Peo in Interest of Prieto

24CA2114 Peo in Interest of Prieto 02-20-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 24CA2114
Pueblo County District Court No. 24MH30121
Honorable Timothy O'Shea, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Julio Adrian Prieto,

Respondent-Appellant.

ORDER AFFIRMED

Division V
Opinion by JUDGE SULLIVAN
Freyre and Schock, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced February 20, 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 Julio Adrian Prieto appeals the district court’s order

authorizing the involuntary administration of medication. We

affirm.

I. Background

¶2 Prieto suffers from schizophrenia. Untreated, he exhibits

symptoms that include auditory hallucinations, paranoia,

delusions, mood dysregulation, aggression, and suicidal ideation.

Deemed incompetent to stand trial in a criminal matter, he was

admitted to the Colorado Mental Health Hospital in Pueblo

(CMHHIP) in October 2024. Though he initially complied with

treatment, he suddenly and intermittently refused medication a few

weeks into his hospitalization.

¶3 The Pueblo County Attorney sought a court order authorizing

the involuntary administration of three medications: olanzapine

(Zyprexa), ziprasidone (Geodone), and haloperidol (Haldol).1

Consistent with People v. Medina, 705 P.2d 961 (Colo. 1985), the

petition asserted that (1) Prieto is incapable of participating in

1 The petition also requested various forms of paliperidone (Invega),

but the treating psychiatrist removed that medication from the
request at the hearing.

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decisions affecting his health and treatment; (2) the requested

treatment is necessary to prevent a significant and likely long-term

deterioration in his mental health condition or to prevent the

likelihood of him causing serious harm to himself or others; (3) a

less intrusive treatment alternative isn’t available; and (4) Prieto’s

need for treatment is sufficient to override any bona fide and

legitimate interest he has in refusing treatment.

¶4 During an evidentiary hearing on the petition, the district

court heard testimony from both Prieto and his treating

psychiatrist, Dr. Hareesh Pillai. At the end of the hearing, the court

found that Dr. Pillai had testified “credibly and persuasively,” and

adopted the opinions he expressed. The court concluded that the

People had proved all four Medina elements and issued an order

authorizing CMHHIP staff to administer the requested medications

to Prieto against his will.

II. Standard of Review

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

evidence supporting an involuntary medication order, we review the

district court’s legal conclusions de novo but defer to its factual

findings if they have record support. People v. Marquardt, 2016 CO

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4, ¶ 8. We view the evidence as a whole and in the light most

favorable to the petitioning party, leaving the resolution of

testimonial conflicts and the determination of witness credibility

solely to the fact finder. People in Interest of Uwayezuk, 2023 COA

69, ¶ 57; People in Interest of R.C., 2019 COA 99M, ¶ 7. 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. R.C., ¶ 7.

III. Discussion

¶6 A district court may order the involuntary administration of

medication to a patient only if the People prove, by clear and

convincing evidence, each of the four elements outlined in Medina.2

Medina, 705 P.2d at 973. Prieto doesn’t contest the second and

fourth Medina elements. He contends only that the evidence

2 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 Prieto 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.

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presented at the hearing was insufficient to prove the first and

third. We aren’t persuaded.

A. The First Medina Element: Incompetency to Participate in
Treatment Decision

¶7 The first Medina element requires that the patient is

incompetent to effectively participate in the relevant treatment

decision. Id. A court may not order the forced medication of an

involuntarily committed patient unless it is satisfied that the

patient’s mental illness has so impaired their judgment as to render

them incapable of participating in decisions affecting their health.

Id. (citation omitted).

¶8 Dr. Pillai offered his expert opinion that Prieto is incompetent

to effectively participate in his treatment decisions. The district

court credited Dr. Pillai’s testimony, adopting the doctor’s opinions

as its own. Still, Prieto asserts that Dr. Pillai’s testimony about why

he believed Prieto was incompetent had nothing to do with Prieto’s

judgment but rather the risk of harm that he poses to himself and

others. But Dr. Pillai testified that, unmedicated or

undermedicated, Prieto lacks insight into his mental illness; indeed,

Prieto himself downplayed the severity of his illness, claiming that

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he only has anxiety. And although Prieto has been able to work

appropriately with the treatment team, voice his opinions on his

treatment, and live a normal life when he is medicated, Dr. Pillai

testified that “so far in this hospitalization, he’s been unable to

participate in [treatment] discussions” due to his mental instability

and assaultive and aggressive behaviors. In addition, Dr. Pillai

observed that, in attempting to speak with Prieto about how he

wants to proceed with treatment, Prieto typically exhibits

“significant thought blocking and poverty of speech.”

¶9 Under these circumstances, we can’t conclude that the

evidence was insufficient to support the district court’s

determination that Prieto is incompetent to effectively participate in

the treatment decision.

B. The Third Medina Element: No Less Intrusive Treatment
Alternative

¶ 10 The third Medina element requires, and the district court

found, that a less intrusive treatment alternative isn’t available.

See id. The record supports this determination.

¶ 11 Dr. Pillai testified that he didn’t believe any alternative method

of treating Prieto would be both as effective and less intrusive than

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the requested medications. He testified that Prieto suffers from

“treatment-resistant” schizophrenia and “[t]he objective

documentation” he had from Prieto’s past hospitalizations indicated

“that he required two antipsychotics, mainly Zyprexa and Geodon,

to stabilize from an acute psychotic phase of his illness.” He

further testified that his treatment team has “tried to treat [Prieto]

on max-dosage Zyprexa, alone, and he continues to [exhibit]

assaultive behavior,” so the Geodone is necessary. Likewise, Dr.

Pillai testified that Haldol was necessary to treat Prieto’s instances

of acute agitation — which, in addition to his assaultive behaviors

at CMHHIP, included punching walls, banging his head against the

wall, and self-harming while in jail — and as an intramuscular

“backup” option.

¶ 12 Nonetheless, Prieto points to his own testimony “assur[ing] the

court that he would take the two primary medications voluntarily

without a court order.” As we understand his argument, Prieto

implies that his willingness to do so constitutes a less intrusive

treatment alternative. But he concedes that he has a history of

refusing medications and his testimony regarding his present

consent was inconsistent at best. When asked if he wanted the

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option of taking the requested medications voluntarily without a

court order being entered, he answered, “[M]aybe . . . not sure.”

And although he initially said he would agree to a consent order, he

abruptly “changed [his] mind” once the court said it would prepare

such an order if that was what Prieto wanted. See People in Interest

of Strodtman, 293 P.3d 123, 133 (Colo. App. 2011) (rejecting the

respondent’s argument that taking her medication orally was an

effective, less intrusive alternative to injection because she lacked

the capacity to consistently take her medication orally). Further,

Dr. Pillai testified that, in discussing Prieto’s ability to take the

medications voluntarily, Prieto said that he didn’t suffer from a

mental illness and denied that medications had any benefit.

¶ 13 Dr. Pillai’s testimony about the need for the requested

medications, along with Prieto’s lack of insight into the benefit and

need for medications and his sudden, intermittent refusals of

treatment, is sufficient to support the conclusion that his stated

willingness to voluntarily comply with the treatment is not a less

intrusive treatment alternative.

IV. Disposition

¶ 14 We affirm the order.

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JUDGE FREYRE and JUDGE SCHOCK concur.

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