25CA0063 Peo in Interest of Galindo 03-27-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA0063 Pueblo County District Court No. 25MH30000 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Troy Lee Galindo,
Respondent-Appellant.
ORDER AFFIRMED
Division III Opinion by JUSTICE MARTINEZ* Dunn and Tow, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced March 27, 2025
Cynthia Mitchell, County Attorney, Kate H. Shafer, Special Assistant County Attorney, Pueblo, Colorado, for Plaintiff-Appellee
Tezak Law, Mary E. Tezak, Florence, Colorado, for Defendant-Appellant
*Sitting by assignment of the Chief Justice under provisions of Colo. Const. art. VI, § 5(3), and § 24-51-1105, C.R.S. 2024. ¶1 Troy Lee Galindo appeals the district court’s order authorizing
the involuntarily administration of medications. We affirm.
I. Background
¶2 Galindo suffers from psychosis not otherwise specified.
Untreated, he exhibits symptoms that include disorganized
thinking, paranoia, and agitation. Deemed incompetent to proceed
in a criminal matter, he was admitted to the Colorado Mental
Health Hospital in Pueblo (CMHHIP) in late 2024.
¶3 After Galindo refused voluntary treatment, the Pueblo County
Attorney petitioned the district court for an order authorizing the
involuntary administration of risperidone (Risperdal) and, in the
event of acute agitation or refusal of Risperdal, intramuscular
injection of olanzapine (Zyprexa). Consistent with People v. Medina,
705 P.2d 961 (Colo. 1985), the petition asserted that (1) Galindo is
incapable of participating in decisions affecting his health and
treatment; (2) the requested treatment is necessary to prevent a
significant and likely long-term deterioration in his mental health
condition or to prevent the likelihood of him causing serious harm
to himself or others; (3) a less intrusive treatment alternative isn’t
available; and (4) Galindo’s need for treatment is sufficient to
1 override any bona fide and legitimate interest he has in refusing
treatment.
¶4 During an evidentiary hearing on the petition, the district
court heard testimony from both Galindo and his supervising
psychiatrist, Dr. Hareesh Pillai. At the end of the hearing, the court
found that Dr. Pillai had testified “credibly and persuasively,” and
adopted the opinions he expressed. The court concluded that the
People had proved all four Medina elements and issued an order
authorizing CMHHIP staff to administer the requested medications
to Galindo against his will.
II. Standard of Review
¶5 When, as here, a patient challenges the sufficiency of the
evidence supporting an involuntary medication order, we review the
district court’s legal conclusions de novo but defer to its factual
findings if they have record support. People v. Marquardt, 2016 CO
4, ¶ 8. We view the evidence as a whole and in the light most
favorable to the petitioning party, leaving the resolution of
testimonial conflicts and the determination of witness credibility
solely to the fact finder. People in Interest of Uwayezuk, 2023 COA
69, ¶ 57; People in Interest of R.C., 2019 COA 99M, ¶ 7. As the fact
2 finder, the district court determines the sufficiency, probative effect,
and weight of the evidence, along with the inferences and
conclusions to be drawn therefrom. R.C., ¶ 7.
III. Discussion
¶6 A district court may order the involuntary administration of
medication to a patient only if the People prove, by clear and
convincing evidence, each of the four elements outlined in Medina.
Medina, 705 P.2d at 973. Galindo doesn’t contest the second and
third Medina elements. He contends only that the evidence
presented at the hearing was insufficient to prove the first and
fourth. We are not persuaded.
A. The First Medina Element
¶7 The first Medina element requires a court to determine
whether the patient is incompetent to effectively participate in the
relevant treatment decision. Id. 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.
3 ¶8 Dr. Pillai offered his expert opinion that Galindo is incapable of
effectively participating in decisions affecting his health, including
the decision on whether psychiatric medications are neededThe
district court credited Dr. Pillai’s testimony, adopting the doctor’s
opinions as its own. Nonetheless, Galindo asserts that Dr. Pillai’s
testimony was insufficient because (1) it did not “speak” to
Galindo’s ability to participate in treatment discussions and (2)
“seem[ed] to rely heavily on the fact” that Galindo has a history of
mental health certifications, which Medina indicates is insufficient
to satisfy this element. But Dr. Pillai’s testimony that Galindo is
incapable of effectively participating in decisions about whether
psychiatric medications are needed does address Galindo’s ability to
effectively participate in treatment discussions. In addition, Dr.
Pillai testified that Galindo has only limited insight into his mental
illness and has indeed denied suffering from any psychiatric illness.
Further, as the district court noted, Galindo’s own testimony
reflected a lack of insight into his mental illness: he denied the
severity of his mental illness, instead claiming that he suffers from
trauma and post-traumatic stress disorder. Also, when asked if he
suffered any of the symptoms described by Dr. Pillai — namely,
4 disorganized thinking, paranoia, and agitation — he answered,
“No.”
¶9 Under these circumstances, we cannot conclude that the
evidence was insufficient to support the district court’s
determination that Galindo is incompetent to effectively participate
in the relevant treatment decision.
B. The Fourth Medina Element
¶ 10 The fourth Medina element requires a court to determine
whether the patient’s refusal of treatment “is bona fide and
legitimate.” Id. 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.
¶ 11 The district court found (and the parties do not appear to
dispute) that Galindo has experienced unwanted side effects from
some of the medications he has been prescribed. Avoiding side
effects from medications is a bona fide and legitimate reason for
refusing treatment. See id. (“The patient’s refusal may stem from a
prior unfavorable experience with similar treatment . . . .”). Galindo
5 contends that the district court erred by finding that his prognosis
without treatment is so unfavorable that his personal preference
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25CA0063 Peo in Interest of Galindo 03-27-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA0063 Pueblo County District Court No. 25MH30000 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Troy Lee Galindo,
Respondent-Appellant.
ORDER AFFIRMED
Division III Opinion by JUSTICE MARTINEZ* Dunn and Tow, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced March 27, 2025
Cynthia Mitchell, County Attorney, Kate H. Shafer, Special Assistant County Attorney, Pueblo, Colorado, for Plaintiff-Appellee
Tezak Law, Mary E. Tezak, Florence, Colorado, for Defendant-Appellant
*Sitting by assignment of the Chief Justice under provisions of Colo. Const. art. VI, § 5(3), and § 24-51-1105, C.R.S. 2024. ¶1 Troy Lee Galindo appeals the district court’s order authorizing
the involuntarily administration of medications. We affirm.
I. Background
¶2 Galindo suffers from psychosis not otherwise specified.
Untreated, he exhibits symptoms that include disorganized
thinking, paranoia, and agitation. Deemed incompetent to proceed
in a criminal matter, he was admitted to the Colorado Mental
Health Hospital in Pueblo (CMHHIP) in late 2024.
¶3 After Galindo refused voluntary treatment, the Pueblo County
Attorney petitioned the district court for an order authorizing the
involuntary administration of risperidone (Risperdal) and, in the
event of acute agitation or refusal of Risperdal, intramuscular
injection of olanzapine (Zyprexa). Consistent with People v. Medina,
705 P.2d 961 (Colo. 1985), the petition asserted that (1) Galindo is
incapable of participating in decisions affecting his health and
treatment; (2) the requested treatment is necessary to prevent a
significant and likely long-term deterioration in his mental health
condition or to prevent the likelihood of him causing serious harm
to himself or others; (3) a less intrusive treatment alternative isn’t
available; and (4) Galindo’s need for treatment is sufficient to
1 override any bona fide and legitimate interest he has in refusing
treatment.
¶4 During an evidentiary hearing on the petition, the district
court heard testimony from both Galindo and his supervising
psychiatrist, Dr. Hareesh Pillai. At the end of the hearing, the court
found that Dr. Pillai had testified “credibly and persuasively,” and
adopted the opinions he expressed. The court concluded that the
People had proved all four Medina elements and issued an order
authorizing CMHHIP staff to administer the requested medications
to Galindo against his will.
II. Standard of Review
¶5 When, as here, a patient challenges the sufficiency of the
evidence supporting an involuntary medication order, we review the
district court’s legal conclusions de novo but defer to its factual
findings if they have record support. People v. Marquardt, 2016 CO
4, ¶ 8. We view the evidence as a whole and in the light most
favorable to the petitioning party, leaving the resolution of
testimonial conflicts and the determination of witness credibility
solely to the fact finder. People in Interest of Uwayezuk, 2023 COA
69, ¶ 57; People in Interest of R.C., 2019 COA 99M, ¶ 7. As the fact
2 finder, the district court determines the sufficiency, probative effect,
and weight of the evidence, along with the inferences and
conclusions to be drawn therefrom. R.C., ¶ 7.
III. Discussion
¶6 A district court may order the involuntary administration of
medication to a patient only if the People prove, by clear and
convincing evidence, each of the four elements outlined in Medina.
Medina, 705 P.2d at 973. Galindo doesn’t contest the second and
third Medina elements. He contends only that the evidence
presented at the hearing was insufficient to prove the first and
fourth. We are not persuaded.
A. The First Medina Element
¶7 The first Medina element requires a court to determine
whether the patient is incompetent to effectively participate in the
relevant treatment decision. Id. 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.
3 ¶8 Dr. Pillai offered his expert opinion that Galindo is incapable of
effectively participating in decisions affecting his health, including
the decision on whether psychiatric medications are neededThe
district court credited Dr. Pillai’s testimony, adopting the doctor’s
opinions as its own. Nonetheless, Galindo asserts that Dr. Pillai’s
testimony was insufficient because (1) it did not “speak” to
Galindo’s ability to participate in treatment discussions and (2)
“seem[ed] to rely heavily on the fact” that Galindo has a history of
mental health certifications, which Medina indicates is insufficient
to satisfy this element. But Dr. Pillai’s testimony that Galindo is
incapable of effectively participating in decisions about whether
psychiatric medications are needed does address Galindo’s ability to
effectively participate in treatment discussions. In addition, Dr.
Pillai testified that Galindo has only limited insight into his mental
illness and has indeed denied suffering from any psychiatric illness.
Further, as the district court noted, Galindo’s own testimony
reflected a lack of insight into his mental illness: he denied the
severity of his mental illness, instead claiming that he suffers from
trauma and post-traumatic stress disorder. Also, when asked if he
suffered any of the symptoms described by Dr. Pillai — namely,
4 disorganized thinking, paranoia, and agitation — he answered,
“No.”
¶9 Under these circumstances, we cannot conclude that the
evidence was insufficient to support the district court’s
determination that Galindo is incompetent to effectively participate
in the relevant treatment decision.
B. The Fourth Medina Element
¶ 10 The fourth Medina element requires a court to determine
whether the patient’s refusal of treatment “is bona fide and
legitimate.” Id. 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.
¶ 11 The district court found (and the parties do not appear to
dispute) that Galindo has experienced unwanted side effects from
some of the medications he has been prescribed. Avoiding side
effects from medications is a bona fide and legitimate reason for
refusing treatment. See id. (“The patient’s refusal may stem from a
prior unfavorable experience with similar treatment . . . .”). Galindo
5 contends that the district court erred by finding that his prognosis
without treatment is so unfavorable that his personal preference
must yield to the state’s interest in preserving his health and
protecting his safety and safety of others in the institution.
Because the record supports the court’s determination, we disagree.
¶ 12 Dr. Pillai opined that the failure to medicate Galindo would be
more harmful than the risks posed by the requested medications.
In support of this opinion, Dr. Pillai testified that, without
medication, Galindo is “easily irritable and impulsive to the point
that he required an episode of seclusion and restraint and was
extremely agitated towards staff members.” Indeed, early on in his
hospitalization, Galindo frequently required “assault precautions”
because he became easily angered. Since his previous
hospitalization, his presentation deteriorated and he became more
threatening, which resulted in emergency medications. With
medication, his psychotic symptoms improve and he is less agitated
and does well.
¶ 13 Dr. Pillai also testified that, without the requested
medications, Galindo posed a serious risk of harm to others.
Galindo himself acknowledged that he can be aggressive toward
6 other people if he believes they are “being deceptive or . . .
manipulat[ive] or controlling.”
¶ 14 Dr. Pillai acknowledged that the requested medications have
some potential adverse side effects. But Dr. Pillai explained that
Galindo would be monitored for any side effects from the requested
medication regimen, and additional medications existed to
neutralize some of the side effects. Dr. Pillai also said that he did
not believe Galindo could be treated with the anti-anxiety
medication he preferred because it would not be effective in treating
the underlying symptoms of psychosis.
¶ 15 Under these circumstances, we perceive no error in the court’s
determination that Galindo’s prognosis without the requested
medications was so unfavorable that his reasons for refusing
medication must yield to the state’s legitimate interests in
preserving his life and health and protecting the safety of those in
the institution.
IV. Disposition
¶ 16 We affirm the order.
JUDGE DUNN and JUDGE TOW concur.