Peo in Interest of GS

Opinion

26CA1298 Peo in Interest of GS 08-27-2026 COLORADO COURT OF APPEALS

Court of Appeals No. 26CA1298 City and County of Denver Probate Court No. 26MH544 Honorable Beth A. Tomerlin, Magistrate

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

ORDER AFFIRMED

Division III

Opinion by JUDGE FREYRE

Johnson and Kuhn, JJ., concur

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

Announced August 27, 2026

Miko Brown, City Attorney, Daniel Horwitz, Assistant City Attorney, Denver, Colorado, for Petitioner -Appellee

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

¶1 Respondent, G.S., appeals the magistrate’s order authorizing staff at Denver Health and Hospital Authority (Denver Health) to treat him with electroconvulsive therapy (ECT) without his consent. We affirm.

I. Background

¶2 In early June 2026, G.S. was admitted to Denver Health after his mother brought him in. The Denver City Attorney filed a motion for short-term certification and a petition for the administration of involuntary ECT. G.S.’s treating psychiatrist, Dr. Dimitri Zouev, reported that G.S. had been admitted to the hospital with a history of schizophrenia and repeated episodes of catatonia, previously treated favorably at Denver Health with ECT. At the time of admission, G.S. was malodorous and disheveled, was largely mute, and only followed commands intermittently. G.S. also had a low body mass index and showed signs of malnutrition.

¶3 At the June 16, 2026 hearing on the petition, Dr. Zouev testified that G.S. remained catatonic on the unit. He testified that initially G.S. had a positive response to treatment with Ativan, but G.S.’s “catatonia score” was back up. At the time of the hearing G.S. was receiving three milligrams of Ativan three times a day.

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¶4 Dr. Zouev described catatonia as a syndrome that occurs due to a variety of medical and psychiatric conditions and involves symptoms like (1) mutism, where a person stops talking; (2) stupor, where a person is immobile and having difficulty moving; and (3) negativism, where a person does not follow commands. Dr. Zouev testified that catatonia is high risk because an individual can stop eating and drinking and could medically decompensate.

¶5 Dr. Zouev also explained that immediately prior to his hospitalization at Denver Health, G.S. had been treated at a different facility and released as an outpatient. That facility had administered an anti-psychotic medication to G.S. in the form of a long-acting injectable. Dr. Zouev testified that anti-psychotic medications can worsen catatonia, and he explained that because G.S. had a long-acting injectable on board, he was also at risk of developing a condition called neuroleptic malignant syndrome, which can be dangerous because it potentially causes fever, blood pressure instability, and muscle rigidity.

¶6 Dr. Zouev described ECT treatment, including that it required the patient to be under general anesthesia, and opined that it is the “gold standard” to treat catatonia. He also explained its side effects,

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most commonly short-term memory loss. Dr. Zouev opined that without ECT, G.S. would continue to eat minimally, drink minimally, and was at risk of malnutrition, kidney failure, and other dangerous medical conditions.

¶7 G.S. testified in opposition to the petition for involuntary treatment stating that “one milligram [of Ativan] three times a day is enough for me at my place.” He disputed experiencing catatonia, saying his behavior was a choice, and he denied any need for ECT.

¶8 The magistrate granted the short-term certification and the petition authorizing Denver Health to administer ECT treatments. On appeal, G.S. challenges only the order authorizing ECT.

II. Discussion

¶9 The magistrate found that the People had proven by clear and convincing evidence all four elements required under People v. Medina, 705 P.2d 961, 973 (Colo. 1985), to authorize the involuntary administration of medical treatment.

¶ 10 G.S. challenges the sufficiency of the evidence supporting only the fourth Medina element, namely, whether the patient’s need for the treatment is sufficiently compelling to override any bona fide and legitimate interest of the patient in refusing the treatment. Id.;

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see also People in Interest of M.K.M., 765 P.2d 1075, 1076 (Colo. App. 1988) (approving of the use of Medina criteria to analyze an order for involuntary ECT treatment). The first three elements are whether the patient is incompetent to effectively participate in the treatment decision, whether the treatment is necessary to prevent a significant and likely long-term deterioration in the patient’s mental condition or to prevent the likelihood of the patient’s causing serious harm to themself or others in the institution, and whether a less intrusive treatment alternative is available. Medina, 705 P.2d at 973. G.S. does not challenge the first three elements.

¶ 11 We conclude that the evidence is sufficient to support the court’s finding on the fourth Medina element.

A. Applicable Legal Principles

¶ 12 The magistrate’s order presents a mixed question of fact and law. People in Interest of Strodtman, 293 P.3d 123, 131 (Colo. App. 2011). We defer to the magistrate’s factual findings if there is evidence supporting them, but we review its legal conclusions de novo. Id. We must determine whether the evidence, viewed as a whole and in the light most favorable to the prevailing party, is sufficient to support the magistrate’s order. People in Interest of

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R.K.L., 2016 COA 84, ¶ 13. Testimony by a physician supporting a petition for involuntary treatment may be sufficient. See id. at ¶ 30 (citing People v. Pflugbeil, 834 P.2d 843, 847 (Colo. App. 1992)). Both the resolution of testimonial conflicts and the determination of witness credibility are solely within the province of the fact finder. People in Interest of Ramsey, 2023 COA 95, ¶ 23.

B. Analysis

¶ 13 G.S. contends that the magistrate erred by finding that the People established the fourth Medina element by clear and convincing evidence because the ruling focused solely on whether Dr. Zouev believed that ECT represented the medically preferred course of treatment rather than on whether G.S.’s need for treatment was sufficiently compelling enough to override his bona fide and legitimate interests in refusing treatment. We disagree.

¶ 14 The magistrate considered G.S.’s objection to treatment. She noted that G.S. testified that he did not think he was experiencing catatonia and did not think he needed ECT. The magistrate rejected these reasons as not bona fide or legitimate because they conflicted with Dr. Zouev’s expert testimony, which the magistrate found more credible. See Ramsey, ¶ 23.

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¶ 15 The magistrate also considered G.S.’s statements that “one milligram [of Ativan] three times a day” was “enough for him” and that he experienced memory issues after previously undergoing ECT. The magistrate found these objections bona fide and legitimate. But the magistrate also found that in light of Dr. Zouev’s testimony, G.S.’s need for treatment was sufficiently compelling to override his legitimate interests in refusing ECT. This finding is supported by the record.

¶ 16 Dr. Zouev testified that without ECT treatments, G.S. would continue to eat minimally, shower minimally, have poor hygiene, remain malodorous, and risked physical decompensation. He explained that when G.S. was admitted to Denver Health, G.S. had a condition called high anion gap metabolic acidosis, which is a sign of malnutrition. Dr. Zouev opined that G.S. could experience renal failure because of his unwillingness to drink fluids. He testified that G.S. cannot live on his own and explained that G.S.’s mother was unable to care for him full time. To illustrate, Dr. Zouev testified that the day before the hearing, G.S. “was not able to communicate about anything.”

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¶ 17 Dr. Zouev testified that G.S. had responded well in the past to ECT treatments and explained that the treatments are not “curative” meaning most patients require ongoing medication or maintenance treatments. He testified that ECT has risks, mainly associated with the use of general anesthesia and that memory loss is a common side effect, but that it typically resolves. In sum, Dr. Zouev testified that ECT was “vital” to G.S.’s treatment, that failing to use ECT would be more harmful than the side effects, and that G.S.’s prognosis without it was poor.

¶ 18 To be sure, ECT treatment is not without risks and side effects. But there was sufficient evidence in the record to conclude that these risks and side effects are outweighed by the benefits of ECT to improve G.S.’s psychiatric symptoms and to prevent long-term deterioration of his mental condition. Accordingly, the evidence was sufficient to support the magistrate’s finding on the fourth Medina element. com III. Disposition

¶ 19 The order is affirmed.

JUDGE JOHNSON and JUDGE KUHN concur.