People in the Interest of Ferguson.
2025 COA 82. No. 25CA0905. Care and Treatment of Persons With Mental Health Disorders—Involuntary Medication Administration—Treatment Plan—Ineffective Assistance of Counsel.
October 9, 2025
Ferguson was found incompetent to proceed in three criminal cases and was jailed while waiting for a bed at a competency restoration facility. While in jail, Ferguson believed that officers were putting semen, urine, or genital warts in his food. He was also verbally aggressive with officers and his treating psychiatrist at the jail, Dr. Haug, and he tried to hit them with bodily fluids. Dr. Haug is a psychiatrist at Denver Health Medical Center (Denver Health), which provides medical and psychiatric care to jail detainees. Dr. Haug diagnosed Ferguson with an unspecified schizophrenia spectrum disorder based in part on Ferguson’s delusional belief that his food was being tampered with and evidence that while he had received outpatient treatment at Denver Health, Ferguson was responding to internal stimuli and engaging in conversations with people who were not there. Ferguson consistently refused to take antipsychotic medication, so Denver Health filed a petition to involuntarily medicate him with four antipsychotic medications, an antianxiety medication, and two medications to treat any side effects. At Ferguson’s counsel’s request, the court appointed Dr. Dicke, an expert witness, to conduct an independent psychiatric evaluation of Ferguson. Dr. Dicke’s report agreed with Dr. Haug’s prescription for involuntary medication administration. The court applied the four-element test for the involuntary administration of medication in People v. Medina, 705 P.2d 961, 973 (Colo. 1985), concluded that the People proved all elements, and granted the petition.
On appeal, Ferguson argued that the People did not sufficiently prove the first Medina element. The parties agreed that the Medina test is applicable. Under Medina, a probate court may authorize involuntary medication administration if the People prove by clear and convincing evidence that (1) the person is incompetent to effectively participate in the treatment decision; (2) the treatment is necessary to prevent significant and likely long-term deterioration in the person’s mental health condition or to prevent the likelihood that the person will cause serious harm to themself or others; (3) a less intrusive treatment alternative is not available; and (4) the person’s treatment need is sufficiently compelling to override any legitimate interest of the person in refusing treatment. Here, there is ample evidence, including Dr. Haug’s testimony, for the finding that Ferguson was incompetent to effectively participate in the treatment decision.
Ferguson also contended that the People did not sufficiently prove the third and fourth Medina elements. He maintained that the probate court erred by authorizing three additional antipsychotic medications and the antianxiety medication as backup medications to Dr. Haug’s preferred medication, Zyprexa. He asserted that authorizing only Zyprexa was a less intrusive treatment alternative to authorizing the use of all four antipsychotic medications. The court of appeals held that when a treating physician lacks sufficient knowledge of the patient’s medical history on which medication offers the most effective treatment, articulates a reasonable plan for sequencing alternative medications, and shows the need for flexibility in treatment options, the probate court may authorize the full set of options. First, authorization for the antianxiety medication Ativan—which is not an antipsychotic medication—was not an alternative to Zyprexa but rather a sedative that Dr. Haug requested to treat Ferguson’s agitation. Here, Dr. Haug testified that he lacked a documented history of Ferguson taking any of the four antipsychotic medications, so he would not treat Ferguson with all four antipsychotic medications at the same time but rather would first try Zyprexa and only try the others if Ferguson experienced Zyprexa’s side effects or if Zyprexa was not effective. Further, the probate court found that Dr. Haug needs authority to switch Ferguson to another medication quickly, a finding that was supported by Dr. Haug’s testimony. Because Dr. Haug lacked sufficient knowledge of Ferguson’s medical history to know which medication would best address his circumstances and developed a plan for treatment flexibility by using a reasonable number of alternatives, the probate court did not err by including all four antipsychotic medication options in its order.
Ferguson also argued that his counsel in the probate proceedings was ineffective. Three days after the evidentiary hearing, Ferguson filed a pro se “objection” and “demand for rehearing” raising an ineffective assistance claim against the attorney who represented him at the evidentiary hearing. The probate court appointed new counsel for Ferguson on appeal but did not grant Ferguson a new evidentiary hearing on the petition to involuntarily medicate him. Appellate counsel represented that he could not develop an argument to support Ferguson’s ineffective assistance claim nor an argument for a reasonable probability for a different outcome had trial counsel called the witnesses that Ferguson alleges would have supported his position. Here, Ferguson’s allegations in his pro se ineffective assistance claim were insufficient because he failed to identify the substance of the witnesses’ testimony or how calling those witnesses would have changed the result in the involuntary medication proceeding. The court thus found no basis to conclude that Ferguson’s trial counsel was ineffective and declined to remand the matter for an evidentiary hearing.
The order was affirmed.