Peo in Interest of O'Donnell

25CA1848 Peo in Interest of O’Donnell 12-04-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1848
Pueblo County District Court No. 25MH30083
Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Matthew Joseph O’Donnell,

Respondent-Appellant.

ORDER AFFIRMED

Division II
Opinion by JUDGE MEIRINK
Fox and Brown, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced December 4, 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, Matthew Joseph O’Donnell, 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 O’Donnell 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 that included auditory hallucinations, paranoia, racing

thoughts, impulsivity, and agitation. After O’Donnell jumped over a

couch and punched a peer in the face, the hospital administered

emergency medication.

¶3 At the request of O’Donnell’s treating physician, Dr. Hareesh

Pillai, the People filed a petition to involuntarily medicate O’Donnell

with risperidone (also known as Risperdal) and haloperidol (also

known as Haldol). The district court held an evidentiary hearing, at

which Dr. Pillai and O’Donnell testified. After hearing the evidence,

the court found that the People had established all four elements

for the involuntary administration of medication set forth in People

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

1
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.1 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

1 When the state seeks to administer antipsychotic drugs to a

mentally ill criminal defendant involuntarily so that she 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.

2
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

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 O’Donnell contends only that the evidence was insufficient to

prove the fourth Medina element. We disagree.

¶8 In assessing this 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 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.

3
¶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.” In contrast, the

court determined that O’Donnell was not credible, but “even with

his credibility issues,” it still found that he had bona fide and

legitimate reasons for refusing medication. The court based its

decision, in part, on O’Donnell’s testimony that he experienced

vomiting, depression, tiredness, and problems going to the

bathroom. The court also relied on O’Donnell’s testimony that he

was “supposed to be taking home remedies as a Christian.”

¶ 10 Nevertheless, the district court found that these bona fide and

legitimate interests were outweighed by the state’s legitimate

interest in preserving O’Donnell’s life and health and protecting the

safety of others in the institution. In particular, the court relied on

(1) evidence that, while on medication, O’Donnell was “less irritable”

and displayed “less aggression on the unit”; and (2) Dr. Pillai’s

opinion that, without the medication, there would be a “re-

emergence” of those symptoms.

¶ 11 The record supports the district court’s findings. Dr. Pillai

testified that O’Donnell did not believe that he had a mental illness

4
or that he needed medication to control his behavior. Therefore, Dr.

Pillai believed that O’Donnell’s rationale for refusing medication was

“based off his limited insight” into his mental illness. Still, Dr. Pillai

said that, even if O’Donnell had legitimate reasons to refuse

medications, the need for medication still outweighed any risk. As

Dr. Pillai explained, when medicated, O’Donnell’s condition

improved, he was removed from “assault precautions,” he

experienced fewer hallucinations, and he exhibited less irritability

and aggression on the unit.

¶ 12 Dr. Pillai also opined that O’Donnell was likely to cause harm

to himself and others in the hospital if left untreated. In support,

Dr. Pillai pointed to the incident in which O’Donnell jumped over a

couch and punched a peer in the face. Dr. Pillai said that this

incident, which occurred before O’Donnell started taking

medication, appeared to be related to O’Donnell’s “underlying

psychiatric condition” and required staff to restrain and seclude

him. Dr. Pillai said that, if O’Donnell stopped taking the

medications, he would “deteriorate” and start exhibiting the same

symptoms of agitation, delusions, paranoia, and hallucinations that

he presented with when he was admitted to the hospital.

5
¶ 13 On appeal, O’Donnell recounts the evidence supporting the

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

for refusing medication. But O’Donnell does not challenge any of

the evidence establishing that his prognosis without treatment was

so unfavorable that his preference against medication had to yield

to the state’s interest in preserving his life and health and

protecting the safety of those in the hospital. The district court

weighed this evidence and determined that O’Donnell’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).

¶ 14 Therefore, viewing the evidence in the light most favorable to

the People, we conclude that there was sufficient evidence that

O’Donnell’s personal preference to refuse medication had to yield to

the state’s legitimate interest to protect his health and 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.).

6
IV. Disposition

¶ 15 The order is affirmed.

JUDGE FOX and JUDGE BROWN concur.

7