Peo in Interest of ND

• Court: Colorado Court of Appeals
• Decided: February 26, 2026
• Docket: 25CA2401
• Status: Unpublished

Opinion

25CA2401 Peo in Interest of ND 02-26-2026

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA2401 Pueblo County District Court No. 25MH30118 Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of N.D.,

Respondent-Appellant.

ORDER AFFIRMED

Division III Opinion by JUDGE MOULTRIE Dunn and Bernard*, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced February 26, 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

*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 N.D. appeals the district court’s order authorizing the

involuntary administration of medications under the four-part test

articulated in People v. Medina, 705 P.2d 961 (Colo. 1985). He

contests the sufficiency of the evidence only as to the fourth Medina

element. We conclude that sufficient evidence supports this

element. Accordingly, we affirm.

I. Background

¶2 N.D. was committed to the Colorado Mental Health Hospital in

Pueblo (the hospital) after he was found not guilty by reason of

insanity in an El Paso County criminal case. He has been confined

to the hospital since October 1, 2025, and has been diagnosed with

psychosis not otherwise specified. Since his admission to the

hospital, he has deteriorated significantly with intensifying

symptoms including pressured speech, disorganized thinking, poor

sleep, grandiose delusions, paranoia, agitation, and response to

internal stimuli. He has told hospital staff that he is a “world-class

martial artist . . . trained to snap necks.” In addition, he told a staff

member, “I was hoping to get your help and learn how to break

necks better. I have killed over 1000 people in my life, and I just

could use the extra help and training.”

1 ¶3 N.D. has consistently refused medications, so his treating

psychiatrist, Dr. Hareesh Pillai, requested an order authorizing

their involuntary administration. The People petitioned the district

court for review of N.D.’s refusal. After a hearing, the court

authorized the involuntary administration of olanzapine (Zyprexa),

paliperidone (Invega and Invega Sustenna), and lithium; and all

laboratory work, physical assessments, and appropriate testing

necessary to monitor the medications, including any potential side

effects.

II. Legal Principles and Standard of Review

¶4 A district court may authorize the involuntary administration

of medication if the petitioning party establishes each of the

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

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 person’s mental health 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 person’s need for treatment

2 is sufficiently compelling to override any bona fide and legitimate

interest of the person in refusing treatment. Id. at 973.

¶5 We assess whether the evidence, considered as a whole and

viewed in the light most favorable to the People, sufficiently

supports the court’s order. People in Interest of R.K.L., 2016 COA

84, ¶ 13. The testimony of the physician seeking to administer

treatment may be sufficient, without more, to satisfy the Medina

test. Id. at ¶ 30.

¶6 Application of the Medina test is a mixed question of fact and

law. People v. Marquardt, 2016 CO 4, ¶ 8. We defer to the district

court’s factual findings if they are supported by the record but

review the court’s legal conclusions de novo. Id. It is the sole

province of the fact finder to resolve testimonial conflicts and to

determine the weight and credibility of the evidence. See People in

Interest of D.N.W., 2024 COA 129, ¶ 20 (appellate courts must defer

to a district court’s determinations of witness credibility and the

weight afforded to the evidence). Where the evidence supports the

district court’s findings and conclusions, we may not substitute our

judgment for that of the district court. People in Interest of A.J.L.,

243 P.3d 244, 255 (Colo. 2010).

3 III. The Fourth Medina Element

¶7 The fourth Medina element requires a court to determine

whether the patient’s refusal of treatment “is bona fide and

legitimate.” Medina, 705 P.2d at 974. If so, the court must

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.

¶8 N.D. expressed a desire to refuse medications due to both

unwanted side effects and religious beliefs. Although the district

court did not find all of N.D.’s objections credible, it assumed for

the purposes of analysis that all of his stated reasons were bona

fide and legitimate. Nonetheless, the district court found that

N.D.’s prognosis without treatment is so unfavorable that his

personal preference must yield to the state’s interest in preserving

his health and protecting his safety and the safety of others in the

institution. Because the record supports the court’s determination,

we will not disturb it.

4 ¶9 The district court credited Dr. Pillai’s hearing testimony that

the failure to medicate N.D. would be more harmful than the risks

posed by the requested medications. In support of this opinion, Dr.

Pillai testified that, without medication, N.D. continues to

experience severe mental health deterioration and refuses adequate

food and water, thus posing a serious risk to himself. Indeed,

roughly a week before the hearing, N.D.’s treatment team expressed

“extreme concern” about his food and water intake and reported

rapid weight loss — representing seven percent of N.D.’s body

weight — in the roughly two months he had been at the hospital.

The district court expressly noted N.D.’s failure to adequately

nourish himself in weighing whether N.D.’s personal preference

must yield to the state’s interest in preserving his life and health.

¶ 10 Similarly, the court noted, the hospital has an interest in

protecting the safety of those in the institution. N.D. himself

testified that he would “fight back” if hospital staff attempt to

medicate him. And he has made statements that he has killed over

a thousand people. Although the court acknowledged that these

latter statements were likely hyperbolic, it nonetheless found that

the state’s interest in protecting the safety of those in the institution

5 was also sufficient to override any bona fide and legitimate reason

N.D. has in refusing treatment.

¶ 11 Under these circumstances, we perceive no error in the court’s

determination that N.D.’s prognosis without the requested

medications was so unfavorable that his reasons for refusing

medication must yield to the state’s legitimate interests in

preserving his life and health and protecting the safety of those in

the institution. Although N.D. asserts that the district court erred

in finding that his interests in refusing medication were outweighed

by the state’s, we may not reweigh the evidence. See D.N.W., ¶ 20.

IV. Disposition

¶ 12 The order is affirmed.

JUDGE DUNN and JUDGE BERNARD concur.