Peo in Int of AFH

26CA0553 Peo in Interest of AFH 06-11-2026

COLORADO COURT OF APPEALS

Court of Appeals No. 26CA0553
Pueblo County District Court No. 26MH30032
Honorable Gregory J. Styduhar, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of A.F.H.,

Respondent-Appellant.

ORDER AFFIRMED

Division III
Opinion by JUDGE KUHN
Freyre and Johnson, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced June 11, 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 A.F.H. appeals the district court’s order authorizing staff at the

Colorado Mental Health Hospital in Pueblo (CMHHIP) to medicate

him against his will. We affirm.

I. Background

¶2 A.F.H. was admitted to CMHHIP after being found incompetent

to proceed on criminal charges. According to the affidavit and

testimony of Dr. Hareesh Pillai, the psychiatrist who supervises

A.F.H.’s care and treatment, A.F.H. suffers from an unspecified

mood disorder that causes disorganized thinking and behavior,

agitation, delusions, and paranoia. He has a long history of

psychiatric hospitalizations, mental health holds, and

incarcerations.

¶3 A.F.H. was prescribed Risperdal and Depakote in jail, but he

had not been compliant with those prescriptions before his arrival

at CMHHIP. About three weeks after A.F.H. arrived at CMHHIP,

staff began administering Zyprexa and Depakote on an emergency

basis to manage his episodes of aggression, including slamming

and breaking a door, yelling and screaming curses, and glaring and

posturing toward staff with his fists clenched. After a few days on

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those medications, A.F.H. displayed notable improvement in his

symptoms.

¶4 The People petitioned for a six-month order authorizing the

involuntary administration of Zyprexa, Depakote, and Haldol, along

with laboratory work and testing to monitor possible side effects.

The district court held an evidentiary hearing, where Dr. Pillai

clarified that CMHHIP staff would continue scheduled doses of

Zyprexa and Depakote, and they would administer Haldol as a

backup medication only if A.F.H. refused oral doses of Depakote.

Dr. Pillai further testified about each of the four elements required

for the involuntary administration of medication under People v.

Medina, 705 P.2d 961, 973 (Colo. 1985).1 As to A.F.H.’s interest in

refusal, Dr. Pillai testified that he knew of no bona fide and

legitimate reason for A.F.H. to refuse Zyprexa and Depakote —

1 When the State seeks to administer antipsychotic drugs to a

mentally ill criminal defendant involuntarily so that he can stand
trial, a reviewing court applies the Supreme Court’s test in Sell v.
United States, 539 U.S. 166, 178 (2003). However, reviewing courts
apply state law tests if the State, as here, seeks to administer
antipsychotics involuntarily for a different purpose, including a
purpose “related to the individual’s dangerousness, or . . . the
individual’s own interests where refusal to take drugs puts his
health gravely at risk.” Id. at 181-82.

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A.F.H.’s symptoms had been increasing in severity when off the

medication but had markedly improved since taking Zyprexa and

Depakote, and he had reported no significant side effects other than

some sedation.

¶5 A.F.H. also testified. He explained that he objected to taking

the prescribed medications because did not have a mental illness

and he preferred to treat his illnesses, including scoliosis, with a

vegan diet. He alleged that he suffered from several side effects

from Zyprexa or Depakote, including (1) lethargy and slow

movement; (2) restlessness; (3) muscle pain and neck symptoms,

which he also attributed to scoliosis and soreness from an injection;

and (4) issues with throat swelling, speaking, and swallowing,

though he emphasized that those symptoms were mild or

nonexistent as compared to when he was taking Abilify.

¶6 At the conclusion of the hearing, the district court found Dr.

Pillai’s testimony to be credible and persuasive. It found A.F.H.’s

testimony, particularly as to his alleged side effects, not reliable.

The court ultimately found that the People had provided clear and

convincing evidence for each of the Medina elements, and the court

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issued an order authorizing CMHHIP staff to administer all the

requested medications for a period of six months.

¶7 On appeal, A.F.H. challenges the sufficiency of the evidence

supporting the court’s order.

II. Analysis

¶8 A.F.H. challenges the sufficiency of the evidence for only the

fourth Medina element. He argues that he “has a bona fide and

legitimate interest in refusing medication due to both the risk of

potential side effects and the adverse effects he is currently

experiencing” and “his decision to refuse medication should be

understood as a considered response to legitimate health risks

rather than noncompliance.” Accordingly, we review whether the

evidence in the record is sufficient to support the court’s decision

on the fourth Medina element.2

A. Applicable Law and Standard of Review

¶9 A district court may authorize the involuntary administration

of medication to a patient only if the People establish each of the

2 We decline to address A.F.H.’s challenge, made for the first time in

his reply brief on appeal, to the medication dosages that the district
court approved. See In Interest of L.B., 2017 COA 5, ¶ 48 (“We do
not consider arguments raised for the first time in a reply brief.”).

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following elements by clear and convincing evidence: (1) the patient

is incompetent to participate effectively in the treatment decision;

(2) treatment by medication is necessary either to prevent a

significant and likely long-term deterioration in the patient’s mental

condition or to prevent the likelihood of the patient causing serious

harm to themself or others in the institution; (3) a less intrusive

treatment alternative isn’t available; and (4) the patient’s need for

treatment with medication is sufficiently compelling to override

their bona fide and legitimate interest in refusing medication.

Medina, 705 P.2d at 973; see People in Interest of Strodtman, 293

P.3d 123, 131 (Colo. App. 2011). A treatment provider’s testimony

alone may constitute clear and convincing evidence. See People v.

Pflugbeil, 834 P.2d 843, 846-47 (Colo. App. 1992).

¶ 10 When, as here, a patient challenges the sufficiency of the

evidence, we review the record as a whole and, viewing it in the light

most favorable to the People, determine whether the evidence is

sufficient to support the court’s decision. People in Interest of

Ramsey, 2023 COA 95, ¶ 23. We review the court’s conclusions of

law de novo and defer to its findings of fact if supported by evidence

in the record. People v. Marquardt, 2016 CO 4, ¶ 8. We also defer

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to the district court’s resolution of evidentiary conflicts and its

determinations of witness credibility, the weight of the evidence,

and the inferences to be drawn from it. See People in Interest of

R.C., 2019 COA 99M, ¶ 7.

B. Sufficient Evidence Supports the District Court’s
Conclusion on the Fourth Medina Element

¶ 11 In assessing the sufficiency of evidence for the fourth Medina

element, a court must determine (1) “whether the patient’s refusal

is bona fide and legitimate”; and, if so, (2) “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. Here, the court found that both prongs favored the

involuntary administration of medication. We conclude that the

record supports the district court’s ultimate finding on this element.

¶ 12 For the purposes of our analysis, we assume that A.F.H.’s

alleged side effects are a bona fide and legitimate reason for

refusing the prescribed medications, noting that A.F.H.’s reports of

sedation or lethargy were undisputed. Even so, Dr. Pillai’s

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testimony provided ample evidence to support the district court’s

finding that A.F.H.’s need for treatment was sufficiently compelling

to override his bona fide and legitimate interest in avoiding these

effects. See Pflugbeil, 834 P.2d at 846-47. Dr. Pillai testified that

(1) A.F.H.’s symptoms, especially the aggressive behavior described

above, were becoming more severe without medication; (2) his

agitation and aggression, refusal to shower, excessive focus on his

vegan diet, and paranoid or delusional complaints had significantly

improved since beginning medication; and (3) without medication,

A.F.H. could pose a serious risk of harm to others in the institution.

We need not consider whether A.F.H.’s testimony supports an

alternate finding because we defer to the district court’s resolution

of conflicting evidence. See R.C., ¶ 7.

¶ 13 Because the record supports the court’s finding that A.F.H.’s

prognosis without medication is so unfavorable that his bona fide

and legitimate interest in refusal must yield to the People’s

legitimate interests in preserving his health and in protecting the

safety of those in the CMHHIP, we conclude that the fourth Medina

element was satisfied. See Marquardt, ¶ 8. To the extent A.F.H.

asks us — for the first time in his reply brief — to reweigh his

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interests against those of the State, we decline to do so. See R.C.,

¶ 7; see also In Interest of L.B., 2017 COA 5, ¶ 48 (“We do not

consider arguments raised for the first time in a reply brief.”).

III. Disposition

¶ 14 The order authorizing the involuntary administration of

medication is affirmed.

JUDGE FREYRE and JUDGE JOHNSON concur.

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