25CA1346 Peo in Interest of Hamilton 10-02-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1346 Pueblo County District Court No. 25MH30007 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Tyshun T. Hamilton,
Respondent-Appellant.
ORDER AFFIRMED
Division II Opinion by JUDGE MEIRINK Fox and Brown, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced October 2, 2025
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 Respondent, Tyshun T. Hamilton, appeals the district court’s
order authorizing the staff at the Colorado Mental Health Hospital
in Pueblo (the hospital) to involuntarily medicate him. We affirm.
I. Background
¶2 Hamilton was committed to the hospital after being found
incompetent to proceed in his criminal case. He was diagnosed
with schizophrenia and presented with symptoms that included
disorganized thinking, auditory and visual hallucinations, and
hypersexual behavior. Hamilton had a history of suicide attempts,
not responding to redirection, threatening to kill others, and
requiring seclusion and manual restraint. Initially, Hamilton took
medication voluntarily, but after hospital staff found a pill hidden in
his room, he admitted that he was not taking his medication.
¶3 In January 2025, the People filed a petition to involuntarily
medicate Hamilton with olanzapine (Zyprexa) and valproic acid
(Depakote). The district court granted the People’s petition based
on the parties’ stipulation. After receiving consistent medication
treatment, Hamilton’s psychotic symptoms decreased, his self-
injurious behavior resolved, and his hypersexual behavior
decreased in severity and frequency.
1 ¶4 In July 2025, the People petitioned the district court for review
of the involuntary treatment order, asking the court for
authorization to continue treatment with olanzapine and valproic
acid. The court held an evidentiary hearing, at which Hamilton and
his treating psychiatrist, Dr. Paul Mattox, testified. After hearing
the evidence, the court found that Dr. Mattox had testified “credibly
and persuasively” and that the People had established all four
elements for the involuntary administration of medication set forth
in People v. Medina, 705 P.2d 961, 973 (Colo. 1985). It therefore
granted the petition.
II. Applicable Law and Standard of Review
¶5 A district court may order the involuntary administration of
medication if the People prove by clear and convincing evidence that
(1) the patient is incompetent to effectively participate in the
treatment decision; (2) the treatment is necessary to prevent a
significant and likely long-term deterioration in the patient’s mental
health condition or to prevent the likelihood of the patient causing
serious harm to himself or others at the institution; (3) a less
intrusive treatment alternative is not available; and (4) the patient’s
2 need for treatment is sufficiently compelling to override any bona
fide and legitimate interest of the patient in refusing treatment. Id.
¶6 Application of the Medina test involves mixed questions of fact
and law.1 People v. Marquardt, 2016 CO 4, ¶ 8. We defer to the
district court’s factual findings if they have record support and
review its legal conclusions de novo. Id.
¶7 When a patient challenges the sufficiency of the evidence
supporting an involuntary medication order, we must affirm if the
evidence, viewed as a whole and in the light most favorable to the
People, is sufficient to support the order. People in Interest of
R.K.L., 2016 COA 84, ¶ 13 (“The testimony of the physician seeking
to administer treatment may be sufficient by itself to satisfy” the
Medina elements.). As the fact finder, the district court determines
the sufficiency, probative effect, and weight of the evidence, along
1 When the state seeks to administer antipsychotic drugs to a
mentally ill criminal defendant involuntarily so that she can stand trial, a reviewing court applies the Supreme Court’s test in Sell v. United States, 539 U.S. 166, 178 (2003). However, reviewing courts apply state law tests if the state, as here, seeks to administer antipsychotics involuntarily for “a different purpose,” including a purpose “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 with the inferences and conclusions to be drawn therefrom. People
in Interest of R.C., 2019 COA 99M, ¶ 7.
III. Analysis
¶8 Hamilton contends only that the evidence was insufficient to
prove the fourth Medina element. We disagree.
¶9 In assessing this element, a court must first determine
“whether the patient’s refusal is bona fide and legitimate.” Medina,
705 P.2d at 974. If it is, the court must then 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.
¶ 10 The district court found that Hamilton had bona fide and
legitimate reasons for his refusal, and it pointed to his concerns
that the medication made him feel sick, “slow[ed] everything down,”
prevented him from “mov[ing] always as he want[ed] to,” and caused
shortness of breath and tiredness. But it found that these bona
fide and legitimate interests were outweighed by the state’s
legitimate interest in “preserving [Hamilton’s] life and health . . .
4 and protecting the safety of others.” The record supports the
district court’s findings.
¶ 11 Dr. Mattox opined that the failure to medicate Hamilton would
be more harmful than the risks posed by the requested
medications. In support of this opinion, Dr. Mattox testified that,
without the requested medications, Hamilton would likely
“deteriorate,” and he would become “assaultive towards staff,” “re-
engage in self-injurious behavior,” and have “increased hypersexual
behavior.” Dr. Mattox noted that, since Hamilton had begun
consistent medication, all his symptoms had improved
“significantly.”
¶ 12 Dr. Mattox acknowledged that the requested medications had
potential adverse side effects. But he testified that Hamilton had
tolerated the medications and that the staff had not observed any
side effects. Dr. Mattox also noted that Hamilton has expressed his
dissatisfaction with taking medication, but he did not fully
understand the basis for his complaint. He also said that Hamilton
said the medication “didn’t make him feel right” but denied
experiencing any of the common side effects.
5 ¶ 13 On appeal, Hamilton maintains that the side effects he
described — such as a “shakiness in [his] soul” — could not be
observed by a third party and would not appear in a lab test.
Consequently, he contends that the district court erred by
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25CA1346 Peo in Interest of Hamilton 10-02-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1346 Pueblo County District Court No. 25MH30007 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Tyshun T. Hamilton,
Respondent-Appellant.
ORDER AFFIRMED
Division II Opinion by JUDGE MEIRINK Fox and Brown, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced October 2, 2025
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 Respondent, Tyshun T. Hamilton, appeals the district court’s
order authorizing the staff at the Colorado Mental Health Hospital
in Pueblo (the hospital) to involuntarily medicate him. We affirm.
I. Background
¶2 Hamilton was committed to the hospital after being found
incompetent to proceed in his criminal case. He was diagnosed
with schizophrenia and presented with symptoms that included
disorganized thinking, auditory and visual hallucinations, and
hypersexual behavior. Hamilton had a history of suicide attempts,
not responding to redirection, threatening to kill others, and
requiring seclusion and manual restraint. Initially, Hamilton took
medication voluntarily, but after hospital staff found a pill hidden in
his room, he admitted that he was not taking his medication.
¶3 In January 2025, the People filed a petition to involuntarily
medicate Hamilton with olanzapine (Zyprexa) and valproic acid
(Depakote). The district court granted the People’s petition based
on the parties’ stipulation. After receiving consistent medication
treatment, Hamilton’s psychotic symptoms decreased, his self-
injurious behavior resolved, and his hypersexual behavior
decreased in severity and frequency.
1 ¶4 In July 2025, the People petitioned the district court for review
of the involuntary treatment order, asking the court for
authorization to continue treatment with olanzapine and valproic
acid. The court held an evidentiary hearing, at which Hamilton and
his treating psychiatrist, Dr. Paul Mattox, testified. After hearing
the evidence, the court found that Dr. Mattox had testified “credibly
and persuasively” and that the People had established all four
elements for the involuntary administration of medication set forth
in People v. Medina, 705 P.2d 961, 973 (Colo. 1985). It therefore
granted the petition.
II. Applicable Law and Standard of Review
¶5 A district court may order the involuntary administration of
medication if the People prove by clear and convincing evidence that
(1) the patient is incompetent to effectively participate in the
treatment decision; (2) the treatment is necessary to prevent a
significant and likely long-term deterioration in the patient’s mental
health condition or to prevent the likelihood of the patient causing
serious harm to himself or others at the institution; (3) a less
intrusive treatment alternative is not available; and (4) the patient’s
2 need for treatment is sufficiently compelling to override any bona
fide and legitimate interest of the patient in refusing treatment. Id.
¶6 Application of the Medina test involves mixed questions of fact
and law.1 People v. Marquardt, 2016 CO 4, ¶ 8. We defer to the
district court’s factual findings if they have record support and
review its legal conclusions de novo. Id.
¶7 When a patient challenges the sufficiency of the evidence
supporting an involuntary medication order, we must affirm if the
evidence, viewed as a whole and in the light most favorable to the
People, is sufficient to support the order. People in Interest of
R.K.L., 2016 COA 84, ¶ 13 (“The testimony of the physician seeking
to administer treatment may be sufficient by itself to satisfy” the
Medina elements.). As the fact finder, the district court determines
the sufficiency, probative effect, and weight of the evidence, along
1 When the state seeks to administer antipsychotic drugs to a
mentally ill criminal defendant involuntarily so that she can stand trial, a reviewing court applies the Supreme Court’s test in Sell v. United States, 539 U.S. 166, 178 (2003). However, reviewing courts apply state law tests if the state, as here, seeks to administer antipsychotics involuntarily for “a different purpose,” including a purpose “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 with the inferences and conclusions to be drawn therefrom. People
in Interest of R.C., 2019 COA 99M, ¶ 7.
III. Analysis
¶8 Hamilton contends only that the evidence was insufficient to
prove the fourth Medina element. We disagree.
¶9 In assessing this element, a court must first determine
“whether the patient’s refusal is bona fide and legitimate.” Medina,
705 P.2d at 974. If it is, the court must then 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.
¶ 10 The district court found that Hamilton had bona fide and
legitimate reasons for his refusal, and it pointed to his concerns
that the medication made him feel sick, “slow[ed] everything down,”
prevented him from “mov[ing] always as he want[ed] to,” and caused
shortness of breath and tiredness. But it found that these bona
fide and legitimate interests were outweighed by the state’s
legitimate interest in “preserving [Hamilton’s] life and health . . .
4 and protecting the safety of others.” The record supports the
district court’s findings.
¶ 11 Dr. Mattox opined that the failure to medicate Hamilton would
be more harmful than the risks posed by the requested
medications. In support of this opinion, Dr. Mattox testified that,
without the requested medications, Hamilton would likely
“deteriorate,” and he would become “assaultive towards staff,” “re-
engage in self-injurious behavior,” and have “increased hypersexual
behavior.” Dr. Mattox noted that, since Hamilton had begun
consistent medication, all his symptoms had improved
“significantly.”
¶ 12 Dr. Mattox acknowledged that the requested medications had
potential adverse side effects. But he testified that Hamilton had
tolerated the medications and that the staff had not observed any
side effects. Dr. Mattox also noted that Hamilton has expressed his
dissatisfaction with taking medication, but he did not fully
understand the basis for his complaint. He also said that Hamilton
said the medication “didn’t make him feel right” but denied
experiencing any of the common side effects.
5 ¶ 13 On appeal, Hamilton maintains that the side effects he
described — such as a “shakiness in [his] soul” — could not be
observed by a third party and would not appear in a lab test.
Consequently, he contends that the district court erred by
“expressing skepticism” about whether he was experiencing side
effects. We are not persuaded.
¶ 14 Although the court expressed some doubt about whether
Hamilton was in fact experiencing the side effects that he described,
it relied on Dr. Mattox’s testimony to find that Hamilton had
described “possible side effects.” It then noted that, based on the
evidence, his claim “could be accurate” and therefore concluded
that Hamilton had bona fide and legitimate reasons to refuse
medication. In other words, although the court identified the
contrary evidence, it ultimately agreed with Hamilton that he had
bona fide and legitimate reasons for refusing medication. We
therefore discern no error.
¶ 15 To the extent that Hamilton now argues that the district court
erred by attributing less than appropriate weight to the evidence of
his bona fide and legitimate concerns, we are not persuaded to
reach a different result for the following two reasons. First, the
6 record supports the court’s findings about Hamilton’s reported side
effects, and we cannot reweigh the evidence to reach a different
result. See People in Interest of Ramsey, 2023 COA 95, ¶ 30.
Second, Hamilton presents no argument as to how his need for
treatment was not sufficiently compelling to override his bona fide
and legitimate concerns. Therefore, even if the court minimized his
concerns, there is still no basis for us to conclude that those
concerns outweighed the need for medication.
IV. Disposition
¶ 16 The order is affirmed.
JUDGE FOX and JUDGE BROWN concur.