Peo in Interest of Binford

26CA0510 Peo in Interest of Binford 06-18-2026

COLORADO COURT OF APPEALS

Court of Appeals No. 26CA0510
Pueblo County District Court No. 26MH30021
Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Brian Binford,

Respondent-Appellant.

ORDER AFFIRMED

Division IV
Opinion by JUDGE LUM
Welling and Schock, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced June 18, 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 Brian Binford appeals the district court’s order authorizing

staff at the Colorado Mental Health Hospital in Pueblo (the hospital)

to medicate him without his consent. We affirm.

I. Background

¶2 Binford was admitted to the hospital in February 2026 after

being found incompetent to proceed in four criminal cases. His

symptoms included delusions, response to internal stimuli, thought

disorganization, disinhibition, impulsivity, agitation, and assaultive

behavior. He was diagnosed with unspecified bipolar disorder.

¶3 This wasn’t the first time that Binford was admitted to the

hospital for competency restoration. When he was previously

admitted in December 2024, he had nearly identical symptoms.

But after being treated with the antipsychotic medication Zyprexa

(olanzapine) and the mood-stabilizing medication Depakote (valproic

acid) for several months, he was restored to competency and

released.

¶4 Upon Binford’s readmission to the hospital in February 2026,

he began fighting, kicking, and spitting at staff members, and he

was placed in seclusion and restraint and treated with emergency

medications. The same month, the People petitioned the district

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court for authorization to involuntarily medicate Binford with the

antipsychotic medications Zyprexa and Haldol (haloperidol), the

mood stabilizer Depakote, and the anxiolytic benzodiazepine

medication Ativan (lorazepam).

¶5 At the hearing on the petition, an official at the hospital

reported that Binford had refused to attend the hearing, and

Binford’s counsel then waived Binford’s appearance. The only

testifying witness at the hearing was Binford’s psychiatrist at the

hospital, Dr. Hareesh Pillai.

¶6 Dr. Pillai testified that Binford’s unspecified bipolar disorder,

which Dr. Pillai described as “severe,” constitutes a substantial

disorder that grossly impairs Binford’s judgment or capacity to

recognize reality or to control his behavior. He testified that the

requested medications were necessary to prevent both (1) a

significant and likely long-term deterioration in Binford’s bipolar

disorder and (2) the likelihood of Binford causing serious harm to

others in the hospital. Dr. Pillai explained that he planned to treat

Binford with Zyprexa and Depakote because those two medications

had been effective in treating Binford during his previous hospital

stay in 2024-2025. He also explained that he was requesting

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Ativan because Binford was frequently being treated with that for

his agitation. Finally, he explained that he was requesting the

injectable medication Haldol as an alternative to Depakote because

Binford frequently refused to take Depakote orally.

¶7 Following Dr. Pillai’s testimony, the district court found that

he had testified credibly and persuasively, and it adopted his

opinions. The court then examined each of the four elements of the

test from People v. Medina, 705 P.2d 961, 973 (Colo. 1985),

concluded that the People had met their burden of proving all four

elements, and granted the petition.

II. Applicable Law and Standard of Review

¶8 The parties agree that the Medina test applies here. Under

that test, a district court may authorize the involuntary

administration of medication if the People demonstrate by clear and

convincing evidence that

(1) the patient is incompetent to effectively participate in the

treatment decision;

(2) the treatment with medication 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

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patient causing serious harm to himself or others in the

institution;

(3) a less intrusive treatment alternative is not available; and

(4) the patient’s need for treatment with medication is

sufficiently compelling to override any bona fide and legitimate

interest he has in refusing treatment.

Id.1

¶9 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, while we

review the court’s legal conclusions de novo. Id. Resolving conflicts

in testimony and determining the credibility of the witnesses are

matters solely within the province of the district court. People in

Interest of Ramsey, 2023 COA 95, ¶ 23.

1 A different test applies to petitions to administer involuntary

medication for the purpose of restoring competency. See People in
Interest of R.F., 2019 COA 110, ¶¶ 10-15 & n.1 (discussing the test
from Sell v. United States, 539 U.S. 166, 180 (2003)). Although
Binford was admitted to the hospital for that purpose, the parties
do agree — as do we — that People v. Medina, 705 P.2d 961 (Colo.
1985), applies here because the purpose of the petition in this case
is to prevent Binford from causing harm to himself or others and to
prevent a significant and long-term deterioration in his mental
condition. See R.F.,¶ 11 n.1.
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III. Analysis

¶ 10 Binford does not contest the district court’s rulings that the

People met their burden of proving the first, second, and third

Medina elements. However, he challenges the sufficiency of the

evidence supporting the court’s ruling that the People met their

burden of proving the fourth Medina element.

¶ 11 In analyzing the fourth Medina element, a court first

determines “whether the patient’s refusal [of treatment] is bona fide

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

determines “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.

¶ 12 On a sufficiency challenge, we must determine whether the

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

People, is sufficient to support the district court’s order. People in

Interest of R.K.L., 2016 COA 84, ¶ 13. The testimony of the

physician seeking to administer treatment may be sufficient,

without more, to satisfy the Medina test. Id. at ¶ 30.

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¶ 13 Binford argues that he had two bona fide and legitimate

reasons for refusing the medications: first, to avoid the sedation

that he experienced from the medications during his 2024-2025

hospital stay; and second, to avoid other potential side effects that

the medications can cause. However, as the district court found,

although Binford had experienced sedation during his 2024-2025

hospital stay, there was no evidence that he was experiencing

sedation during his current hospital stay. Similarly, although Dr.

Pillai listed the other potential side effects that the medications can

cause, there was no evidence that Binford was experiencing any

such side effects.

¶ 14 Nevertheless, like the district court, we conclude that even if

Binford had bona fide and legitimate reasons to refuse the

medications, they are outweighed by Binford’s compelling need for

treatment with the medications. On appeal, Binford discusses only

his interests in refusing the medications; he does not address how

those interests should be weighed against his need for treatment.

And notably, Binford has conceded the second Medina element that

the medications are necessary to prevent both (1) a significant and

likely long-term deterioration in his condition, and (2) the likelihood

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of him causing serious harm to others in the hospital. The district

court’s finding that the fourth Medina element was met here is

strongly supported by Dr. Pillai’s testimony, which the court

credited, that (1) Binford’s condition is severe; (2) Zyprexa and

Depakote had been effective in treating his condition during his

2024-2025 hospital stay; (3) Binford had not experienced any side

effects from the medications other than “some sedation”; (4) he was

not aware of Binford having any underlying health conditions that

could be affected or worsened by the medications; and (5) the

failure to medicate Binford would be more harmful than the risks

posed by the use of the medications. See Marquardt, ¶ 8; Ramsey,

¶ 23; R.K.L., ¶¶ 13, 30.

¶ 15 In Binford’s reply brief, he argues that Dr. Pillai could not

know whether he was experiencing any side effects because the

“primary method” to determine whether a patient is experiencing

side effects is through the patient’s self-reporting, but he had been

refusing to communicate with his treatment team. However, Dr.

Pillai testified that the treatment team also monitors for side effects

by observing the patient’s presentation on the unit, drawing lab

work, obtaining vital signs, and conducting physical examinations.

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More importantly, though, because Binford did not appear at the

hearing and therefore did not testify regarding any such side effects,

the suggestion that he may have been experiencing side effects is

speculative.

¶ 16 For these reasons, we discern no error in the district court’s

ruling that the fourth Medina element was met.

IV. Disposition

¶ 17 The order is affirmed.

JUDGE WELLING and JUDGE SCHOCK concur.

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