Peo in Interest of ADW

Opinion

26CA1074 Peo in Interest of ADW 09-10-2026 COLORADO COURT OF APPEALS

Court of Appeals No. 26CA1074 Pueblo County District Court No. 26MH30064 Honorable Gregory Styduhar, Judge

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

ORDER AFFIRMED

Division III

Opinion by JUDGE JOHNSON

Freyre and Kuhn, JJ., concur

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

Announced September 10, 2026

Cynthia Mitchell, County Attorney, Kate H. Shafer, Special Assistant County Attorney, Pueblo, Colorado, for Petitioner-Appellee

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

¶1 A.D.W. appeals the district court’s order authorizing staff at the Colorado Mental Health Hospital in Pueblo (the hospital) to medicate him without his consent. We affirm.

I. Background

¶2 A.D.W. was admitted to the hospital in April 2026 after being found incompetent to proceed in a criminal case. His symptoms included hallucinations, paranoia, delusions, agitation, and impulsivity. His psychiatrist at the hospital, Dr. Hareesh Pillai (Dr. Pillai), diagnosed him with an unspecified mood disorder.

¶3 During A.D.W.’s first two weeks at the hospital, he intermittently complied with taking his medications. But he became increasingly irritable and began threatening staff. After an incident in which he repeatedly swung his closed fists at staff members, staff started him on emergency medications. Soon after, the State filed a petition seeking authorization to medicate A.D.W. involuntarily with two antipsychotic medications — Zyprexa (olanzapine) and Thorazine (chlorpromazine) — and the mood- stabilizing medication Depakote (valproic acid), as well as seeking the necessary laboratory work to monitor any side effects.

2

¶4 At the hearing on the petition, Dr. Pillai and A.D.W. testified, and Dr. Pillai’s affidavit was admitted as an exhibit. Dr. Pillai, who was accepted as an expert in clinical psychiatry, testified that A.D.W.’s unspecified mood disorder constitutes a substantial disorder that grossly impairs his judgment or capacity to recognize reality or control his behavior. Dr. Pillai explained that the two antipsychotic medications can improve a patient’s symptoms like delusions, paranoia, and thought disorganization, while Depakote can improve manic symptoms like impulsivity, aggression, and agitation. He further explained that he was requesting Zyprexa and Depakote as A.D.W.’s scheduled medications, as well as injectable Thorazine for the occasions, if any, when A.D.W. refuses to take Depakote orally.

¶5 Dr. Pillai also testified that A.D.W. started to show some improvement while being medicated. In fact, he specified that “the primary safety concern of [A.D.W.’s] assaultive behaviors has drastically improved,” indicating that “the medications are improving some of [A.D.W.’s manic] symptoms and improving some of the underlying paranoia, impulsivity and delusions that played a role” in the aggressive behavior.

3

¶6 When A.D.W. was asked at the hearing whether he has a mental illness, he responded, “I do, I suppose, but I don’t know what it’s been narrowed down to” and so “it’s hard to know what mental illness I actually do have.” A.D.W. testified that, other than the Subutex, which he takes for his opioid use disorder, his preferred medication is Wellbutrin because “that is the one pill that does work for [his] mental health.” He also testified that he does not like taking the requested medications because they “make [him] stupid,” explaining that they slow down his thinking, impair his memory, and make it difficult to communicate effectively, both orally and in writing.

¶7 Following the testimony, the district court found that Dr. Pillai had testified credibly, as well as consistently with his affidavit. The court then examined each of the four elements from People v. Medina, 705 P.2d 961, 963-64, 973 (Colo. 1985), concluding that the State met its burden satisfying the elements. As a result, it granted the petition.

II. Standard of Review and Applicable Law

¶8 Application of the Medina test involves mixed questions of fact and law. People v. Marquardt, 2016 CO 4, ¶ 8. We defer to the

4

district court’s factual findings if they have record support, while we review the court’s legal conclusions de novo. Id. Resolving conflicts in testimony and determining the credibility of the witnesses are matters solely within the province of the district court. People in Interest of Ramsey, 2023 COA 95, ¶ 23.

¶9 Under Medina, a district court may authorize the involuntary administration of antipsychotic medication if the State demonstrates by clear and convincing evidence that (1) the patient is incompetent to effectively participate in the treatment decision;

(2) the treatment with antipsychotic medication is necessary to prevent a significant and likely long-term deterioration in the patient’s mental health condition or to prevent the likelihood of him causing serious harm to himself or others in the institution;

(3) a less intrusive treatment alternative is not available; and (4) the patient’s need for treatment with antipsychotic medication is sufficiently compelling to override any bona fide and legitimate interest he has in refusing treatment.

5

Medina, 705 P.2d at 973.1 III. Sufficiency of the Evidence

¶ 10 A.D.W. does not contest the district court’s findings that the State met its burden of proving the second and third Medina elements. Instead, he challenges the sufficiency of the evidence supporting the court’s rulings as to the first and fourth Medina elements.

¶ 11 On a sufficiency challenge, we must determine whether the evidence, viewed as a whole and in the light most favorable to the State, is sufficient to support the district court’s order. People in Interest of R.K.L., 2016 COA 84, ¶ 13. The testimony of the physician seeking to administer treatment may be sufficient, without more, to satisfy the Medina test. Id. at ¶ 30.

1 A different test applies to petitions to administer medication

involuntarily for the purpose of restoring a defendant’s competency in a criminal case. See People in Interest of R.F., 2019 COA 110, ¶¶ 10-15 & n.1 (discussing the test from Sell v. United States, 539 U.S. 166, 180 (2003)). Although A.D.W. was initially admitted to the hospital for that purpose, the petition’s stated purposes, and the district court’s bases for granting the petition, were to prevent a significant and long-term deterioration in his mental condition and to prevent the likelihood of him causing serious harm to others in the hospital. These considerations comprise the second Medina element. See id. at ¶ 11 n.1.

6

A. The First Medina Element

¶ 12 The first Medina element requires the State to establish “the patient’s incompetency to make treatment decisions.” Medina, 705 P.2d at 973. To meet this standard, a district court must be satisfied that “the patient’s mental illness has so impaired his judgment as to render him ‘incapable of participating in decisions affecting his health.’” Id. (quoting Goedecke v. State, Dep’t of Insts., 603 P.2d 123, 125 (Colo. 1979)). But it is not enough for the patient to merely participate in the treatment decision; the patient must be able to “effectively participate” in the decision. Medina, 705 P.2d at 963; People v. Gilliland, 769 P.2d 477, 483 (Colo. 1989).

¶ 13 The district court concluded that A.D.W. is incompetent to effectively participate in decisions concerning treatment of his mental illness. It based that conclusion on findings that he has limited insight into his mental illness because, although he recognizes that he has some type of mental illness, he does not understand the symptoms he is experiencing, that his mental illness is causing the symptoms, and the role of medications in improving the symptoms.

7

¶ 14 Those findings are supported by Dr. Pillai’s testimony, which the court credited. See Marquardt, ¶ 8; Ramsey, ¶ 23; R.K.L., ¶¶ 13, 30. Dr. Pillai explained that A.D.W. has limited insight into his mental illness because, although A.D.W. acknowledged receiving treatment in the past for a psychiatric illness, he does not seem to fully understand “how the symptoms of his illness affect his thinking and behavior” and “the role of medications in improving those symptoms.” As an example, Dr. Pillai focused on A.D.W.’s inability to connect that his unpredictable and aggressive behaviors are related to his underlying delusions, paranoia, thought disorganization, impulsivity, and agitation, which are caused by his unspecified mood disorder. Nor does A.D.W. “see” the role the requested medications have in improving those symptoms. Because we conclude the district court’s findings are supported by Dr. Pillai’s testimony, there is sufficient evidence to support the first Medina element. See Marquardt, ¶ 8; Ramsey, ¶ 23; R.K.L., ¶¶ 13, 30.

¶ 15 Nonetheless, A.D.W. advances two main arguments on appeal, both of which we conclude are unavailing.

8

¶ 16 First, he emphasizes that he recognizes he has some type of mental illness. He also emphasizes that he is not refusing any treatment, but rather, he believes he is not receiving the proper treatment. While A.D.W. does not elaborate further on these positions, recall that his preferred medication for his “mental health” is Wellbutrin. Dr. Pillai explained that Wellbutrin is an antidepressant, not an antipsychotic, and that Wellbutrin “is contraindicated for symptoms of mania.” Dr. Pillai also opined that Wellbutrin “wouldn’t be able to treat” A.D.W.’s mental illness. Given that the district court credited Dr. Pillai’s testimony, A.D.W.’s desire to take a medication for his mental illness that would not treat his symptoms supports the conclusion that he is incompetent to effectively participate in the decision on how to treat his mental illness. See Medina, 705 P.2d 963; Gilliland, 769 P.2d at 483.

¶ 17 Second, A.D.W. emphasizes that he could articulate coherently the reasons why he does not want to take the requested medications, such that they slow down his thinking, impair his memory, and make it difficult to communicate effectively. As an initial matter, a patient’s ability to “articulate his or her preferences” regarding treatment does not necessarily mean the

9

patient is competent to effectively participate in the treatment decision. People in Interest of Strodtman, 293 P.3d 123, 132 (Colo. App. 2011).

¶ 18 Even so, A.D.W.’s reasons for not wanting to take the medications were explained during Dr. Pillai’s testimony, who suspected that “what [A.D.W. is] reporting is [actually] improving symptoms of mania and racing thoughts.” The doctor further explained that patients being treated with such medications for mania often have the same complaint of slow thinking.

¶ 19 Likewise, the doctor acknowledged that, while slow thinking could also be caused by “extreme sedation” from the medications, based on his observations, A.D.W. had not appeared lethargic on the medications. A.D.W.’s desire not to take the medications to avoid slow thinking further supports that he is incompetent to effectively participate in his treatment decisions because the medications are actually improving his mania symptoms. See Medina, 705 P.2d 963; Gilliland, 769 P.2d at 483.

¶ 20 And in terms of A.D.W.’s reported impaired memory, Dr. Pillai testified that A.D.W. underwent cognitive testing by a nurse, and no impaired memory was “detected” based on the results. A.D.W.’s

10

lack of an impaired memory while medicated also supports that he is incompetent to effectively participate in the treatment decision. See Medina, 705 P.2d 963; Gilliland, 769 P.2d at 483.

¶ 21 Finally, in terms of A.D.W.’s reported difficulty in communicating, the district court found that A.D.W.’s testimony at the hearing was “fairly coherent,” specifically, that A.D.W. “was articulate and he was fast speaking.” So, the district court implicitly found that A.D.W. was, in fact, not having difficulty communicating despite being medicated.

B. The Fourth Medina Element

¶ 22 In analyzing the fourth Medina element, a court first determines “whether the patient’s refusal [of treatment] is bona fide and legitimate.” Medina, 705 P.2d at 974. If it is, the court then determines “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.

¶ 23 Notably, A.D.W. does not contest the district court’s finding that the State sufficiently proved the second Medina element,

11

namely, that treatment with the requested medications is necessary to prevent a significant and likely long-term deterioration in A.D.W.’s mental health condition and to prevent the likelihood of him causing serious harm to others in the institution. We deem this to be a concession that the medications are necessary for those two purposes. And the evidence strongly supports the court’s findings that the medications are necessary for those two purposes, particularly the purpose of protecting the safety of others in the hospital, given Dr. Pillai’s testimony that “the primary safety concern of [A.D.W.’s] assaultive behaviors has drastically improved” on the medications.

¶ 24 That being said, A.D.W.’s argument is that his need for treatment with the requested medications is not sufficiently compelling to override his bona fide and legitimate interests in refusing treatment. In so arguing, however, he simply reasserts the same bona fide and legitimate interests he argued in relation to the first Medina element. As we concluded in Part III.A above, those arguments are unpersuasive and remain equally so with respect to the fourth Medina element. Given that the district court credited

12

Dr. Pillai’s testimony, we affirm the district court’s conclusion that the fourth Medina element was met.

IV. Individualized Findings

¶ 25 Finally, A.D.W. contends that we should reverse the order or remand the case for further findings because the district court failed to make individualized findings in its written order. We are unpersuaded. The court made individualized findings during its oral ruling at the hearing. Issuing a detailed oral ruling and then issuing a written order merely summarizing the oral ruling, is permissible (and is common in not only mental health cases, but other types of cases as well). See In re Marriage of Thorburn, 2022 COA 80, ¶ 9 n.1 (treating an “oral ruling as supplementing the written order”); In re Marriage of Cespedes, 895 P.2d 1172, 1176 (Colo. App. 1995) (considering the district court’s oral ruling in rejecting a contention that its findings and conclusions in its written order were inadequate).

V. Conclusion

¶ 26 The order is affirmed.

JUDGE FREYRE and JUDGE KUHN concur.