25CA1397 Peo in Interest of Pennington 10-02-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1397 Pueblo County District Court No. 25MH30066 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Bobby R. Pennington,
Respondent-Appellant.
ORDER AFFIRMED
Division VI Opinion by JUDGE SULLIVAN Welling and Gomez, 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, Bobby R. Pennington, 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 Pennington was committed to the hospital after being found
incompetent to proceed in his criminal case. He was diagnosed
with an unspecified mood disorder and presented with symptoms
that included agitation, irritability, pressured speech, racing
thoughts, and hyper-religious thinking. Pennington also had a
history of self-harming behavior, including thirty suicide attempts,
and said that he wanted to take his own life before the cartel could
torture him to death.
¶3 The hospital started Pennington on emergency medication
after he slapped a peer and refused to take his medications for
about a week. He also threatened a staff member, telling her that
he would grab her by the hair and slam her head into the wall.
Pennington said that “the voice of God” had instructed him to stop
his medications because he needed to be sober in order to engage in
“spiritual warfare.” Pennington later said that he refused the
medications because they were causing bedwetting and seizures.
1 ¶4 In July 2025, the People filed a petition to involuntarily
medicate Pennington with olanzapine (Zyprexa), lithium,
chlorpromazine (Thorazine), and lamotrigine (Lamictal). The district
court held an evidentiary hearing, at which Pennington and his
treating psychiatrist, Dr. Hareesh Pillai, testified. After hearing the
evidence, the court found that Dr. Pillai had testified “credibly and
persuasively” and that the People had established all four elements
for the involuntary administration of medication under People v.
Medina, 705 P.2d 961, 973 (Colo. 1985). The court therefore
granted the People’s 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 themself or others at the institution; (3) a less
intrusive treatment alternative isn’t 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. 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
with the inferences and conclusions to be drawn therefrom. People
in Interest of R.C., 2019 COA 99M, ¶ 7.
III. Analysis
¶8 Pennington’s sole contention on appeal is that the People
presented insufficient evidence to prove the first Medina element.
We disagree.
3 ¶9 Under the first Medina element, the district court may not
order the forced medication of an involuntarily committed patient
unless it is satisfied that the patient’s mental illness has so
impaired their judgment as to render them incapable of
participating in decisions affecting their health. Medina, 705 P.2d
at 973.
¶ 10 The district court found that Pennington was incompetent to
effectively participate in his own treatment decisions. Specifically,
the court found that, although Pennington had some “limited
insight” into his mental illness, he was still “incapable of making
informed treatment decisions” because he didn’t “see the need for
the medications with his symptoms.” The court provided three
examples supporting this finding:
1. Pennington refused lithium because he said that it
caused bedwetting, but the evidence showed that the
bedwetting started before he was given lithium.
2. Pennington said that he stopped taking lithium because
he “wanted to hear God’s voice” again.
4 3. Pennington couldn’t “make the connection” between his
continued requests for an antidepressant (i.e., Effexor)
and his increased manic symptoms.
The record supports the court’s findings.
¶ 11 Dr. Pillai opined that Pennington had limited insight into his
mental illness. Dr. Pillai noted that, on the one hand, Pennington
understood that he had been previously diagnosed with major
depressive disorder and that his illness caused depression, suicide
attempts, and hospitalization. But on the other hand, Pennington
did not fully understand the symptoms caused by his unspecified
mood disorder, such as irritability, impulsivity, aggression, and
delusions.
¶ 12 Dr. Pillai opined that, because of Pennington’s mental illness,
he couldn’t effectively participate in decisions about his treatment.
Dr. Pillai noted that there had been “multiple medication changes”
since Pennington was initially admitted into the hospital and that
there “seem[ed] to be a disagreement about the main symptoms
that [were] just trying to be treated.” At one point, Pennington
requested Effexor, but after starting it, his manic symptoms
5 worsened. The staff stopped the antidepressant and, as a result,
Pennington became “resistant to working with his provider.”
¶ 13 Pennington also refused to take lithium, claiming it caused
bedwetting. But Dr. Pillai testified that bedwetting wasn’t a
common side effect of lithium. He also said that he hadn’t received
any reports of bedwetting while Pennington was on lithium, and in
fact the reports of bedwetting started before Pennington began
treatment with lithium. Dr. Pillai noted that Pennington had
previously indicated that he refused lithium because it made “God’s
voice go away,” leading Dr. Pillai to conclude that Pennington
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25CA1397 Peo in Interest of Pennington 10-02-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1397 Pueblo County District Court No. 25MH30066 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Bobby R. Pennington,
Respondent-Appellant.
ORDER AFFIRMED
Division VI Opinion by JUDGE SULLIVAN Welling and Gomez, 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, Bobby R. Pennington, 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 Pennington was committed to the hospital after being found
incompetent to proceed in his criminal case. He was diagnosed
with an unspecified mood disorder and presented with symptoms
that included agitation, irritability, pressured speech, racing
thoughts, and hyper-religious thinking. Pennington also had a
history of self-harming behavior, including thirty suicide attempts,
and said that he wanted to take his own life before the cartel could
torture him to death.
¶3 The hospital started Pennington on emergency medication
after he slapped a peer and refused to take his medications for
about a week. He also threatened a staff member, telling her that
he would grab her by the hair and slam her head into the wall.
Pennington said that “the voice of God” had instructed him to stop
his medications because he needed to be sober in order to engage in
“spiritual warfare.” Pennington later said that he refused the
medications because they were causing bedwetting and seizures.
1 ¶4 In July 2025, the People filed a petition to involuntarily
medicate Pennington with olanzapine (Zyprexa), lithium,
chlorpromazine (Thorazine), and lamotrigine (Lamictal). The district
court held an evidentiary hearing, at which Pennington and his
treating psychiatrist, Dr. Hareesh Pillai, testified. After hearing the
evidence, the court found that Dr. Pillai had testified “credibly and
persuasively” and that the People had established all four elements
for the involuntary administration of medication under People v.
Medina, 705 P.2d 961, 973 (Colo. 1985). The court therefore
granted the People’s 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 themself or others at the institution; (3) a less
intrusive treatment alternative isn’t 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. 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
with the inferences and conclusions to be drawn therefrom. People
in Interest of R.C., 2019 COA 99M, ¶ 7.
III. Analysis
¶8 Pennington’s sole contention on appeal is that the People
presented insufficient evidence to prove the first Medina element.
We disagree.
3 ¶9 Under the first Medina element, the district court may not
order the forced medication of an involuntarily committed patient
unless it is satisfied that the patient’s mental illness has so
impaired their judgment as to render them incapable of
participating in decisions affecting their health. Medina, 705 P.2d
at 973.
¶ 10 The district court found that Pennington was incompetent to
effectively participate in his own treatment decisions. Specifically,
the court found that, although Pennington had some “limited
insight” into his mental illness, he was still “incapable of making
informed treatment decisions” because he didn’t “see the need for
the medications with his symptoms.” The court provided three
examples supporting this finding:
1. Pennington refused lithium because he said that it
caused bedwetting, but the evidence showed that the
bedwetting started before he was given lithium.
2. Pennington said that he stopped taking lithium because
he “wanted to hear God’s voice” again.
4 3. Pennington couldn’t “make the connection” between his
continued requests for an antidepressant (i.e., Effexor)
and his increased manic symptoms.
The record supports the court’s findings.
¶ 11 Dr. Pillai opined that Pennington had limited insight into his
mental illness. Dr. Pillai noted that, on the one hand, Pennington
understood that he had been previously diagnosed with major
depressive disorder and that his illness caused depression, suicide
attempts, and hospitalization. But on the other hand, Pennington
did not fully understand the symptoms caused by his unspecified
mood disorder, such as irritability, impulsivity, aggression, and
delusions.
¶ 12 Dr. Pillai opined that, because of Pennington’s mental illness,
he couldn’t effectively participate in decisions about his treatment.
Dr. Pillai noted that there had been “multiple medication changes”
since Pennington was initially admitted into the hospital and that
there “seem[ed] to be a disagreement about the main symptoms
that [were] just trying to be treated.” At one point, Pennington
requested Effexor, but after starting it, his manic symptoms
5 worsened. The staff stopped the antidepressant and, as a result,
Pennington became “resistant to working with his provider.”
¶ 13 Pennington also refused to take lithium, claiming it caused
bedwetting. But Dr. Pillai testified that bedwetting wasn’t a
common side effect of lithium. He also said that he hadn’t received
any reports of bedwetting while Pennington was on lithium, and in
fact the reports of bedwetting started before Pennington began
treatment with lithium. Dr. Pillai noted that Pennington had
previously indicated that he refused lithium because it made “God’s
voice go away,” leading Dr. Pillai to conclude that Pennington
“wanted to stop the lithium because it was improving some
psychotic symptoms.”
¶ 14 Notwithstanding this evidence supporting the district court’s
finding, Pennington asserts that the district court erred because the
evidence established that he had a “clear understanding of his own
symptoms and how the medications can treat them.” In support,
he points to evidence that he asked to restart lithium when he
began “suffering intrusive thoughts.”
¶ 15 But the record shows that, shortly after Pennington restarted
lithium, he again refused it, and when a provider tried to provide
6 education about lithium, Pennington cursed and threw a cup of
water at her. See People in Interest of Ramsey, 2023 COA 95, ¶ 45
(evidence that the patient would yell at the provider when she tried
to discuss medication supported the finding that the patient was
incompetent to effectively participate in treatment decisions).
Pennington later refused all medications, including lithium,
because the “voice of God” told him to stop taking them.
¶ 16 Pennington next contends that the district court erred by
finding that he couldn’t make the connection between his use of
Effexor and increased manic symptoms. He maintains that his
request to resume Effexor was a “perfectly rational and well-
reasoned” decision and that Dr. Pillai’s concerns with treating his
mania only established a “difference in priorities.” Again, the record
shows otherwise.
¶ 17 Dr. Pillai testified that, when Pennington was initially admitted
to the hospital, his provider “agreed to trial him on Effexor” based
on his “complaints and his request to be started on that
medication.” But when the Effexor was increased to a “more
therapeutic level,” Pennington “began having worsening symptoms
of mania.” Dr. Pillai opined that the “combination of lithium and
7 lamotrigine” would “target some of those depressive type
symptoms,” given the “symptoms of paranoia and delusions
contributing to these types of depressive symptoms.”
¶ 18 In contrast, Pennington believed that the hospital stopped
providing him with Effexor because he refused to attend group
therapy. When specifically asked whether he recognized a
connection between the Effexor and increased manic symptoms,
Pennington answered, “not at all” and that “[i]t was the exact
opposite.”
¶ 19 Therefore, the record supports the district court’s finding that
Pennington couldn’t recognize the connection between his use of
Effexor and increased manic symptoms. The record also belies
Pennington’s assertion that his continued request for Effexor was
merely a “difference in priorities” between him and Dr. Pillai. See
People in Interest of Strodtman, 293 P.3d 123, 132 (Colo. App. 2011)
(a patient must demonstrate more than the ability to “articulate his
or her preferences”; rather, “[t]o participate effectively contemplates
action in addition to words”).
¶ 20 In sum, given the evidence supporting Pennington’s limited
insight into his need for the requested medications and the severity
8 of his illness, in combination with the weight the district court
placed on Dr. Pillai’s credibility, we can’t conclude that insufficient
evidence supported the court’s determination that Pennington is
incompetent to effectively participate in the relevant treatment
decision. See People in Interest of D.N.W., 2024 COA 129, ¶ 20
(deferring to the court’s determination of witness credibility and the
weight afforded that testimony).
IV. Disposition
¶ 21 We affirm the order.
JUDGE WELLING and JUDGE GOMEZ concur.