25CA1952 Peo in Interest of Hickey 12-24-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1952 Pueblo County District Court No. 25MH30088 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Adrian Russell Hickey,
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 December 24, 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, Adrian Russell Hickey, appeals the district court
order authorizing staff at the Colorado Mental Health Hospital in
Pueblo (CMHHIP) to medicate him against his will. We affirm.
I. Background
¶2 Hickey was admitted to CMHHIP after being found
incompetent to proceed on criminal charges. According to the
affidavit of Dr. Hareesh Pillai, Hickey’s treating physician, Hickey
suffers from schizoaffective disorder. He has a long history of
psychiatric hospitalizations, medication refusal, and impulsive,
assaultive, and self-harming behavior.
¶3 Hickey was taking Zyprexa, Depakote, and two
antidepressants when he arrived at CMHHIP, but he still displayed
self-harming behavior, delusions, and paranoia. The staff at
CMHHIP attempted to improve his symptoms by reducing the
antidepressant medications, but Hickey resisted the change by
refusing to take Zyprexa and Depakote. At the end of four days
during which Hickey banged his head, swallowed a battery,
attempted to fight staff, and damaged property, CMHHIP began
administering medications on an emergency basis. A few days
later, Hickey punched a peer, causing multiple facial fractures.
1 ¶4 The People petitioned for a six-month order authorizing the
involuntary administration of Zyprexa, Depakote, and Thorazine.
Dr. Pillai clarified that CMHHIP would administer Zyprexa and
Depakote on a scheduled basis, and Thorazine only as needed for
episodes of acute agitation or refusals of oral Depakote. At the
evidentiary hearing, which Hickey attended remotely, the district
court heard testimony from only Dr. Pillai and a CMHHIP staff
member. The staff member was called to testify because they saw
Hickey rip a laptop in two and leave the room during Dr. Pillai’s
testimony at the hearing. Because Hickey “voluntarily chose[] to
walk out” of the room, he did not testify. Defense counsel,
nevertheless, asked to “continue [to] have the hearing, even though
[Hickey] . . . cho[se] not to participate. . . .”
¶5 Dr. Pillai testified about each of the four elements required for
involuntary administration of medication under People v. Medina,
705 P.2d 961, 973 (Colo. 1985).1 He explained that although
1 When the state seeks to administer antipsychotic drugs to a
mentally ill criminal defendant involuntarily so that he 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
2 Hickey had reported potential side effects like anxiety and
depression, Hickey refused Zyprexa and Depakote primarily based
on his strong preference to be medicated with only antidepressants.
Based on a review of multiple hospitalizations, Dr. Pillai opined that
treating Hickey with a combination of Zyprexa and Depakote — and
no additional medications — was appropriate and effective. Indeed,
Hickey’s symptoms would linger or worsen (1) without Zyprexa and
Depakote; and (2) when Zyprexa and Depakote were paired with
antidepressants.
¶6 At the conclusion of the hearing, the district court found the
testimony of Dr. Pillai and the CMHHIP staff member to be credible.
It found that the People had provided clear and convincing evidence
for each of the Medina elements, and it issued an order authorizing
CMHHIP staff to administer all of the requested medications for a
period of six months.
¶7 On appeal, Hickey challenges the sufficiency of the evidence
supporting the court’s order.
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 II. Legal Authority and Standard of Review
¶8 A district court may authorize the involuntary administration
of medication to a patient if the treating facility establishes each of
the following Medina 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 himself or others in the institution; (3) a less
intrusive treatment alternative is not available; and (4) the patient’s
need for treatment with medication is sufficiently compelling to
override his bona fide and legitimate interest in refusing
medication. Id.; see People in Interest of Strodtman, 293 P.3d 123,
131 (Colo. App. 2011). A physician’s testimony alone may
constitute clear and convincing evidence. See People v. Pflugbeil,
834 P.2d 843, 846-47 (Colo. App. 1992).
¶9 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
4 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.
III. Analysis
¶ 10 Hickey challenges the sufficiency of the evidence for only the
first and fourth Medina elements. He argues that Dr. Pillai’s
testimony did not show (1) that he was incapable of effectively
participating in treatment decisions; or (2) a sufficiently compelling
need to override his interests in refusing the requested medications.
See Medina, 705 P.2d at 973-74. We conclude that the record
provides ample support for the court’s findings.
A. The First Medina Element
¶ 11 In its findings on this element, the court noted that Hickey’s
perception that he suffers from anxiety and depression showed
some insight into his mental illness. Hickey argues that for this
5 reason, the evidence offered by the People for the first Medina
element falls short. We disagree.
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25CA1952 Peo in Interest of Hickey 12-24-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1952 Pueblo County District Court No. 25MH30088 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Adrian Russell Hickey,
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 December 24, 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, Adrian Russell Hickey, appeals the district court
order authorizing staff at the Colorado Mental Health Hospital in
Pueblo (CMHHIP) to medicate him against his will. We affirm.
I. Background
¶2 Hickey was admitted to CMHHIP after being found
incompetent to proceed on criminal charges. According to the
affidavit of Dr. Hareesh Pillai, Hickey’s treating physician, Hickey
suffers from schizoaffective disorder. He has a long history of
psychiatric hospitalizations, medication refusal, and impulsive,
assaultive, and self-harming behavior.
¶3 Hickey was taking Zyprexa, Depakote, and two
antidepressants when he arrived at CMHHIP, but he still displayed
self-harming behavior, delusions, and paranoia. The staff at
CMHHIP attempted to improve his symptoms by reducing the
antidepressant medications, but Hickey resisted the change by
refusing to take Zyprexa and Depakote. At the end of four days
during which Hickey banged his head, swallowed a battery,
attempted to fight staff, and damaged property, CMHHIP began
administering medications on an emergency basis. A few days
later, Hickey punched a peer, causing multiple facial fractures.
1 ¶4 The People petitioned for a six-month order authorizing the
involuntary administration of Zyprexa, Depakote, and Thorazine.
Dr. Pillai clarified that CMHHIP would administer Zyprexa and
Depakote on a scheduled basis, and Thorazine only as needed for
episodes of acute agitation or refusals of oral Depakote. At the
evidentiary hearing, which Hickey attended remotely, the district
court heard testimony from only Dr. Pillai and a CMHHIP staff
member. The staff member was called to testify because they saw
Hickey rip a laptop in two and leave the room during Dr. Pillai’s
testimony at the hearing. Because Hickey “voluntarily chose[] to
walk out” of the room, he did not testify. Defense counsel,
nevertheless, asked to “continue [to] have the hearing, even though
[Hickey] . . . cho[se] not to participate. . . .”
¶5 Dr. Pillai testified about each of the four elements required for
involuntary administration of medication under People v. Medina,
705 P.2d 961, 973 (Colo. 1985).1 He explained that although
1 When the state seeks to administer antipsychotic drugs to a
mentally ill criminal defendant involuntarily so that he 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
2 Hickey had reported potential side effects like anxiety and
depression, Hickey refused Zyprexa and Depakote primarily based
on his strong preference to be medicated with only antidepressants.
Based on a review of multiple hospitalizations, Dr. Pillai opined that
treating Hickey with a combination of Zyprexa and Depakote — and
no additional medications — was appropriate and effective. Indeed,
Hickey’s symptoms would linger or worsen (1) without Zyprexa and
Depakote; and (2) when Zyprexa and Depakote were paired with
antidepressants.
¶6 At the conclusion of the hearing, the district court found the
testimony of Dr. Pillai and the CMHHIP staff member to be credible.
It found that the People had provided clear and convincing evidence
for each of the Medina elements, and it issued an order authorizing
CMHHIP staff to administer all of the requested medications for a
period of six months.
¶7 On appeal, Hickey challenges the sufficiency of the evidence
supporting the court’s order.
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 II. Legal Authority and Standard of Review
¶8 A district court may authorize the involuntary administration
of medication to a patient if the treating facility establishes each of
the following Medina 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 himself or others in the institution; (3) a less
intrusive treatment alternative is not available; and (4) the patient’s
need for treatment with medication is sufficiently compelling to
override his bona fide and legitimate interest in refusing
medication. Id.; see People in Interest of Strodtman, 293 P.3d 123,
131 (Colo. App. 2011). A physician’s testimony alone may
constitute clear and convincing evidence. See People v. Pflugbeil,
834 P.2d 843, 846-47 (Colo. App. 1992).
¶9 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
4 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.
III. Analysis
¶ 10 Hickey challenges the sufficiency of the evidence for only the
first and fourth Medina elements. He argues that Dr. Pillai’s
testimony did not show (1) that he was incapable of effectively
participating in treatment decisions; or (2) a sufficiently compelling
need to override his interests in refusing the requested medications.
See Medina, 705 P.2d at 973-74. We conclude that the record
provides ample support for the court’s findings.
A. The First Medina Element
¶ 11 In its findings on this element, the court noted that Hickey’s
perception that he suffers from anxiety and depression showed
some insight into his mental illness. Hickey argues that for this
5 reason, the evidence offered by the People for the first Medina
element falls short. We disagree.
¶ 12 A patient is incompetent to effectively participate in treatment
decisions when his “mental illness has so impaired his judgment as
to render him ‘incapable of participating in decisions affecting his
health.’” Id. at 973 (citation omitted). Although this Medina
element may be satisfied if a patient fails to recognize that he has a
mental illness, see People in Interest of C.J.R., 2016 COA 133, ¶ 32,
the converse is not necessarily true.
¶ 13 Dr. Pillai — whose testimony the district court found to be
credible — testified that Hickey does not understand his symptoms,
how the symptoms influence his behavior, or how treatments affect
his symptoms. He further testified that although antidepressant
medications were contraindicated for Hickey’s treatment, Hickey
frequently requested them and consequently required much higher
doses or multiple types of antipsychotics to reduce his symptoms.
For these reasons, Dr. Pillai opined that Hickey was incompetent to
effectively participate in his treatment decisions. Dr. Pillai’s
testimony was unrefuted because Hickey voluntarily left the
proceedings.
6 ¶ 14 Viewing the foregoing evidence in the light most favorable to
the People, we conclude that it is sufficient to support the court’s
finding by clear and convincing evidence that Hickey is incompetent
to effectively participate in his treatment decisions. See Ramsey,
¶ 23. Thus, we will not disturb the court’s decision.
B. 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.
¶ 16 Dr. Pillai testified that Hickey’s reported symptoms of anxiety
and depression could be caused by either the medication or his
underlying illness. The district court found that Hickey’s interest in
avoiding those symptoms could be bona fide and legitimate reasons
for refusing Zyprexa and Depakote. Assuming so, the court
proceeded to make findings on the second part of the fourth Medina
7 element. Noting the “severe nature and gravity of his illness” and
the danger Hickey posed to himself and others, the court found that
his prognosis without treatment is so unfavorable that his interest
in refusing Zyprexa and Depakote must yield to the People’s
interests in preserving his life and health and in protecting the
safety of those in CMHHIP. Hickey argues only that (1) his interest
in avoiding anxiety and depression is bona fide and legitimate —
which we do not address because the court assumed it to be true;
and (2) the court erred in finding that the People’s evidence was
clear and convincing. We perceive no error.
¶ 17 Dr. Pillai testified that without proper medication, Hickey was
aggressive, agitated, impulsive, paranoid, and delusional; whereas
when he took Zyprexa and Depakote, he returned to his baseline.
As discussed in Part I, Hickey engaged in several incidents of
aggression and self-harm when he was not properly medicated with
only Zyprexa and Depakote. As to Hickey’s interest in avoiding side
effects, Dr. Pillai opined that Hickey had historically tolerated those
medications well, with minimal side effects.
¶ 18 Because the record supports the court’s finding that Hickey’s
prognosis without treatment is so unfavorable that his interest in
8 avoiding potential side effects must yield to the legitimate interests
of the People, we will not disturb it. See Ramsey, ¶ 23. And to the
extent Hickey’s conclusory argument asks us to reweigh the
evidence, we decline to do so. See R.C., ¶ 7.
IV. Disposition
¶ 19 The order is affirmed.
JUDGE FOX and JUDGE BROWN concur.