Peo in Interest of Gilmore

Opinion

26CA0669 Peo in Interest of Gilmore 07-02-2026

COLORADO COURT OF APPEALS

Court of Appeals No. 26CA0669 Pueblo County District Court No. 26MH30039 Honorable Gregory J. Styduhar, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Adam Hardy Gilmore,

Respondent-Appellant.

ORDER AFFIRMED

Division VII Opinion by JUDGE SULLIVAN Pawar and Meirink, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced July 2, 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 Adam Hardy Gilmore appeals the district court’s order

authorizing staff at the Colorado Mental Health Hospital in Pueblo

(CMHHIP) to medicate him against his will. We affirm.

I. Background

¶2 Gilmore was admitted to CMHHIP after being found

incompetent to proceed on criminal charges. According to the

affidavit and testimony of Dr. Zachary Wickline, the psychiatrist

who supervises Gilmore’s care and treatment, Gilmore suffers from

an unspecified bipolar disorder that causes episodic mood changes,

irritable and aggressive mood states, manic behavior, impulsivity,

disinhibition, and delusions. He has a long history of psychiatric

hospitalizations and emergency mental health holds.

¶3 Before he was deemed incompetent to proceed, Gilmore

presented with “extreme anger and rage” and expressed suicidal

ideation. In October 2025, he was admitted to CMHHIP, where he

was minimally adherent with treatments and routinely refused

medical appointments. In January 2026, staff began administering

Zyprexa and lithium on a ten-day emergency basis in response to

concerns about Gilmore’s behavior, including screaming in the

middle of the night, throwing pebbles and snowballs at staff

1 windows, swallowing pebbles because he “needed more fiber,”

throwing juice on the carpet, saying that there was a bomb in the

building, and antagonizing other patients and trying to get them to

“revolt.” After a few days on Zyprexa and lithium, Gilmore’s

behavior and thought processes improved. Nonetheless, he was

unwilling to take medication voluntarily. The district court denied

the People’s petition to continue involuntary administration of

Zyprexa and lithium beyond a ten-day period.

¶4 When Gilmore discontinued medication, his concerning

behaviors returned and escalated. On March 22, 2026, he scared a

nurse by aggressively lunging, pointing a finger in her face, and

yelling. He continued yelling even as he was ushered away, and his

aggressive and intimidating behavior persisted later in the day.

CMHHIP staff once again began administering medication on an

emergency basis, and Gilmore’s condition once again improved.

The People petitioned for a six-month order authorizing the

involuntary administration of Zyprexa and lithium, along with

laboratory work and testing to monitor possible side effects.

¶5 The district court held an evidentiary hearing, where Dr.

Wickline testified about each of the four elements required for the

2 involuntary administration of medication under People v. Medina,

705 P.2d 961, 973 (Colo. 1985).1 As to Gilmore’s interests in

refusing medication, Dr. Wickline testified that Gilmore didn’t think

he needed psychiatric medication and had complained of side

effects including (1) blood in his stool; (2) kidney damage; and

(3) tiredness or “zonking him out,” in addition to other nonspecific

complaints. Dr. Wickline explained that the requested medications

were highly unlikely to cause blood in Gilmore’s stool; Gilmore’s

bloodwork, which CMHHIP would continue to monitor, showed no

evidence of kidney damage; and although Zyprexa can cause

sedation, this side effect tends to improve within a few weeks of

initiating treatment. In light of the minimal nature of the bona fide

side effects and the observable improvement in Gilmore’s condition

1 When the State seeks to administer antipsychotic drugs to a

mentally ill criminal defendant involuntarily so that they can stand trial, a reviewing court applies the Supreme Court’s test in Sell v. United States, 539 U.S. 166, 178 (2003). But reviewing courts apply state law tests if the State, as here, seeks to administer antipsychotics involuntarily for a different purpose, including for purposes “related to the individual’s dangerousness, or . . . the individual’s own interests where refusal to take drugs puts his health gravely at risk.” Id. at 181-82.

3 when medicated, Dr. Wickline opined that the benefits of

medication outweighed the risks.

¶6 Gilmore was present for the majority of Dr. Wickline’s

testimony but voluntarily left the room after interrupting the

proceedings several times to deny swallowing pebbles, encouraging

a revolt, having delusions, and needing medication. He also argued

that CMHHIP staff “don’t even understand what’s going on with

[him]”; “they’re just drugging [him]”; and he “can’t function.” Just

before Gilmore left, his attorney warned, “if you leave now, nothing

you say can be considered.” Gilmore responded, “Well, that’s fine.”

He didn’t return to the hearing, and his attorney declined to present

an argument.

¶7 Relying on Dr. Wickline’s uncontroverted affidavit and

testimony, which the district court found credible, the court found

that the People had provided clear and convincing evidence for each

of the Medina elements. On appeal, Gilmore challenges the

sufficiency of the evidence supporting the court’s order.

II. Analysis

¶8 Gilmore challenges the sufficiency of the evidence for the first

and fourth Medina elements. We conclude sufficient evidence

4 supported the district court’s decision that the People had satisfied

their burden on both elements.2

A. Applicable Law and Standard of Review

¶9 A district court may authorize the involuntary administration

of medication to a patient only if the People establish each of the

following elements by clear and convincing evidence: (1) the patient

is incompetent to participate effectively in the treatment decision;

(2) treatment by medication is necessary either to prevent a

significant and likely long-term deterioration in the patient’s mental

condition or to prevent the likelihood of the patient causing serious

harm to themself or others in the institution; (3) a less intrusive

treatment alternative isn’t available; and (4) the patient’s need for

treatment with medication is sufficiently compelling to override

their bona fide and legitimate interest in refusing medication.

Medina, 705 P.2d at 973; see People in Interest of Strodtman, 293

P.3d 123, 131 (Colo. App. 2011). A treatment provider’s testimony

2 We decline to address Gilmore’s challenge, made for the first time

in his reply brief on appeal, to the “overly broad spectrum of medications and delivery modalities” that the district court approved. See In Interest of L.B., 2017 COA 5, ¶ 48 (“We do not consider arguments raised for the first time in a reply brief.”).

5 alone may constitute clear and convincing evidence. See People v.

Pflugbeil, 834 P.2d 843, 846-47 (Colo. App. 1992).

¶ 10 When, as here, a patient challenges the sufficiency of the

evidence, we review the record as a whole and, viewing it in the light

most favorable to the People, determine whether the evidence is

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

Ramsey, 2023 COA 95, ¶ 23. We review the court’s conclusions of

law de novo and defer to its findings of fact if supported by evidence

in the record. People v. Marquardt, 2016 CO 4, ¶ 8. We also defer

to the district court’s resolution of evidentiary conflicts and its

determinations of witness credibility, the weight of the evidence,

and the inferences to be drawn from it. See People in Interest of

R.C., 2019 COA 99M, ¶ 7.

B. Sufficient Evidence Supported the First Medina Element

¶ 11 Gilmore argues that the evidence offered by the People falls

short because the record shows that he has partial insight into his

condition. We disagree.

¶ 12 A patient is incompetent to effectively participate in treatment

decisions when his “mental illness has so impaired his judgment as

6 to render him ‘incapable of participating in decisions affecting his

health.’” Medina, 705 P.2d at 973 (citation omitted).

¶ 13 Dr. Wickline’s affidavit and testimony, which the district court

found credible, support the court’s findings that Gilmore was

incompetent to effectively participate in his treatment decisions.

Dr. Wickline’s affidavit and testimony established that Gilmore (1) is

mentally ill; (2) has “quite limited” insight into his mental illness;

(3) doesn’t consistently recognize a need for treatment; (4) doesn’t

take medication for a clinically significant period of time or at

appropriate dosages; (5) doesn’t think he needs medication and

doesn’t appreciate that medications play a role in controlling his

symptoms; and (6) routinely refuses medical treatment, including

physical therapy. This evidence was sufficient to satisfy the first

Medina element. See People in Interest of R.K.L., 2016 COA 84, ¶ 33

(noting that a patient’s inability to realistically assess the benefits of

medication supports such a finding).

¶ 14 We aren’t persuaded by Gilmore’s argument that the court

must find otherwise based on his ability to identify plausible side

effects and articulate his preference for refusing medication. See

Strodtman, 293 P.3d at 132 (noting that the first Medina element

7 “contemplates action in addition to words”). And we are similarly

unpersuaded that Gilmore’s statements during Dr. Wickline’s

testimony require a different result. We defer to the district court’s

impressions at the evidentiary hearing and decline to reconsider its

assignment of weight to certain evidence and its resolution of

evidentiary conflicts. See R.C., ¶ 7. Because the evidence is

sufficient to support the court’s decision, we will not disturb it. See

Ramsey, ¶ 23.

C. Sufficient Evidence Supported the Fourth Medina Element

¶ 15 In assessing the sufficiency of evidence for the fourth Medina

element, a court must determine (1) “whether the patient’s refusal

is bona fide and legitimate”; and, if so, (2) “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.” Medina, 705

P.2d at 974. Gilmore contends that the district court erred by

finding that both prongs favored the involuntary administration of

medication. We conclude that the record supports the district

court’s ultimate finding on this element.

8 ¶ 16 For the purpose of our analysis, we assume that Gilmore’s

alleged side effects and potential religious objection to taking

medication are bona fide and legitimate reasons for his refusal to

take Zyprexa and lithium. Even so, Dr. Wickline’s testimony and

affidavit support the district court’s finding that Gilmore’s

preference must yield to the People’s legitimate interests because

Gilmore’s symptoms worsen when he isn’t taking medication, which

creates a risk of harm to himself or others in CMHHIP (as described

in Part I of this opinion).

¶ 17 Because Dr. Wickline’s testimony and affidavit provide clear

and convincing evidence for the court’s ultimate finding that

Gilmore’s prognosis without medication is so unfavorable that any

bona fide and legitimate interest in refusal must yield to the

People’s legitimate interests in preserving his health and in

protecting the safety of those in CMHHIP, we conclude that the

People satisfied the fourth Medina element.

III. Detailed Written Order Not Required

¶ 18 Although Gilmore primarily frames his appeal as a challenge

to the sufficiency of the evidence, he also contends that the district

court erred by failing to make individualized findings for each

9 Medina element in its written order. We reject this contention for

two reasons. First, as exemplified by the findings listed in Parts II.B

and II.C above, the court made individualized findings in its oral

order at the conclusion of the evidentiary hearing. Second, Gilmore

doesn’t cite, and we aren’t aware of, any legal authority requiring

written findings.

IV. Disposition

¶ 19 We affirm the order.

JUDGE PAWAR and JUDGE MEIRINK concur.