Peo in Interest of Wolf

26CA0548 Peo in Interest of Wolf 05-14-2026

COLORADO COURT OF APPEALS

Court of Appeals No. 26CA0548
Pueblo County District Court No. 26MH30029
Honorable Amiel Markenson, Judge

The People of the State of Colorado,

Petitioner-Appellee,

In the Interest of Stephen Christopher Wolf,

Respondent-Appellant.

ORDER AFFIRMED

Division I
Opinion by JUDGE DUNN
J. Jones and Fox, JJ., concur

NOT PUBLISHED PURSUANT TO C.A.R. 35(e)
Announced May 14, 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 Stephen Christopher Wolf appeals the district court’s order

authorizing the involuntary administration of medication. We

affirm.

I. Background

¶2 Wolf was committed to the Colorado Mental Health Hospital in

Pueblo (CMHHIP) after being found incompetent to proceed in a

criminal case. He was diagnosed with psychosis and displayed,

among other things, paranoia and hallucinations. Wolf refused

recommended medical treatment.

¶3 After he exhibited escalating aggression toward staff, including

“swinging and kicking” at them, Wolf was given emergency

medication. The People then petitioned for authorization to

continue administering antipsychotic and mood stabilizing

medications to Wolf.

¶4 At an evidentiary hearing, Dr. Hareesh Pillai — the

psychiatrist supervising Wolf’s treatment — testified about Wolf’s

history of mental illness and his diagnosed psychosis and

accompanying symptoms. He also described the requested

medications, how they treat Wolf’s mental illness, and the possible

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side effects. And Dr. Pillai opined that the medications were

necessary to treat Wolf’s mental illness.

¶5 Wolf also testified. He did not admit to having a mental

illness. He explained that he wanted to participate in treatment

decisions and described various side effects that he had

experienced from the medications, including vertigo, sedation,

drooling, and feeling like his “organs are failing.”

¶6 The district court granted the petition. It found that Dr. Pillai

had testified “credibly and persuasively” and that the People had

proved all four elements of the test set forth in People v. Medina,

705 P.2d 961, 973 (Colo. 1985). The court issued an order

authorizing the involuntary administration of the requested

medications.

II. Applicable Law and Standard of Review

¶7 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

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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.1

¶8 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. It is for the district court,

as the fact finder, to determine the credibility of witnesses; the

sufficiency, probative effect, and weight of the evidence; and the

inferences and conclusions to be drawn from the evidence. People

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

¶9 When a patient challenges the sufficiency of the evidence

supporting an involuntary medication order, we must affirm if the

1 We recognize that, when the purpose of administering medications

is to restore competency in a criminal case, courts usually must
apply the Supreme Court’s test from Sell v. United States, 539 U.S.
166, 180-81 (2003). But the parties do not dispute that People v.
Medina, 705 P.2d 961, 973 (Colo. 1985), provides the appropriate
analytical framework here. We agree, given that the purpose of the
involuntary treatment was, in large part, to prevent Wolf from
causing serious harm to himself or others. See Sell, 539 U.S. at
181-83.

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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. The treating psychiatrist’s testimony

may suffice. Id. at ¶ 30.

III. Discussion

¶ 10 Wolf challenges the sufficiency of the evidence supporting the

district court’s order. He specifically contends that the evidence

was insufficient to support the court’s findings that the People had

established the first, third, and fourth Medina elements. We

disagree.

A. The First Medina Element

¶ 11 The first Medina element requires the People to prove that the

patient is incompetent to effectively participate in the relevant

treatment decision. Medina, 705 P.2d at 973. This element is

satisfied if the court finds that “the patient’s mental illness has so

impaired his judgment as to render him ‘incapable of participating

in decisions affecting his health.’” Id. (citation omitted).

¶ 12 The district court found that Wolf has “no or limited insight

into his mental illness and is incapable of making informed

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treatment decisions” based on his history of psychotic symptoms

and unwillingness to voluntarily participate in treatment.

¶ 13 The record supports the court’s findings. Dr. Pillai testified

that Wolf does not have insight into his mental illness and that he

is incompetent to effectively participate in treatment decisions. Dr.

Pillai added that Wolf “does not appear to understand that he

suffers from” psychotic symptoms and needs medication to treat the

symptoms. Underscoring that point, Wolf told Dr. Pillai that “he did

not need medications.”

¶ 14 Largely disregarding this testimony, Wolf relies on his own

testimony that he wanted to participate in medication decisions.

But Wolf refused to say whether he has a mental illness and

testified that he’s “not psychotic.” Though Wolf says he simply

“exercised his rights by declining to state whether he has a mental

illness,” he also never admitted that he needed any medication and

never agreed to voluntarily take any medication. That Wolf did not

acknowledge his mental illness or his need for treatment is evidence

that he is not able to effectively participate in treatment decisions.

See People in Interest of Strodtman, 293 P.3d 123, 132 (Colo. App.

2011) (affirming finding that patient was incompetent to effectively

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participate in treatment decision because, among other reasons,

she did not believe she had a mental illness and had not “embraced

her need for treatment”).

¶ 15 And though Wolf argues that he understands his legal

circumstances because he requested consultation with his attorney

before talking to Dr. Pillai about medications and side effects, he

doesn’t explain how this request establishes that he understands

the severity of his mental illness and the need for the requested

medications.

¶ 16 In any event, the court credited Dr. Pillai’s testimony that Wolf

lacks insight into the severity of his illness and is incompetent to

effectively participate in treatment decisions. Thus, the evidence

was sufficient to support the court’s finding that the first Medina

element was satisfied.

B. The Third Medina Element

¶ 17 The third Medina factor requires the court to determine that

there is no less intrusive alternative to the proposed medication.

This factor “encompasses not only the gravity of any harmful effects

from the proposed treatment but also the existence, feasibility, and

efficacy of alternative methods of treating the patient’s condition or

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of alleviating the danger created by that condition.” Medina, 705

P.2d at 974. A “‘less intrusive alternative’ constitutes an available

treatment that has less harmful side effects and is at least as

effective at alleviating a patient’s condition as the proposed

treatment.” Strodtman, 293 P.3d at 133 (citation omitted).

¶ 18 Dr. Pillai testified that Wolf requires the requested medications

to treat his psychosis. He specifically explained how the

medications treat psychotic symptoms like hallucinations,

paranoia, and delusions and can improve impulsivity, disinhibition,

and aggression. And he testified that no alternative methods of

treatment would be as effective and less intrusive than the

requested medications.

¶ 19 Though Wolf argues that allowing him to take medication on a

voluntary basis is a less intrusive alternative, and that he wants a

collaborative role in his treatment, Dr. Pillai testified that Wolf did

not acknowledge he needed medication and had refused treatment.

And Wolf never testified that he would take any medication without

a court order.

¶ 20 The record therefore supports the district court’s finding that

the third Medina element was satisfied.

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C. The Fourth Medina Element

¶ 21 In evaluating the fourth Medina element — whether the

patient’s need for the requested medication is sufficiently

compelling to override a bona fide and legitimate interest in refusing

it — a court must consider “whether the patient’s refusal is bona

fide and legitimate” and, if it is, “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.” Medina, 705 P.2d at 974.

¶ 22 The district court acknowledged that Wolf had experienced

some side effects and implicitly found that Wolf’s concerns about

side effects were bona fide and legitimate. But it found that Wolf’s

prognosis without treatment “is so unfavorable” that his “personal

preference must yield” to the state’s “legitimate interests . . . in

preserving” Wolf’s life and health.

¶ 23 Wolf maintains that his desire to avoid side effects is a bona

fide and legitimate interest for refusing the requested medications.

And he says that he “expressed a willingness” to work with the

treatment team “to identify less invasive or more tolerable treatment

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alternatives.” But Dr. Pillai testified that there are no effective and

less intrusive treatment alternatives and that side effects would be

monitored and could be treated.

¶ 24 While we do not minimize Wolf’s experienced side effects, Wolf

doesn’t dispute his unfavorable prognosis without the requested

medications. Indeed, Wolf doesn’t contest the district court’s

finding on the second Medina element — that the medications are

necessary to prevent a significant and likely long-term deterioration

in his mental health condition. And Dr. Pillai confirmed that,

without medication, Wolf’s mental condition would deteriorate, and

he would pose a risk of harm to others.

¶ 25 We therefore conclude that the record supports the district

court’s finding that the fourth Medina element was satisfied.

IV. Disposition

¶ 26 The order is affirmed.

JUDGE J. JONES and JUDGE FOX concur.

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