25CA1355 Peo in Interest of Zaczek 12-18-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1355 Pueblo County District Court No. 25MH30008 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Brian Zaczek,
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 December 18, 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 Brian Zaczek 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 Zaczek was admitted to the hospital in December 2024 after a
district court found him incompetent to proceed in three criminal
cases. He was originally diagnosed with an unspecified mood
disorder. His symptoms included having disorganized thinking and
being delusional and paranoid. Based on his belligerent behavior,
which included threatening staff members and another patient, as
well as repeatedly refusing to take psychiatric medications, his
doctor started him on emergency medications.
¶3 In January 2025, the district court granted the State’s petition
to medicate Zaczek involuntarily with two antipsychotic medications
— Zyprexa (olanzapine) and Haldol (haloperidol) — and the mood-
stabilizing medication Depakote (valproic acid).
¶4 In July 2025, the State again petitioned the district court for
authorization to medicate Zaczek involuntary, this time limiting its
request to only Zyprexa and Depakote.
1 ¶5 At the hearing on the petition, Zaczek’s psychiatrist at the
hospital, an expert in clinical psychiatry, testified that, although
Zaczek had shown improvement, he continued to exhibit symptoms
of having disorganized thinking and being delusional, paranoid, and
irritable. The psychiatrist had refined his diagnosis of Zaczek to an
unspecified bipolar disorder, which he testified constitutes a
substantial disorder that grossly impairs Zaczek’s judgment or
capacity to recognize reality or control behavior. The psychiatrist
also testified that Zaczek doesn’t believe that he has a mental
illness or needs to take any psychiatric medications. The
psychiatrist opined that continuing to treat Zaczek with Zyprexa
and Depakote was necessary to prevent a significant and likely
long-term deterioration of his mental condition. The psychiatrist
(1) explained the potential side effects of the medications; (2)
testified that Zaczek has gained some weight while in the hospital
and reported experiencing gastrointestinal side effects, blurry
vision, photosensitivity, and shaky hands; and (3) testified that
Zaczek was taking other medications to alleviate side effects.
Ultimately, the psychiatrist opined that Zaczek’s need for the
medications, as evidenced by the improvement in his mental state
2 and decrease in threatening and aggressive behavior, outweighs his
interest in avoiding the side effects.
¶6 Zaczek testified that he doesn’t have a mental illness, that he
prefers not taking any medications, that the medications haven’t
helped him, and that he won’t take the medications without a court
order. He testified that, while on the medications, his Crohn’s
disease has worsened, he has developed gastrointestinal ulcers, and
he has experienced diarrhea and constipation. He also testified
that he has gained weight and has experienced foggy vision, fuzzy
thoughts, loss of balance, and headaches.
¶7 The psychiatrist was recalled to the witness stand, testifying
that the medications don’t cause gastrointestinal ulcers.
¶8 Following the testimony, the district court found that the
psychiatrist had testified credibly and persuasively, and it adopted
the psychiatrist’s opinions. The court then examined each of the
four elements of the test from People v. Medina, 705 P.2d 961, 973
(Colo. 1985). It concluded that the State had met its burden of
proving all four elements by clear and convincing evidence and
granted the petition to involuntarily medicate Zaczek.
3 II. Applicable Law and Standard of Review
¶9 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 at the institution;
(3) a less intrusive treatment alternative isn’t 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.
1 A different test applies to petitions to administer medication
involuntarily for the purpose of restoring competency for a criminal proceeding. 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)). Although Zaczek was admitted to the hospital for that purpose, the petition’s stated purpose, and the district court’s basis for granting the petition, was to prevent a significant and long-term deterioration in Zaczek’s mental condition, which is relevant to the second Medina element. See R.F., ¶ 11 n.1.
4 ¶ 10 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
¶ 11 Zaczek states expressly in his opening brief that he doesn’t
contest the district court’s rulings that the State met its burden of
proving the first and third Medina elements.
¶ 12 As to the second Medina element, Zaczek initially argues in his
opening brief that “the People failed to establish the second and
fourth [Medina] elements by clear and convincing evidence.” But in
specifically addressing the second Medina element, Zaczek says that
“[t]his element is uncontested.” And in the conclusion of his
opening brief, he challenges only the fourth Medina element,
arguing that the district court “erred when it found that element
four of Medina was met by clear and convincing evidence.” Because
Zaczek doesn’t present any specific argument challenging the
5 district court’s ruling on the second Medina element, we won’t
address it. See C.A.R. 28(a)(7)(B); People in Interest of C.N., 2018
COA 165, ¶ 44.
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25CA1355 Peo in Interest of Zaczek 12-18-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1355 Pueblo County District Court No. 25MH30008 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Brian Zaczek,
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 December 18, 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 Brian Zaczek 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 Zaczek was admitted to the hospital in December 2024 after a
district court found him incompetent to proceed in three criminal
cases. He was originally diagnosed with an unspecified mood
disorder. His symptoms included having disorganized thinking and
being delusional and paranoid. Based on his belligerent behavior,
which included threatening staff members and another patient, as
well as repeatedly refusing to take psychiatric medications, his
doctor started him on emergency medications.
¶3 In January 2025, the district court granted the State’s petition
to medicate Zaczek involuntarily with two antipsychotic medications
— Zyprexa (olanzapine) and Haldol (haloperidol) — and the mood-
stabilizing medication Depakote (valproic acid).
¶4 In July 2025, the State again petitioned the district court for
authorization to medicate Zaczek involuntary, this time limiting its
request to only Zyprexa and Depakote.
1 ¶5 At the hearing on the petition, Zaczek’s psychiatrist at the
hospital, an expert in clinical psychiatry, testified that, although
Zaczek had shown improvement, he continued to exhibit symptoms
of having disorganized thinking and being delusional, paranoid, and
irritable. The psychiatrist had refined his diagnosis of Zaczek to an
unspecified bipolar disorder, which he testified constitutes a
substantial disorder that grossly impairs Zaczek’s judgment or
capacity to recognize reality or control behavior. The psychiatrist
also testified that Zaczek doesn’t believe that he has a mental
illness or needs to take any psychiatric medications. The
psychiatrist opined that continuing to treat Zaczek with Zyprexa
and Depakote was necessary to prevent a significant and likely
long-term deterioration of his mental condition. The psychiatrist
(1) explained the potential side effects of the medications; (2)
testified that Zaczek has gained some weight while in the hospital
and reported experiencing gastrointestinal side effects, blurry
vision, photosensitivity, and shaky hands; and (3) testified that
Zaczek was taking other medications to alleviate side effects.
Ultimately, the psychiatrist opined that Zaczek’s need for the
medications, as evidenced by the improvement in his mental state
2 and decrease in threatening and aggressive behavior, outweighs his
interest in avoiding the side effects.
¶6 Zaczek testified that he doesn’t have a mental illness, that he
prefers not taking any medications, that the medications haven’t
helped him, and that he won’t take the medications without a court
order. He testified that, while on the medications, his Crohn’s
disease has worsened, he has developed gastrointestinal ulcers, and
he has experienced diarrhea and constipation. He also testified
that he has gained weight and has experienced foggy vision, fuzzy
thoughts, loss of balance, and headaches.
¶7 The psychiatrist was recalled to the witness stand, testifying
that the medications don’t cause gastrointestinal ulcers.
¶8 Following the testimony, the district court found that the
psychiatrist had testified credibly and persuasively, and it adopted
the psychiatrist’s opinions. The court then examined each of the
four elements of the test from People v. Medina, 705 P.2d 961, 973
(Colo. 1985). It concluded that the State had met its burden of
proving all four elements by clear and convincing evidence and
granted the petition to involuntarily medicate Zaczek.
3 II. Applicable Law and Standard of Review
¶9 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 at the institution;
(3) a less intrusive treatment alternative isn’t 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.
1 A different test applies to petitions to administer medication
involuntarily for the purpose of restoring competency for a criminal proceeding. 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)). Although Zaczek was admitted to the hospital for that purpose, the petition’s stated purpose, and the district court’s basis for granting the petition, was to prevent a significant and long-term deterioration in Zaczek’s mental condition, which is relevant to the second Medina element. See R.F., ¶ 11 n.1.
4 ¶ 10 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
¶ 11 Zaczek states expressly in his opening brief that he doesn’t
contest the district court’s rulings that the State met its burden of
proving the first and third Medina elements.
¶ 12 As to the second Medina element, Zaczek initially argues in his
opening brief that “the People failed to establish the second and
fourth [Medina] elements by clear and convincing evidence.” But in
specifically addressing the second Medina element, Zaczek says that
“[t]his element is uncontested.” And in the conclusion of his
opening brief, he challenges only the fourth Medina element,
arguing that the district court “erred when it found that element
four of Medina was met by clear and convincing evidence.” Because
Zaczek doesn’t present any specific argument challenging the
5 district court’s ruling on the second Medina element, we won’t
address it. See C.A.R. 28(a)(7)(B); People in Interest of C.N., 2018
COA 165, ¶ 44.
¶ 13 As to the fourth Medina element, Zaczek contends that the
State presented insufficient evidence to show that his need for the
medications is sufficiently compelling to override his bona fide and
legitimate interest in not taking them.
¶ 14 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 so, 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
the patient placed in its charge and in protecting the safety of those
in the institution.” Id.
¶ 15 On 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
6 physician seeking to administer treatment may be sufficient,
without more, to satisfy the Medina test. Id. at ¶ 30.
¶ 16 The district court found that Zaczek’s interest in avoiding the
side effects he has been experiencing is bona fide and legitimate.
But the court also found that Zaczek’s prognosis without the
medications is so unfavorable that his personal preference must
yield to the State’s legitimate interest in preserving his life and
health and in protecting the safety of others in the hospital. In
doing so, the court found that Zaczek’s deteriorating mental health
alone would have been sufficient to make that finding, but that
Zaczek’s threatening behavior toward staff members and another
patient strengthened that finding “above and beyond.”
¶ 17 The record supports the district court’s finding that the State
sufficiently proved the fourth Medina element. The court credited
the psychiatrist’s testimony and adopted his opinions that Zaczek
had shown improvement on the medications and that continuing to
treat Zaczek with the medications was necessary to prevent a
significant and likely long-term deterioration of his mental
condition. Given the district court’s credibility determination, we
discern no error in its finding that Zaczek’s compelling need for the
7 medications outweighs his interest in avoiding the side effects he
has experienced. See Ramsey, ¶ 23; R.K.L., ¶¶ 13, 30.
¶ 18 Zaczek’s arguments on appeal, emphasizing both the side
effects he has experienced and the medications’ other side-effect
risks, effectively amount to a disagreement with the way the district
court balanced the two considerations. But in solely emphasizing
his side effects, Zaczek downplays the psychiatrist’s testimony
about the compelling need to treat his psychiatric condition with
the medications. Given that the district court credited the
psychiatrist’s testimony and adopted his opinions, we discern no
error. See Ramsey, ¶ 23; R.K.L., ¶¶ 13, 30.
IV. Disposition
¶ 19 We affirm the order.
JUDGE WELLING and JUDGE GOMEZ concur.