25CA1848 Peo in Interest of O’Donnell 12-04-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1848 Pueblo County District Court No. 25MH30083 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Matthew Joseph O’Donnell,
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 4, 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, Matthew Joseph O’Donnell, 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 O’Donnell was committed to the hospital after being found
incompetent to proceed in his criminal case. He was diagnosed
with psychosis, not otherwise specified, and presented with
symptoms that included auditory hallucinations, paranoia, racing
thoughts, impulsivity, and agitation. After O’Donnell jumped over a
couch and punched a peer in the face, the hospital administered
emergency medication.
¶3 At the request of O’Donnell’s treating physician, Dr. Hareesh
Pillai, the People filed a petition to involuntarily medicate O’Donnell
with risperidone (also known as Risperdal) and haloperidol (also
known as Haldol). The district court held an evidentiary hearing, at
which Dr. Pillai and O’Donnell testified. After hearing the evidence,
the court found 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), and granted the petition.
1 II. Applicable Law and Standard of Review
¶4 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
need for treatment is sufficiently compelling to override any bona
fide and legitimate interest of the patient in refusing treatment.1 Id.
¶5 Application of the Medina test involves mixed questions of fact
and law. People v. Marquardt, 2016 CO 4, ¶ 8. We defer to the
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.
2 district court’s factual findings if they have record support and
review its legal conclusions de novo. Id.
¶6 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. As the fact finder, the district court
determines the sufficiency, probative effect, and weight of the
evidence, along with the inferences and conclusions to be drawn
therefrom. People in Interest of R.C., 2019 COA 99M, ¶ 7.
III. Analysis
¶7 O’Donnell contends only that the evidence was insufficient to
prove the fourth Medina element. We disagree.
¶8 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.
3 ¶9 After considering the evidence, the district court determined
that Dr. Pillai had testified “credibly and persuasively” and
“adopt[ed] the opinions expressed by the doctor.” In contrast, the
court determined that O’Donnell was not credible, but “even with
his credibility issues,” it still found that he had bona fide and
legitimate reasons for refusing medication. The court based its
decision, in part, on O’Donnell’s testimony that he experienced
vomiting, depression, tiredness, and problems going to the
bathroom. The court also relied on O’Donnell’s testimony that he
was “supposed to be taking home remedies as a Christian.”
¶ 10 Nevertheless, the district court found that these bona fide and
legitimate interests were outweighed by the state’s legitimate
interest in preserving O’Donnell’s life and health and protecting the
safety of others in the institution. In particular, the court relied on
(1) evidence that, while on medication, O’Donnell was “less irritable”
and displayed “less aggression on the unit”; and (2) Dr. Pillai’s
opinion that, without the medication, there would be a “re-
emergence” of those symptoms.
¶ 11 The record supports the district court’s findings. Dr. Pillai
testified that O’Donnell did not believe that he had a mental illness
4 or that he needed medication to control his behavior. Therefore, Dr.
Pillai believed that O’Donnell’s rationale for refusing medication was
“based off his limited insight” into his mental illness. Still, Dr. Pillai
said that, even if O’Donnell had legitimate reasons to refuse
medications, the need for medication still outweighed any risk. As
Dr. Pillai explained, when medicated, O’Donnell’s condition
improved, he was removed from “assault precautions,” he
experienced fewer hallucinations, and he exhibited less irritability
and aggression on the unit.
¶ 12 Dr. Pillai also opined that O’Donnell was likely to cause harm
to himself and others in the hospital if left untreated. In support,
Dr. Pillai pointed to the incident in which O’Donnell jumped over a
couch and punched a peer in the face. Dr. Pillai said that this
incident, which occurred before O’Donnell started taking
medication, appeared to be related to O’Donnell’s “underlying
psychiatric condition” and required staff to restrain and seclude
him. Dr. Pillai said that, if O’Donnell stopped taking the
medications, he would “deteriorate” and start exhibiting the same
symptoms of agitation, delusions, paranoia, and hallucinations that
he presented with when he was admitted to the hospital.
5 ¶ 13 On appeal, O’Donnell recounts the evidence supporting the
Free access — add to your briefcase to read the full text and ask questions with AI
25CA1848 Peo in Interest of O’Donnell 12-04-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1848 Pueblo County District Court No. 25MH30083 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Matthew Joseph O’Donnell,
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 4, 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, Matthew Joseph O’Donnell, 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 O’Donnell was committed to the hospital after being found
incompetent to proceed in his criminal case. He was diagnosed
with psychosis, not otherwise specified, and presented with
symptoms that included auditory hallucinations, paranoia, racing
thoughts, impulsivity, and agitation. After O’Donnell jumped over a
couch and punched a peer in the face, the hospital administered
emergency medication.
¶3 At the request of O’Donnell’s treating physician, Dr. Hareesh
Pillai, the People filed a petition to involuntarily medicate O’Donnell
with risperidone (also known as Risperdal) and haloperidol (also
known as Haldol). The district court held an evidentiary hearing, at
which Dr. Pillai and O’Donnell testified. After hearing the evidence,
the court found 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), and granted the petition.
1 II. Applicable Law and Standard of Review
¶4 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
need for treatment is sufficiently compelling to override any bona
fide and legitimate interest of the patient in refusing treatment.1 Id.
¶5 Application of the Medina test involves mixed questions of fact
and law. People v. Marquardt, 2016 CO 4, ¶ 8. We defer to the
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.
2 district court’s factual findings if they have record support and
review its legal conclusions de novo. Id.
¶6 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. As the fact finder, the district court
determines the sufficiency, probative effect, and weight of the
evidence, along with the inferences and conclusions to be drawn
therefrom. People in Interest of R.C., 2019 COA 99M, ¶ 7.
III. Analysis
¶7 O’Donnell contends only that the evidence was insufficient to
prove the fourth Medina element. We disagree.
¶8 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.
3 ¶9 After considering the evidence, the district court determined
that Dr. Pillai had testified “credibly and persuasively” and
“adopt[ed] the opinions expressed by the doctor.” In contrast, the
court determined that O’Donnell was not credible, but “even with
his credibility issues,” it still found that he had bona fide and
legitimate reasons for refusing medication. The court based its
decision, in part, on O’Donnell’s testimony that he experienced
vomiting, depression, tiredness, and problems going to the
bathroom. The court also relied on O’Donnell’s testimony that he
was “supposed to be taking home remedies as a Christian.”
¶ 10 Nevertheless, the district court found that these bona fide and
legitimate interests were outweighed by the state’s legitimate
interest in preserving O’Donnell’s life and health and protecting the
safety of others in the institution. In particular, the court relied on
(1) evidence that, while on medication, O’Donnell was “less irritable”
and displayed “less aggression on the unit”; and (2) Dr. Pillai’s
opinion that, without the medication, there would be a “re-
emergence” of those symptoms.
¶ 11 The record supports the district court’s findings. Dr. Pillai
testified that O’Donnell did not believe that he had a mental illness
4 or that he needed medication to control his behavior. Therefore, Dr.
Pillai believed that O’Donnell’s rationale for refusing medication was
“based off his limited insight” into his mental illness. Still, Dr. Pillai
said that, even if O’Donnell had legitimate reasons to refuse
medications, the need for medication still outweighed any risk. As
Dr. Pillai explained, when medicated, O’Donnell’s condition
improved, he was removed from “assault precautions,” he
experienced fewer hallucinations, and he exhibited less irritability
and aggression on the unit.
¶ 12 Dr. Pillai also opined that O’Donnell was likely to cause harm
to himself and others in the hospital if left untreated. In support,
Dr. Pillai pointed to the incident in which O’Donnell jumped over a
couch and punched a peer in the face. Dr. Pillai said that this
incident, which occurred before O’Donnell started taking
medication, appeared to be related to O’Donnell’s “underlying
psychiatric condition” and required staff to restrain and seclude
him. Dr. Pillai said that, if O’Donnell stopped taking the
medications, he would “deteriorate” and start exhibiting the same
symptoms of agitation, delusions, paranoia, and hallucinations that
he presented with when he was admitted to the hospital.
5 ¶ 13 On appeal, O’Donnell recounts the evidence supporting the
district court’s finding that he had a bona fide and legitimate reason
for refusing medication. But O’Donnell does not challenge any of
the evidence establishing that his prognosis without treatment was
so unfavorable that his preference against medication had to yield
to the state’s interest in preserving his life and health and
protecting the safety of those in the hospital. The district court
weighed this evidence and determined that O’Donnell’s preference
had to yield to the state’s interests. We cannot reweigh the
evidence to reach a different result. See People in Interest of
Uwayezuk, 2023 COA 69, ¶ 57 (noting that, if ample evidence
supports the decision, a reviewing court cannot substitute its
judgment for that of the district court).
¶ 14 Therefore, viewing the evidence in the light most favorable to
the People, we conclude that there was sufficient evidence that
O’Donnell’s personal preference to refuse medication had to yield to
the state’s legitimate interest to protect his health and to protect
others in the hospital. See id.; see also R.K.L., ¶ 13 (“The testimony
of the physician seeking to administer treatment may be sufficient
by itself to satisfy” the Medina elements.).
6 IV. Disposition
¶ 15 The order is affirmed.
JUDGE FOX and JUDGE BROWN concur.