26CA1083 Peo in Interest of WH 09-17-2026 COLORADO COURT OF APPEALS
Court of Appeals No. 26CA1083 Costilla County District Court No. 26MH2 Honorable Kim Cortez-Rodriguez, Judge
The People of the State of Colorado, Petitioner-Appellee, In the Interest of W.H., II, Respondent-Appellant.
ORDER AFFIRMED
Division VI
Opinion by JUDGE KUHN
Welling and Meirink, JJ., concur
NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced September 17, 2026
Anne E. Kelly, District Attorney, Suzy Manown, Deputy District Attorney, Alamosa, Colorado, for Petitioner-Appellee
Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant
¶1 Respondent, W.H., II, appeals the district court’s order authorizing the staff at the Colorado Mental Health Hospital in Pueblo (CMHHIP) to involuntarily medicate him. We affirm.
I. Background
¶2 In 2025, W.H. was admitted to CMHHIP after being found incompetent to proceed in a criminal case. At that time, he was placed in the Restoring Individuals Safely and Effectively (RISE) program at the detention facility where he was admitted for restoration services. W.H. refused medication treatment and was described as manic with grandiose and persecutory beliefs. He also refused treatment for extremely elevated blood pressure, and in March 2026, he was sent to the emergency room for a hypertensive crisis.
¶3 Thereafter, W.H. was transferred to CMHHIP to continue his restoration treatment, and a short-term certification was filed. He was diagnosed with unspecified mood disorder. W.H. was observed occasionally responding to internal stimuli and presented with poor hygiene. His blood pressure remained elevated, and he refused any medical intervention as he believed he could control his blood
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pressure with a diet of “sardines, mackerel, fruits, and veggies” and, regardless, the medication would “burn through [him] like a tic-tac.”
¶4 In April 2026, W.H. was placed on court-ordered medications — namely, olanzapine (Zyprexa), and lithium. However, W.H. continually refused to take his medications. With the use of monthly intramuscular (IM) backups and, at times, administration by nasogastric (NG) tube, W.H.’s symptoms began to improve, and he became more compliant with his blood pressure medications.
¶5 The following month, CMHHIP petitioned the district court to authorize continued treatment with involuntary medication. The court held an evidentiary hearing, at which both W.H. and the psychiatrist supervising his care testified. The psychiatrist described W.H.’s mental health disorder and accompanying symptoms. He also described the requested medications — Zyprexa, haloperidol (Haldol), lithium, propranolol (Inderal), and risperidone (Risperdal) — and explained their possible side effects. And he opined that the medications were necessary to treat W.H.’s symptoms. W.H. testified that he did not have a mental illness and was unwilling to take any of the requested medications. He also
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described some of the side effects he had experienced while taking Zyprexa and lithium and expressed his belief that he has “free will to live or die,” arguing that based on this he should be permitted to decline to take the newly requested medications.
¶6 At the conclusion of the hearing, the district court granted the petition and issued an order authorizing the involuntary administration of the requested medications.
II. Analysis
¶7 W.H. contends that the evidence is insufficient to prove the first and fourth elements from the test set forth in People v. Medina, 705 P.2d 961, 973 (Colo. 1985). 1 He also contends that the court
1 When the People seek an order authorizing involuntary
administration of medication solely to restore a defendant to competency to stand trial, a court must apply the test set forth in Sell v. United States, 539 U.S. 166, 180-81 (2003). But “if forced medication is warranted for a different purpose, . . . related to the individual’s own interests,” then applying state-law tests, which account for those purposes, is preferred. Id. at 182. Because the petition’s stated purposes and the district court’s bases for granting the petition were (1) to prevent a significant and long-term deterioration in W.H.’s mental condition and (2) to prevent the likelihood of him causing serious harm to himself, we apply the framework from People v. Medina, 705 P.2d 961, 973 (Colo. 1985), to the parties’ contentions.
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failed to make individualized findings in support of those elements. We disagree with both contentions.
A. Applicable Law and Standard of Review
¶8 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 themselves 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. Id.
¶9 When a patient challenges the sufficiency of the evidence supporting an involuntary medication order, we review the district court’s legal conclusions de novo and defer to its factual findings if supported by the record. People v. Marquardt, 2016 CO 4, ¶ 8. We view the evidence as a whole and in the light most favorable to the People as the petitioning party. People in Interest of Uwayezuk, 2023 COA 69, ¶ 57; People in Interest of R.C., 2019 COA 99M, ¶ 7.
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As the fact finder, the district court determines credibility; the sufficiency, probative effect, and weight of the evidence; and the inferences and conclusions to be drawn therefrom. R.C., ¶ 7.
B. Incompetent to Effectively Participate
¶ 10 The first Medina element requires a court to determine whether the patient is incompetent to effectively participate in the relevant treatment decision. Medina, 705 P.2d at 973. A 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 the patient incapable of participating in decisions affecting their health. Id.
¶ 11 The district court found that W.H. is incompetent to effectively participate in treatment decisions. In doing so, the court noted the psychiatrist’s testimony that W.H. was unwilling to have any conversations with his treatment providers about his treatment. The court observed that, during W.H.’s own testimony, he had difficultly “stay[ing] on topic,” and it was “difficult to understand how much of the information he [was] able to absorb and effectively evaluate.” Ultimately, the court found that W.H.’s symptoms were
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preventing him from having “those meaningful discussions to allow him to effectively participate in his treatment decisions.”
¶ 12 W.H. asserts he is competent to effectively participate in his treatment decisions because he can distinguish between the requested medications, is willing to take Seroquel,2 and objects only to the newly requested medications. But while W.H. agreed at the beginning of the hearing that he was willing to take Seroquel, he testified later that he did not want to take any medication. Further, the psychiatrist testified that Seroquel was not as effective at treating serious mental illness as the requested medications. He explained that “for it to convey any therapeutic effect” for W.H.’s symptoms, the dosage would need to be so high that it would likely cause more adverse effects than the requested medications.
¶ 13 We are also not persuaded by W.H.’s suggestion that, because he participates in groups and is not a behavior management problem on the unit, he is competent to effectively participate in his treatment decisions. There is no indication in this record that group participation directly equates to an ability effectively
2 W.H. testified that he had previously been prescribed Seroquel to help him sleep.
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participate in treatment decisions. The district court found, with record support, that W.H. had over a year of participation in groups as part of the RISE program, and yet, “over the course of that time, his mental condition deteriorated and his blood pressure continued to present serious and significant imminent threat to his wellbeing.”3
¶ 14 Finally, we note the psychiatrist’s testimony that it was unclear whether W.H. fully understood his diagnosis or the proposed medications, given his refusal to speak to his treatment team. Notwithstanding W.H.’s assertion to the contrary, this is evidence that the district court can properly rely on to conclude that W.H. cannot effectively participate in treatment decisions. See People in Interest of Strodtman, 293 P.3d 123, 132 (Colo. App. 2011) (affirming the finding that the patient was incompetent to effectively participate in the treatment decision because, among other reasons, she had not “embraced her need for treatment”).
3 Indeed, the psychiatrist explained at the hearing that the
symptoms that W.H. “displays are not able to be treated with just groups or talk therapy alone and require medication treatment.” [TR 5/29/26 p. 33.].
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¶ 15 Thus, we conclude that the evidence was sufficient to support the court’s determination that the first Medina element was satisfied.
C. Need for Treatment and Legitimate Interest in Refusing Treatment
¶ 16 W.H. also contends that the evidence was insufficient to prove the fourth Medina element — that his need for the requested medications is sufficiently compelling to override his bona fide and legitimate interest in refusing to take them.
¶ 17 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 [S]tate in preserving the life and health of the patient placed in its charge and in protecting the safety of those in the institution.” Id.
¶ 18 The district court acknowledged W.H.’s “significant side effects,” recognized his personal belief in “free will,” and found that his concerns about side effects were bona fide and legitimate. However, the court didn’t find that W.H.’s belief that his “free will”
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allows him to choose something that risks his death was sufficient. To the contrary, the court found that W.H.’s need for treatment overrides his stated reasons for refusal given “the real serious risk presented by [his] high blood pressure.”
¶ 19 On appeal, W.H. maintains that he has a bona fide and legitimate interest in declining the requested medications. This is because of his objections to medications he does “not understand” and concerns that he is being forcibly medicated (through injections and other invasive methods) without adequate justification. But the district court found, with record support, that any lack of understanding on W.H.’s part concerning the proposed treatment results from his refusal to meet with his treatment team about it.
¶ 20 Even assuming that W.H.’s refusal in this regard is bona fide and legitimate, see id. (noting a “patient’s refusal may stem from . . . any number of reasons”), he provides no argument disputing the district court’s finding that his need for treatment is sufficiently compelling to override his interests.
¶ 21 Namely, W.H. doesn’t contest the district court’s finding that the second Medina element was met — that the requested medications are necessary to prevent a significant and likely long-
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term deterioration in his mental health condition and serious harm to himself. The psychiatrist testified to as much, explaining that the severity of W.H.’s uncontrolled hypertension has been “alarming” to his treatment team and “[t]he reason for [W.H.] refusing treatment for the hypertension seems to be closely tied to his underlying mood illness.” The psychiatrist added, “treating his underlying psychiatric illness appropriately will improve his insight to where he’s able to manage his medical illnesses appropriately” but declining to do so will likely cause a “severe and irreversible medical complication,” at worst “a heart attack or something that leads to death.”
¶ 22 W.H. also contends that the district court impermissibly authorized “an expansive array” of medications that were unsupported by the evidence. In support, he points to the psychiatrist’s testimony that if W.H. complied with the requested treatment, he would only need Zyprexa and lithium, but Risperdal and long-acting injections are necessary if future refusals occur.
¶ 23 In R.K.L., a division of this court concluded that “mere speculation” that a patient “might need [the requested] medications in the future” was insufficient to satisfy the fourth Medina element.
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People in Interest of R.K.L., 2016 COA 84, ¶ 44. Even so, a court may authorize involuntary treatment with a backup medication if there is a specific, articulable concern that the approved treatment strategy will be ineffective. See People in Interest of D.N.W., 2024 COA 129, ¶ 18 (permitting the authorization of an involuntary backup medication for a specific, articulable concern that the primary medication could be ineffective based on the respondent’s medical history); see also People in Interest of Ferguson, 2025 COA 82, ¶ 1 (concluding that a treating physician’s demonstrated need for flexibility in treatment options is a relevant consideration for the authorization of more than one medication option).
¶ 24 The psychiatrist testified that W.H. is currently taking Zyprexa and lithium, but “there have been obstacles to providing effective treatment” as he “has frequently refused these medications.” Accordingly, the psychiatrist explained that Haldol was necessary in the event W.H. refused to take lithium, and Risperdal was necessary in the event he refused to take Zyprexa. Given W.H.’s history of refusing to take medications voluntarily, the psychiatrist’s testimony provides a specific, articulable concern sufficient to
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justify involuntary treatment with Risperdal and Haldol, under the narrow circumstances described. See D.N.W., ¶ 18.
¶ 25 We therefore conclude that the record supports the district court’s finding that the fourth Medina element was satisfied.
D. Individualized Findings
¶ 26 Although W.H. primarily frames his appeal as a challenge to the sufficiency of the evidence, he also contends that the district court erred by failing to make individualized findings for each Medina element in its written order. We disagree for two reasons.
¶ 27 First, the record refutes W.H.’s contention that the district court’s order “consisted primarily of boilerplate findings and conclusory check-box determinations.” The court’s order was comprised of (1) the court’s own observations made at the hearing; (2) factual findings that were supported by the record; (3) accurate summaries of the testimony provided by the psychiatrist and W.H.; and (4) well-reasoned conclusions based on those findings. Indeed, nowhere in the order is there a “conclusory check-box” determination.
¶ 28 Second, even assuming the district court’s written order is somehow deficient, the court made individualized findings in its
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oral ruling at the conclusion of the evidentiary hearing. Reciting a detailed oral ruling and then issuing a written ruling merely summarizing the oral ruling is permitted (and is common in not only mental health cases, but other types of cases as well). See In re Marriage of Thornburn, 2022 COA 80, ¶ 9 n.1 (treating an “oral ruling as supplementing the written order”); In re Marriage of Cespedes, 895 P.2d 1172, 1176 (Colo. App. 1995) (considering district court’s oral ruling in rejecting a contention that its findings and conclusions in its written order were inadequate).
III. Disposition
¶ 29 The order is affirmed.
JUDGE WELLING and JUDGE MEIRINK concur.