Peo in Interest of AW

Opinion

26CA0969 Peo in Interest of AW 07-30-2026

COLORADO COURT OF APPEALS

Court of Appeals No. 26CA0969 Jefferson County District Court No. 26MH1777 Honorable Jessica Marie Walker, Magistrate

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of A.W.,

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 July 30, 2026

Kimberly Sorrells, County Attorney, Sarah Oviatt, Senior Assistant County Attorney, Golden, Colorado, for Petitioner-Appellee

Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant ¶1 Respondent, A.W., appeals a magistrate’s order certifying her

for short-term involuntary treatment and authorizing the

involuntary administration of antipsychotic, antianxiety, mood

stabilizing, and side-effect treatment medications. She contends

that the evidence was insufficient to uphold the order. Because we

disagree, we affirm the order.

I. Background

¶2 In May 2026, A.W. was admitted to Centennial Peaks Hospital

with increasing paranoia and grandiose delusions. A.W. made

statements that “people had been trying to kill her since 1993” and

that she is fearful of “the man connected with Epstein.” In the

hospital, she presented with hyperverbal speech, concerning

behaviors, and paranoia.

¶3 The hospital was unable to obtain any previous medical

records for her. However, A.W. reported she had been diagnosed

with schizophrenia in the past. Her treating physician at

Centennial Peaks had a working diagnosis of schizoaffective

disorder because of her manic presentation.

¶4 After unsuccessfully discussing voluntary options for

treatment, the hospital requested that A.W. be certified for short-

1 term mental health treatment under section 27-65-109, C.R.S.

2025, and sought an order authorizing the involuntary

administration of six antipsychotic medications, two mood-

stabilizers, two antianxiety medications, and two medications to

treat side effects.

¶5 After A.W. objected, a magistrate held an evidentiary hearing.

The magistrate heard testimony from A.W. and from her treating

physician, Dr. Roderick O’Brien, who testified as an expert in

psychiatry. After the hearing, the magistrate entered an order

certifying A.W. for short-term treatment. The magistrate found by

clear and convincing evidence that A.W. had a mental health

disorder, was gravely disabled, and had refused voluntary

treatment. And finding that the People had proved all four elements

of the test set forth in People v. Medina, 705 P.2d 961, 973 (Colo.

1985), the magistrate also authorized the involuntary

administration of four antipsychotic medications, one mood-

stabilizer, one antianxiety medication, and two medications to treat

side effects. The court also authorized laboratory work to monitor

for potential adverse effects from the treatment.

2 II. Analysis

¶6 A.W. contends that the district court erred when it (1) found

that she was gravely disabled and certified her for short-term

treatment and (2) authorized the involuntary administration of

medication. We address each contention in turn.

A. Short-Term Certification

¶7 A.W. first argues that the evidence was insufficient to support

the finding that she was gravely disabled and, therefore, the

magistrate erred by certifying her for short-term treatment. We

disagree.

1. Applicable Law and Standard of Review

¶8 A magistrate may certify a person for involuntary short-term

treatment if the magistrate finds, by clear and convincing evidence,

that the person has a mental health disorder and, as a result, is a

danger to herself or others or is gravely disabled.

§§ 27-65-109(1)(a), 27-65-113(1), C.R.S. 2025.

¶9 As relevant here, a person is “gravely disabled” when she is

“incapable of making informed decisions about or providing for [her]

essential needs without significant supervision and assistance from

other people.” § 27-65-102(17), C.R.S. 2025. As a result of the

3 inability to make informed decisions, a gravely disabled person is at

risk of, among other things, “significant psychiatric deterioration, or

mismanagement of the person’s essential needs that could result in

substantial bodily harm.” Id.; see also People v. Taylor, 618 P.2d

1127, 1134 (Colo. 1980) (interpreting “basic personal needs” to

mean “those fundamental necessities of human existence,”

including “food, shelter, clothing, and medical care”).

¶ 10 Whether a person is gravely disabled is a fact-specific

determination that depends on the person’s condition at the time

the finding is made. People in Interest of Vivekanathan, 2013 COA

143M, ¶ 14. We review the record as a whole and in light the most

favorable to the People to determine whether the evidence is

sufficient to support the fact finder’s decision. People in Interest of

Ramsey, 2023 COA 95, ¶ 23. We defer to the court’s factual

findings if sufficient record evidence supports them. Id.

2. Grave Disability

¶ 11 The magistrate found that A.W. was gravely disabled because

her mental illness had “impaired her ability to recognize reality” as

a result of her “delusions” and “hallucinations.” And the magistrate

found that her paranoia affected her ability to “receiv[e] enough

4 nutrition for her to be healthy.” The magistrate further found that

because of her mental illness, A.W. was at risk of substantial bodily

harm and worsening physical illness including hypothyroidism for

which she required medication. Moreover, the magistrate found

that A.W.’s safety was compromised because of her dangerous

interactions with her peers. The magistrate also found that

voluntary treatment had been discussed and — despite the fact that

A.W. voluntarily accepted a “small percentage” of the medications

offered to her — “reasonable grounds exist to believe that she will

not continue with that voluntary treatment.”

¶ 12 In arguing that she is not gravely disabled, A.W. emphasizes

that although Dr. O’Brien testified that she was unable to make

informed decisions regarding her essential needs, he also testified

that she recognized her need for treatment and voluntarily sought

help at the hospital. But Dr. O’Brien testified that when he spoke

with A.W., he observed that she “does not have an understanding of

the diagnosis” and “does not comprehend the consequences of

failing to treat the diagnosis.” He testified that in addition to getting

inadequate sleep, it has been difficult for hospital staff to get A.W.

to eat an adequate amount of food or take medication because of

5 her paranoid belief that she is being poisoned. He testified that

outside of an inpatient hospital with a locked psychiatric ward, “her

safety would be very jeopardized.” Illustrating this, he testified that

A.W.’s interaction with peers is “generally inappropriate and

dangerous” and that her hypersexualized behaviors required the

hospital to separate her from other patients to avoid them “taking

advantage of her.”

¶ 13 With respect to other medical conditions, Dr. O’Brien testified

that A.W. had hypothyroidism, which requires medication and, in

his opinion, she was unable to consistently take her medication on

her own. And he testified that even if A.W. said she would take

medication voluntarily, he did not believe she would follow through

with doing so.

¶ 14 Throughout her appeal, A.W. argues that Dr. O’Brien’s

opinions are not based on any past medical history and that he

possessed only limited knowledge about her life outside the

hospital. Indeed, Dr. O’Brien testified that he had been unable to

obtain A.W.’s historical medical records or get collateral information

from family and friends. However, he testified from his personal

6 observation and his review of the hospital’s medical records. The

magistrate found his testimony credible.

¶ 15 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 A.W. 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,

we perceive no error in the magistrate certifying A.W. for short-term

treatment.

B. Involuntary Administration of Medication

¶ 16 A.W. also asserts that the magistrate erred when authorizing

the involuntary administration of medication. She asserts that

none of the four elements required by Medina were established by

sufficient evidence.

1. Applicable Law and Standard of Review

¶ 17 A court may authorize the involuntary administration of

medication if the People establish each of the following elements by

clear and convincing evidence: (1) the person is incompetent to

effectively participate in the treatment decision; (2) the treatment is

7 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 herself 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.

¶ 18 We determine whether the evidence, viewed as a whole and in

the light most favorable to the People, is sufficient to support the

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.

¶ 19 Application of the Medina test is a mixed question of fact and

law. People v. Marquardt, 2016 CO 4, ¶ 8. We defer to the court’s

factual findings if they are supported by the record but review de

novo the court’s legal conclusions. Id. Both the resolution of

testimonial conflicts and the determination of witness credibility are

solely within the province of the fact finder. Ramsey, ¶ 23. Where

the evidence supports the court’s findings and conclusions, we may

8 not substitute our judgment for that of the court. People in Interest

of A.J.L., 243 P.3d 244, 255 (Colo. 2010).

2. The First Medina Element

¶ 20 The first Medina element requires a court to determine

whether the patient is incompetent to effectively participate in the

relevant treatment decision. Medina, 705 P.2d at 973. A court may

not order the forced medication of an involuntarily committed

patient unless it is satisfied that the patient’s mental illness has so

impaired their judgment as to render them incapable of

participating in decisions affecting their health. Id.

¶ 21 At the hearing, Dr. O’Brien testified that A.W. does not

understand her diagnosis or need for treatment. He testified that

when he attempted to discuss taking medication voluntarily, “her

response is mostly incoherent” and she fixates on tangential issues,

including her belief that she is pregnant in spite of a negative

pregnancy test performed at the hospital and evaluation by internal

medicine doctors.

¶ 22 Nonetheless, A.W. asserts that her own testimony reflects that

her judgment is not impaired because she “voluntarily walked into

the hospital to seek treatment.” In fact, she testified that she went

9 to the hospital because she was “cold” and wanted to check in for

“three days voluntarily,” not because she recognized her need for

treatment.

¶ 23 She also asserts on appeal that she “thoughtfully considered

her ongoing treatment options” by contacting a sober recovery

house and securing a bed. But it is unclear how an addiction

recovery facility would provide adequate treatment to address A.W.’s

mental illness given her working diagnosis of schizoaffective

disorder.

¶ 24 A.W. appears to disagree with Dr. O’Brien’s diagnosis,

asserting that she wants to return to her home state of Vermont

where her post-traumatic stress disorder, depression, and attention

deficient hyper-activity disorder could all be treated with

Wellbutrin. And she testified that she was robbed, leading her to

experience PTSD symptoms, not that she had the mental health

disorders claimed by the doctors. But the magistrate credited Dr.

O’Brien’s testimony, including his working diagnosis. As noted, the

testimony of the physician seeing to administer treatment may be

sufficient, without more, to satisfy the Medina test. R.K.L., ¶ 30.

10 ¶ 25 Under these circumstances, we cannot conclude that the

evidence was insufficient to support the magistrate’s determination

that A.W. is incompetent to effectively participate in the relevant

treatment decision.

3. The Second Medina Element

¶ 26 The second Medina element may be satisfied by showing either

(1) a significant and likely long-term deterioration or (2) the

likelihood of serious harm to self or others in the institution.

Medina, 705 P.2d at 973.

¶ 27 After considering the evidence, the magistrate found that the

medications were necessary to prevent a significant and likely long-

term deterioration, noting the doctor’s testimony that the longer a

person is manic or psychotic the “more a deterioration can occur

and the harder it is to treat . . . those particular symptoms.” And

the magistrate noted Dr. O’Brien’s testimony that A.W.’s prognosis

without any medication was not good, particularly related to her

ability to step down to a lower level of care.

¶ 28 A.W. argues that Dr. O’Brien’s testimony was not sufficient

because he “offered little individualized explanation” regarding her

situation specifically. But Dr. O’Brien described the severity of

11 A.W.’s illness and opined that if she does not take the requested

medication, there would be a significant and likely long-term

deterioration of her mental condition. Moreover, the second Medina

element does not speak of certainties; it is framed as a likelihood.

¶ 29 In sum, we defer to the magistrate’s determination that Dr.

O’Brien was a credible and persuasive witness. See Marquardt, ¶ 8

(deferring to the magistrate’s findings of fact if they are supported

by the record). And Dr. O’Brien’s expert opinion that, without

requested medications, A.W. would likely suffer a significant and

long-term deterioration of her mental health condition is sufficient

to support the magistrate’s conclusion. R.K.L., ¶ 30.

4. The Third Medina Element

¶ 30 The third Medina element “encompasses not only the gravity of

any harmful effects from the proposed treatment but also the

existence, feasibility, and efficacy of alternative methods of treating

the patient’s condition or of alleviating the danger created by that

condition.” Medina, 705 P.2d at 974. A “‘less intrusive alternative’

constitutes an available treatment that has less harmful side effects

and is at least as effective at alleviating a patient’s condition as the

12 proposed treatment.” People in Interest of Strodtman, 293 P.3d 123,

133 (Colo. App. 2011).

¶ 31 Dr. O’Brien testified about each medication he requested and

how they intended to use each one, including alternative

medications in case A.W. did not respond to or had allergic or other

reactions to the medications. He testified that the requested

medications would allow him the flexibility to treat A.W.’s mental

illness and any side effects. He further testified that there was no

viable, less intrusive alternatives to treatment with medication.

¶ 32 A.W. argues that a less intrusive alternative was to discharge

her to the sober living facility and allow her to seek treatment there.

But a less intrusive alternative must be “at least as effective at

alleviating a patient’s condition as the proposed treatment,” id., and

Dr. O’Brien’s testimony made clear that A.W.’s symptoms could not

be adequately treated without medication. He testified that the

hospital provided group therapy, a recreational therapist, a physical

therapist, and other services. Those services “are helpful to

augment the pharmacotherapy, but without a full reasonable

treatment with medication, [A.W.’s] prognosis is very poor.”

13 ¶ 33 Deferring to the magistrate’s determinations of the witnesses’

credibility and the weight afforded to Dr. O’Brien’s testimony, as we

must, we conclude that the record contains sufficient support for

the finding as to the third Medina element. See Medina, 705 P.2d at

974; A.J.L., 243 P.3d at 255.

5. The Fourth Medina Element

¶ 34 When 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 [S]tate in preserving the life and health of

the patient placed in its charge and in protecting the safety of those

in the institution.” Id.

¶ 35 The magistrate stated that “from what the court can tell,”

A.W.’s objections to the medication were that the medications will

kill her, others are attempting to poison her, the hospital is being

bribed by “big pharma,” and some other “religious and traditional”

reasons. Nonetheless, the magistrate found that A.W.’s medical

14 condition was “quite grave” and thus overrode any interests she had

in refusing the medications.

¶ 36 On appeal, A.W. challenges the magistrate’s ruling by listing

the potential side effects of the ordered medications and repeating

her objections to the use of some of the medications based on

previous allergic reactions. She also reiterates her concerns that

she might be pregnant.

¶ 37 The magistrate heard both A.W.’s testimony about a potential

pregnancy and Dr. O’Brien’s testimony that A.W. had undergone

testing and the hospital felt “confident within a reasonable degree of

medical certainty” that she was not pregnant. After hearing this

testimony, the magistrate opted to order involuntary medication,

implying that the magistrate found Dr. O’Brien’s testimony more

persuasive on this point. See In re Marriage of Udis, 780 P.2d 499,

504 (Colo. 1989) (noting an appellate court may presume that the

district court considered all the evidence presented, even if the

order does not expressly recite such evidence).

¶ 38 The magistrate tailored her order such that only necessary

antipsychotics would be administered. The magistrate noted A.W.’s

testimony that she had had a bad reaction to Haldol at the hospital,

15 but A.W. also testified that it was somewhat helpful to her mental

state. Moreover, Dr. O’Brien testified that he had no evidence that

A.W. experienced a bona fide allergic reaction to any medications

and explained that her description sounded more like a side effect

from the medications.

¶ 39 Viewing this record in the light most favorable to the People,

we perceive sufficient clear and convincing evidence of a compelling

need for the involuntary administration of medications. See

Ramsey, ¶ 23. We conclude that the record amply supports the

magistrate’s findings regarding the fourth Medina element.

III. Disposition

¶ 40 The order is affirmed.

JUDGE FREYRE and JUDGE JOHNSON concur.