The Colorado Supreme Court cleared the way Monday for admitted Planned Parenthood shooter Robert Lewis Dear Jr. to be medicated against his will.
The state's highest court declined to review Dear's challenge of a Colorado Court of Appeals decision in January to allow him to be forcibly medicated.
The ruling appears to position state psychologists to begin a long and painstaking process to try to unlock Dear's mind from delusions that mental heath evaluators say have gripped his mind for decades.
Dear, 60, has been in the Colorado Mental Health Institute in Pueblo for two years, since a judge ruled him mentally incompetent to stand trial, meaning he does not have a "rational" understanding of the court process.
State psychologists say Dear suffers delusional disorder. He repeatedly has railed in court against forced medication, claiming to have had a "chemical lobotomy."
State doctors have asked the court to administer three antipsychotic medications and another to minimize side effects - Zyprexa, Abilify, Haldol and Cogentin - at least three of which are injectable.
But forensic psychologists have cautioned that antipsychotic medications are not guaranteed to clear the delusions.
"It'll be a long road. It's not going to be quick," said Max Wachtel, an Aurora-based forensic psychologist who has conducted up to 700 competency evaluations. Still, he said successful treatment is a "highly realistic" goal.
Treatment for Dear's delusional disorder is usually slow, and it is combined with some form of counseling or talk therapy, Wachtel said in January.
The medications need time to take effect, experts say. Then psychologists must build trust with their patients, lest they get wrapped into the delusions as well. The process can take months or years.
The treatment might be complicated for Dear because of his longstanding delusions. Dear believes FBI agents have followed and persecuted him as part of a nationwide conspiracy. The delusions have grown to include the Pueblo hospital staff, who he believes "are not there to help him," the appeals court ruling said.
Dear can be held indefinitely, up to the rest of his life, on the first-degree murder charges in the slayings of three people, including a police officer from the University of Colorado at Colorado Springs.
A judge would have to find that Dear has been made competent before he can face the 179 counts against him.
Dear has admitted gunning down the three people to "save the babies" at Colorado Springs' Planned Parenthood clinic on Nov. 27, 2015. He also told police he decided to make his stand against the FBI at Planned Parenthood, which he described as the "most evil" place on Earth.
Ke'Arre Stewart, Jennifer Markovsky and UCCS Officer Garrett Swasey were killed in the attack.
Five of nine others wounded in the shootout were law enforcement officers.
The Gazette's Jakob Rodgers contributed to this report.