellant.

ORDER AFFIRMED

Division VII
Opinion by JUDGE TOW
Lum and Moultrie, JJ., concur

Announced October 9, 2025

Katie McLoughlin, Acting City Attorney, Daniel Horwitz, Assistant City
Attorney, Denver, Colorado, for Petitioner-Appellee

Richard Slosman, Boulder, Colorado, for Respondent-Appellant
¶1 Theodore Ferguson appeals the probate court’s order

authorizing the involuntary administration of four antipsychotic

medications to treat his schizophrenia, one antianxiety medication

to treat his agitation, and two medications to treat any negative side

effects. This appeal requires us to clarify the conditions under

which a court may include authorization of more than one

medication option to treat a particular condition in an involuntary

medication order. We conclude that, when a treating physician

(1) lacks sufficient knowledge of the patient’s medical history to

know which medication will be most effective in treating the patient,

(2) articulates a reasonable plan for the sequence in which the

alternatives will be administered, and (3) demonstrates a need for

flexibility in treatment options, the probate court may authorize the

full set of options.

¶2 Because the record supports the probate court’s findings in

this regard and we discern no other basis to disturb its order, we

affirm.

I. Background

¶3 In January 2025, Ferguson was found incompetent to proceed

in three criminal cases. While Ferguson was being held in the

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Denver jail awaiting a bed at a competency restoration facility, he

maintained a delusional belief that multiple officers at the jail were

tampering with his food by putting semen, urine, or genital warts in

it. He was also verbally aggressive with officers and tried to hit

them with bodily fluids.

¶4 Ferguson’s treating psychiatrist at the jail was Dr. James

Haug, a psychiatrist at Denver Health Medical Center, which

provides medical and psychiatric care to detainees at the jail.

Ferguson was also verbally aggressive with Dr. Haug and tried to hit

him with bodily fluids. Dr. Haug diagnosed Ferguson with an

unspecified schizophrenia spectrum disorder. That diagnosis was

based, at least in part, on Ferguson’s delusional belief that his food

was being tampered with, along with evidence that, during prior

outpatient treatment at Denver Health, he was responding to

internal stimuli and having conversations with people who were not

there.

¶5 Because Ferguson has consistently refused to take any

antipsychotic medication, Denver Health filed a petition in April

2025 to involuntarily medicate him pursuant to section 16-8.5-112,

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C.R.S. 2025. Dr. Haug requested authorization to treat Ferguson

with

• four antipsychotic medications: Zyprexa (olanzapine),

Risperdal (risperidone), Haldol (haloperidol), and Invega

(paliperidone);

• the antianxiety medication Ativan (lorazepam); and

• two medications to treat any side effects: Benadryl

(diphenhydramine) and Cogentin (benztropine).

¶6 After the petition was filed, Ferguson’s counsel successfully

moved to appoint an expert witness to conduct an independent

psychiatric evaluation of Ferguson. The psychologist who

conducted that independent evaluation, Dr. John Dicke, filed a

report agreeing that Ferguson “needs to be involuntarily

administered psychotropic drugs according to [Dr. Haug’s]

prescription.” Dr. Dicke explained that conclusion as follows:

So . . . severe is [Ferguson’s paranoid
schizophrenia] that he is obsessed with the
notion there are feces, urine and semen in his
food. [Ferguson] has to be isolated in the jail
because of his paranoia and history of
assaulting others and guards. This isolation
can only lead to more severe paranoia . . . .
[Ferguson’s] reasons for refusing medication
are largely based on paranoid delusions and

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are not legitimate . . . . [W]ithout some sort of
psychotropic intervention, [Ferguson’s]
prognosis is very grim indeed.

¶7 Dr. Haug and Ferguson both testified at the hearing on the

petition. Dr. Dicke’s report was admitted into evidence.

¶8 Dr. Haug, who testified as an expert in adult psychiatry,

described Ferguson’s schizophrenia as “severe,” explaining that,

among other things, Ferguson is unable to recognize reality and

does not have insight into his mental illness. Dr. Haug testified

that medication was “[a] hundred percent” essential to treat

Ferguson effectively, and, as explained further below, he testified in

detail about his reasoning for requesting the four antipsychotic

medications, the antianxiety medication, and the two medications

to treat any negative side effects. He also testified that Ferguson

believed that he had only ADHD and refused to take antipsychotic

medications.

¶9 During Ferguson’s testimony, which is at times difficult to

discern from the transcript, he appears to have confirmed his belief

that he has ADHD, not schizophrenia, and he testified that it is not

possible to have both conditions. He testified that he has taken

some of the requested medications in the past. And he also

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confirmed that he believes officers were tampering with his food by

putting “semen, blood, feces, [and] genital [warts]” in it.

¶ 10 Following the testimony, the probate court found that

Dr. Haug had testified credibly and that, to the extent Ferguson’s

testimony contradicted Dr. Haug’s testimony, Ferguson’s testimony

was not credible. The court then examined each of the four

elements of the test from People v. Medina, 705 P.2d 961, 973 (Colo.

1985), for the involuntary administration of medication, concluded

that the People had met their burden of proving all four elements,

and granted the petition.

II. Applicable Law and Standard of Review

¶ 11 The parties agree that the Medina test applies here. Under

that test, a probate court may authorize the involuntary

administration of medication if the People prove 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

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patient’s causing serious harm to himself or others at the

institution;

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

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

to override any bona fide and legitimate interest of the

person in refusing treatment.

Id.

¶ 12 Application of the Medina test involves mixed questions of fact

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

probate court’s factual findings if they have record support, but we

review the court’s legal conclusions de novo. Id. Resolving conflicts

in testimony and determining the credibility of the witnesses are

matters solely within the province of the probate court. People in

Interest of Ramsey, 2023 COA 95, ¶ 23.

¶ 13 On a challenge to the sufficiency of the evidence, we review the

record de novo to determine whether the evidence, when viewed as

a whole and in the light most favorable to the People, is sufficient to

support the probate court’s order. Id. The testimony of the

physician seeking to administer treatment may be sufficient,

without more, to satisfy the Medina test by clear and convincing

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evidence. See People v. Pflugbeil, 834 P.2d 843, 847 (Colo. App.

1992).

III. Analysis

¶ 14 Ferguson contends that the probate court erred by authorizing

the three additional antipsychotic medications (Risperdal, Haldol,

and Invega) and the antianxiety medication (Ativan) as “backup”

medications to Dr. Haug’s preferred medication (Zyprexa). He does

not challenge the authorization of the two medications to treat

potential side effects.

¶ 15 Ferguson does not present any argument challenging the

probate court’s ruling that the second Medina element was met

here. Instead, the three arguments he raises are as follows. First,

he argues that the People did not sufficiently prove the first Medina

element — namely, that he was incompetent to effectively

participate in the treatment decision. Second, in an argument

implicating the third and fourth Medina elements, he argues that

the probate court should have authorized the involuntary

administration of only Zyprexa, not Risperdal, Haldol, Invega, and

Ativan as well. And third, he raises an issue concerning the alleged

7
ineffective assistance of his counsel in the probate court

proceedings.

A. Incompetent to Effectively Participate in Treatment Decision

¶ 16 The probate court found that Ferguson was incompetent to

effectively participate in the treatment decision. That finding is

supported by Dr. Haug’s testimony, which the court credited.

Specifically, Dr. Haug testified that (1) Ferguson has schizophrenia,

treatment of which requires antipsychotic medication; (2) Ferguson

“doesn’t think he has any mental health issues” and instead

believes that he has only ADHD; (3) Ferguson was not willing to

take antipsychotic medication to treat his schizophrenia; and

(4) Ferguson’s refusal to take antipsychotic medication made

Dr. Haug’s discussions with Ferguson regarding such medication

unproductive.

¶ 17 Ferguson argues that he was competent to effectively

participate in the treatment decision because he had conversations

with both Dr. Haug and Dr. Dicke about, for example, his belief that

he had only ADHD and his concerns about taking the antipsychotic

and antianxiety medications. His mere involvement in those

8
conversations, however, does not mean that Ferguson was

competent to effectively participate in the treatment decision.

¶ 18 In light of the probate court’s credibility determinations and

resolution of conflicts in the evidence, there is ample support for the

court’s finding, and we will not disturb it. See People in Interest of

Strodtman, 293 P.3d 123, 131-32 (Colo. App. 2011) (although the

patient was able to articulate her preferences and concerns about

medication side effects, the division affirmed the magistrate’s

finding that the patient was incompetent to effectively participate in

the treatment decision because she did not believe she had

schizophrenia and had not embraced her need for treatment of the

condition); People in Interest of R.K.L., 2016 COA 84, ¶ 33 (affirming

the probate court’s finding that the patient was incompetent to

effectively participate in the treatment decision because the patient

did not believe he had a mental illness and the psychiatrist testified

that she did not believe the patient would voluntarily take any

medication to treat the illness).

B. Authorizing a Reasonable Set of Options

¶ 19 That brings us to Ferguson’s contention, implicating the third

and fourth Medina elements, that the probate court should have

9
authorized the involuntary administration of only Zyprexa, and that

it therefore erred by also authorizing the involuntary administration

of the three additional antipsychotic medications — Risperdal,

Haldol, and Invega — and the antianxiety medication Ativan.

¶ 20 We first address and reject Ferguson’s challenge to the court’s

authorization of Ativan. Contrary to Ferguson’s argument, Ativan

was not an “alternative” to Zyprexa. Ativan is not an antipsychotic

medication, which is used to directly treat Ferguson’s

schizophrenia, but, rather, a sedative that Dr. Haug requested to

treat Ferguson’s agitation. The probate court found that Ativan is

“needed to treat Mr. Ferguson’s agitation. He has been getting very

angry when people approach his cell and . . . he has been throwing

bodily fluids.” Although the psychiatrist testified that he did not

plan to “immediately” administer Ativan, he testified that Ferguson

“has shown periods of agitation” — such as getting angry and

“throwing bodily fluids” — that would “necessitate” using Ativan.

We discern no error in the probate court’s decision to authorize the

involuntary administration of Ativan to Ferguson. See Marquardt,

¶ 8; Ramsey, ¶ 23.

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¶ 21 We now turn to whether the probate court erred by

authorizing the involuntary administration of not only Zyprexa but

also Risperdal, Haldol, and Invega. Dr. Haug testified that he would

not treat Ferguson with all four antipsychotic medications at the

same time but, instead, would treat Ferguson first with Zyprexa

and only try the others if Ferguson experienced Zyprexa’s side

effects or if Zyprexa was not effective. If that happened, Dr. Haug

testified, he would then try Risperdal, then Haldol, and then Invega.

He testified as to the sequence in which he would try the different

medications and explained why each choice was preferable to the

others lower on the list. He explained that it could take up to six

weeks to determine if each antipsychotic medication was effectively

treating Ferguson’s schizophrenia.

¶ 22 Significantly, Dr. Haug testified that he had no documented

history of Ferguson ever taking any of the four antipsychotic

medications. And, although Ferguson told Dr. Haug that he had

taken all the medications in the past and that none of them was

helpful for him, Dr. Haug testified that he did not feel that he could

rely on Ferguson’s assertion. As to all four antipsychotic

medications, Dr. Haug testified that he could not be certain which

11
medication or combination of medications would restore Ferguson

to psychiatric stability.

¶ 23 Finally, Dr. Haug was asked about the viability of having to

return to court for authorization to switch to a different medication.

When asked if he had “any concerns” about having to return to

court for authorization to move to each of the alternatives, Dr. Haug

responded, “I would be concerned that . . . his condition would

continue to deteriorate and continue to be very difficult to treat.”

¶ 24 Ferguson argues that authorizing the use of only Zyprexa was

a less intrusive treatment alternative to authorizing the use of all

four antipsychotic medications (the third Medina element), and that

authorizing the use of only Zyprexa would properly weigh his bona

fide and legitimate interest in refusing the other three antipsychotic

medications against his need for treatment (the fourth Medina

element).

¶ 25 In support of that argument, he relies on People in Interest of

R.C., 2019 COA 99M, a case involving authorization to involuntarily

administer backup medications. The People’s answer brief and our

own research reveal two additional such cases: People in Interest of

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R.K.L., 2016 COA 84, and People in Interest of D.N.W., 2024 COA

129. We address these three cases in chronological order.

¶ 26 In R.K.L., the patient’s psychiatrists testified that they

intended to use only one antipsychotic medication, Invega, to treat

the patient’s schizophrenia because the patient had responded well

to Invega in the past. R.K.L., ¶ 38. However, the psychiatrists also

requested authorization to treat the patient with ten other

antipsychotic medications “in case he stopped responding to Invega

or developed an intolerable allergy or side effect.” Id. at ¶¶ 38, 40.

The division reversed the probate court’s order authorizing the use

of the other ten antipsychotic medications. Id. at ¶ 47. The

division reasoned that “mere speculation” that the patient might

need the backup medications in the future did not show that the

psychiatrists were currently unable to treat the patient without the

authority to administer them, “especially because both psychiatrists

testified that Invega currently was an effective treatment for [the

patient].” Id. at ¶ 44 (emphasis added).

¶ 27 Similarly, in R.C., the People requested authorization to

involuntarily treat the patient with Zyprexa and five other

medications. R.C., ¶ 4. However, the psychiatrist testified that the

13
patient had been taking Zyprexa for ten days before the hearing,

that his condition had improved, and that the psychiatrist planned

to continue treating the patient with only Zyprexa “for the time

being.” Id. at ¶ 10. The division reversed the district court’s ruling

authorizing the five other medications, reasoning that the

psychiatrist did not testify that the patient “needed to receive the

[subject] [m]edications at the time of the hearing” and “did not state

unconditionally” that the patient would need to take them in the

future. Id. at ¶ 11. The division further explained, “The possibility

that Zyprexa may no longer be an effective treatment for [the

patient], at some unspecified time in the future, is insufficient to

justify the entry of an order authorizing the immediate

administration” of the subject medications. Id. at ¶ 14.

¶ 28 The crucial distinction separating R.K.L. and R.C. from this

case is that in R.K.L. and R.C., a primary medication had already

proved effective in treating the patient, but here, the probate court

found that Dr. Haug “does not know which [of the antipsychotic

medications] would return [Ferguson] to stability.” That finding is

supported by Dr. Haug’s testimony that he had no documented

history of Ferguson ever taking any of the four antipsychotic

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medications, he “[could not] say one way or the other” whether

Zyprexa would be effective in treating Ferguson, and he could not

be certain which medication or combination of medications would

restore Ferguson to psychiatric stability. Although the divisions’

focus in R.K.L. and R.C. was that it was speculative whether any of

the alternative medications would ever be necessary to treat the

patients, we believe the appropriate focus under the circumstances

here is that it is speculative whether Zyprexa (or any of the other

three antipsychotic medications) will be effective in treating

Ferguson.

¶ 29 The other significant facet of this case is that the probate court

found that Dr. Haug “need[s] to have the authority to switch

[Ferguson] to another medication quickly.” (Emphasis added.) That

finding is supported by Dr. Haug’s testimony that if he were forced

to wait, for example, twenty-one days — which was the time it took

the petition for involuntary medication administration to get to

hearing — to begin administering a new antipsychotic medication,

he would be concerned that Ferguson’s condition “would continue

to deteriorate” and would “be very difficult to treat.” Because of

that, and because Dr. Haug had no idea which antipsychotic

15
medication will be effective in treating Ferguson, we discern no

error in the probate court’s granting Dr. Haug a reasonable degree

of flexibility to discover which medication worked best.

¶ 30 That brings us to the third relevant case, D.N.W. In that case,

the patient was responding effectively to Haldol; on appeal, she

challenged the district court’s order authorizing the administration

of lithium because she had not needed to be prescribed lithium over

the past nine months. D.N.W., ¶ 9. However, the probate court

found that, although the patient was not currently taking lithium,

the doctor needed the ability to administer lithium, which had been

effective in treating the patient’s previous episodes of mania. Id. at

¶¶ 10-12. The division concluded that a psychiatrist “must be

given some flexibility, under prescribed circumstances, to

involuntarily administer a backup medication.” Id. at ¶ 17. The

division in D.N.W. then said,

A court has the authority to authorize the
administration of a backup medication only
when the petitioner presents clear and
convincing evidence, and the court finds a
specific articulable concern, that the
involuntary administration of the primary
medication will be ineffective, if the patient
experiences a recurrence of a condition or

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symptoms that previously required
administration of the backup medication.

Id. at ¶ 18 (emphasis added).

¶ 31 To the extent the division in D.N.W. intended to create a rule

that a backup medication may be ordered “only when” the

circumstances at issue in D.N.W. are present, we disagree and

decline to follow D.N.W. See People v. Johnson, 2020 COA 124, ¶ 12

(one division of the court of appeals is not obligated to follow

another division’s precedent), aff’d, 2021 CO 79. The division in

D.N.W. — which was limited to evaluating the particular

circumstances in that case — could not purport to foresee all other

possible scenarios that would warrant authorizing one or more

backup medications.

¶ 32 Here, Dr. Haug lacked sufficient knowledge of Ferguson’s

medical history to know which medication would best address the

circumstances requiring involuntary medication. He thus

developed a reasonable plan for the sequence in which he would try

a reasonable number of alternatives. And he identified a need for

flexibility in treatment options without having to return to court

each time he sought to try a new medication. We conclude that,

17
under these circumstances, the probate court did not err by

including all four antipsychotic medication options in its order.

C. Alleged Ineffective Assistance of Counsel

¶ 33 Three days after the evidentiary hearing, and one day before

the probate court issued its order, Ferguson filed a pro se

“objection” and “demand for rehearing” in which he raised an

ineffective assistance claim against the attorney who represented

him at the evidentiary hearing. The claim read as follows:

“[Counsel] presented no witnesses, especially from Children’s

Hospital (Denver); Denver Health, namely Dr. Hurlbut; Boulder

Community Hospital; [and] Bounder County Mental Health. That

due to this fact, Respondent experienced ineffective assistance of

counsel.”

¶ 34 In response to the ineffective assistance claim, Ferguson’s

counsel moved to withdraw from the case, and the probate court

appointed new counsel for Ferguson to represent him on appeal.

The court did not grant Ferguson a new evidentiary hearing on the

petition to involuntarily medicate him.

¶ 35 In the opening brief, Ferguson’s appellate counsel has brought

to our attention the pro se ineffective assistance claim Ferguson

18
raised in the probate court. However, appellate counsel represents

that he “is not able to develop an argument that trial counsel’s

performance was outside of what would be considered

professionally competent assistance” because “Respondent’s trial

counsel argued the points Respondent raised, involved an

independent expert, assured that Respondent was available for the

hearing requesting a continuance for him to do so, and had

Respondent testify.” Appellate counsel also represents that he “is

not able to develop an argument that . . . there is a reasonable

probability that the outcome would have been different” had trial

counsel called these witnesses because it “is not clear how

witnesses from previous hospitalizations, as Respondent alleges,

might have been . . . used effectively in support of Respondent’s

position.”

¶ 36 In People in Interest of Uwayezuk, 2023 COA 69, ¶¶ 16-20, a

division of this court held that the right to effective assistance of

counsel applies to involuntary medication proceedings under

section 16-8.5-112. The division in Uwayezuk held that the same

standards governing an ineffective assistance claim in a criminal

proceeding or a dependency and neglect proceeding also generally

19
apply in an involuntary medication proceeding. See Uwayezuk,

¶¶ 21-31.

¶ 37 So a respondent raising a claim of ineffective assistance in an

involuntary medication proceeding must show that (1) counsel’s

performance was deficient and (2) the respondent was prejudiced by

counsel’s errors. See id. at ¶ 22 (citing Strickland v. Washington,

466 U.S. 668, 687 (1984)). But an appellate court will remand the

case for further factual findings only when the respondent’s

allegations “are sufficiently specific to constitute a prima facie

showing of ineffective assistance of counsel.” Id. at ¶ 28 (quoting

A.R. v. D.R., 2020 CO 10, ¶ 63). If the respondent’s “allegations

lack sufficient specificity, then the ineffective assistance of counsel

claim may be summarily denied.” Id. (quoting A.R., ¶ 63).

¶ 38 Ferguson’s allegations in his pro se ineffective assistance claim

were insufficient because he did not identify what the substance of

the witnesses’ testimony would have been or how calling those

witnesses would have changed the result in the involuntary

medication proceeding. See People in Interest of E.D., 2025 COA 11,

¶ 71; People v. Chambers, 900 P.2d 1249, 1252 (Colo. App. 1994).

We thus decline to remand the matter for an evidentiary hearing

20
and discern no basis to conclude that Ferguson’s trial counsel was

ineffective.

IV. Disposition

¶ 39 The order is affirmed.

JUDGE LUM and JUDGE MOULTRIE concur.

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