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March 19, 2026 Get Citation Alerts Download PDF Add Note

Peo in Interest of SRW

Colorado Court of Appeals

• Citations: None known
• Docket Number: 25CA1985

• Precedential Status: Non-Precedential

• Opinion

• Authorities (6)

• Cited By (0)

• Summaries (0)

• Similar Cases (0)

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Combined Opinion

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

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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.

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¶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

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(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)).

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¶ 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

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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.

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¶ 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

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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.

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