25CA1847 Peo in Interest of Tuitea 12-04-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1847 Pueblo County District Court No. 19MH7 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Jeremiah Ceo Tuitea,
Respondent-Appellant.
ORDER AFFIRMED
Division VI Opinion by JUDGE GOMEZ Welling and Sullivan, 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, Jeremiah Ceo Tuitea, appeals the district court’s
order authorizing the staff at the Colorado Mental Health Hospital
in Pueblo (the hospital) to treat him with electroconvulsive therapy
(ECT). We affirm.
I. Background
¶2 Tuitea was civilly committed to the hospital in 2019. After
receiving short-term treatment for six months, Tuitea was certified
for long-term care and treatment by the hospital for schizoaffective
disorder, bipolar type. His treatment included a regimen of
antipsychotic medications. In June 2024, the hospital also began
treating him with ECT due to persistent psychotic symptoms, mood
symptoms, and significant aggressive behavior.
¶3 In August 2025, the People petitioned the district court to
review Tuitea’s refusal of treatment. The court held an evidentiary
hearing, at which Dr. Paul Mattox, Tuitea’s psychiatrist, and Tuitea
testified. Dr. Mattox described Tuitea’s disorder and accompanying
symptoms. He also described ECT and its possible side effects and
opined that it was necessary to treat Tuitea’s symptoms. Tuitea
testified that he believes he has a mental illness but provided
conflicting testimony as to whether he was willing to agree to ECT.
1 He also testified that he hadn’t experienced any side effects from
ECT but believed that it was “dangerous.”
¶4 The district court found that Dr. Mattox had testified “credibly
and persuasively,” and that the People had proved the criteria as set
forth in People v. Medina, 705 P.2d 961, 973 (Colo. 1985), and
People in Interest of M.K.M., 765 P.2d 1075, 1076 (Colo. App. 1988).
Accordingly, the court granted the petition authorizing the staff at
the hospital to involuntarily administer ECT.
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 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.
Medina, 705 P.2d at 973. The Medina elements apply in cases
2 involving the proposed involuntary administration of ECT. See
M.K.M., 765 P.2d at 1076.
¶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. It is for the district court,
as the fact finder, to determine the credibility of witnesses; the
sufficiency, probative effect, and the weight of the evidence; and the
inferences and conclusions to be drawn from the evidence. People
in Interest of R.C., 2019 COA 99M, ¶ 7.
¶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 treating
psychiatrist alone may suffice. Id. at ¶ 30.
III. Analysis
¶8 Tuitea contends that the evidence was insufficient to prove the
fourth Medina element. We disagree.
3 ¶9 In assessing the fourth Medina element — whether the
patient’s need for treatment is sufficiently compelling to override
any legitimate interest in refusing treatment — a court must
consider “whether the patient’s refusal is bona fide and legitimate”
and, if it is, “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.” Medina, 705 P.2d at 974.
¶ 10 Tuitea contends that the state’s interest in treating him is
insufficient to overcome his bona fide and legitimate interest in
“avoiding serious side effects” — namely, anxiety related to the
procedure, his belief that ECT is dangerous, and tiredness and
confusion when the treatment is over.
¶ 11 As to Tuitea’s appellate contentions that ECT treatments
cause unwanted anxiety and are dangerous, at the hearing he
didn’t advance those as reasons for refusing to participate in ECT.
Dr. Mattox testified that “about six months ago, prior to our hearing
at that time,” Tuitea “express[ed] concern about anxiety relating to
going to the treatments” but “that is not something that he’s
4 recently expressed.” And nothing in Tuitea’s testimony related to
any feelings of anxiety concerning ECT treatments. Tuitea also
testified that he wasn’t experiencing any side effects from the ECT
treatments. His only pertinent testimony was that he wanted the
court to know that ECT was “dangerous,” but he didn’t provide this
as a reason for refusing to participate in it. Moreover, Dr. Mattox
confirmed that Tuitea doesn’t have any underlying health
conditions that could be affected or worsened by ECT. Dr. Mattox
also testified that Tuitea hadn’t in recent months voiced any side
effects from, or complaints about, ECT. He further explained that
while there can be “long-term memory risks” from ECT, Tuitea’s
“memory and cognitive abilities ha[d] improved,” and his treatment
team hadn’t observed any side effects related to any long-term
cognitive memory problems.
¶ 12 As to the only stated side effect Tuitea was apparently
experiencing (which Dr. Mattox testified about) — tiredness and
confusion following the treatment — the district court expressly
acknowledged that “those are symptoms that are a bona fide reason
for not wanting to take [the proposed treatment].” However, after
weighing Tuitea’s bona fide and legitimate interests against the
5 state’s interest in preserving his life and health and protecting the
safety of those in the institution, the court found that the need to
administer ECT is sufficiently compelling to override his concerns.
¶ 13 These findings enjoy record support. Dr.
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25CA1847 Peo in Interest of Tuitea 12-04-2025
COLORADO COURT OF APPEALS
Court of Appeals No. 25CA1847 Pueblo County District Court No. 19MH7 Honorable Amiel Markenson, Judge
The People of the State of Colorado,
Petitioner-Appellee,
In the Interest of Jeremiah Ceo Tuitea,
Respondent-Appellant.
ORDER AFFIRMED
Division VI Opinion by JUDGE GOMEZ Welling and Sullivan, 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, Jeremiah Ceo Tuitea, appeals the district court’s
order authorizing the staff at the Colorado Mental Health Hospital
in Pueblo (the hospital) to treat him with electroconvulsive therapy
(ECT). We affirm.
I. Background
¶2 Tuitea was civilly committed to the hospital in 2019. After
receiving short-term treatment for six months, Tuitea was certified
for long-term care and treatment by the hospital for schizoaffective
disorder, bipolar type. His treatment included a regimen of
antipsychotic medications. In June 2024, the hospital also began
treating him with ECT due to persistent psychotic symptoms, mood
symptoms, and significant aggressive behavior.
¶3 In August 2025, the People petitioned the district court to
review Tuitea’s refusal of treatment. The court held an evidentiary
hearing, at which Dr. Paul Mattox, Tuitea’s psychiatrist, and Tuitea
testified. Dr. Mattox described Tuitea’s disorder and accompanying
symptoms. He also described ECT and its possible side effects and
opined that it was necessary to treat Tuitea’s symptoms. Tuitea
testified that he believes he has a mental illness but provided
conflicting testimony as to whether he was willing to agree to ECT.
1 He also testified that he hadn’t experienced any side effects from
ECT but believed that it was “dangerous.”
¶4 The district court found that Dr. Mattox had testified “credibly
and persuasively,” and that the People had proved the criteria as set
forth in People v. Medina, 705 P.2d 961, 973 (Colo. 1985), and
People in Interest of M.K.M., 765 P.2d 1075, 1076 (Colo. App. 1988).
Accordingly, the court granted the petition authorizing the staff at
the hospital to involuntarily administer ECT.
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 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.
Medina, 705 P.2d at 973. The Medina elements apply in cases
2 involving the proposed involuntary administration of ECT. See
M.K.M., 765 P.2d at 1076.
¶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. It is for the district court,
as the fact finder, to determine the credibility of witnesses; the
sufficiency, probative effect, and the weight of the evidence; and the
inferences and conclusions to be drawn from the evidence. People
in Interest of R.C., 2019 COA 99M, ¶ 7.
¶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 treating
psychiatrist alone may suffice. Id. at ¶ 30.
III. Analysis
¶8 Tuitea contends that the evidence was insufficient to prove the
fourth Medina element. We disagree.
3 ¶9 In assessing the fourth Medina element — whether the
patient’s need for treatment is sufficiently compelling to override
any legitimate interest in refusing treatment — a court must
consider “whether the patient’s refusal is bona fide and legitimate”
and, if it is, “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.” Medina, 705 P.2d at 974.
¶ 10 Tuitea contends that the state’s interest in treating him is
insufficient to overcome his bona fide and legitimate interest in
“avoiding serious side effects” — namely, anxiety related to the
procedure, his belief that ECT is dangerous, and tiredness and
confusion when the treatment is over.
¶ 11 As to Tuitea’s appellate contentions that ECT treatments
cause unwanted anxiety and are dangerous, at the hearing he
didn’t advance those as reasons for refusing to participate in ECT.
Dr. Mattox testified that “about six months ago, prior to our hearing
at that time,” Tuitea “express[ed] concern about anxiety relating to
going to the treatments” but “that is not something that he’s
4 recently expressed.” And nothing in Tuitea’s testimony related to
any feelings of anxiety concerning ECT treatments. Tuitea also
testified that he wasn’t experiencing any side effects from the ECT
treatments. His only pertinent testimony was that he wanted the
court to know that ECT was “dangerous,” but he didn’t provide this
as a reason for refusing to participate in it. Moreover, Dr. Mattox
confirmed that Tuitea doesn’t have any underlying health
conditions that could be affected or worsened by ECT. Dr. Mattox
also testified that Tuitea hadn’t in recent months voiced any side
effects from, or complaints about, ECT. He further explained that
while there can be “long-term memory risks” from ECT, Tuitea’s
“memory and cognitive abilities ha[d] improved,” and his treatment
team hadn’t observed any side effects related to any long-term
cognitive memory problems.
¶ 12 As to the only stated side effect Tuitea was apparently
experiencing (which Dr. Mattox testified about) — tiredness and
confusion following the treatment — the district court expressly
acknowledged that “those are symptoms that are a bona fide reason
for not wanting to take [the proposed treatment].” However, after
weighing Tuitea’s bona fide and legitimate interests against the
5 state’s interest in preserving his life and health and protecting the
safety of those in the institution, the court found that the need to
administer ECT is sufficiently compelling to override his concerns.
¶ 13 These findings enjoy record support. Dr. Mattox opined that
the failure to administer ECT would be more harmful than the risks
posed by it. In support of this opinion, Dr. Mattox explained that
the hospital began ECT “because of [Tuitea’s] inability to progress
towards discharge due to his treatment resistant psychiatric
symptoms and recurrent aggressive behavior.” And since receiving
ECT, Tuitea had “responded very well” and experienced “dramatic
positive benefits.” Dr. Mattox explained that Tuitea’s “auditory
hallucinations, delusional thinking, and disorganized thinking ha[d]
decreased significantly” and “[h]is aggressive behavior ha[d]
essentially resolved.” Dr. Mattox described Tuitea as “more alert,
communicative, and interactive.”
¶ 14 Dr. Mattox also testified that if ECT were to be discontinued,
he didn’t “see [Tuitea] having a significant likelihood of being able to
be discharged into the community.” Instead, Dr. Mattox opined
that Tuitea would risk “deterioration to his prior active state of
psychosis, mood instability, and aggressive behavior.” Indeed,
6 Dr. Mattox described how previous attempts to decrease the
frequency of ECT treatments had resulted in a return of Tuitea’s
psychotic symptoms and aggressive behavior.
¶ 15 To be sure, ECT treatment is not without risks and side
effects. But there was sufficient evidence in the record to conclude
that these risks and side effects are outweighed by the benefits of
ECT to improve Tuitea’s psychiatric symptoms and prevent long-
term deterioration in his mental condition. Accordingly, the
evidence was sufficient to support the court’s finding on the fourth
Medina element.
¶ 16 Because Tuitea doesn’t challenge the district court’s findings
concerning the other Medina elements, we don’t consider those
elements, and we conclude that the evidence was sufficient to
support the involuntary medication order.
IV. Disposition
¶ 17 The order is affirmed.
JUDGE WELLING and JUDGE SULLIVAN concur.