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March 19, 2026 Get Citation Alerts Download PDF Add Note

Peo in Interest of SMG

Colorado Court of Appeals

• Citations: None known
• Docket Number: 26CA0046

• Precedential Status: Non-Precedential

• Opinion

• Authorities (3)

• Cited By (0)

• Summaries (0)

• Similar Cases (370)

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Combined Opinion

26CA0046 Peo in Interest of SMG 03-19-2026

COLORADO COURT OF APPEALS

Court of Appeals No. 26CA0046
Pueblo County District Court No. 25MH30124
Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of S.M.G.,

Respondent-Appellant.

ORDER AFFIRMED

Division II
Opinion by JUDGE SULLIVAN
Fox and Kuhn, 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 Petitioner-Appellee

Tezak Law, P.C., Mary Tezak, Florence, Colorado, for Respondent-Appellant
¶1 Respondent, S.M.G., 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 S.M.G. was committed to the hospital after being found

incompetent to proceed in his criminal cases. He was diagnosed

with psychosis, not otherwise specified, and his symptoms included

delusions, agitation, paranoia, and response to internal stimuli.

After S.M.G. was observed yelling and slamming things in the

shower, the hospital staff began administering emergency

medication.

¶3 At the request of S.M.G.’s treating physician, Dr. Hareesh

Pillai, the People filed a petition to involuntarily medicate S.M.G.

with olanzapine (also known as Zyprexa), haloperidol (also known

as Haldol), and lithium. The district court held an evidentiary

hearing, at which Dr. Pillai and S.M.G. testified. After hearing the

evidence, the court found 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), and granted the

petition.

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II. Applicable Law and Standard of Review

¶4 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 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.

¶5 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.

1 A different test applies to petitions to administer involuntary

medication solely to restore competency. Sell v. United States, 539
U.S. 166, 180-81 (2003). But the parties don’t dispute that People
v. Medina, 705 P.2d 961 (Colo. 1985), applies here because the
purpose of the medications is to prevent S.M.G. from (1) suffering a
significant and long-term deterioration in his mental condition and
(2) causing serious harm to himself or others in the institution. See
Sell, 539 U.S. at 181-83.

2
¶6 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. 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

from the evidence. People in Interest of R.C., 2019 COA 99M, ¶ 7.

III. Analysis

¶7 S.M.G. contends only that the evidence was insufficient to

prove the fourth Medina element. We disagree.

¶8 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 so, 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

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.

¶9 After considering the evidence, the district court determined

that S.M.G.’s need for treatment was sufficiently compelling to

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override any bona fide and legitimate interests that he had in

refusing medication. In so finding, the court described some of

S.M.G.’s objections to the medication, including (1) side effects such

as hair loss, weight gain, and cramping; (2) health concerns such as

neuropathy, blood sugar levels, and a heart condition; and (3) his

religious beliefs. The court noted that none of the side effects or

health conditions posed any significant risks at that time and that

the hospital would continue to monitor them. As for S.M.G.’s

religious objections, the court found that S.M.G. had “religious

beliefs and concerns with taking medication,” but the specific

nature of S.M.G.’s religious objection was “a little unclear.” As we

read the court’s order, the court assumed for the purpose of its

analysis that S.M.G.’s religious objections were bona fide and

legitimate.

¶ 10 Even so, the district court found that the state’s legitimate

interests in preserving S.M.G.’s life and health and protecting the

safety of others in the institution outweighed his reasons for

refusing medication. In reaching this conclusion, the court pointed

to S.M.G.’s “dangerousness.” Among other things, the court noted

that S.M.G. had assaulted a cellmate while in the jail and had

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“admit[ted] to swinging at staff and spitting on staff” during his stay

at the hospital.

¶ 11 The record supports the district court’s findings. Dr. Pillai

testified that S.M.G.’s refusal to take medication was irrational and

unreasonable under the circumstances. Dr. Pillai acknowledged

that side effects from the medications could qualify as a bona fide

and legitimate reason to refuse medication, but he noted that

S.M.G. hadn’t experienced any “severe side effects” and, in any

event, he was skeptical that some of S.M.G.’s complaints were

“based in reality.” As to the health issues, Dr. Pillai testified that

(1) S.M.G.’s blood sugar levels were normal; (2) there was no

evidence of neuropathy; and (3) although S.M.G. had bradycardia, it

didn’t “seem to be affecting him,” he previously “did well” on the

medications despite his bradycardia, and he didn’t “need active

intervention.”

¶ 12 During his testimony, S.M.G. described himself as a “very

religious person” and said that his religion is a “big part of [his] life.”

He also felt “insult[ed]” when told that his “delusions are interfering

with reality” because that is “literally what prayer is.” He said that

the medications “greatly diminished” his ability to “connect[] with

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God” because they cause “psychological dullness.” S.M.G. didn’t

testify, however, that his religious beliefs prohibited him from

taking the medications.

¶ 13 Dr. Pillai opined that, even considering these issues, S.M.G.’s

need for medication still outweighed any risk. As Dr. Pillai

explained, when medicated, S.M.G.’s condition improved and the

only significant side effect he reported — cramping — was alleviated

by switching his mood stabilizer from Depakote to lithium. Dr.

Pillai also testified that, without medications, S.M.G. would

continue to deteriorate and pose a significant risk of harm to

others. In support, Dr. Pillai pointed to S.M.G.’s history of previous

hospitalization and his presentation during his current hospital

stay. Specifically, Dr. Pillai discussed two previous incidents during

which S.M.G. assaulted other individuals because he believed they

were “interrupting his sleep via telepathy.” Dr. Pillai also said that,

during his current hospitalization, S.M.G. “incite[d] an incident”

with another patient and punched a nurse.

¶ 14 On appeal, S.M.G. recounts the evidence supporting the

district court’s finding that he had a bona fide and legitimate reason

for refusing medication. But S.M.G. doesn’t challenge the evidence

6
establishing that his prognosis without treatment was so

unfavorable that his preference against medication must yield to

the state’s interests in preserving his life and health and protecting

the safety of those in the hospital. The district court weighed this

evidence and determined that S.M.G.’s preference had to yield to

the state’s interests. We can’t reweigh the evidence to reach a

different result. See People in Interest of Uwayezuk, 2023 COA 69,

¶ 57 (noting that, if ample evidence supports the decision, a

reviewing court can’t substitute its judgment for that of the district

court).

¶ 15 Accordingly, viewing the evidence in the light most favorable to

the People, we conclude that sufficient evidence supported the

district court’s determination that S.M.G.’s personal preference to

refuse medication must yield to the state’s legitimate interests in

protecting his health and others in the hospital. See id.; see also

R.K.L., ¶ 13 (“The testimony of the physician seeking to administer

treatment may be sufficient by itself to satisfy” the Medina

elements.).

IV. Disposition

¶ 16 We affirm the order.

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JUDGE FOX and JUDGE KUHN concur.

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