DC Circuit Rejects Special Circumstances Argument of Potential Lengthy Civil Commitment in Upholding Involuntary Medication Order

United States v. Dillon, 738 F.3d 284 (D.C.Cir. 2013)

The District of Columbia Circuit Court of Appeals upheld on December 24, 2013, the district court’s order authorizing involuntary treatment with antipsychotic medication to restore the defendant’s competency to stand trial. The Court found no merit in the defendant’s argument under the first prong of United States v. Sell, 539 U.S. 166 (2003), that his potential civil commitment undermined the government’s interest in prosecuting him for threatening the President of the United States.

The defendant Simon Dillon was indicted for threatening the President of the United States. Dillon, who had been repeatedly hospitalized for mental illness, sent an email to a Secret Service agent from a location three blocks from the White House, stating that he would not harm the President if the agent met with him and agreed to “meet the demands of God.” If the agent did not, the President would get the worst Christmas present ever, would suffer for 30 days, and would wish for death that would not come to him. The Secret Service arrested Dillon the next day, and the D.C. Department of Mental Health sought his civil commitment. Following an administrative hearing in January 2012, the Mental Health Commission recommended his outpatient civil commitment. Dillon was then re-arrested and shortly thereafter, the district court ordered him committed for a competency evaluation.

Two government doctors first evaluated Dillon at the Metropolitan Correctional Center, and in a March 2012 report, diagnosed him with schizophrenia, paranoid type, but concluded he was competent to stand trial. Their opinion came with less than the usual degree of psychological certainty because they found Dillon was unable to rationally consider an insanity defense. As a result, both Dillon and the government requested a further psychiatric evaluation, and the court committed him to Butner Federal Medical Center. At Butner, he was diagnosed with delusional disorder, grandiose type, and the evaluator concluded he was incompetent to stand trial. Following a hearing, the district court found him incompetent to stand trial and committed him for a determination as to whether he could be restored to competency. Following a competency restoration study submitted to the court in February 2013, two evaluators diagnosed Dillon with schizoaffective disorder, bipolar type and concluded he could be restored to competency with antipsychotic medication. They based their conclusion on studies estimating the rate at which defendants are successfully restored to competency and on Dillon’s medical history indicating he had responded favorably to psychotropic medication during prior hospitalizations. They also reported that Dillon was not a danger to himself or others while in custody.

As a result of this report, the court held a Sell hearing at which both the evaluating psychologist and psychiatrist testified. The district court found that the government had an important interest in bringing the defendant to trial that was not undermined by special circumstances, and that involuntary medication would significantly further that interest. On appeal, the D.C. Circuit first reviewed the Supreme Court decisions on involuntary medication, including the Sell decision. It then concluded that it should conduct a de novo review of the district court’s holding under the first prong of Sell as to the importance of the governmental interest in prosecuting the case, and that it should review the remaining findings on the other three prongs for clear error, following the approach of the majority of other circuits, except the Tenth Circuit.

Dillon first challenged the district court’s finding under the first prong of Sell that important governmental interests were at stake. Dillon conceded that the crime with which he was charged was serious, but argued that special circumstances existed that lessened the importance of the government’s interest, namely the prospect of lengthy civil commitment and his own purported non-dangerousness. Dillon, however, failed to argue the potential for his civil commitment before the district court, even though the government mentioned it in its brief and argument. The Court of Appeals therefore found he had waived his ability to raise this argument on appeal. The Court further found that the argument would not have succeeded in any event even though Sell raised the potential for lengthy civil commitment as a special circumstance that could undermine the government’s interest in prosecution. The Court noted that Dillon was only civilly committed to outpatient treatment following his arrest on these charges, and given his second argument that he was not dangerous, it was unlikely he would have been committed to civil “confinement,” the term used in Sell instead of civil “commitment.”

Dillon also argued that he was not dangerous and this factor undermined the government’s interest in prosecuting him. The Court found, however, that although the government has an interest in incapacitating someone who is a danger to the public, it is not the government’s sole interest. The governmental interest also includes protecting the public by incapacitating the defendant, promoting respect for the law, and providing just punishment for an offense.

Dillon next argued under the second prong of the Sell test that the medication was not substantially likely to restore his competency. He stated that the schizoaffective diagnosis was inaccurate and he instead suffered from a delusional disorder. He argued the success rate for treating delusional disorders with antipsychotic medication was too low to warrant his forced medication. The Court pointed out, however, that the last two doctors who diagnosed Dillon with schizoaffective disorder had a much longer time to observe him and arrive at the correct diagnosis, plus his medical history reflected he had previously responded favorably to treatment with antipsychotic medication. The Court therefore found that the district court’s determinations were not clearly erroneous and upheld its order to treat Dillon with medication over his objection to restore his competency to stand trial.

Found in DMHL Volume 33 Issue 1

Tenth Circuit Requires Treatment Plan with Medications and Maximum Dosages before Authorizing Involuntary Medication of Incompetent Defendant

United States v. Chavez, 734 F.3d 1247 (10th Cir. 2013)

The Tenth Circuit Court of Appeals overturned on November 13, 2013, the district court’s order authorizing treatment of an incompetent defendant with antipsychotic medication over his objection. Following the precedent of three other circuits, the Tenth Circuit held that the government must submit a treatment plan containing the proposed medications and maximum dosages before the trial court can determine whether the second and fourth prongs required under United States v. Sell, 539 U.S. 166 (2003), have been met in order to justify an involuntary medication order. In order to authorize medication of an incompetent defendant under Sell, the government must establish 1) that important governmental interests are at stake, 2) the involuntary medication will significantly further those interests, 3) the involuntary medication is necessary to further those interests, and 4) the administration of the mediation is medically appropriate and in the defendant’s best medical interests.

Reydecel Chavez, a Mexican citizen, was arrested in New Mexico and charged with being a felon in possession of a firearm, being an illegal alien in possession of a firearm, and reentry into the United States as a removed alien. Soon after he was charged, both his attorney and the government agreed that Chavez should be evaluated for his competency to stand trial. The district court committed him to the Bureau of Prisons medical center in Springfield, Missouri for a competency determination. The psychologist performing the evaluation reported that Chavez was diagnosed with paranoid schizophrenia and was not competent to stand trial. He also reported that Chavez was not a danger to himself or others while in custody and could likely be restored to competency with antipsychotic medication, which he was refusing.

At the competency hearing, the district court found Chavez incompetent to stand trial, and at the court’s suggestion, the government filed a motion to require him to undergo treatment with medication over his objection. The same evaluator testified in general terms as to the treatment Chavez would likely receive, but the government presented no individualized treatment plan. The evaluator testified that an individualized treatment plan would be prepared for Chavez only after involuntary treatment was authorized by the court. He also testified that as a psychologist he could not prescribe medication for Chavez, but that the “typical” treatment plan would involve injection with Haldol. Side effects could be addressed with a change in medication or administration of drugs specifically designed to treat them. He further testified that three-fourths of defendants treated with antipsychotic medications are successfully restored to competency. Following this testimony, and over Chavez’s objection, the district court found that a specific treatment plan was not necessary to meet the Sell requirements and ordered his treatment over objection, requiring only a status report in about six weeks.

On appeal, the Tenth Circuit found that the first two prongs of the Sell test were purely issues of law for the appellate court to decide de novo, but the third and fourth prongs were factual determinations that the appellate court would reverse only if they were clearly erroneous with no evidence in the record to support them. The Tenth Circuit then analyzed the evidence supporting the Sell requirements and agreed with Chavez’s arguments that without a specific treatment plan identifying which medications would be administered to him and at what doses, the district court had insufficient information to make the required findings. The Court of Appeals found that the need for a high level of detail is plainly contemplated by the Sell case. Without evidence in the record that a psychiatrist who will be prescribing the drugs solely to render him competent to stand trial, the court cannot ensure as a legal matter under the second Sell prong that the administration of the drugs will be substantially unlikely to produce side effects that will interfere with Chavez’s ability to assist his attorney in presenting a defense. Also, without knowing which drugs the government might administer and at what dosage, the court has no evidence upon which it can determine under the fourth prong whether the treatment will be medically appropriate for Chavez. In addition, the court’s order sets no meaningful limits on the government’s discretion in treating Chavez and is so open-ended that it would give treatment staff carte blanche to experiment with what might be dangerous drugs or dangerously high dosages of drugs.

In making these findings, the Tenth Circuit followed the decisions from three other circuits. The Ninth Circuit held in United States v. Hernandez-Vasquez, 513 F.3d 908 (9th Cir. 2007), that to pass muster under Sell, 1) the district court’s order must identify the specific medication or range of medications the physicians are permitted to use, 2) the maximum dosages, and 3) the duration of time the involuntary medication may continue before requiring a report back to the court. Similarly, the Fourth Circuit held in United States v. Evans, 404 F.3d 227 (4th Cir. 2005), that the government must set forth the particular medication, including the dosage. The Sixth Circuit in United States v. Green, 532 F.3d 538 (6th Cir. 2008), also upheld a specific treatment plan that set forth the specific medications, alternative means of injecting it, the specific dosage, and the potential side-effects.

In following these cases, the Tenth Circuit decided that a balance must be struck between the judicial oversight needed to protect the defendant’s constitutional rights and the need of medical staff to retain flexibility in providing effective treatment. The Court then held that a court may approve a treatment plan as long as all drugs that might be administered to a defendant and their maximum dosages are specified. In so doing, the Tenth Circuit found that the district court’s order lacked sufficient information to determine whether the second and fourth requirements under Sell were met, reversed the order and remanded the case for further proceedings.

Found in DMHL Volume 33 Issue 1

Competency to Stand Trial/Restoration of Competency

Sell criteria for involuntary treatment to restore competency apply to sentencing phase

United States v. Cruz, 757 F.3d 372 (3d Cir. 2014) cert. denied, No. 14-7512, 2015 WL 133477 (U.S. Jan. 12, 2015)

Cruz was arrested and convicted on two counts of threatening a federal law enforcement officer. After the court received the pre-sentence investigation report, the prosecution successfully moved for a determination of competency. A Federal Bureau of Prisons forensic psychologist concluded that Cruz was mentally incompetent and suffered from schizophrenic disorder, bipolar type. After a hearing, the court concluded that Cruz was incompetent and found that he could not proceed with sentencing.

A second report concurred with the diagnosis, noted Cruz’s ongoing refusal to take antipsychotic medication recommended by BOP personnel, concluded that without medication Cruz would remain incompetent, and stated that “there is a substantial probability that [his] competency can be restored with a period of forced medication.” The prosecution obtained an order authorizing the BOP to medicate Cruz against his will.

On appeal, the issue was whether “the Government, pursuant to the Supreme Court's decision in Sell v. United States, 539 U.S. 166, 123 S.Ct. 2174, 156 L.Ed.2d 197 (2003), can have a sufficiently important interest in forcibly medicating a defendant to restore his mental competency and render him fit to proceed with sentencing.” In affirming the decision of the federal district court, the Third Circuit held that the government could have a sufficiently important interest in sentencing a defendant for serious crimes to justify involuntary medication. Relying on the stated concern in Sell that “memories may fade or evidence may be lost,” the Third Circuit held the same concern applies with equal force in the sentencing context (the guilt phase was at issue in Sell) because it means that it may be “difficult or impossible to sentence a defendant who regains competence after years of commitment.” Additionally, while it may be cognizable that some crimes are not “serious” enough to justify forcible medication at the sentencing stage, Cruz’s offense was certainly “serious” enough.

The United States Supreme Court denied certiorari in January 2015.

Found in DMHL Volume 34 Issue 1

Forced medications to restore competency to stand trial

After prior reversal and remand, the Fourth Circuit rules that the district court made the specific inquiries and findings in the record as required by Sell to support the determination that less restrictive alternatives to forced medication to restore competency were not available

U.S. v. Chatmon, 596 Fed.App’x 216 (4th Cir. 2015)

This case, though unpublished, provides useful guidance from the Fourth Circuit on the evidentiary foundations required to support a court order to restore a defendant to competency to stand trial through the forcible administration of medications.

Chatmon was indicted for conspiracy to distribute crack cocaine and heroin, an offense with a minimum sentence of 10 years and maximum of life imprisonment. Following submissions by his attorney that Chatmon’s condition during incarceration had deteriorated to the point that he could no longer assist counsel in his own defense, Chatmon was transferred for competence evaluation to the Butner Federal Medical Center, where he was diagnosed with paranoid schizophrenia.

The district court found Chatmon incompetent to stand trial. Chatmon was returned to Butner for evaluation of whether he could be restored to competence, where he was placed in solitary confinement. The evaluation report confirmed the diagnosis, noted that Chatmon denied having any mental illness and refused treatment, and stated there was a “substantial probability” that competency could be restored through treatment with haloperidol decanoate. The government requested Court authorization to restore Chatmon to competency through forced medication.

The district court found that the government had met the test set out in Sell v. United States, 539 U.S. 166, 181 (2003)8 , and authorized the forced medication. Chatmon appealed. In United States v. Chatmon, 718 F.3d 369 (4th Cir. 2013), the Fourth Circuit Court of Appeals reversed the district court and remanded the matter. The Court noted that the district court had made sufficient findings for the first, second, and fourth prongs of Sell, but had failed to consider less intrusive means for restoring competence. Chatmon had submitted evidence of improved behavior upon being transferred to the open population at Butner and an option of group therapy to improve competence. The Court also noted that a “court order to the defendant backed by the contempt power” is acceptable as a less intrusive means for administering drugs.

On remand from the Fourth Circuit, the district court ordered the defendant to take his medication or be held in civil contempt. The penalty was set as thirty days' imprisonment, during which medication was offered each day, but Chatmon declined it. The district court then reviewed deposition testimony addressing whether housing in Butner’s open population and group therapy could result in restoration. The doctors opined that improvements in behavior were not the same as improved competency or mental health, and that treatments other than medication could be beneficial but not by themselves effective treatment for psychosis. They stated that haloperidol was the “only” effective means to restore Chatmon’s competency. The defense offered no rebuttal to the testimony, and the district court ordered forced medication.

Chatmon appealed the district court’s new order, but the Fourth Circuit found that the record created by the district court “made careful findings” and “examined less intrusive means,” thus satisfying all Sell factors, before ordering that Chatmon be forcibly medicated.

Found in DMHL Volume 34 Issue 2

Forced medication of involuntarily committed patients

Disability Rights New Jersey, Inc. v. Comm'r, New Jersey Dep't of Human Servs., No. 13-4255, 2015 WL 4620273 (3d Cir. Aug. 4, 2015)

State administrative procedure authorizing hospital medical panel review and approval of forced medication of patients in non-emergency situations does not violate ADA or constitutional rights of patients

Background: Plaintiffs brought action challenging New Jersey’s administrative policy for the forcible medication of involuntarily committed persons in state psychiatric hospitals in non-emergency situations. The plaintiffs alleged that the policy—which required in-hospital medical panel review, approval and oversight of all proposed involuntary medications, with various procedural requirements and the right to inhospital appeal and review—violated the Americans with Disabilities Act (ADA), Rehabilitation Act (RA), and the 14th Amendment, and asked that the Court require the state to establish a procedure for judicial review. The district court found that the state’s administrative policy was valid, except as to patients who had been found by a court to be ready for discharge and were in the hospital awaiting transfer to the community (“CEPP” patients). The district court granted summary judgment to the state in regard to all but the CEPP patients. Summary judgment was awarded to the plaintiffs in regard to the CEPP patients. Both the plaintiffs and the state appealed.

Holdings: A 3-judge panel of the Court of Appeals affirmed the district court’s ruling, “though not for all its stated reasons.” The panel, relying heavily on the U.S. Supreme Court’s decision in Washington v. Harper, 494 U.S. 210 (1990), found that New Jersey’s medically-based panel review process properly balanced the liberty interests of the nonCEPP patient with the state’s interests in both the safety of the hospital and the treatment and return to the community of the patient. Relying on Mathews v. Eldridge, 424 U.S. 319 (1976), however, the panel found the CEPP patients’ due process rights were violated by New Jersey’s policy.

Notable Points:

Due process analysis by the Court for non-CEPP patients: Noting that the U.S. Supreme Court had never addressed the constitutional right of involuntarily committed patients to refuse recommended medications for treatment, the panel adopted the balancing test applied to prisoners who refuse recommended psychotropic medications. The panel explained that, although convicted criminals in prisons do not have the same due process rights as persons held in non-criminal facilities, the U.S. Supreme Court’s treatment of forced medications in such cases makes clear that they can be justified only for non-punishment purposes; thus, application of Harper was not confined to prisoners. Because the New Jersey policy was essentially identical to the policy challenged in Harper, the panel found that it met all due process and related constitutional standards.

Due process analysis by the Court for CEPP patients: The panel specifically found that the standards in Harper could not be applied to CEPP patients, who had been “adjudicated by a court to be nondangerous.” The panel turned to the 3-pronged balancing test set out in Mathews v. Eldridge. 10 The panel noted that the administrative policy would permit forcible medication “even after a judge has ruled that the factual basis for their continued civil commitment has disappeared.” If a patient on CEPP status had so deteriorated that forcible medication of that patient had become necessary, the “appropriate course” for the state would be to recommit the patient.

Found in DMHL Volume 34 Issue 3

Restoration of competency through forcible medication

United States v. Watson, 793 F.3d 416 (4th Cir. 2015)

Sell standard requires government to make a particularized showing by clear and convincing evidence that proposed treatment is substantially likely to restore defendant to competency

Background: The government requested court authorization to medicate defendant involuntarily in order to restore him to competency to stand trial. The district court granted the request finding that the government had met the Sell requirements8 by clear and convincing evidence. Defendant appealed, claiming that the government failed to satisfy (1) the first Sell prong because the “important governmental interest at stake” in prosecuting Watson was mitigated by the fact that Watson had the “possibility” of an affirmative defense of “not guilty by reason of insanity” and (2) the second Sell prong because the government did not prove that the proposed forced medication was substantially likely to render Watson competent to stand trial.

Holdings: In a 2-1 panel decision, the Court reversed the District Court, holding that the record showed that the government not only failed to meet the second Sell prong, but could not meet it, and it dismissed the matter, without remand to the District Court for further hearing.

Notable Points: Emphasizing the importance of the liberty interest at stake, the intrusiveness of the act of forcible medication, and the burden of “clear and convincing evidence” that the government had to meet, the Court ruled that the evidence in the record failed to show that the forced medication proposed for Watson was substantially likely to restore Watson to competency. The Court, noting that Watson had a “rare” delusional disorder, concluded that the government’s expert, and the research relied upon by that expert, addressed the efficacy of the proposed forced medication for people suffering from psychosis in general and that the government failed to address the medication’s likely effect on this defendant in particular.

Found in DMHL Volume 34 Issue 3

Forced administration of medication to restore defendant to competency to stand trial under the Sell standard

Oregon State Hosp. v. Butts, 359 P.3d 1187 (Or. 2015)

Mandamus action cannot be used by hospital where defendant is being treated to challenge decision of trial court that Sell standard has been met

Background: Daniel Butts was charged with 21 felony counts, including nine counts of aggravated murder. When the Circuit Court found him unable to assist in his own defense, Butts was committed to a state hospital. The Circuit Court then entered a Sell order, directing the hospital to involuntarily medicate Butts in order to restore his competency to stand trial. The hospital, having determined that the treatment was not medically necessary, petitioned the Supreme Court for a writ of mandamus directing the trial court to vacate the order, and the Supreme Court of Oregon issued an alternative writ of mandamus while it heard the parties’ arguments.

Holdings: The Supreme Court of Oregon ultimately dismissed the alternative writ of mandamus. It held that (1) mandamus relief was not available to the hospital based solely on its disagreement with the trial court’s findings of fact, and (2) the trial court had implied authority under the applicable statute (determination of fitness statute) to issue a Sell order. The Supreme Court began its discussion of the mandamus issue by stating that “it has become hornbook law in this state that the writ of mandamus cannot be used as a means of controlling judicial discretion.” A writ of mandamus can only be used if the trial court’s decision represents “fundamental legal error” or is “outside the permissible range of discretionary choices.” Thus, the primary issue on review was whether the trial court had the power to order the hospital to involuntarily medicate Butts when the hospital did not agree that the medication was medically necessary.

The Supreme Court of Oregon noted that it had already concluded that courts have implicit authority to issue Sell orders. It noted that the trial court “made extensive findings of fact based on medical evidence” and did so “after resolving disputed factual issues based on medical testimony in the proper exercise of its role as factfinder.” Ultimately, the Supreme Court of Oregon rejected the hospital’s argument that it should be granted “veto power” where a hospital disagrees with a court’s issuance of a Sell order.

Found in Found in DMHL Volume 34, Issue 4

Forced administration of medication to restore defendant to competency to stand trial under the Sell standard

Warren v. State, 778 S.E.2d 749 (Ga. 2015)

Trial court's order “was insufficient in numerous respects” to support defendant’s forced medication for the sole purpose of restoring his competency for trial

Background: After Jesse James Warren was indicted on four counts of murder in connection with a mass shooting, he was found incompetent to stand trial and placed in the custody of the Department of Behavioral Health and Development Disabilities. The state of Georgia filed a petition under Sell to medicate Warren involuntarily in an attempt to restore his competency. The Superior Court for Cobb County granted the state’s motion and the defendant appealed.

Holdings: The Georgia Supreme Court held that, although the state had important governmental interests in restoring Warren’s competency for a timely prosecution and no special circumstances significantly undermined those interests, the factual findings were insufficient to support Warren’s involuntary medication. Important to the Georgia Supreme Court was the “absence of a specific treatment plan” that identified the drugs the State proposed to administer, in what doses and by what methods. The Court noted that “courts must consider less intrusive means for administering the drugs” (emphasis added by Georgia Supreme Court). Finally, the Court pointed to an absence of evidence in the record suggesting that the State sought to involuntarily medicate Warren for “the alternative purpose of preventing him from being a danger to himself or others.”

Found in Found in DMHL Volume 34, Issue 4

Administration of Psychotropic Medication over Objection of NGRI Patient

People v. Marquardt, 364 P.3d 499 (Co. 2016)

In the case of a person who is a hospitalized NGRI acquittee and currently receiving antipsychotic medication that is preventing further deterioration of the person but is insufficient to improve person’s condition, the Colorado Supreme Court rules that the person’s objection to increased medication must be honored despite state’s claim that more medication is needed for any improvement.

Background: After being found not guilty by reason of insanity and being diagnosed with schizoaffective disorder, bipolar type, with prominent paranoia, Larry Marquardt was committed to the Colorado Mental Health Institute at Pueblo (“CMHIP”). Marquardt, at first, took ten milligrams of antipsychotic medication daily, and refused to take more. Because his attending psychiatrist felt that a dose of ten milligrams was only partially effective, the State petitioned to have the dosage increased to the maximum of twenty milligrams daily. The trial court found that an increased dosage was “necessary to prevent a significant long-term deterioration in [Marquardt’s] mental condition.” Because the court determined that Marquardt would not be released from the institution unless his condition improved, and that that was unlikely without an increased medication, the trial court ordered Marquardt to submit to the increased dose. Marquardt appealed, arguing that the trial court had misapplied the controlling case law, People v. Medina, 705 P.2d 961 (1985).

Holding: The Supreme Court of Colorado found that the trial court had applied the incorrect legal test—misapplying Medina by relying on evidence that Marquardt was not improving on the lower dose. Rather, the court explained, Medina required that a court must find a patient to be deteriorating in order to justify increased medication against the patient’s wishes.

Notable Points:

Deterioration, not just lack of improvement, is required for an order of forced medication: People v. Medina, 705 P.2d 961 (1985) sets forth a test to determine whether non-consenting treatment by antipsychotic medication may be administered to an involuntary committed mental patient. The test is one that involves mixed questions of law and fact, and is a four-factor test. The State must show: “(1) that the patient is incompetent to effectively participate in the treatment decision; (2) that treatment by antipsychotic medication is necessary to prevent a significant and likely long-term deterioration in the patient's mental condition or to prevent the likelihood of the patient's causing serious harm to himself or others in the institution; (3) that a less intrusive treatment alternative is not available; and (4) that the patient's need for treatment by antipsychotic medication is sufficiently compelling to override any bona fide and legitimate interest of the patient in refusing treatment. To determine whether a patient is “in danger of long-term deterioration” it is not enough to show that a patient will not likely recover without an increased dose of medication—the State must show that there is a danger of long-term deterioration in the patient’s condition. Although the state has a legitimate interest in institutional security, that interest is not sufficient to expose those in its care to increased or nonconsensual medication “solely for the purpose of alleviating the risk of some possibility of future injury or damage to the patient or others.”

Found in Found in DMHL Volume 35, Issue 1

Treatment over Objection to Restore Defendant to Competency to Stand Trial

U.S. v. Onuoha, 820 F.3d 1049 (9th Cir. 2016)

Ninth Circuit vacates and remands district court order authorizing treatment, finding government failed to show proposed treatment is in the defendant’s best medical interests.

Background: From 2004 to 2012, Onuoha served in the National Guard. From 2006 to September 2013, when he resigned, Onuoha worked as a Transportation Security Administration (TSA) screener at LAX Airport. A few hours after resigning, Onuoha returned to TSA headquarters at LAX and left a note for a former supervisor who had been involved in a suspension of Onuoha earlier that summer. The government alleged that Onuoha then made calls to a TSA checkpoint and to the LAX police department alluding to sending a message to America and the world and telling them to evacuate LAX. TSA headquarters was evacuated. Law enforcement officials went to Onuoha’s apartment and discovered that all of his belongings had been removed and all that remained was a large note reading “09/11/2013 THERE WILL BE FIRE! FEAR! FEAR! FEAR!” Later that day, Onuoha called LAX police and told them that he was at a church in Riverside, CA. He told police that he did not intend to make a bomb threat or injure anyone and that he only wanted to deliver a message. Onuoha waited at the church until he was apprehended.

Onuoha’s defense counsel submitted a report that Onuoha suffered from paranoid schizophrenia and planned to raise a diminished-capacity defense. The government requested a competency evaluation, and Onuoha was found not competent to stand trial. The government then filed a motion for an order to involuntarily medicate Onuoha with the goal of restoring him to competency, which the district court granted.

Holding: On appeal, the Ninth Circuit vacated and remanded, holding that the district court erred in finding that the proposed treatment was in Onuoha’s best medical interest under the Sell test. The court of appeals held that the district court was correct in finding that there is an important government interest at stake in prosecuting Onuoha, but the district court clearly erred in finding that the proposed course of treatment was in Onuoha’s best medical interests.

Notable Points:

The seriousness of the offense outweighed the “special circumstance” of time detained: The first Sell factor requires the government to prove that important governmental interests are at stake in prosecuting Onuoha. In Sell, the court recognized that there may be some special circumstances that diminish the government’s interest in prosecution, including the amount of time the defendant had already been confined. In this case, the court considered that Onuoha had already spent time in custody since September 2013, amounting to confinement beyond the minimum possible sentence. Nevertheless, the court found it important that a conviction and resulting sentence for the serious crime at issue is significant in terms of general deterrence, not just incapacitation of a specific individual. Here, the court concluded that the government’s valid interest in prosecuting Onuoha outweighed any special circumstances of Onuoha’s detention.

The government did not meet its burden for proving the fourth Sell factor by clear and convincing evidence: The fourth Sell factor requires the government to prove that administration of the drugs is medically appropriate and therefore in Onuoha’s best medical interest in light of his medical condition. The Ninth Circuit held that after hearing the testimony of a medical expert experienced in administering involuntary medication, the district court could not credit the expert’s testimony without exploring contradictory evidence in the record. In this case, contradictory evidence included that the recommended treatment increased the risk of side effects, the dosage proposed was higher than is generally recommended, and the use of the proposed drug does not conform to the community standard of care. Because involuntary medication orders are disfavored in light of the significant liberty interests at stake, and because the record demonstrated that the proposed treatment included dosages higher than generally recommended, the medication was not in Onuoha’s best medical interest.

Found in DMHL Volume 35, Issue 2

Treatment over Objection to Restore Defendant to Competency to Stand Trial

United States v. Sheikh, No. 15-4616, 2016 U.S. App. LEXIS 9920 (4th Cir. June 1, 2016)

Fourth Circuit upholds district court order authorizing treatment. [Editor’s Note: This is an unpublished opinion and, thus, is not binding precedent. It is included because it is an instructive case regarding fact-finding under Sell and United States v. Watson, 793 F.3d 416 (4th Cir. 2015). DMHL previously covered Watson in Volume 34, Issue 3.]

Background: The United States charged Basit Javed Sheikh with one count of violating 18 U.S.C. § 2339B after his alleged attempt to join al-Nusrah Front, a foreign terrorist organization designated by the Secretary of State as an alias for al-Qa’ida. The district court concluded that Sheikh was incompetent to stand trial after two pretrial competency examinations, and ordered him hospitalized for attempted competency restoration. Sheikh refused to cooperate with treatment, and the United States moved for permission to involuntarily medicate him based on his psychiatric evaluation. At the Sell hearing, three medical experts testified and the district court determined that involuntary medication was appropriate. The order was stayed pending Sheikh’s anticipated interlocutory appeal.

Holding: The Fourth Circuit affirmed, holding that the district court had properly applied the four-part test established by Sell, and had adequately explained its findings. The court found that involuntary medication of the defendant would significantly further the United States’ prosecution interests without a substantial likelihood of producing side effects that would interfere with the defendant’s ability to assist counsel in conducting a defense.

Notable Points:

The possibility of civil commitment did not sufficiently mitigate the United States’ prosecutorial interest to preclude involuntary medication: The first Sell factor weighs the government’s interest in bringing to trial an individual accused of a “serious” crime. Fourth Circuit precedent has recognized that a crime carrying a statutory maximum of ten years or more qualifies as “serious” within the Sell context—the crime of which Sheikh was accused carried a statutory maximum of fifteen years. Despite this strong prosecutorial interest, Sheikh contended that the district court had erred by failing to find the possibility of his civil commitment to be a special circumstance sufficient to negate the United States’ prosecutorial interests (see U.S. v. Onuoha below, which discusses special circumstances as well). Sheikh argued that the likelihood of his civil commitment mitigated (and negated) the government’s prosecutorial interest because they “need not be concerned that he will be released to the public” even in the absence of a conviction.

The Fourth Circuit disagreed. Although the district court did weigh the possibility of civil commitment, it found that, particularly given the nature of the charges against Sheikh, that possibility did not negate the government’s prosecutorial interests. Stating that “not every serious crime is equally serious,” the Fourth Circuit found that the government’s interest in combating terrorism is “an urgent objective of the highest order” and that the relevant criminal statute (§ 2339B) represents the “considered judgment of Congress and the Executive that providing material support to a designated foreign terrorist organization—even seemingly benign support— bolsters the terrorist activities of that organization.” Ultimately, the Fourth Circuit held that although the possibility of civil commitment mitigates one aspect of the government’s prosecutorial interest (i.e., ensuring Sheikh will not be released into the community), it did not address the additional prosecutorial interest of general deterrence that is achieved when “a person is convicted of a serious crime, thus deterring others from making the same mistake.”

Found in DMHL Volume 35, Issue 2

Judicial Order Authorizing Involuntary Administration of Medication in Hospital Setting

In re I.G., 2016 VT 95

Vermont Supreme Court reverses lower court order authorizing medication over objection of involuntarily committed patient because the lower court failed to make specific findings on whether patient’s written statement of objection to medication, made prior to hospitalization, was a competent refusal that had to be honored under Vermont law.

Background: I.G. was hospitalized at the Vermont Psychiatric Care Hospital (VPCH) pursuant to a court order stemming from an arrest for assaulting his girlfriend. I.G. was previously hospitalized at VPCH and was diagnosed with schizophrenia. When he was discharged from VPCH after the previous hospitalization, he started living at a residence for people with mental illness. While there, I.G. signed a document purported to be an advance directive stating that he did not want any psychiatric medication. Following I.G.’s current hospitalization, VCPH filed an application to involuntarily medicate I.G. After a hearing, the trial court ordered I.G.’s involuntary medication for 90 days. I.G. appealed. 

Holding: The Vermont Supreme Court ruled that the trial court did not adequately address the issue of whether the purported advance directive was a competent written expression or preference regarding medication according to Vermont statute. The court reversed and remanded for a determination of I.G.’s competency at the time of signing the advance directive.

Notable Point:

Advance directive: The Vermont Supreme Court reversed the decision of the trial court even though the advance directive at issue in this case did not meet the statutory requirements of an advance directive because it was not signed by two witnesses.

Found in DMHL Volume 35, Issue 3