Background
Brian Tolley Lozsi was charged with multiple felonies in Adams County (Case No. 24CR156) and found incompetent to stand trial. He was ordered to undergo competency restoration and placed in inpatient treatment at the Colorado Mental Health Hospital in Pueblo, where his treating psychiatrist diagnosed him with delusional disorder — a condition causing him to be detached from reality and to experience persistent delusions primarily of a sexual nature.
After Lozsi began refusing antipsychotic medication, the People petitioned the Pueblo County District Court to authorize involuntary administration of two medications. Following a hearing on March 16, 2026, the district court found that the People had satisfied all four factors required by Sell v. United States, 539 U.S. 166 (2003), and authorized the involuntary administration of Risperdal (risperidone), with Haldol (haloperidol) injections as a backup. The court also ordered monitoring of medication levels and side effects, with the order to remain in effect through the completion of Lozsi’s criminal trial.
Lozsi appealed, conceding that the evidence supported the first, third, and fourth Sell factors but arguing that the evidence was insufficient to establish the second factor — specifically, that the proposed medications were substantially unlikely to produce side effects interfering with his ability to assist in his own defense.
The Court’s Holding
The Court of Appeals affirmed the district court’s involuntary medication order. Applying clear error review to the district court’s factual findings on the second Sell factor — consistent with People in Interest of R.F., 2019 COA 110 — the court held that the record amply supported the finding that the proposed medications were substantially unlikely to cause side effects interfering with Lozsi’s ability to assist counsel at trial.
The court credited the testimony of Lozsi’s treating psychiatrist, Dr. Zachary Wickline, who opined as an uncontested expert in clinical psychiatry that Risperdal is commonly used, well tolerated, and that any side effects are typically mild and short-lived. Dr. Wickline further testified that Lozsi’s pre-existing gastrointestinal issues were clinically unlikely to be exacerbated by the medications because the relevant physiological mechanisms differ. The district court had expressly credited this testimony over Lozsi’s argument that GI side effects posed a meaningful risk to his ability to participate in his defense.
The appellate court declined to disturb those credibility determinations, noting that resolving conflicts in testimony and assessing witness credibility are the province of the fact finder. Because Lozsi did not contest the other three Sell factors on appeal, the court did not address them.
Key Takeaways
- Under Sell v. United States, the state must prove all four factors by clear and convincing evidence before a court may authorize involuntary antipsychotic medication to restore a defendant’s competency to stand trial.
- The Colorado Court of Appeals applies clear error review — not de novo review — to a district court’s factual findings on the second Sell factor (whether medication will significantly further the government’s interest without unduly harmful side effects), following People in Interest of R.F., 2019 COA 110.
- Credible expert psychiatric testimony that proposed medications are well tolerated and unlikely to interfere with a defendant’s ability to assist counsel is sufficient to satisfy the second Sell factor, even where some potential for side effects exists.
- Arguments raised for the first time in a reply brief will not be considered on appeal.
Why It Matters
This unpublished decision illustrates how Colorado appellate courts evaluate the evidentiary sufficiency of involuntary medication orders in competency restoration proceedings. The court’s reaffirmation of clear error review for the second Sell factor — as opposed to the de novo standard that some earlier divisions had applied — is significant for practitioners litigating these orders, as it sets a demanding standard for overturning a trial court’s credibility-based findings on side-effect risks.
The case also underscores the practical weight that treating-psychiatrist testimony carries in Sell hearings. Where a qualified expert addresses both the likelihood of benefit and the risks of interference with the defense, and the trial court credits that testimony, appellate reversal will be difficult to obtain.