SUMMARY

June 27, 2019

2019COA99

No. 19CA0647, People in Interest of R.C. — Health and Welfare 

— Care and Treatment of Persons with Mental Health Disorders 

— Involuntary Administration of Medication

This is the first reported Colorado decision that addresses a 

situation where the People seek the involuntary administration of 

medications that the treating physician believes may need to be 

given at a later date, if the patient’s current medication stops being 

efficacious, but that do not currently need to be administered. 

Nonetheless, the lower court granted the physician immediate 

authorization to administer the additional medications. In addition, 

the People did not seek an order for the involuntary administration 

of the patient’s current medication, despite the psychiatrist’s 

concern that the patient may stop taking it voluntarily. A division 

of the court of appeals concludes that the People did not carry their 

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.
burden under People v. Medina, 705 P.2d 961 (Colo. 1985), to prove 

that the involuntary administration of the additional medications 

was the less intrusive alternative.
COLORADO COURT OF APPEALS 2019COA99

Court of Appeals No. 19CA0647

Pueblo County District Court No. 19MH81

Honorable Jill S. Mattoon, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of R.C.,

Respondent-Appellant.

ORDER REVERSED

Division IV

Opinion by JUDGE LIPINSKY

Román and J. Jones, JJ., concur

Announced June 27, 2019

Cynthia Mitchell, County Attorney, Kate H. Shafer, Special Assistant County 

Attorney, Pueblo, Colorado, for Petitioner-Appellee

The Law Firm of John L. Rice, John L. Rice, Pueblo, Colorado, for RespondentAppellant
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¶ 1 Appellant, R.C., appeals the district court’s order authorizing 

mental health personnel to medicate him involuntarily. We reverse.

I. Background

¶ 2 R.C. was committed to the Colorado Mental Health Institute at 

Pueblo (CMHIP) after being found incompetent to proceed in a 

criminal case. A CMHIP staff psychiatrist, Dr. Lennart Abel,

diagnosed R.C. with bipolar disorder mania with psychosis. 

¶ 3 Following R.C.’s assault of a staff member at CMHIP, the 

People filed a petition seeking a court order authorizing the 

administration of involuntary medication. At a hearing on the 

petition, Dr. Abel testified that R.C. was voluntarily taking Zyprexa. 

Dr. Abel opined that R.C. would not continue to take this drug

voluntarily because he had previously refused to take medication. 

¶ 4 The People did not seek an order allowing R.C. to be 

involuntarily medicated with Zyprexa, however. Rather, the People 

sought authorization to medicate R.C. involuntarily with six other 

drugs: Olanzapine, Haldol, Abilify, Lithium, Depakote, and 

Clozapine (the Six Medications). Dr. Abel testified that R.C. “can be 

treated with Zyprexa but I’m not sure if that would be the case over 

the time. Therefore, I have the other medications on the petition.”
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¶ 5 The district court granted the People’s petition and entered an 

order authorizing the involuntary administration of the Six 

Medications, effective immediately. On appeal, R.C. contends that 

insufficient evidence supported the order. We agree and, therefore, 

reverse.

II. Involuntary Administration of Medication

¶ 6 An order for involuntary administration of medications must 

be supported by clear and convincing evidence

(1) that the patient is incompetent to effectively 

participate in the treatment decision; (2) that 

treatment by antipsychotic 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’s causing serious harm to himself or 

others in the institution; (3) that a less 

intrusive treatment alternative is not available; 

and (4) that the patient’s need for treatment by 

antipsychotic medication is sufficiently 

compelling to override any bona fide and 

legitimate interest of the patient in refusing 

treatment. 

People v. Medina, 705 P.2d 961, 973 (Colo. 1985). The People bear 

the burden to prove each element. People in Interest of Strodtman, 

293 P.3d 123, 131 (Colo. App. 2011).
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¶ 7 “Applying the Medina test involves mixed questions of law and 

fact.” People v. Marquardt, 2016 CO 4, ¶ 8, 364 P.3d 499, 502. We 

defer to the district court’s factual findings if they are supported by 

the record and review its legal conclusions de novo. Id. The district 

court, as fact finder, “has discretion to determine the credibility of 

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

evidence; and the inferences and conclusions to be drawn from it. 

If supported by the record, a trial court’s findings and conclusions 

. . . will not be disturbed on review.” People in Interest of 

S.M.A.M.A., 172 P.3d 958, 962 (Colo. App. 2007); accord People in 

Interest of C.A.K., 652 P.2d 603, 613 (Colo. 1982).

¶ 8 R.C. contests only the third element of the Medina test, 

asserting that the district court erred in finding that no less 

intrusive treatment alternative was available. He argues that his 

voluntarily taking Zyprexa at the time of the hearing clearly showed 

that a less intrusive treatment option was available. We conclude 

that the record does not support the district court’s finding that the 

People met their burden on this element of Medina. 

¶ 9 A treatment is less intrusive when it has fewer harmful side 

effects and is at least as effective at treating a patient’s condition as 
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the proposed treatment. Strodtman, 293 P.3d at 133 (citing Medina, 

705 P.2d at 974). 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.” Medina, 705 P.2d at 974. 

¶ 10 Dr. Abel testified that R.C. had been taking Zyprexa 

voluntarily for ten days before the hearing. Dr. Abel agreed that 

R.C.’s behavior had improved since he began taking Zyprexa, 

testifying that R.C. is “not as manic as he was before.” He also

stated that, even if the court authorized the administration of the 

Six Medications, he would “keep [R.C.] on Zyprexa” because, “for 

the time being, [R.C.] can be treated with Zyprexa.” He was, 

however, “not sure if that would be the case over . . . time.” 

¶ 11 Thus, Dr. Abel did not testify that R.C. needed to receive the 

Six Medications at the time of the hearing and, moreover, did not 

state unconditionally that R.C. would need to take the Six 

Medications in the future.

¶ 12 Based on this record, we agree with R.C. that insufficient 

evidence supports the district court’s finding that no less intrusive 
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treatment alterative than Zyprexa is available. To the contrary, Dr. 

Abel’s testimony establishes that continued administration of 

Zyprexa is a less intrusive treatment alternative than 

administration of the Six Medications.

¶ 13 Not only does this conclusion follow logically from Dr. Abel’s 

testimony, but it finds support in People in Interest of R.K.L., 2016 

COA 84, 412 P.3d 827. In R.K.L., a division of this court concluded 

that “mere speculation” that a patient “might need [the specified]

medications in the future” was insufficient to establish that his

psychiatrists were currently unable to provide effective treatment. 

Id. at ¶ 44, 412 P.3d at 837. This was especially true because the 

psychiatrists were successfully treating the patient with only one of 

the medications listed in their petition. Id. 

¶ 14 While the R.K.L. division reached that conclusion in the 

context of the fourth Medina factor, we consider this reasoning

relevant to our analysis of the third factor. The possibility that 

Zyprexa may no longer be an effective treatment for R.C., at some 

unspecified time in the future, is insufficient to justify the entry of 

an order authorizing the immediate administration of the Six 

Medications. See id. Moreover, the trial court’s order authorizing 
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the immediate involuntary administration of the Six Medications 

cannot be squared with Dr. Abel’s testimony that R.C. does not 

need the Six Medications now and may never need them. 

¶ 15 Further, Dr. Abel did not testify that the Six Medications 

would be more effective in treating R.C. than is Zyprexa. Dr. Abel’s 

general concern that R.C. had previously refused to take prescribed 

medications does not address why the People needed an order for 

the involuntary administration of the Six Medications while R.C.

was voluntarily taking Zyprexa. 

¶ 16 For these reasons, we conclude that the People did not carry

their burden of proving the lack of a less intrusive alternative than 

administration of the Six Medications. See Medina, 705 P.2d at 

973. The record evidence establishes that the continued 

administration of Zyprexa is a less intrusive treatment alternative 

than administering the Six Medications. We also therefore conclude

that the record does not support the district court’s determination 

of the third Medina factor. See R.K.L., ¶ 44, 412 P.3d at 837. 

III. Conclusion

¶ 17 The order is reversed. 

JUDGE ROMÁN and JUDGE J. JONES concur.