Peo in Interest of PG

25CA1232 Peo in Interest of PG 09-18-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1232
Pueblo County District Court No. 23MH8
Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of P.G.,

Respondent-Appellant.

ORDER AFFIRMED

Division III
Opinion by JUDGE KUHN
Dunn and Lipinsky, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced September 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 P.G. appeals the district court’s order authorizing involuntary

administration of his medication. We affirm the order.

I. Background

¶2 P.G. has been diagnosed with schizophrenia. Previously, the

district court had granted an extension of P.G.’s long-term care and

treatment at Health Solutions, a designated facility of the Colorado

Behavioral Health Administration. Then recently, at the request of

Health Solutions staff psychiatrist Arlene Shanklin, M.D., the

People filed a petition seeking authorization to involuntarily

administer Invega Sustenna (an antipsychotic medication) to P.G.

¶3 The district court held an evidentiary hearing on the petition.

Dr. Shanklin, who the parties stipulated was an expert in the field

of clinical psychiatry, testified for the People; P.G. testified on his

own behalf. The court found Dr. Shanklin’s testimony credible and

persuasive and adopted her opinions. The court further found that

the People had proved the necessary elements for the involuntary

administration of medication under People v. Medina, 705 P.2d 961,

973 (Colo. 1985), and issued an order authorizing Health Solutions

staff to administer Invega Sustenna to P.G. against his will.

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II. Analysis

A. Legal Principles and Standard of Review

¶4 A person who is involuntarily committed retains the right to

refuse treatment. See id. at 971. Even so, a district court may

authorize the involuntary administration of medication if the People

establish each of the following elements by clear and convincing

evidence: (1) the person 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 person’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 (4) the person’s

need for treatment is sufficiently compelling to override any bona

fide and legitimate interest of the person in refusing treatment. Id.

at 973.

¶5 In a sufficiency challenge, we review whether the evidence,

viewed as a whole and in the light most favorable to the People, is

sufficient to support the court’s order. People in Interest of R.K.L.,

2016 COA 84, ¶ 13. The testimony of the physician seeking to

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administer treatment may be sufficient, without more, to satisfy the

Medina test. Id. at ¶ 30.

¶6 Application of the Medina test is a mixed question of fact and

law. People v. Marquardt, 2016 CO 4, ¶ 8. We defer to the district

court’s factual findings if they are supported by the record but

review the court’s legal conclusions de novo. Id. Both the

resolution of testimonial conflicts and the determination of witness

credibility are solely within the province of the fact finder. People in

Interest of Ramsey, 2023 COA 95, ¶ 23. When the evidence

supports the district court’s findings and conclusions, we will not

substitute our judgment for that of the district court. See People in

Interest of A.J.L., 243 P.3d 244, 255 (Colo. 2010).

B. Significant and Likely Long-Term Deterioration

¶7 P.G. does not contest the district court’s determination of the

first, third, or fourth elements of the Medina test. He contends only

that the evidence presented at the hearing was insufficient to prove

the second element. We disagree.

¶8 As noted, under the second Medina element, a court must

determine, by clear and convincing evidence, that the proposed

treatment is necessary either to prevent (1) a significant and likely

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long-term deterioration in the patient’s mental condition or (2) the

likelihood of the patient causing serious harm to himself or others.

Medina, 705 P.2d at 973. These are “alternative factors.” Id. In

considering the first, the court focuses on “the nature and gravity of

the patient’s illness, the extent to which the medication is essential

to effective treatment, the prognosis without the medication, and

whether the failure to medicate will be more harmful to the patient

than any risks posed by the medication.” Id. The second

alternative considers whether, without the proposed treatment, the

patient will likely constitute a continuing and significant threat to

the safety of himself or others. Id. at 973-74.

¶9 The court determined that the People had proved both factors.

In considering the first alternative, the court found that, without

Invega Sustenna, P.G.’s prognosis was poor. In particular, the

court found credible Dr. Shanklin’s testimony that if P.G. stops

taking the medication, his mental health will decompensate within

a few weeks to a month, when the medication leaves his system.

The court also found that, at that time, he will show symptoms of

his illness, including hallucinations, delusions, a decrease in

wanting to move forward with or improve his life, and a decrease in

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self-care. And the court found that, without the medication, P.G.

will likely return to illicit drug use, which will cause additional

decompensation.

¶ 10 We defer to the district court’s determination that Dr.

Shanklin was a credible and persuasive witness. See Marquardt,

¶ 8. Dr. Shanklin described the severity of P.G.’s illness and opined

that if he does not take the requested medication, there would be a

significant and likely long-term deterioration of his mental

condition. She described P.G.’s demonstrable improvement while

on a consistent Invega Sustenna regimen, including a significant

decrease in psychotic symptoms, hallucinations, and delusions,

and an increase in his ability to engage with his treatment team.

She noted, however, that his improvement does not mean that P.G.

is cured and the medication is no longer needed; instead,

schizophrenia requires ongoing treatment to maintain stability. She

opined that, upon ceasing medication, P.G.’s condition would

deteriorate in precisely the ways the court found. And she testified

that the failure to medicate him would be more harmful than the

risks posed by the requested medication.

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¶ 11 This record supports the district court’s determination that

the requested treatment is necessary to prevent a significant and

likely long-term deterioration in P.G.’s mental condition.

¶ 12 Nonetheless, P.G. asserts that the court’s analysis “boils down

to a finding that the [requested] medication has been effective” and

“leaves no room for [him] to ever be free from court-ordered

medication.” We disagree with this premise. For starters, the

effectiveness of the medication is indeed a part of the court’s inquiry

into the second Medina element. See Medina, 705 P.2d at 973.

Moreover, Dr. Shanklin’s testimony, which the district court

credited on this point, demonstrates that ongoing treatment will be

required for P.G. to maintain a stable mental condition. And P.G.

testified that, without a court order, he would stop taking the

Invega Sustenna. Thus, whether P.G. requires court-ordered

medication in the future will depend on the course of his treatment,

the efficacy of that treatment, his choices, and the other attendant

circumstances at that time.

¶ 13 Having concluded that sufficient evidence supports the court’s

finding as to the deterioration factor of Medina’s second element,

and because the second Medina element is phrased in the

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disjunctive, we need not reach P.G.’s contention that the court also

erred by finding medication is necessary to prevent the likelihood of

P.G. causing serious harm to himself. See id.; see also Lombard v.

Colo. Outdoor Educ. Ctr., Inc., 187 P.3d 565, 571 (Colo. 2008) (“[T]he

disjunctive use of the word ‘or’ marks distinctive categories.”).

III. Disposition

¶ 14 The order is affirmed.

JUDGE DUNN and JUDGE LIPINSKY concur.

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