The Colorado Court of Appeals upheld a ruling allowing admitted Planned Parenthood shooter Robert Lewis Dear Jr. to be medicated against his will.
The panel's unanimous decision Thursday can be appealed to the state Supreme Court, but it represents a victory for prosecutors hoping to eventually have Dear, 59, stand trial for the November 2015 rampage that left three people dead and nine people wounded.
Even so, forensic psychologists cautioned that antipsychotic medications were no guarantee to clear the delusions that have plagued Dear's mind for more than two decades.
"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.
Dear has repeatedly railed in court against forced medication - claiming to have had a "chemical lobotomy."
Dear is being held in the Colorado Mental Health Institute in Pueblo, awaiting a possible trial that has been on hold since a judge found him mentally incompetent in May 2016. That means he does not understand court proceedings and can't assist in his defense.
Dear believes FBI agents have followed and persecuted him as part of a nationwide conspiracy. The delusions have since grown to include the Pueblo hospital staff, who he believes "are not there to help him," Thursday's order said.
State hospital doctors asked the court to administer three antipsychotic medications and another to minimize side effects medications - Zyprexa, Abilify, Haldol and Cogentin - at least three of which are injectable.
It remained unclear Friday evening whether doctors at the hospital would begin administering those medications during Dear's 42-day window to file an appeal.
But they would likely stop if an appeal is filed and the state Supreme Court agrees to hear the case, said Joshua Tolini, a Colorado Springs defense attorney not affiliated with the case.
Treatment for Dear's delusional disorder is usually slow and painstaking, and it is combined with some form of counseling or talk therapy, Wachtel said.
Time is needed to let the medications take effect, experts said. Then psychologists must build trust with their patients - lest they get wrapped into the delusions as well. It's a process that can take months, sometimes much longer.
A judge would have to find that Dear has been made competent before he can face the 179 counts filed by prosecutors, including first-degree murder.
Dear has admitted gunning down three people to "save the babies" at Colorado Springs' lone 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 University of Colorado at Colorado Springs police officer Garrett Swasey died in the attack.
Five of the nine others wounded in the attack were law enforcement officers.
Under state law, Dear's competency must be reviewed every 90 days - his next hearing is scheduled for Feb. 13.
Prosecutors have sought to have him forcibly medicated to hasten a case that has dragged into its third year.
His condition appeared "essentially identical" after having been treated in a special ward for defendants ruled mentally unfit to stand trial for at least six months, according to the opinion authored by Judge Laurie A. Booras for the three-judge panel.
Adding antipsychotic medications is "substantially likely" to turn that tide, testified one of Dear's psychiatrists, Dr. John DeQuardo.
He cited a study that found more than three-quarters of delusional disorder patients were restored to competency when given such medications. But it was far less effective for people with delusions for more than 13 years, as is the case with Dear.