Peo in Interest of Zaczek

25CA1355 Peo in Interest of Zaczek 12-18-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA1355
Pueblo County District Court No. 25MH30008
Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Brian Zaczek,

Respondent-Appellant.

ORDER AFFIRMED

Division VI
Opinion by JUDGE SULLIVAN
Welling and Gomez, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced December 18, 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 Brian Zaczek 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 Zaczek was admitted to the hospital in December 2024 after a

district court found him incompetent to proceed in three criminal

cases. He was originally diagnosed with an unspecified mood

disorder. His symptoms included having disorganized thinking and

being delusional and paranoid. Based on his belligerent behavior,

which included threatening staff members and another patient, as

well as repeatedly refusing to take psychiatric medications, his

doctor started him on emergency medications.

¶3 In January 2025, the district court granted the State’s petition

to medicate Zaczek involuntarily with two antipsychotic medications

— Zyprexa (olanzapine) and Haldol (haloperidol) — and the mood-

stabilizing medication Depakote (valproic acid).

¶4 In July 2025, the State again petitioned the district court for

authorization to medicate Zaczek involuntary, this time limiting its

request to only Zyprexa and Depakote.

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¶5 At the hearing on the petition, Zaczek’s psychiatrist at the

hospital, an expert in clinical psychiatry, testified that, although

Zaczek had shown improvement, he continued to exhibit symptoms

of having disorganized thinking and being delusional, paranoid, and

irritable. The psychiatrist had refined his diagnosis of Zaczek to an

unspecified bipolar disorder, which he testified constitutes a

substantial disorder that grossly impairs Zaczek’s judgment or

capacity to recognize reality or control behavior. The psychiatrist

also testified that Zaczek doesn’t believe that he has a mental

illness or needs to take any psychiatric medications. The

psychiatrist opined that continuing to treat Zaczek with Zyprexa

and Depakote was necessary to prevent a significant and likely

long-term deterioration of his mental condition. The psychiatrist

(1) explained the potential side effects of the medications; (2)

testified that Zaczek has gained some weight while in the hospital

and reported experiencing gastrointestinal side effects, blurry

vision, photosensitivity, and shaky hands; and (3) testified that

Zaczek was taking other medications to alleviate side effects.

Ultimately, the psychiatrist opined that Zaczek’s need for the

medications, as evidenced by the improvement in his mental state

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and decrease in threatening and aggressive behavior, outweighs his

interest in avoiding the side effects.

¶6 Zaczek testified that he doesn’t have a mental illness, that he

prefers not taking any medications, that the medications haven’t

helped him, and that he won’t take the medications without a court

order. He testified that, while on the medications, his Crohn’s

disease has worsened, he has developed gastrointestinal ulcers, and

he has experienced diarrhea and constipation. He also testified

that he has gained weight and has experienced foggy vision, fuzzy

thoughts, loss of balance, and headaches.

¶7 The psychiatrist was recalled to the witness stand, testifying

that the medications don’t cause gastrointestinal ulcers.

¶8 Following the testimony, the district court found that the

psychiatrist had testified credibly and persuasively, and it adopted

the psychiatrist’s opinions. The court then examined each of the

four elements of the test from People v. Medina, 705 P.2d 961, 973

(Colo. 1985). It concluded that the State had met its burden of

proving all four elements by clear and convincing evidence and

granted the petition to involuntarily medicate Zaczek.

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II. Applicable Law and Standard of Review

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

that test, a district court may authorize the involuntary

administration of medication if the State demonstrates 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 isn’t 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.

1 A different test applies to petitions to administer medication

involuntarily for the purpose of restoring competency for a criminal
proceeding. 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 Zaczek was admitted to the hospital for that
purpose, the petition’s stated purpose, and the district court’s basis
for granting the petition, was to prevent a significant and long-term
deterioration in Zaczek’s mental condition, which is relevant to the
second Medina element. See R.F., ¶ 11 n.1.

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¶ 10 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.

III. Analysis

¶ 11 Zaczek states expressly in his opening brief that he doesn’t

contest the district court’s rulings that the State met its burden of

proving the first and third Medina elements.

¶ 12 As to the second Medina element, Zaczek initially argues in his

opening brief that “the People failed to establish the second and

fourth [Medina] elements by clear and convincing evidence.” But in

specifically addressing the second Medina element, Zaczek says that

“[t]his element is uncontested.” And in the conclusion of his

opening brief, he challenges only the fourth Medina element,

arguing that the district court “erred when it found that element

four of Medina was met by clear and convincing evidence.” Because

Zaczek doesn’t present any specific argument challenging the

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district court’s ruling on the second Medina element, we won’t

address it. See C.A.R. 28(a)(7)(B); People in Interest of C.N., 2018

COA 165, ¶ 44.

¶ 13 As to the fourth Medina element, Zaczek contends that the

State presented insufficient evidence to show that his need for the

medications is sufficiently compelling to override his bona fide and

legitimate interest in not taking them.

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

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

legitimate.” Medina, 705 P.2d at 974. If so, 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.

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

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

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

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

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physician seeking to administer treatment may be sufficient,

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

¶ 16 The district court found that Zaczek’s interest in avoiding the

side effects he has been experiencing is bona fide and legitimate.

But the court also found that Zaczek’s prognosis without the

medications is so unfavorable that his personal preference must

yield to the State’s legitimate interest in preserving his life and

health and in protecting the safety of others in the hospital. In

doing so, the court found that Zaczek’s deteriorating mental health

alone would have been sufficient to make that finding, but that

Zaczek’s threatening behavior toward staff members and another

patient strengthened that finding “above and beyond.”

¶ 17 The record supports the district court’s finding that the State

sufficiently proved the fourth Medina element. The court credited

the psychiatrist’s testimony and adopted his opinions that Zaczek

had shown improvement on the medications and that continuing to

treat Zaczek with the medications was necessary to prevent a

significant and likely long-term deterioration of his mental

condition. Given the district court’s credibility determination, we

discern no error in its finding that Zaczek’s compelling need for the

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medications outweighs his interest in avoiding the side effects he

has experienced. See Ramsey, ¶ 23; R.K.L., ¶¶ 13, 30.

¶ 18 Zaczek’s arguments on appeal, emphasizing both the side

effects he has experienced and the medications’ other side-effect

risks, effectively amount to a disagreement with the way the district

court balanced the two considerations. But in solely emphasizing

his side effects, Zaczek downplays the psychiatrist’s testimony

about the compelling need to treat his psychiatric condition with

the medications. Given that the district court credited the

psychiatrist’s testimony and adopted his opinions, we discern no

error. See Ramsey, ¶ 23; R.K.L., ¶¶ 13, 30.

IV. Disposition

¶ 19 We affirm the order.

JUDGE WELLING and JUDGE GOMEZ concur.

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