25CA1985 Peo in Interest of SRW 03-19-2026
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1985 Pueblo County District Court No. 25MH30093 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of S.R.W.,
Respondent-Appellant.
ORDER AFFIRMED
Division II Opinion by JUDGE FOX Kuhn and Sullivan, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced March 19, 2026
Cynthia Mitchell, County Attorney, Kate H. Shafer, Special Assistant County Attorney, Pueblo, Colorado, for Appellee
Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant ¶1 S.R.W. appeals the district court’s order authorizing staff at
the Colorado Mental Health Hospital in Pueblo (the hospital) to
medicate him without his consent. We affirm.
I. Background
¶2 S.R.W. was admitted to the hospital in September 2025 after
being found incompetent to proceed in two criminal cases. His
symptoms included delusions and paranoia — as well as believing
that numerous unrelated people were conspiring against him — and
behaving in impulsive, agitated, and threatening ways. His
psychiatrist at the hospital, Dr. Hareesh Pillai, diagnosed him with
psychosis (not otherwise specified). After an incident in which
S.R.W. postured toward staff members with closed fists, threatened
to kill them, spit at them after he was restrained, and bit one of
them, he was given emergency medications.
¶3 The State petitioned the district court for authorization to
medicate S.R.W. involuntarily with two antipsychotic medications —
Zyprexa (olanzapine) and Thorazine (chlorpromazine) — and the
mood-stabilizing medication Depakote (valproic acid).
¶4 At the hearing on the petition, Dr. Pillai and S.R.W. testified.
Dr. Pillai, whom the parties stipulated is an expert in clinical
1 psychiatry, testified that S.R.W.’s psychosis constitutes a
substantial disorder that grossly impairs his judgment or capacity
to recognize reality or to control his behavior. Dr. Pillai testified
that S.R.W. needs psychiatric medications and has already shown
improvement on the requested medications; however, the doctor
reported that S.R.W. doesn’t believe he has a psychiatric illness or
needs medication. Dr. Pillai opined that without the requested
medications, S.R.W. will experience a significant and likely long-
term deterioration of his mental condition and will pose a risk of
serious harm to others in the hospital. Finally, the doctor testified
that S.R.W. has reported experiencing multiple side effects from the
medications and that using them is against his religion.
¶5 S.R.W. testified that he does not have a mental illness, is not a
danger to others, and will not take medications voluntarily. He
testified that his religion — the Ausar Auset Society — forbids him
from taking medication, while clarifying on cross-examination that
it forbids mind-altering medication. He also testified about various
side effects he has experienced from the medications, including
drowsiness, dizziness, fatigue, drooling, urinary incontinence,
testicular pain, difficulty sleeping, and inability to focus.
2 ¶6 Following the testimony, the district court found that Dr.
Pillai’s testimony was credible and persuasive, and it adopted his
opinions. The court then examined each of the four elements of the
test from People v. Medina, 705 P.2d 961, 973 (Colo. 1985),
concluded that the State had met its burden of proving all four
elements, and granted the petition.
II. Applicable Law and Standard of Review
¶7 The parties agree that the Medina test applies here. Under
that test, a district court may authorize the involuntary
administration of medication if the State demonstrates 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 in the institution;
(3) a less intrusive treatment alternative is not available; and
3 (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.
¶8 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, while we
review the court’s legal conclusions de novo. Id. Resolving conflicts
in testimony and determining the credibility of the witnesses are
matters solely within the province of the district court. People in
Interest of Ramsey, 2023 COA 95, ¶ 23.
III. Analysis
¶9 S.R.W. expressly does not contest the district court’s rulings
that the State met its burden of proving the second and third
Medina elements.
1 A different test applies to petitions to administer medication
involuntarily for the purpose of restoring a defendant’s competency in a criminal case. See People in Interest of R.F., 2019 COA 110, ¶¶ 10-15 & n.1 (discussing the test from Sell v. United States, 539 U.S. 166, 180 (2003)).
4 ¶ 10 As to the first Medina element, S.R.W. initially argues in his
opening brief that “the People failed to establish the first and fourth
[Medina] elements by clear and convincing evidence.” However, in
specifically addressing the first Medina element, S.R.W. says only
that “[t]his element is uncontested.” Because S.R.W. does not
present any specific argument challenging the district court’s ruling
on the first Medina element, we will not address it. See C.A.R.
28(a)(7)(B); People in Interest of C.N., 2018 COA 165, ¶ 44.
¶ 11 We now turn to the fourth Medina element, the only element
that S.R.W. specifically challenges on appeal. He contends that the
evidence was insufficient to show that his need for the medications
is sufficiently compelling to override his bona fide and legitimate
interests in not taking them.
¶ 12 In analyzing the fourth Medina element, a court first
determines “whether the patient’s refusal is bona fide and
legitimate.” Medina, 705 P.2d at 974. If it is, the court then
determines “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
5 the patient placed in its charge and in protecting the safety of those
in the institution.” Id.
¶ 13 In a sufficiency challenge, we must determine whether the
evidence, viewed as a whole and in the light most favorable to the
State, is sufficient to support the district 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. R.K.L., ¶ 30.
¶ 14 In terms of S.R.W.’s interests in not taking the medications,
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25CA1985 Peo in Interest of SRW 03-19-2026
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1985 Pueblo County District Court No. 25MH30093 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of S.R.W.,
Respondent-Appellant.
ORDER AFFIRMED
Division II Opinion by JUDGE FOX Kuhn and Sullivan, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e) Announced March 19, 2026
Cynthia Mitchell, County Attorney, Kate H. Shafer, Special Assistant County Attorney, Pueblo, Colorado, for Appellee
Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant ¶1 S.R.W. appeals the district court’s order authorizing staff at
the Colorado Mental Health Hospital in Pueblo (the hospital) to
medicate him without his consent. We affirm.
I. Background
¶2 S.R.W. was admitted to the hospital in September 2025 after
being found incompetent to proceed in two criminal cases. His
symptoms included delusions and paranoia — as well as believing
that numerous unrelated people were conspiring against him — and
behaving in impulsive, agitated, and threatening ways. His
psychiatrist at the hospital, Dr. Hareesh Pillai, diagnosed him with
psychosis (not otherwise specified). After an incident in which
S.R.W. postured toward staff members with closed fists, threatened
to kill them, spit at them after he was restrained, and bit one of
them, he was given emergency medications.
¶3 The State petitioned the district court for authorization to
medicate S.R.W. involuntarily with two antipsychotic medications —
Zyprexa (olanzapine) and Thorazine (chlorpromazine) — and the
mood-stabilizing medication Depakote (valproic acid).
¶4 At the hearing on the petition, Dr. Pillai and S.R.W. testified.
Dr. Pillai, whom the parties stipulated is an expert in clinical
1 psychiatry, testified that S.R.W.’s psychosis constitutes a
substantial disorder that grossly impairs his judgment or capacity
to recognize reality or to control his behavior. Dr. Pillai testified
that S.R.W. needs psychiatric medications and has already shown
improvement on the requested medications; however, the doctor
reported that S.R.W. doesn’t believe he has a psychiatric illness or
needs medication. Dr. Pillai opined that without the requested
medications, S.R.W. will experience a significant and likely long-
term deterioration of his mental condition and will pose a risk of
serious harm to others in the hospital. Finally, the doctor testified
that S.R.W. has reported experiencing multiple side effects from the
medications and that using them is against his religion.
¶5 S.R.W. testified that he does not have a mental illness, is not a
danger to others, and will not take medications voluntarily. He
testified that his religion — the Ausar Auset Society — forbids him
from taking medication, while clarifying on cross-examination that
it forbids mind-altering medication. He also testified about various
side effects he has experienced from the medications, including
drowsiness, dizziness, fatigue, drooling, urinary incontinence,
testicular pain, difficulty sleeping, and inability to focus.
2 ¶6 Following the testimony, the district court found that Dr.
Pillai’s testimony was credible and persuasive, and it adopted his
opinions. The court then examined each of the four elements of the
test from People v. Medina, 705 P.2d 961, 973 (Colo. 1985),
concluded that the State had met its burden of proving all four
elements, and granted the petition.
II. Applicable Law and Standard of Review
¶7 The parties agree that the Medina test applies here. Under
that test, a district court may authorize the involuntary
administration of medication if the State demonstrates 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 in the institution;
(3) a less intrusive treatment alternative is not available; and
3 (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.
¶8 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, while we
review the court’s legal conclusions de novo. Id. Resolving conflicts
in testimony and determining the credibility of the witnesses are
matters solely within the province of the district court. People in
Interest of Ramsey, 2023 COA 95, ¶ 23.
III. Analysis
¶9 S.R.W. expressly does not contest the district court’s rulings
that the State met its burden of proving the second and third
Medina elements.
1 A different test applies to petitions to administer medication
involuntarily for the purpose of restoring a defendant’s competency in a criminal case. See People in Interest of R.F., 2019 COA 110, ¶¶ 10-15 & n.1 (discussing the test from Sell v. United States, 539 U.S. 166, 180 (2003)).
4 ¶ 10 As to the first Medina element, S.R.W. initially argues in his
opening brief that “the People failed to establish the first and fourth
[Medina] elements by clear and convincing evidence.” However, in
specifically addressing the first Medina element, S.R.W. says only
that “[t]his element is uncontested.” Because S.R.W. does not
present any specific argument challenging the district court’s ruling
on the first Medina element, we will not address it. See C.A.R.
28(a)(7)(B); People in Interest of C.N., 2018 COA 165, ¶ 44.
¶ 11 We now turn to the fourth Medina element, the only element
that S.R.W. specifically challenges on appeal. He contends that the
evidence was insufficient to show that his need for the medications
is sufficiently compelling to override his bona fide and legitimate
interests in not taking them.
¶ 12 In analyzing the fourth Medina element, a court first
determines “whether the patient’s refusal is bona fide and
legitimate.” Medina, 705 P.2d at 974. If it is, the court then
determines “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
5 the patient placed in its charge and in protecting the safety of those
in the institution.” Id.
¶ 13 In a sufficiency challenge, we must determine whether the
evidence, viewed as a whole and in the light most favorable to the
State, is sufficient to support the district 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. R.K.L., ¶ 30.
¶ 14 In terms of S.R.W.’s interests in not taking the medications,
the district court found that S.R.W.’s religious belief was a bona fide
and legitimate reason for not taking mind-altering medications. In
terms of S.R.W.’s reported side effects, much of the court’s
discussion during its oral ruling focused on reasons to question
S.R.W.’s credibility regarding the alleged side effects; for example,
during his lengthy testimony, he was not drooling, did not look
fatigued, and expressed himself in a way that reflected an ability to
focus. However, the court nevertheless assumed that avoiding side
effects was also a bona fide and legitimate reason for S.R.W.’s
refusal to take the medications voluntarily.
6 ¶ 15 We, too, will assume that S.R.W.’s religion and his desire to
avoid side effects are bona fide and legitimate reasons for refusing
the medications. That brings us to the second question of whether
S.R.W.’s need for treatment is sufficiently compelling to override
those interests. In his opening brief, S.R.W. does not specifically
discuss his need for treatment, instead only cursorily arguing that
his need for treatment does not override his interests in not taking
the medications. And while he argues in his reply brief that he is
not a threat to others, he does not address the district court’s
finding that the requested medications are necessary to prevent a
significant and likely long-term deterioration in his mental health
condition. In fact, as mentioned, he does not challenge the district
court’s finding on the second Medina element and thus appears to
concede that the requested medications are necessary to prevent a
significant and likely long-term deterioration in his mental health
condition.
¶ 16 We discern no error in the district court’s finding that the
State sufficiently proved that S.R.W.’s compelling need for
treatment overrides his interests in refusing the medications. Dr.
Pillai’s testimony, which the court credited, amply supported the
7 district court’s findings about the severity of S.R.W.’s mental health
condition. See Marquardt, ¶ 8; Ramsey, ¶ 23. The court also
credited Dr. Pillai’s testimony that the requested medications are
necessary to prevent a significant and likely long-term deterioration
in his mental health condition and to prevent the likelihood of him
causing serious harm to others in the institution. Given the
severity of S.R.W.’s mental health condition and the necessity of
treating that condition with the requested medications, we discern
no error in the district court’s finding on the fourth Medina element.
IV. Disposition
¶ 17 The order is affirmed.
JUDGE KUHN and JUDGE SULLIVAN concur.