Peo in Interest of Fair

25CA0743 Peo in Interest of Fair 09-04-2025

COLORADO COURT OF APPEALS

Court of Appeals No. 25CA0743
Pueblo County District Court No. 25MH30031
Honorable Amiel Markenson, Judge

People of the State of Colorado,

Petitioner-Appellant,

In the Interest of John Thomas Fair

Respondent-Appellee.

ORDER AFFIRMED IN PART AND REVERSED IN PART,
AND CASE REMANDED WITH DIRECTIONS

Division V
Opinion by JUDGE JOHNSON
Welling and Grove, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced September 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 The State sought and obtained an order authorizing the

involuntary administration of Depakote and Haldol to John Thomas

Fair (Fair). The district court, however, denied the State’s request

to involuntarily administer Zyprexa on grounds that the State failed

to prove by clear and convincing evidence the fourth factor under

People v. Medina, 705 P.2d 961, 973 (Colo. 1985). The State

appeals that portion of the court’s order. Due to insufficient factual

findings, we are unable to meaningfully review the district court’s

findings on the fourth Medina factor. Therefore, we reverse the

portion of the order denying the State’s request to involuntarily

administer Zyprexa and remand the case to the district court for

further proceedings. We otherwise affirm the order.

I. Background

¶2 Fair was admitted to the Colorado Mental Health Hospital in

Pueblo (CMHHIP) after being found incompetent to proceed on

criminal charges. According to the affidavit of his treating

physician, Dr. Hareesh Pillai (Dr. Pillai), Fair is a thirty-eight-year-

old man with a long history of psychiatric illness, restoration

treatment, and poor medication compliance. He has been

diagnosed with schizoaffective disorder.

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¶3 When Fair arrived at CMHHIP, he appeared to be

hallucinating, and he behaved in a paranoid and aggressive

manner. After yelling at housekeeping, throwing things, punching

walls, and threatening to “beat the shit out of” security staff, Fair

was involuntarily medicated on an emergency basis with Zyprexa,

an antipsychotic, and Depakote, a mood stabilizer. His symptoms

improved on Zyprexa and Depakote, but he refused Zyprexa after

the ten-day course of emergency medications ended.

¶4 The State petitioned for a six-month order permitting it to

involuntarily administer Zyprexa, Depakote, and Haldol — a second

antipsychotic for use only on an as-needed basis. In his

accompanying affidavit, Dr. Pillai averred that (1) Fair needed

antipsychotic medication both to prevent a deterioration in his

mental condition and to preserve the safety of others in the

institution; (2) a less intrusive treatment was not available; and

(3) Fair’s need for treatment was sufficiently compelling to override

any bona fide and legitimate interest in refusing treatment.

¶5 Dr. Pillai’s affidavit was admitted at the hearing on the

petition, at which both Fair and Dr. Pillai testified. As relevant

here, Fair testified as follows:

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• He does not have a mental illness.

• He had previously taken Seroquel (an antipsychotic

medication) at the Denver Detention Center.

• Seroquel treated his symptoms and didn’t cause side

effects.

• Zyprexa caused him to experience dizziness and low

energy.

• He would rather take Seroquel than Zyprexa.

¶6 Dr. Pillai testified that he recommended Zyprexa instead of

Seroquel because

• Fair had shown improvement on Zyprexa;

• Seroquel is not a first-line treatment for severe psychotic

illness;

• Seroquel is less effective, causes more side effects, and

usually requires a much higher dose than Zyprexa to

treat psychotic symptoms; and

• Fair’s medical records since 2020 did not indicate an

adherence to any antipsychotic treatment.

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Dr. Pillai further testified that, from his review, Fair’s records did

not show that Fair had ever been treated with Seroquel, but he also

acknowledged that he “may be missing parts of [Fair’s] record where

he was taking Seroquel.”

¶7 At the conclusion of the hearing, the district court

“automatically” granted an order to administer Depakote and Haldol

because Fair had not objected to being ordered to take those

medications. As to Zyprexa, the district court denied the petition.

The court determined, without making any factual findings, that the

State had proved the first three Medina factors but it also concluded

that the State had not established the fourth Medina factor for

Zyprexa by clear and convincing evidence.

¶8 The parties characterize the district court’s findings and legal

conclusions differently, and because the wording is important to

our analysis, we recount the court’s denial of Zyprexa’s

administration here:

I think [for] Medina factors 1 through 3 I would
find just for appellate purposes, even without
making [a] lengthy and detailed finding now
that they have been met by clear and
convincing evidence . . . . It’s really the fourth
factor that I have the issue with . . . .

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To some extent I agree with [the People] that
there are credibility issues clearly with [Fair].
That’s not a question. There are credibility
issues.

However, even with those credibility issues, at
least as to the dizziness and the fatigue, those
have been noted by [Fair] to staff as well.
The[re] still could be issues with his . . .
credibility, but . . . the Court finds that there’s
been enough to show that he has had those
issues. And those are bona fide and legitimate
interests, being dizzy and having fatigue.

The Court finds that he has stated in the past
he has taken Seroquel without those side
effects. Even with my concerns about his
credibility, the testimony from the doctor, at
least as the Court remembers it, is he doesn’t
have any record of the Seroquel ever being
taken. However, he may be missing records.

So that’s not really — not questioning Dr.
Pillai’s credibility at all. I found him extremely
credible. I think that actually [boosts his
credibility] to say, I may have not seen that,
or . . . I don’t have that record. If anything, it
makes him more credible. But as to this issue
I don’t know if that’s true or not 100 percent.

Therefore, I can’t find by clear and convincing
evidence that the need for treatment is
sufficiently compelling and overrides that bona
fide legitimate interest, just because of the
unknown.

The court further found that CMHHIP could “try [Fair] on Seroquel,”

deeming that treatment “appropriate.”

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¶9 The State now appeals.

II. Analysis

¶ 10 On appeal, the State argues that the district court erred in its

application of the law to the evidence regarding Zyprexa. For the

reasons below, we conclude that we lack sufficient findings on the

fourth Medina factor to adequately review the court’s ruling, and

because the court did not make any findings on the second and

third factors, we cannot rely on the court’s findings on those factors

to bridge that gap.

A. Standard of Review

¶ 11 We review a court order involving the involuntary

administration of medication as a mixed question of law and fact.

People in Interest of Strodtman, 293 P.3d 123, 131 (Colo. App.

2011). When reviewing a district court’s application of the Medina

factors, we defer to the court’s findings of fact if supported by the

record, and we review the court’s legal conclusions de novo. People

v. Marquardt, 2016 CO 4, ¶ 8. We also defer to the district court’s

resolution of evidentiary conflicts and its determinations of witness

credibility, the weight of the evidence, and the inferences to be

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drawn from the evidence. People in Interest of R.C., 2019 COA 99M,

¶ 7.

B. Insufficient Findings on the Fourth Medina Factor

¶ 12 When the State seeks to involuntarily administer antipsychotic

medication to a patient, it must prove, by clear and convincing

evidence, that (1) the patient is incompetent to participate effectively

in the treatment decision; (2) treatment by medication is necessary

either to prevent a significant and likely long-term deterioration in

the patient’s mental condition or to prevent the likelihood of the

patient causing serious harm to themself or others in the

institution; (3) a less intrusive treatment alternative isn’t available;

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

sufficiently compelling to override their bona fide and legitimate

interest in refusing medication. Medina, 705 P.2d at 973.

¶ 13 The fourth factor involves a two-step analysis: (1) whether the

patient has a “bona fide and legitimate” reason for refusing the

medication; and, if he does, (2) “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

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life and health of the patient placed in its charge and in protecting

the safety of those in the institution.” Id. at 974.

¶ 14 The second step of the analysis is a balancing test under

which the court weighs the patient’s interest in refusing medication

against the State’s interests in involuntarily medicating the patient.

To review whether the court misapplied the law when it performed

this balancing test, we first note that the court made specific

findings as to Fair’s bona fide and legitimate reasons for refusing

Zyprexa. The parties agree, as do we, that the record supports the

district court’s finding that Fair’s interest in avoiding dizziness and

low energy is a bona fide and legitimate reason to refuse Zyprexa.

But the court did not make any findings as to the State’s interests,

nor did it then make findings that balanced Fair’s interest against

the State’s interest to explain why Fair’s interest prevailed.

¶ 15 We acknowledge that a court’s findings might be implicit, see

People in Interest of C.L.T., 2017 COA 119, ¶ 36, but its ruling must

be sufficiently understandable to allow for appellate review, Weston

v. T & T, LLC, 271 P.3d 552, 561 (Colo. App. 2011) (A district “court

must make sufficient findings, so that, when they are considered

together with the record, the reviewing court can conduct a

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meaningful review.”). We determine for three reasons that the

court’s lack of findings on the fourth Medina factor renders its

ruling unreviewable.

¶ 16 First, the court’s ruling on the fourth Medina factor implies

that (1) the State did not adequately refute Fair’s testimony that he

had previously taken Seroquel without side effects, and (2) Seroquel

was an appropriate and less intrusive treatment. The inquiry

concerning treatment alternatives, such as Fair’s suggested

voluntary treatment with Seroquel rather than the involuntary

treatment with Zyprexa, falls under the third Medina factor. See

Medina, 705 P.2d at 973; see also, e.g., R.C., ¶¶ 6-12 (analyzing less

intrusive treatment alternatives under the third Medina factor).

This factor requires the court to reach a legal conclusion as to

whether a less intrusive alternative to the proposed medications is

available, based on factual findings, including whether the

alternative treatment (1) has less harmful side effects and (2) is at

least as effective at alleviating a patient’s condition as the proposed

treatment. Strodtman, 293 P.3d at 133; see also Medina, 705 P.2d

at 973-74 (discussing the appropriate analysis under the third and

fourth factors). As we read the district court’s order, it at best

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found that Fair suffered fewer side effects from Seroquel than

Zyprexa. But the court made no findings comparing the efficacy of

Fair’s preferred medication with the State’s requested one.

¶ 17 Second, the court’s ruling on the fourth Medina factor does not

address whether Fair’s long-term prognosis without the treatment is

so “unfavorable” that the State’s interests in his health and in the

safety of others in the institution must override his bona fide and

legitimate interests in refusing Zyprexa. And to the extent the court

concluded that the State had proved the second Medina factor by

showing that Fair required treatment to prevent a significant and

likely long-term deterioration in his mental condition, we cannot, on

the existing record, square that finding with the court’s ruling on

the fourth factor, which must have impliedly found that Fair’s

prognosis without treatment was not so unfavorable that the State’s

interests would prevail over his. Indeed, we discern no findings,

implicit or explicit, about either the gravity of Fair’s prognosis

without antipsychotic treatment or the strength of the State’s

interests in treating him.

¶ 18 Finally, the absence of findings about Fair’s prognosis without

treatment and the State’s legitimate interest in medicating him is

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further complicated by the court’s ambiguous credibility findings.

We generally defer to a court’s credibility determinations, see R.C.,

¶ 7, and we may not reweigh the evidence, People in Interest of A.R.,

2018 COA 177, ¶ 54, aff’d, 2020 CO 10. But here, the court found

Dr. Pillai “extremely credible,” while it noted that there were

“credibility issues” with Fair’s testimony. Nevertheless, in ruling as

it did, the court appears to have credited some of Fair’s testimony,

but it did not explain why it might have accepted some statements

while rejecting others.

C. Relief

¶ 19 When a district court misapplies the law, there have been

times when an appellate court could properly apply the law to the

court’s factual findings on de novo review and simply reverse the

court’s order. See People in Interest of Marquardt, 2014 COA 57,

¶¶ 21-22 (reversing because the district court misapplied the

second Medina factor), aff’d, 2016 CO 4; People in Interest of

Joergensen, 2022 COA 126, ¶ 13 (reversing because the district

court misapplied of one of the factors from Sell v. United States, 539

U.S. 166, 179-82 (2003)).

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¶ 20 Unlike in Marquardt and Joergensen, we do not have sufficient

factual findings for de novo review in Fair’s case. This is because

the court bypassed an essential part of the fourth Medina factor —

whether the State has legitimate interests in treating Fair with the

requested medication and how those interests weigh against Fair’s

refusal. To the extent we might generally be able to discern such

findings from the other Medina factors, we cannot do so here

because of the complete absence of factual findings on the third

factor and only partial findings on the second factor. For these

reasons, we are unable to provide meaningful appellate review of

the court’s order denying the State’s request to involuntarily

administer Zyprexa to Fair. Thus, we conclude that we must

remand this case to the district court to reconsider its order in light

of the legal principles discussed in this opinion.

¶ 21 We are cognizant that by the time this opinion is announced,

more than four months will have passed since the April 7

evidentiary hearing, and Fair’s relevant medical information may

have changed. For that reason, we will leave it to the court’s

discretion to determine whether it needs to receive additional

evidence on remand.

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III. Conclusion

¶ 22 The portion of the district court’s order denying the State’s

petition for the involuntary administration of Zyprexa is reversed,

and we remand the case for further proceedings consistent with this

opinion. The order is otherwise affirmed.

JUDGE WELLING and JUDGE GROVE concur.

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