Peo in Int of Horstmann

25CA1582 Peo in Interest of Horstmann 02-05-2026

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1582
Pueblo County District Court No. 25MH30076
Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Megan Christine Horstmann a/k/a Horstman,

Respondent-Appellant.

ORDER AFFIRMED

Division V
Opinion by JUDGE LIPINSKY
Tow and Martinez*, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced February 5, 2026

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

*Sitting by assignment of the Chief Justice under provisions of Colo. Const. art.
VI, § 5(3), and § 24-51-1105, C.R.S. 2025.
¶1 Megan Christine Horstmann, also known as Horstman,

appeals the district court’s order authorizing staff at the Colorado

Mental Health Hospital in Pueblo (the hospital) to medicate her

without her consent. We affirm.

I. Background

¶2 Horstmann was admitted to the hospital in July 2025 after

she was found incompetent to proceed in a criminal case. Her

symptoms included chronic psychosis, delusions, episodes of mania

and depression, talking to unseen others, and irritability.

Horstmann was diagnosed with schizoaffective disorder, bipolar

type. She refused to take medication to treat her mental health

disorder, however. After a physical altercation in which she hit,

kicked, and spit at hospital staff, she was started on emergency

medications. The State petitioned the district court for

authorization to medicate Horstmann involuntarily with two

antipsychotic medications, Zyprexa (olanzapine) and Haldol

(haloperidol).

¶3 At the hearing on the petition, which was conducted three

weeks after Horstmann’s admission to the hospital, her psychiatrist

at the hospital testified that her schizoaffective disorder, bipolar

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type, constitutes a substantial disorder that grossly impairs

Horstmann’s judgment or capacity to recognize reality or control her

behavior. The psychiatrist explained that he was requesting

authorization to administer up to 80 milligrams of Zyprexa per day,

an antipsychotic medication, orally or intramuscularly, and, when

needed, Haldol, another antipsychotic medication, orally up to

40 milligrams per day. He reported that Horstmann had already

shown improvement on 30 milligrams of Zyprexa per day and that,

in addition to its antipsychotic effect, it had stabilized her mood.

¶4 The psychiatrist also described Horstmann’s deterioration

when not on antipsychotic medication, explaining that she had

been through twenty years of hospitalizations and bipolar episodes,

and was living on the street when she was arrested ten months

before her hospitalization. He also reported that, during the

competency examination in her criminal case, she said that she

could hear radio waves from the CIA and FBI.

¶5 Horstmann testified that her mental health disorders were

“paranormal schizo” and “paranormal nympho” and said that her

“paranormal schizo” allows her to “hear those who have passed

over.” Her testimony on direct examination primarily consisted of

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descriptions of the side effects she had experienced when taking

Zyprexa, as well as some of her underlying medical conditions. On

cross-examination, she asserted that she was the founder of the

hospital and that she had created “HIPAA” (presumably referring to

the Health Insurance Portability and Accountability Act).

¶6 Following Horstmann’s testimony, the district court found that

the psychiatrist had testified credibly and persuasively, and it

adopted his opinions. The court then examined each of the four

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

1985); concluded that the State had met its burden of proving all

four of the Medina elements; and granted the petition.

II. Applicable Law and Standard of Review

¶7 The parties agree that the Medina test applies. Under that

test, a district court may authorize the involuntary administration

of medication if the State demonstrates by clear and convincing

evidence that

(1) the patient is incompetent to effectively participate in the

treatment decision;

(2) the treatment by antipsychotic medication is necessary to

prevent a significant and likely long-term deterioration in

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the patient’s mental health condition or to prevent the

likelihood of the patient causing serious harm to herself

or others in 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. (The test from Sell v. United States, 539 U.S. 166, 180-81

(2003), applies to petitions to administer medication involuntarily

for the purpose of rendering a defendant competent to stand

trial. See People in Interest of R.F., 2019 COA 110, ¶¶ 10-15, ¶ 11

n.1, 451 P.3d 1238, 1241-42, 1241 n.1. Although Horstmann was

initially admitted to the hospital for that purpose, the State filed the

petition to prevent a significant and long-term deterioration in her

mental condition and to prevent her from causing serious harm to

others at the hospital. These considerations are relevant to the

second Medina element. See id. at ¶ 11 n.1, 451 P.3d at 1241 n.1.

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

and law. People v. Marquardt, 2016 CO 4, ¶ 8, 364 P.3d 499, 502.

We defer to the district court’s factual findings if they have record

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support, while 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 district

court. People in Interest of Ramsey, 2023 COA 95, ¶ 23, 541 P.3d

1198, 1204.

III. Analysis

¶9 Horstmann does not expressly contest the district court’s

rulings that the State met its burden of proving the first, second,

and third Medina elements. However, she challenges the sufficiency

of the evidence supporting the court’s ruling on the fourth Medina

element — that her need for the medications is sufficiently

compelling to override any bona fide and legitimate interest she has

in refusing to take them voluntarily. In analyzing the fourth Medina

element, a court first determines “whether the patient’s refusal is

bona fide and legitimate.” Medina, 705 P.2d at 974. If it is, the

court then determines “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.” Id.

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¶ 10 On a sufficiency challenge, we must determine whether the

evidence, viewed as a whole and in the light most favorable to the

State, is sufficient to support the district court’s order. People in

Interest of R.K.L., 2016 COA 84, ¶ 13, 412 P.3d 827, 832. The

testimony of the physician seeking to administer treatment may be

sufficient, without more, to satisfy the Medina test. Id. at ¶ 30, 412

P.3d at 834.

¶ 11 The district court found that, even if the “litany” of reasons

Horstmann gave for not wanting to take the medications were all

bona fide and legitimate, her need for the medications was

nonetheless sufficiently compelling to override those interests.

Given that the district court credited the psychiatrist’s testimony,

and viewing the evidence as a whole and in the light most favorable

to the State, we discern no error in the district court’s conclusion

that the State had proved the fourth Medina element by clear and

convincing evidence. See Ramsey, ¶ 23, 541 P.3d at 1204; R.K.L.,

¶ 13, 412 P.3d 827, 832.

¶ 12 Like the district court, we assume that all the interests and

concerns that Horstmann expressed at the hearing were bona fide

and legitimate.

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¶ 13 Nevertheless, we conclude that the State presented clear and

convincing evidence that Horstmann’s need for treatment is

sufficiently compelling and that her prognosis without treatment is

so unfavorable that the district court properly overrode her interests

in not taking the medications. We noted above the substantial

evidence of Horstmann’s compelling need for treatment: her chronic

psychosis, delusions, episodes of mania and depression, talking to

unseen others, irritability, and significant deterioration when not

taking antipsychotic medication. In addition, as explained above,

the psychiatrist testified that the administration of 30 milligrams of

Zyprexa per day had already led to significant improvement for

Horstmann.

¶ 14 We next weigh Horstmann’s arguments regarding her interests

in not taking the medications against her compelling need for

treatment. First, she highlights her testimony regarding the side

effects she said she experienced when taking Zyprexa, including

tremors, rapid speech, and sleepwalking. The district court found

that she experienced tremors, but that medications can neutralize

them. The psychiatrist testified that tremors are a possible side

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effect of Haldol but that medications such as Cogentin “can reverse

that.”

¶ 15 In addition, Horstmann testified that Zyprexa sped up her

speech, caused her to “word vomit,” and made it harder for her to

make sense speaking. In contrast, the psychiatrist testified that

Zyprexa had calmed Horstmann down “pretty quickly” and had

helped her organize her thought processes. He explained that

Zyprexa typically causes the speech of manic patients to be “more

organized to the outside world.” Horstmann also highlights her

testimony regarding her preexisting conditions, such as arrhythmia,

neuropathy, and fibromyalgia, which she said Zyprexa

“exacerbates” or “accentuates.” The psychiatrist, however,

explained that Hortsmann did not have a preexisting heart issue —

a recent EKG was normal — or neuropathy. In addition, the

psychiatrist said that even if Hortsmann had those conditions,

Zyprexa would not negatively affect them. Significantly, the district

court credited this testimony. Finally, Horstmann accuses the

psychiatrist of not obtaining her past medical records, arguing that

“[w]ithout a complete medical history, it is impossible to evaluate

the potential harm to [her] health accurately.” We reject that

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argument because, when asked at the hearing whether he had

obtained Horstmann’s past medical records to assess whether she

had underlying health conditions, the psychiatrist responded, “Not

yet. We’re waiting — she has to sign releases for us to get any of

these records, unfortunately.”

¶ 16 For these reasons, Horstmann’s arguments on appeal

concerning her interests in not taking the requested medications

are not sufficiently persuasive to show that the district court erred

by finding that those interests were outweighed by her compelling

need for treatment with Zyprexa and Haldol.

IV. Disposition

¶ 17 The order is affirmed.

JUDGE TOW and JUSTICE MARTINEZ concur.

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