Peo in Interest of Kazakov

• Court: Colorado Court of Appeals
• Decided: December 24, 2025
• Docket: 25CA1986
• Status: Unpublished

Opinion

25CA1986 Peo in Interest of Kazakov 12-24-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1986 Pueblo County District Court No. 25MH30092 Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Filipp Kazakov,

Respondent-Appellant.

ORDER AFFIRMED

Division A Opinion by JUDGE HAWTHORNE* Román, C.J., and Martinez*, J., 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

*Sitting by assignment of the Chief Justice under provisions of Colo. Const. art. VI, § 5(3), and § 24-51-1105, C.R.S. 2025. ¶1 Respondent, Filipp Kazakov, appeals the district court’s order

authorizing the involuntary administration of antipsychotic

medications for the purpose of restoring him to competency to

stand trial in criminal cases. We affirm.

I. Background

¶2 In two pending criminal cases, the prosecution charged

Kazakov with serious felonies and one misdemeanor. The district

court in those cases ordered a competency evaluation, and Kazakov

was found incompetent to stand trial. He was ordered to undergo

competency restoration. Over the course of seven years, Kazakov

was evaluated six times and found competent three times and

incompetent three times.

¶3 Most recently, in July 2025, Kazakov was found incompetent

and was again transferred to the Colorado Mental Health Hospital

in Pueblo (CMHHIP). While there, Kazakov’s supervising physician,

Dr. Paul Mattox, diagnosed Kazakov with a delusional disorder.

Kazakov refused to take the medications prescribed to address the

disorder.

¶4 In September 2025, the People filed this case under section

16-8.5-112, C.R.S. 2025, seeking permission to involuntarily

1 administer antipsychotic medications to Kazakov and to monitor

him for potential side effects. Specifically, the petition sought

authority to administer Risperdal orally and, alternatively, to

administer Zyprexa intramuscularly if Kazakov refused to take the

Risperdal.

¶5 The district court held an evidentiary hearing on the petition,

at which Dr. Mattox and Kazakov testified. The court found Dr.

Mattox’s testimony credible and persuasive. The court concluded

that the People had met their burden to show that the

administration of medication was necessary to advance the state’s

interest in restoring Kazakov to competency. Specifically, the court

found by clear and convincing evidence that

• Kazakov suffers from a delusional disorder;

• he has no insight into his mental illness and is incapable

of making informed treatment decisions;

• prosecuting the serious crimes with which he is charged

serves an important governmental interest;

• he has experienced a lengthy confinement in an

institution and participated in many evaluations;

2 • based on Dr. Mattox’s explanation of how the requested

medications work, there is nothing novel or experimental

about the medications and they are substantially likely

to render Kazakov competent to stand trial;

• the medications are substantially unlikely to have side

effects that would interfere significantly with Kazakov’s

ability to assist his counsel during trial;

• less intrusive treatments are unlikely to achieve

substantially the same result; and

• administering the medication in this case is medically

appropriate and in Kazakov’s best medical interest

considering his condition.

¶6 Therefore, the court granted the People’s petition.

II. Analysis

¶7 Kazakov contends that the district court’s decision is not

supported by sufficient evidence. We disagree.

A. Applicable Law

¶8 The United States Supreme Court has established a four-part

test for determining when a state may involuntarily administer

antipsychotic medication to restore a criminal defendant’s

3 competency. See Sell v. United States, 539 U.S. 166, 180-81 (2003);

People in Interest of R.F., 2019 COA 110, ¶ 21. The state must

prove each factor by clear and convincing evidence. R.F., ¶ 16.

¶9 First, there must be important governmental interests at

stake. Sell, 539 U.S. at 180; R.F., ¶ 12.

¶ 10 Second, administering involuntary medication must

significantly further the important governmental interests. Sell,

539 U.S. at 180; R.F., ¶ 13. The state satisfies this factor by

showing that (1) administering the medication is substantially likely

to restore the defendant’s competency and (2) the medication is

substantially unlikely to have side effects that will interfere with the

defendant’s ability to assist in his defense. Sell, 539 U.S. at 181;

R.F., ¶ 13.

¶ 11 Third, the involuntary medication must be necessary to

further the government’s interests. Sell, 539 U.S. at 181; R.F., ¶ 14.

The state satisfies this factor by showing that (1) any less intrusive

treatment alternatives are unlikely to achieve substantially the

same results and (2) less intrusive means for administering the

medication were considered. Sell, 539 U.S. at 181; R.F., ¶ 14.

4 ¶ 12 Fourth, administering the treatment must be medically

appropriate — that is, in the defendant’s best medical interests in

light of his medical condition. Sell, 539 U.S. at 181; R.F., ¶ 15.

¶ 13 Only the first factor — whether the government’s asserted

interest is sufficiently important — presents a legal question that

we review de novo. R.F., ¶ 21. The district court’s findings with

respect to the other factors are factual in nature and, therefore, are

subject to review for clear error. Id.

B. Discussion

¶ 14 Kazakov argues that the People did not prove Sell’s second

element with sufficient evidence. We disagree.

¶ 15 Under the second factor, a court must consider whether

involuntary medication will significantly further the government’s

important interests. As noted, relevant to this issue are whether

administering the medication is substantially likely to restore the

defendant’s competency and whether the medication is

substantially unlikely to have side effects interfering with the

defendant’s ability to assist in his defense. Sell, 539 U.S. at 181;

5 ¶ 16 Dr. Mattox was qualified and accepted without objection as an

expert in the field of clinical psychiatry. Based on his contact with

Kazakov as his supervising physician, his review of Kazakov’s

records, and his experience in the field, Dr. Mattox testified that it

would be unlikely that Kazakov’s competency would be restored

without the use of antipsychotic medication and that he believed

that the use of such medications was substantially likely to render

Kazakov competent. Dr. Mattox also discussed potential side

effects of Risperdal and Zyprexa, concluding that they would not

inhibit Kazakov’s ability to assist his counsel during trial and

noting that CMHHIP would monitor his condition and prescribe

additional medications to neutralize any side effects as necessary.

¶ 17 Dr. Mattox testified that in the past Kazakov had taken

antipsychotic medications for only six days on an emergency basis.

Accordingly, he explained that Kazakov had “never had an adequate

trial of an antipsychotic medication.” He opined that the

antipsychotic medications would “work to decrease the intensity” of

Kazakov’s delusional beliefs and hopefully decrease them to a point

where he could “engage[] in more reality-based conversations.” He

testified that the antipsychotic medications actually “help people

6 communicate more effectively.” Finally, Dr. Mattox said that

administering these medications was “medically appropriate and in

the best medical interests” of Kazakov and that the failure to do so

would be more harmful than any potential risk posed by the

medication.

¶ 18 In concluding that the use of involuntary medication was

substantially likely to render Kazakov competent to stand trial, the

district court relied on the testimony of Dr. Mattox, which the court

found credible and persuasive.

¶ 19 Nonetheless, Kazakov contends that Dr. Mattox’s testimony

constituted generalized evidence rather than individualized evidence

and, thus, was insufficient under R.F. As discussed in R.F., ¶ 26,

the People must demonstrate that the proposed treatment plan, as

applied to the particular defendant, is substantially likely to render

the defendant competent to stand trial. We conclude that the

evidence here was sufficiently specific to permit the district court to

rely on it.

¶ 20 The diagnosis and proposed treatment offered by Dr. Mattox

were based on his particular interactions with Kazakov, his medical

experience, and his review of Kazakov’s medical records. The fact

7 that Dr. Mattox made statements regarding the general efficacy of

certain antipsychotic drugs based on his experience does not

dissuade us. So long as the doctor’s medical opinion is based on an

individualized assessment of the particular defendant’s condition,

the doctor’s testimony is sufficient. See State v. Barzee, 2007 UT

95, ¶¶ 90-95 (affirming the district court’s involuntary medication

order where doctors testified about their clinical experience treating

other patients with the same condition and similar symptoms as

the defendant), cited with approval in R.F., ¶ 26; see also United

States v. Diaz, 630 F.3d 1314, 1333-36 (11th Cir. 2011) (affirming

the district court’s order granting the government’s petition where

experts testified about relevant studies and applied data to the

defendant’s condition), cited with approval in R.F., ¶ 26.

¶ 21 We are also unpersuaded by Kazakov’s contention that the

district court erred by rejecting his testimony, and crediting Dr.

Mattox’s testimony, about the proposed medication’s potential side

effects. Again, Dr. Mattox discussed the potential side effects of

Risperdal and Zyprexa; he testified that, in his experience, any side

effects caused by these medications would not significantly interfere

with Kazakov’s ability to assist counsel with his defense at trial and

8 in fact would help him to communicate more effectively. He also

said that Kazakov’s symptoms would be monitored by nursing staff

on a daily basis and that they would prescribe additional

medications to neutralize side effects if necessary.

¶ 22 We acknowledge that Kazakov testified about the side effects

he experienced when the antipsychotic medications were

administered to him on an emergency basis. These side effects

included not feeling in control, like he was dying, and “almost equal

to suicide” because his head was in the wrong place, and trouble

breathing. However, Dr. Mattox testified that Kazakov’s medical

records indicated that during those six days he took the

antipsychotic medications, Kazakov generally denied side effects

and at most reported that he felt tired and the medications “slowed

him down.” And he also noted that the more severe side effects

Kazakov testified about were not documented in his medical

records.

¶ 23 It is the district court’s province to resolve these factual

conflicts, and it found Dr. Mattox more persuasive on this point.

See People in Interest of Uwayezuk, 2023 COA 69, ¶ 57 (leaving to

9 the fact finder the resolution of conflicts in the testimony and the

determination of the witnesses’ credibility).

¶ 24 Because the district court’s decisions are supported by the

record, we will not disturb them. People in Interest of A.J.L., 243

P.3d 244, 255 (Colo. 2010) (noting where ample evidence in the

record supports the district court’s findings and conclusions, the

appellate court may not substitute its judgment for the district

court’s).

III. Disposition

¶ 25 The order is affirmed.

CHIEF JUDGE ROMÁN and JUSTICE MARTINEZ concur.