Peo in Int of DG

Opinion

26CA0970 Peo in Interest of DG 08-27-2026 COLORADO COURT OF APPEALS

Court of Appeals No. 26CA0970 El Paso County District Court No. 26MH178 Honorable Thomas Treinen, Magistrate

The People of the State of Colorado, Petitioner-Appellee, In the Interest of D.G., Respondent-Appellant.

ORDER AFFIRMED

Division III

Opinion by JUDGE KUHN

Freyre and Johnson, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)

Announced August 27, 2026

Kenneth Hodges, County Attorney, Melanie Douglas, Contract Attorney, Colorado Springs, Colorado, for Petitioner-Appellee

Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant

¶1 D.G. appeals a magistrate’s order authorizing an additional three months of short-term care and treatment under section 27-65-109, C.R.S. 2025, and the involuntary administration of several medications. We affirm.

I. Background

¶2 D.G. was admitted to Peak View Behavioral Health for restoration after being found incompetent to proceed in a criminal case. D.G. has a long-standing psychiatric history including diagnoses of paranoid schizophrenia, autism spectrum disorder, and, more recently, bipolar disorder. Early in the course of his hospitalization, D.G. demonstrated agitation, aggression, paranoia, and behavioral dysregulation. D.G. was repeatedly verbally hostile, made threatening statements, and exhibited physical posturing toward staff on at least four separate occasions requiring restraints and emergency medications.

¶3 As a result, in March 2026, D.G.’s treatment providers sought a certification for short-term care and treatment and an order for the involuntary administration of medication. After a hearing, the court granted the certification and ordered the involuntary administration of several medications. D.G. appealed.

2

¶4 During the pendency of the appeal, the People sought to extend the order. A magistrate held a hearing and heard testimony from D.G. and from his treating psychiatrist, Dr. Julie Sanford.

¶5 The magistrate found by clear and convincing evidence that D.G. has a mental health disorder and is gravely disabled. And the magistrate found that the People had clearly and convincingly established all four elements necessary for the involuntary administration of medication. See People v. Medina, 705 P.2d 961, 973 (Colo. 1985). Thus, the magistrate extended the order for short-term certification and ordered continuing involuntary administration of medication. D.G. then amended his notice of appeal to challenge the court’s extension of the orders.1 II. Analysis

¶6 D.G. challenges the sufficiency of the evidence supporting the magistrate’s order. In particular, he contends that the evidence was insufficient to support the magistrate’s determinations that (1) he is gravely disabled and (2) the People established the first and fourth Medina elements.

1 To the extent D.G. attempts to challenge the initial order, any challenge is moot because that order expired on June 23, 2026.

3

A. Applicable Law and Standard of Review

¶7 To authorize short-term mental health treatment, a court must find, as pertinent to this appeal, that the patient has a mental health disorder and, as a result, is gravely disabled or a danger to himself or others. §§ 27-65-109(1)(a), 27-65-108.3(1)(b), C.R.S. 2025 (effective May 21, 2026); People in Interest of Ramsey, 2023 COA 95, ¶ 25. The court may authorize the involuntary administration of medication if the petitioning party establishes each of the following elements: (1) the person is incompetent to effectively participate in the treatment decision; (2) the treatment is necessary to prevent a significant and likely long-term deterioration in the person’s mental health condition or to prevent the likelihood of the patient causing serious harm to himself or others in the institution; (3) a less intrusive treatment alternative is not available; and (4) the person’s need for treatment is sufficiently compelling to override any bona fide and legitimate interest of the person in refusing treatment. Medina, 705 P.2d at 973.

¶8 Both an order of short-term certification and an order authorizing the involuntary administration of medications must be supported by clear and convincing evidence. § 27-65-108.3(1)(b);

4

Ramsey, ¶¶ 25, 39; Medina, 705 P.2d at 971. Clear and convincing evidence is “evidence that is highly probable and free from serious or substantial doubt.” Destination Maternity v. Burren, 2020 CO 41,

¶ 10 (citation omitted).

¶9 In performing our review of such orders, we determine whether the evidence, viewed as a whole and in the light most favorable to the petitioning party, is sufficient to support the court’s determination. People in Interest of R.K.L., 2016 COA 84, ¶ 13. We defer to the court’s factual findings if there is evidence supporting them, but we review the court’s legal conclusions de novo. Ramsey,

¶ 23. Both the resolution of testimonial conflicts and the determination of witness credibility are solely within the province of the fact finder. Id. Where the evidence supports the district court’s findings and conclusions, we may not substitute our judgment for that of the district court. People in Interest of A.J.L., 243 P.3d 244, 255 (Colo. 2010).

B. Grave Disability

¶ 10 A person is gravely disabled when, as a result of a mental health disorder, they are incapable of making informed decisions about or providing for their essential needs without significant

5

supervision and assistance from other people. § 27-65-102(17), C.R.S. 2025 (effective May 21, 2026). As a result of being incapable of making these informed decisions, a person who is gravely disabled is at risk of substantial bodily harm, dangerous worsening of any concomitant serious physical illness, significant psychiatric deterioration, or mismanagement of the person’s essential needs that could result in substantial bodily harm. Id.

¶ 11 Among other things, D.G. argues that the magistrate identified “psychiatric medication” itself as an essential need and reasoned that, without medication, D.G. would experience significant psychiatric deterioration. He asserts that, at most, the People established that he disputes his diagnosis, refuses medication, argues with treatment providers, or may experience psychiatric deterioration if left untreated — but not that he is incapable of making informed decisions about or providing for his essential needs without significant supervision or assistance.

¶ 12 Dr. Sanford testified that D.G. is not able to make informed decisions because his obstinance, anger, and argumentativeness prevent him from being able to function or meet his basic needs. She explained that she attempted to discuss his diagnosis,

6

treatment, and alternative medications to alleviate some of D.G.’s stated side effects, but he refused to have the conversation, insisting that he does not have a mental illness. And he consistently insists he does not need medication even though he admitted to Dr. Sanford that the medication makes him calmer. Dr. Sanford further opined that D.G. could not take care of himself if he was released, explaining that he suffered from a thought disorder, which prevents him from cooperating with even minor requests, such as not eating in a particular area, and his judgment is impaired to the point that he endangers himself.

¶ 13 The magistrate noted that “simply being combative or disagreeable” is not a basis for finding someone gravely disabled but found that D.G’s conduct “rises above the normal level and has veered into the territory of a true thought disorder.” The magistrate agreed that D.G.’s mental illness was not typical of those the court generally found gravely disabled. But the magistrate put significant weight on Dr. Sanford’s testimony that she had waited until she could observe D.G. for a significant period of time before she asked for involuntary medication. And the magistrate found that D.G. had no insight into his mental illness, denied that he suffered any

7

kind of psychiatric illness, and would refuse all medication if not court ordered. In sum, the magistrate found that D.G.’s thought disorder and mental illness interferes with his ability to make thoughtful, considered decisions about his everyday functioning because his combativeness and obstinance are so significant.

¶ 14 Viewing the record as a whole and in the light most favorable to the People, we conclude that this evidence is sufficient to support the magistrate’s finding that D.G. is gravely disabled. See § 27-65-102(17); see also Ramsey, ¶ 23 (“The resolution of conflicts in testimony and determinations of the credibility of the witnesses are solely within the province of the fact finder.”). Thus, the magistrate did not err by extending the certification for short- term treatment.

C. The First Medina Element

¶ 15 The first Medina element requires the People to demonstrate “the patient’s incompetency to make treatment decisions.” Medina, 705 P.2d at 973. A court is prohibited from ordering the forced medication of an involuntarily committed patient unless the court is satisfied that the patient’s mental illness has so impaired their

8

judgment as to render them incapable of participating in decisions affecting their health. Id.

¶ 16 D.G. asserts that the People failed to prove the first Medina element by clear and convincing evidence because the evidence demonstrated that he actively participated in decisions regarding his treatment, including repeatedly discussing his medications, requesting reductions of the medications, negotiating with his treatment team about dosage, and relaying other medication-related concerns. We are not convinced.

¶ 17 The first Medina element does not simply ask whether a patient has the ability to “articulate his or her preferences” regarding treatment. People in Interest of Strodtman, 293 P.3d 123, 132 (Colo. App. 2011) (affirming the magistrate’s finding that the patient was incompetent to effectively participate in the treatment decision because she did not believe she had schizophrenia and had not embraced her need for treatment of the condition even though the patient was able to articulate her preferences and concerns about medication side effects). It requires a finding of incompetence to effectively participate in treatment decisions. Id. Here, the court so found with record support. In particular, the court found that

9

D.G. denied he had “any kind of psychiatric illness and would refuse all medication were he not under a court order.”

¶ 18 Under these circumstances, we perceive no deficiency in the evidence supporting the magistrate’s finding that D.G. is incompetent to effectively participate in the relevant treatment decisions.

D. The Fourth Medina Element

¶ 19 The fourth Medina element requires a court to determine whether the patient’s refusal of treatment “is bona fide and legitimate.” Medina, 705 P.2d at 974. If so, the court must determine “whether the prognosis without treatment is so unfavorable that the patient’s personal preference must yield to the legitimate interests of the state in preserving the life and health of the patient placed in its charge and in protecting the safety of those in the institution.” Id.

¶ 20 D.G. contends that he experienced headaches from the Zyprexa he was receiving and, thus, had a bona fide and legitimate interest in refusing treatment. And he claims that the magistrate’s findings “do not reflect the individualized balancing” required by Medina. But the magistrate found that nothing in either D.G.’s or

10

Dr. Sanford’s testimony indicated that the headaches were so severe or debilitating to cause serious or permanent damage. Further, the magistrate noted that D.G. was “significantly psychiatrically ill and needs these medications in order to become better.”

¶ 21 Lastly, we note that the magistrate relied on Dr. Sanford’s credible expert testimony to find that D.G.’s need for treatment is sufficiently compelling to override his specific objections, as well as to override any bona fide and legitimate interest he has in refusing treatment. The testimony of the physician seeking to administer treatment may be sufficient, without more, to satisfy the Medina test. R.K.L., ¶ 30. Dr. Sanford testified to this effect, and we will not disturb the magistrate’s determination.

III. Disposition

¶ 22 The order is affirmed.

JUDGE FREYRE and JUDGE JOHNSON concur.