Peo in Interest of Howard

25CA1580 Peo in Interest of Howard 11-26-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1580
Pueblo County District Court No. 25MH30074
Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Michael Demetrius Howard,

Respondent-Appellant.

ORDER AFFIRMED

Division I
Opinion by JUDGE GROVE
J. Jones and Schutz, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced November 26, 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 Respondent, Michael Demetrius Howard, 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 Howard was committed to the hospital after being found

incompetent to proceed in his criminal case. He was diagnosed

with psychosis, not otherwise specified, and presented with

symptoms of agitation, aggression, hallucinations, and thought

disorder. After arriving at the hospital, Howard became

increasingly agitated, barricaded himself in his room, and had to be

restrained. He also refused to take any medications, so the hospital

placed him on emergency medication.

¶3 At the request of his treating physician, Dr. Hareesh Pillai, the

People filed a petition to involuntarily medicate Howard with

olanzapine (also known as Zyprexa), valproic acid (also known as

Depakote), and chlorpromazine (also known as Thorazine). A few

days later, the district court held an evidentiary hearing, at which

Dr. Pillai and Howard testified. After hearing the evidence, the

court found that the People had established all four elements for

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the involuntary administration of medication set forth in People v.

Medina, 705 P.2d 961, 973 (Colo. 1985), and granted the petition.

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 is not 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. 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.

¶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

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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

therefrom. People in Interest of R.C., 2019 COA 99M, ¶ 7.

III. Analysis

¶7 Howard contends that the evidence was insufficient to prove

the second and fourth Medina elements. We disagree.

A. The Second Medina Element

¶8 The second Medina element may be satisfied by showing either

(1) a significant and likely long-term deterioration or (2) the

likelihood of serious harm to self or others in the institution.

Medina, 705 P.2d at 973. Because the district court found that the

People failed to prove the latter, we consider only whether the

evidence was sufficient to establish that Howard required

involuntary treatment to prevent a significant and likely long-term

deterioration of his mental health condition.

¶9 After considering the evidence, the district court determined

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

“adopt[ed] the opinions expressed by the doctor.” Then, as relevant

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here, the court found that the requested treatment was necessary to

prevent a significant and likely long-term deterioration of Howard’s

mental condition, noting evidence that Howard had “significantly

improved” but “not fully stabilized” after he was placed on

emergency medication. The record supports the court’s finding.

¶ 10 Dr. Pillai opined that, without treatment, there would be

significant and likely long-term deterioration of Howard’s mental

condition. Dr. Pillai noted that, when Howard was first admitted to

the hospital, he showed “severe aggression,” which “seemed to

worsen at nighttime,” resulting in “outbursts and agitation.” But

once Howard was placed on emergency medication, “the severity of

agitation” improved “significantly.” Dr. Pillai added that Howard’s

“frequent episodes of agitation overnight” had “almost completely

resolved.”

¶ 11 Despite this record, Howard contends that the evidence

described above was “largely irrelevant to the question of long-term

deterioration.” We disagree. The evidence established that Howard

was experiencing significant symptoms (e.g., agitation, aggression,

and hallucinations) related to his mental illness when he was

admitted to the hospital, but he showed substantial improvement

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with the administration of medication. Because Howard’s

symptoms had improved significantly with consistent medication,

the district court could infer that stopping the medication would

result in a deterioration of Howard’s mental condition. See

Marquardt, ¶ 24 (“Viewed in light of preventing deterioration,

achieving and maintaining stability in a severely mentally ill patient

is an achievement.”).

¶ 12 Therefore, viewed in the light most favorable to the People, we

conclude that the evidence was sufficient to establish the second

Medina element. See People in Interest of Strodtman, 293 P.3d 123,

132-33 (Colo. App. 2011) (evidence that the patient was

“functioning poorly upon admission” but “improved dramatically

with administration” of medication supported the court’s finding

that the People had proved the second Medina element).

B. The Fourth Medina Element

¶ 13 In assessing the fourth Medina element, a court must first

determine “whether the patient’s refusal is bona fide and

legitimate.” Medina, 705 P.2d at 974. If it is, the court must then

determine “whether the prognosis without treatment is so

unfavorable that the patient’s personal preference must yield to the

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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.

¶ 14 The district court found that Howard had legitimate and bona

fide reasons for refusing medication, namely his religious and

cultural background, as well as some side effects from the

medication. Howard testified that taking anti-psychotic medication

was inconsistent with his religious and cultural beliefs as a

Lakotan. And although Dr. Pillai testified that Howard had denied

having any side effects and that staff had not observed any, Howard

reported that the medication made him feel “weird” and caused

constipation.

¶ 15 Yet the district court determined that Howard’s prognosis

without treatment was so unfavorable that his preference not to

take medication had to yield to the state’s interest in preserving his

life and health and protecting the safety of those in the institution.

In so concluding, the court pointed to evidence that Howard’s

mental illness had led him to barricade himself in his room and

display aggression — actions that caused potential harm to his own

life and health as well as the safety of others in the institution.

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¶ 16 The record supports this finding. As noted above, Dr. Pillai

testified about Howard’s symptoms upon his arrival at the hospital,

including agitation, aggression, and hallucinations, and how the

symptoms subsided with medication. Howard also admitted to

barricading himself in his room because he did not want to take

medication, which resulted in staff forcibly restraining him.

¶ 17 In challenging the sufficiency of the evidence as to the fourth

Medina element, Howard recounts the evidence supporting the

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

for refusing medication. But Howard does not dispute the evidence

relied on by the court to conclude that his prognosis without

treatment was so unfavorable that his preference not to take

medication had to yield to the state’s interest in preserving his life

and health and protecting the safety of those in the institution. The

court weighed this evidence and determined that Howard’s

preference had to yield to the state’s interests. We cannot 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 cannot substitute its

judgment for that of the district court).

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¶ 18 Therefore, viewed in the light most favorable to the People, we

conclude that there was sufficient evidence that Howard’s personal

preference to refuse medication had to yield to the state’s legitimate

interest to protect his health, as well as to protect 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

¶ 19 The order is affirmed.

JUDGE J. JONES and JUDGE SCHUTZ concur.

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