Case Title: Oregon v. Lopes

Citation: 

Docket Number: S061395

State: oregon

Court: Oregon Supreme Court

Date: 2014-03-20T00:00:00Z

Document:
Filed: March 20, 2014 
 
IN THE SUPREME COURT OF THE STATE OF OREGON 
 
STATE OF OREGON, 
Plaintiff-Adverse Party, 
 
v. 
 
JAMES MICHAEL FRANCIS LOPES,  
aka James Michael Francis Lopez, 
Defendant-Relator. 
 
(CC 120833467; SC S061395) 
 
 
En banc 
 
 
Original proceeding in mandamus.* 
 
 
Argued and submitted December 4, 2013. 
 
Laura Graser, Portland, argued the cause and filed the brief for defendant-relator. 
 
Leigh A. Salmon, Assistant Attorney General, Salem, argued the cause and filed 
the brief for plaintiff-adverse party.  With her on the brief were Ellen F. Rosenblum, 
Attorney General, and Anna M. Joyce, Solicitor General. 
 
Erin C. Lagesen, Assistant Attorney General, Salem, filed a brief for amicus 
curiae Oregon Health Authority.  With her on the brief were Ellen F. Rosenblum, 
Attorney General, and Anna M. Joyce, Solicitor General. 
 
Julia E. Markley, Perkins Coie LLP, Portland, filed a brief for amicus curiae The 
American Civil Liberties Union of Oregon, Inc.  With her on the brief were Kristina J. 
Holm and Joanna T. Perini. 
 
 
WALTERS, J. 
 
Peremptory writ of mandamus to issue. 
*On petition for alternative writ of mandamus from an order of the Multnomah 
County Circuit Court, Eric J. Bloch, Judge. 
 
1 
 
 
 
WALTERS, J. 
1 
 
 
Relator seeks a peremptory writ of mandamus directing the Multnomah 
2 
County Circuit Court to vacate an order authorizing the involuntary administration of 
3 
medication for the purpose of restoring relator's trial competence.  For the reasons that 
4 
follow, we conclude that, although trial courts have statutory authority to enter such 
5 
orders, the order that the trial court entered in this case did not comport with the due 
6 
process requirements of the federal constitution as articulated in Sell v. United States, 539 
7 
US 166, 123 S Ct 2174, 156 L Ed 2d 197 (2003).  Accordingly, we issue the writ. 
8 
 
 
The uncontested facts are as follows.  Relator was arrested on August 16, 
9 
2012, and charged with attempted sex abuse in the first degree.  ORS 163.427(1)(a)(A).  
10 
The indictment alleges that relator attempted to subject a person under 14 to sexual 
11 
contact by attempting to touch a sexual or intimate part of her body.  Attempted sex 
12 
abuse in the first degree is a class C felony. 
13 
 
 
Relator remained in jail pending trial, but, on October 4, 2012, the court 
14 
found reason to doubt relator's fitness to proceed and, after an evaluation, found relator 
15 
unable to aid and assist in his defense.  On November 19, 2012, the court committed 
16 
relator to the Oregon State Hospital (hospital) to be treated until fit. 
17 
 
 
On January 2, 2013, the hospital sent the trial court a letter stating that there 
18 
was no substantial probability that relator would gain or regain the ability to stand trial in 
19 
the foreseeable future.  In the accompanying report, the evaluator specifically stated that 
20 
"[w]ithout an ability to provide psychiatric medication interventions there is no 
21 
substantial probability that [relator] will regain the ability to proceed within the 
22 
2 
 
foreseeable future."  (Emphasis added.)  Relator was discharged from the hospital and 
1 
returned to jail. 
2 
 
 
The court ordered that relator be returned to the hospital for further 
3 
evaluation; the hospital again informed the court that "the unfortunate reality [is] that we 
4 
cannot medicate him against his will [because] he does not have an immediate problem 
5 
with violence or grave disability related to his own self-care." 
6 
 
 
On February 11, 2013, relator moved to dismiss the charges against him.  
7 
The court denied the motion "without prejudice."  On March 27, 2013, the hospital sent 
8 
another letter to the court reiterating that there was no substantial probability that relator 
9 
would regain competency because relator "refuses to take psychotropic medication." 
10 
 
 
A hearing was set on relator's motion to dismiss.  During the hearing, the 
11 
trial court focused on two issues:  first, whether the court had authority to order that 
12 
relator be involuntarily medicated; and, second, if the court had that authority, whether 
13 
the state had proved that an order requiring involuntary medication would comport with 
14 
the constitutional limitations articulated in Sell. 
15 
 
 
As to the first issue, the trial court considered memoranda and arguments 
16 
presented by both parties and concluded that it had authority to order that relator be 
17 
involuntarily medicated.  The court then heard testimony on the factors required to 
18 
support an order under Sell.  Relator's treating psychiatrist testified that there was a 
19 
substantial likelihood that medication could help relator aid and assist and that 
20 
administration of antipsychotic medication was medically appropriate.  On June 3, 2013, 
21 
the court entered an order, which we will refer to as the Sell order, including the 
22 
3 
 
following findings and reaching the following conclusions: 
1 
"5. [Relator] is charged with a serious crime against a person or a 
2 
serious crime against property. (The facts of the individual case must 
3 
be taken into consideration and outlined in making this 
4 
determination.)  The facts are outlined in the State's Probable Cause 
5 
Affidavit and incorporated herein, as Exhibit 1. 
6 
"6. Administration of the medication to [relator] is substantially 
7 
likely to render [relator] competent to stand trial. 
8 
"7. The medication to be administered is substantially unlikely to 
9 
have side effects that will interfere significantly with [relator]'s 
10 
ability to assist counsel in conducting a trial defense. 
11 
"8. Any alternative, less intrusive treatments are unlikely to achieve 
12 
substantially the same results. 
13 
"9. There are no less intrusive means for administering the 
14 
medication. 
15 
"10. Administration of the medication to [relator] is medically 
16 
appropriate, i.e., in [relator]'s best medical interest in light of his 
17 
medical condition. 
18 
"11. There are important governmental interests at stake in bringing 
19 
[relator] to trial, and the involuntary administration of the proposed 
20 
medication will significantly further those state interests and are 
21 
necessary to further those interests." 
22 
(Emphasis in original; bold face deleted.)  The trial court also ordered that relator be 
23 
medicated in accordance with a list of medications and dosages approved by relator's 
24 
psychiatrist. 
25 
 
 
At relator's request, the trial court immediately entered a stay of the Sell 
26 
order to permit relator to challenge it in this court.  Relator then petitioned this court for a 
27 
writ of mandamus directing the trial court to vacate the Sell order.  This court stayed the 
28 
trial court's order and issued an alternative writ of mandamus directing the trial court 
29 
4 
 
either to vacate the Sell order or to show cause for not doing so. 
1 
 
 
This case presents two distinct questions: 
2 
 
 
1.  Do Oregon trial courts have authority to issue orders authorizing 
3 
hospitals to involuntarily medicate patients for the purpose of restoring trial competency? 
4 
 
 
2.  If trial courts do have that authority, did the trial court's order in this 
5 
case comport with the due process requirements of the federal constitution as articulated 
6 
in Sell? 
7 
TRIAL COURT AUTHORITY TO ISSUE SELL ORDERS  
8 
 
 
With regard to the first question, relator argues that Sell assumes, but does 
9 
not grant, judicial authority to issue Sell orders, and that, without explicit statutory 
10 
authorization, trial courts lack that power.  Moreover, relator contends, hospital patients 
11 
have a statutory right to refuse antipsychotic medication, and that right may not be denied 
12 
for the purpose of restoring competency to stand trial. 
13 
 
 
In considering relator's arguments, we must analyze the Oregon statutes and 
14 
administrative rules that apply when a trial court finds a defendant incompetent to aid and 
15 
assist at trial and commits the defendant to a hospital for treatment.  As context for that 
16 
analysis, however, we begin with the United States Supreme Court's reasoning in two 
17 
cases that address an individual's constitutional right to due process when the state seeks 
18 
to medicate the individual against his or her will:  Sell and Washington v. Harper, 494 US 
19 
210, 110 S Ct 1028, 108 L Ed 2d 178 (1990). 
20 
 
 
The petitioner in Harper was a convicted prisoner who had been committed 
21 
to a mental health facility within the state prison system.  When the petitioner refused to 
22 
5 
 
take antipsychotic medication, the medical authorities followed a hearing process 
1 
authorized by the facility's administrative rules and obtained an order that permitted the 
2 
facility to administer the medication involuntarily.1 494 US at 214.  The applicable rules 
3 
permitted the involuntary medication of inmates who were a danger to themselves or 
4 
others or who were gravely disabled. 2  Id. at 215.  When the case reached the United 
5 
States Supreme Court, the Court upheld the facility's order and rejected the petitioner's 
6 
argument that, because the order impinged on the petitioner's liberty interest, due process 
7 
required a judicial hearing in addition to the administrative process that the petitioner had 
8 
been afforded.  Id. at 222. 
9 
 
 
In Sell, a magistrate judge had committed the defendant to a treatment 
10 
facility to restore his ability to aid and assist in his defense, and later had entered an order 
11 
permitting the facility to involuntarily medicate the defendant. 539 US at 171.  On 
12 
appeal, the federal district court determined that the defendant was not dangerous as that 
13 
term was used in Harper but nevertheless affirmed.  Id. at 173-74.  In the United States 
14 
Supreme Court, the issue was whether due process precluded a court from ordering the 
15 
involuntary administration of antipsychotic medication to render a defendant competent 
16 
to stand trial.  The Court held that the constitution permits such an order, but "only if the 
17 
                                              
 
1 
In Harper, the Court noted that the facility's procedures had been developed 
in response to the Court's prior decision in Vitek v. Jones, 445 US 480, 100 S Ct 1254, 63 
L Ed 2d 552 (1980), in which the Court had held that similar procedural protections were 
required before the government could transfer a prisoner to a mental health facility.  
Harper, 494 US at 215. 
 
2 
"Grave disability" was defined by the administrative rules as a condition 
that, left untreated, would cause harm.  Id. n 3. 
6 
 
treatment is medically appropriate, is substantially unlikely to have side effects that may 
1 
undermine the fairness of the trial, and, taking account of less intrusive alternatives, is 
2 
necessary significantly to further important governmental trial-related interests."  Sell, 
3 
539 US at 179.  Accordingly, the Court explained, a court must consider four factors and 
4 
make findings as to each before it approves such an order.3  Id. at 179-84. 
5 
 
 
Relator correctly argues that Sell did not grant trial courts authority to issue 
6 
Sell orders.  Sell arose as an interlocutory appeal from a magistrate's order, and the 
7 
Supreme Court did not have occasion to consider or explore the statutory basis for the 
8 
trial court's authority to issue a Sell order.  Relator therefore is correct that trial court 
9 
authority to issue Sell orders must be found in Oregon law. 
10 
 
 
Unlike many states,4 Oregon has not enacted statutes that explicitly grant 
11 
                                              
 
3 
Although the Court in Sell did not specifically hold that a court as opposed 
to a medical facility must make the requisite findings, the Court referred throughout the 
opinion to findings that "a court" must make.  See, e.g., 539 US at 180 ("a court must find 
that important governmental interests are at stake"); id. at 181 ("the court must conclude 
that involuntary medication will significantly further those concomitant state interests"); 
id. at 183 ("When a court must nonetheless reach the trial competence question, the 
factors discussed above * * * should help it make the ultimate constitutionally required 
judgment.").  (Emphases in original.)  
 
 
The federal regulations addressing the treatment of defendants committed 
because of unfitness to stand trial now require that a court make the requisite findings.  
As noted in United States v. Mann, 532 Fed Appx 481, 487-88 (5th Cir 2013), in 2011 
the regulations were "clarified and updated to reflect current caselaw."  The amendments 
reflected the understanding of the Bureau of Prisons that, under Sell, "[o]nly a Federal 
court of competent jurisdiction may order the involuntary administration of psychiatric 
medication for the sole purpose of restoring a person's competency to stand trial."  
Psychiatric Evaluation and Treatment, 76 Fed Reg 40229-02 (July 8, 2011); see also 28 
CFR § 549.46. 
 
4 
See, e.g., California, Cal Penal Code § 1370(a)(2)(B)(ii), (a)(2)(B)(i)(III) 
7 
 
trial courts authority to enter Sell orders or that implement the Court's decision in Sell.  
1 
The Oregon legislature enacted ORS 161.360 to 161.370, the statutes that govern a 
2 
defendant's incompetence to stand trial, in 1971, before Sell was decided.  Or Laws 1971, 
3 
ch 743, §§ 50 to 52.  Neither those statutes as originally enacted nor the amendments to 
4 
those statutes expressly grant trial courts authority to enter Sell orders or set forth the 
5 
criteria that a court should apply when considering whether to grant such an order.5   
6 
However, the state argues, the broad authority that those statutes do grant to trial courts 
7 
includes, by implication, authority to issue Sell orders in appropriate circumstances.  To 
8 
assess the state's argument, we outline the applicable statutory framework. 
9 
 
 
Under ORS 161.360(1), if a trial court "has reason to doubt the defendant's 
10 
                                                                                                                                                  
(tracking Sell factors and requiring court order to involuntarily medicate defendant); 
Connecticut, Conn Gen Stat § 54-56d(k)(2) (permitting defendant to be medicated 
involuntarily if Sell factors established by clear and convincing evidence); Illinois, 405 
ILCS 5/2-107.1(a-5)(4)(stating factors necessary to permit involuntary medication); Ohio 
Rev Code Ann § 2945.38(B)(1)(c) (stating factors necessary to permit involuntary 
medication and requiring court order); Pennsylvania, 50 Pa Cons Stat § 7402(b) 
(allowing involuntary treatment to restore competency by court order); Utah Code Ann § 
77-15-6.5(3) (specifically tracking Sell factors). 
 
5 
In 1993, the legislature amended ORS 161.370 to bring it into compliance 
with Jackson v. Indiana, 406 US 715, 92 S Ct 1845, 32 L Ed 2d 435 (1972).  Testimony, 
Senate Judiciary Committee, SB 501, Mar 29, 1993, Ex F (statement of Bob Joondeph, 
Oregon Advocacy Center).  Jackson held that a defendant committed "solely on account 
of his incapacity to proceed to trial cannot be held more than the reasonable period of 
time necessary to determine whether there is a substantial probability that he will attain 
that capacity in the foreseeable future."  Id. at 738.  In response to the concern that the 
statute did not comport with the federal standard, the legislature required that a hospital 
and a trial court determine whether a defendant is likely to recover capacity, and that, if a 
defendant is not likely to regain capacity, the defendant be civilly committed or 
discharged.  Or Laws 1993, ch 238, § 3. 
 
8 
 
fitness to proceed by reason of incapacity," the court may order an examination.6  The 
1 
court may call witnesses on the issue or order the defendant to be evaluated by a 
2 
psychiatrist or psychologist.  ORS 161.365.7  The court then must determine whether the 
3 
defendant is fit to proceed, and, if the issue is contested, hold a hearing.  ORS 
4 
161.370(1).8  If the court determines that the defendant lacks fitness to proceed, the court 
5 
                                              
6 
ORS 161.360 provides: 
 
"(1) If, before or during the trial in any criminal case, the court has 
reason to doubt the defendant's fitness to proceed by reason of incapacity, 
the court may order an examination in the manner provided in ORS 
161.365. 
 
"(2) A defendant may be found incapacitated if, as a result of mental 
disease or defect, the defendant is unable: 
 
"(a) To understand the nature of the proceedings against the 
defendant; or 
 
"(b) To assist and cooperate with the counsel of the defendant; or 
 
"(c) To participate in the defense of the defendant." 
7  
ORS 161.365 provides, in part: 
 
"(1) When the court has reason to doubt the defendant's fitness to 
proceed by reason of incapacity as described in ORS 161.360, the court 
may call any witness to its assistance in reaching its decision.  If the court 
determines the assistance of a psychiatrist or psychologist would be helpful, 
the court may: 
 
"(a) Order that a psychiatric or psychological examination of the 
defendant be conducted by a certified evaluator * * * and a report of the 
examination be prepared; or 
 
"(b) Order the defendant to be committed for the purpose of an 
examination * * * ." 
8 
ORS 161.370(1) provides: 
9 
 
must suspend the criminal proceeding.  ORS 161.370(2).9  If the court decides that the 
1 
defendant is "dangerous to self or others as a result of mental disease or defect" or that 
2 
"the services and supervision necessary to restore the defendant's fitness to proceed are 
3 
not available in the community," the court "shall commit the defendant" to a hospital or 
4 
another facility designated by the Oregon Health Authority (OHA).  ORS 161.370(2)(a). 
5 
 
 
On commitment, ORS 161.370(5) requires the hospital to evaluate the 
6 
defendant.10  Within 90 days of the defendant's commitment, the hospital must notify the 
7 
                                                                                                                                                  
 
"When the defendant's fitness to proceed is drawn in question, the 
issue shall be determined by the court.  If neither the prosecuting attorney 
nor counsel for the defendant contests the finding of the report filed under 
ORS 161.365, the court may make the determination on the basis of the 
report.  If the finding is contested, the court shall hold a hearing on the 
issue.  If the report is received in evidence in the hearing, the party who 
contests the finding has the right to summon and to cross-examine any 
psychiatrist or psychologist who submitted the report and to offer evidence 
upon the issue.  Other evidence regarding the defendant's fitness to proceed 
may be introduced by either party." 
9  
ORS 161.370(2) provides, in part: 
 
"If the court determines that the defendant lacks fitness to proceed, 
the criminal proceeding against the defendant shall be suspended and: 
 
"(a) If the court finds that the defendant is dangerous to self or others 
as a result of mental disease or defect, or that the services and supervision 
necessary to restore the defendant's fitness to proceed are not available in 
the community, the court shall commit the defendant to the custody of the 
[hospital]* * *[.]" 
10 
ORS 161.370(5) provides:  
 
"The [hospital] to which the defendant is committed shall cause the 
defendant to be evaluated within 60 days from the defendant's delivery into 
the [hospital’s] custody, for the purpose of determining whether there is a 
substantial probability that, in the foreseeable future, the defendant will 
have the capacity to stand trial.  In addition, the [hospital] shall: 
10 
 
court whether (1) the defendant is presently fit to stand trial; (2) there "is no substantial 
1 
probability that, in the foreseeable future, the defendant will gain or regain the capacity to 
2 
stand trial;" or (3) there "is a substantial probability that, in the foreseeable future, the 
3 
defendant will gain or regain the capacity to stand trial."  ORS 161.370(5)(b). 
4 
 
 
On notification, the trial court must determine whether it concurs and take 
5 
appropriate action.  ORS 161.370(9).11  If the trial court determines that there is no 
6 
substantial probability that the defendant will gain or regain the capacity to stand trial in 
7 
the foreseeable future, the court must either discharge the defendant or initiate civil 
8 
                                                                                                                                                  
 
"(a) Immediately notify the committing court if the defendant, at any 
time, gains or regains the capacity to stand trial or will never have the 
capacity to stand trial. 
 
"(b)Within 90 days of the defendant's delivery into the [hospital's] 
custody, [the hospital must] notify the committing court that: 
 
"(A) The defendant has the present capacity to stand trial; 
 
"(B) There is no substantial probability that, in the foreseeable 
future, the defendant will gain or regain the capacity to stand trial; or 
 
"(C) There is a substantial probability that, in the foreseeable future, 
the defendant will gain or regain the capacity to stand trial.  If the 
probability exists, the [hospital] shall give the court an estimate of the time 
in which the defendant, with appropriate treatment, is expected to gain or 
regain capacity." 
11  
ORS 161.370(9) provides: 
 
"When the committing court receives a notice * * * concerning the 
defendant's progress or lack thereof, the committing court shall determine, 
after a hearing, if a hearing is requested, whether the defendant presently 
has the capacity to stand trial." 
11 
 
commitment proceedings.  ORS 161.370(10).12  If the court determines, instead, that 
1 
there is a substantial probability that the defendant will gain or regain the capacity to 
2 
stand trial, then, "unless the court otherwise orders," the "defendant shall remain in the 
3 
[hospital's] custody where the defendant shall receive treatment designed for the purpose 
4 
of enabling the defendant to gain or regain capacity."  ORS 161.370(6)(a).13  In that 
5 
event, the hospital must provide the court with "an estimate of the time in which the 
6 
                                              
12 
ORS 161.370(10) provides: 
 
"If at any time the court determines that the defendant lacks the 
capacity to stand trial, the court shall further determine whether there is a 
substantial probability that the defendant, in the foreseeable future, will 
gain or regain the capacity to stand trial and whether the defendant is 
entitled to discharge under subsection (7) of this section.  If the court 
determines that there is no substantial probability that the defendant, in the 
foreseeable future, will gain or regain the capacity to stand trial or that the 
defendant is entitled to discharge under subsection (7) of this section, the 
court shall dismiss, without prejudice, all charges against the defendant 
and: 
 
"(a) Order that the defendant be discharged; or 
 
"(b) Initiate commitment proceedings under ORS 426.070 or 
427.235 to 427.290."  
13 ORS 161.370(6)(a) provides:  
 
"If the [hospital] determines that there is a substantial probability 
that, in the foreseeable future, the defendant will gain or regain the capacity 
to stand trial, unless the court otherwise orders, the defendant shall remain 
in the [hospital's] custody where the defendant shall receive treatment 
designed for the purpose of enabling the defendant to gain or regain 
capacity. In keeping with the notice requirement under subsection (5)(b) of 
this section, the [hospital] shall, for the duration of the defendant's period of 
commitment, submit a progress report to the committing court, concerning 
the defendant's capacity or incapacity, at least once every 180 days as 
measured from the date of the defendant's delivery into the [hospital's] 
custody." 
12 
 
defendant, with appropriate treatment, is expected to gain or regain capacity,"  ORS 
1 
161.370(5)(b)(C), and "submit a progress report to the committing court, concerning the 
2 
defendant's capacity or incapacity, at least once every 180 days ."  ORS 161.370(6)(a). 
3 
 
 
The procedures prescribed by ORS 161.370 take place within a specific set 
4 
of time constraints.  No defendant may be committed under ORS 161.370 for a period 
5 
greater than the maximum period that the defendant could have served if convicted, or for 
6 
more than three years, whichever period is less.  ORS 161.370(7)(a).14  Further, if at any 
7 
point the trial court determines that so much time has elapsed that resuming the trial 
8 
would be unjust, the court must dismiss the charges and either discharge the defendant or 
9 
initiate civil commitment proceedings.  ORS 161.370(4).15  Similarly, if the court 
10 
                                              
14 ORS 161.370(7)(a) provides: 
 
"A defendant who remains committed under subsection (6) of this 
section shall be discharged within a period of time that is reasonable for 
making a determination concerning whether or not, and when, the 
defendant may gain or regain capacity.  However, regardless of the number 
of charges with which the defendant is accused, in no event shall the 
defendant be committed for longer than whichever of the following, 
measured from the defendant's initial custody date, is shorter: 
 
"(A) Three years; or 
 
"(B) A period of time equal to the maximum sentence the court 
could have imposed if the defendant had been convicted." 
 
15 ORS 161.370(4) provides: 
 
"When the court, on its own motion or upon the application of the 
superintendent of the hospital or director of the facility in which the 
defendant is committed, a person examining the defendant as a condition of 
release on supervision, or either party, determines, after a hearing, if a 
hearing is requested, that the defendant has regained fitness to proceed, the 
criminal proceeding shall be resumed. If, however, the court is of the view 
13 
 
determines that the defendant has been in the hospital's custody for a period longer than 
1 
the maximum sentence to which the defendant could be sentenced if convicted, or three 
2 
years, the court must discharge the defendant or initiate civil commitment proceedings.  
3 
ORS 161.370(10).  Finally, if the defendant does at some point regain fitness to stand 
4 
trial, and if the defendant is then convicted, any sentence imposed must be reduced by the 
5 
amount of time that the defendant was in the custody of the hospital prior to trial.  ORS 
6 
161.370(12).16 
7 
 
 
In arguing that that statutory framework grants trial courts broad general 
8 
authority to enter orders regarding defendants who are incompetent to stand trial and that 
9 
that general authority includes the authority to enter Sell orders, the state particularly 
10 
relies on ORS 161.370(6)(a), which, again, provides: 
11 
"If the [hospital] determines that there is a substantial probability that, in 
12 
the foreseeable future, the defendant will gain or regain the capacity to 
13 
stand trial, unless the court otherwise orders, the defendant shall remain in 
14 
the [hospital's] custody where the defendant shall receive treatment 
15 
designed for the purpose of enabling the defendant to gain or regain 
16 
capacity." 
17 
                                                                                                                                                  
that so much time has elapsed since the commitment or release of defendant 
on supervision that it would be unjust to resume the criminal proceeding, 
the court on motion of either party may dismiss the charge and may order 
the defendant to be discharged or cause a proceeding to be commenced 
forthwith under ORS 426.070 to 426.170 or 427.235 to 427.290. " 
 
 
16  
ORS 161.370(12) provides, in part: 
 
"If the defendant regains fitness to proceed, the term of any sentence 
received by the defendant for conviction of the crime charged shall be 
reduced by the amount of time the defendant was committed under this 
section * * *." 
14 
 
In the state's view, that provision authorizes a trial court to order a hospital to administer 
1 
specified treatment designed to enable the defendant to gain or regain capacity, and that 
2 
such treatment may include the involuntary administration of antipsychotic medication. 
3 
 
 
Relator argues that ORS 161.370(6)(a) instructs that the defendant receive 
4 
treatment at a particular place -- a hospital -- and, at most, instructs the hospital to 
5 
provide the defendant with treatment that the hospital deems appropriate.  According to 
6 
relator, ORS 161.370(6)(a) is not a grant of authority to a trial court to determine the 
7 
requisite treatment.  A court has no role in prescribing treatment; a court's role is limited 
8 
to ordering a defendant's commitment to or release from a hospital. 
9 
 
 
The question that this case presents lies at the intersection of the parties' 
10 
arguments.  Here, the hospital has determined that the only treatment that will render 
11 
relator competent to stand trial is antipsychotic medication.  The hospital deems that 
12 
treatment appropriate but has declined to order it because relator refuses it and does not 
13 
have "an immediate problem with violence or grave disability related to his own self-
14 
care."  Thus, this case does not present the question whether a trial court has authority to 
15 
order a defendant to be involuntarily medicated when a hospital opposes such treatment.  
16 
Rather, the question here is whether a trial court has authority to enter a Sell order that 
17 
will enable a hospital to act in the manner that the hospital determines to be medically 
18 
appropriate. 
19 
 
 
The hospital's position -- that without a court order it cannot require relator 
20 
to be medicated against his will for the sole purpose of rendering him competent to stand 
21 
trial -- accords with the requirements of due process as articulated in Harper and Sell.  As 
22 
15 
 
noted, Harper holds that a court proceeding is not necessary before a hospital may 
1 
administer involuntary medication to a patient who is a danger to self or others or who 
2 
has a grave disability.  Sell holds that a hospital may administer involuntary medication 
3 
to a patient who is incompetent to stand trial only if a court makes four specified sets of 
4 
findings. 
5 
 
 
Oregon law is consistent with the holdings in those cases.  ORS 426.385(3) 
6 
permits a hospital to administer certain "treatment procedures" without the consent of a 
7 
"person with mental illness" in accordance with administrative rule.  That statute 
8 
provides, in part: 
9 
"A person with mental illness committed to the authority shall have the 
10 
right to be free from potentially unusual or hazardous treatment 
11 
procedures, including convulsive therapy, unless the person has given 
12 
express and informed consent * * * . This right may be denied to a person 
13 
for good cause as defined in administrative rule only by the director of the 
14 
facility in which the person is confined, but only after consultation with and 
15 
approval of an independent examining physician." 
16 
(Emphases added.) 
17 
 
 
Accordingly, OHA has adopted administrative rules which provide that all 
18 
persons who are patients at state institutions for the mentally ill, including those who are 
19 
committed under ORS 161.370, have a right to refuse antipsychotic medication.  See 
20 
OAR 309-114-0005(10) (defining "patient" to mean an individual who is receiving 
21 
treatment in state mental institution); OAR 309-114-0010(1)(a) (stating that "patients" 
22 
may refuse significant procedures); OAR 309-114-0005(3) (defining "committed" to 
23 
mean committed under statutes including ORS 161.370); OAR 309-114-0020(1) (setting 
24 
out good cause to administer significant procedure without consent to person 
25 
16 
 
"committed" to OHA); OAR 309-114-0020(1)(e) (requiring additional findings for 
1 
patients under ORS 161.370 jurisdiction).17  Those rules then permit a hospital to deny 
2 
that right in certain delineated circumstances.  At the time that relator was committed to 
3 
the hospital, former OAR 309-114-0010 (2011) specified three instances in which a 
4 
hospital could administer treatment without a patient's consent:  if a patient was legally 
5 
incapacitated, if there was an emergency, or if the hospital determined that "good cause" 
6 
existed for the denial of a patient's right to consent.18  Under OAR 309-114-0020(1)(e), 
7 
                                              
 
17  
The administrative rules apply more broadly than does ORS 426.385(3) and 
the authority for that broader application is unclear.  It could be that the administrative 
rules recognize that the right to refuse a significant procedure arises from the due process 
clause of the federal constitution or a federal or state constitutional right to privacy.  See, 
e.g., Sell, 539 US at 178; Harper, 494 US at 221-22; Riggins v. Nevada, 504 US 127, 
137, 112 S Ct 1810, 118 L Ed 2d 479 (1992) (discussing the "defendant's liberty interest 
in freedom from unwanted antipsychotic drugs").  See also Myers v. Alaska Psychiatric 
Inst., 138 P3d 238, 246 (Alaska 2006) ("Alaska's statutory provisions permitting 
nonconsensual treatment with psychotropic medications implicate fundamental liberty 
and privacy interests.").   
18  
Former OAR 309-114-0010 (2011) provided, in part:  
 
"(1)(a) Basic Rule: Patients * * * may refuse any significant 
procedure and may withdraw at any time consent previously given to a 
significant procedure. Any refusal or withdrawal or withholding of consent 
shall be documented in the patient's record. 
 
"(b) Personnel of a state institution shall not administer a significant 
procedure to a patient unless written informed consent is obtained from or 
on behalf of the patient in the manner prescribed in these rules, except as 
follows: 
 
"(A) Administration of significant procedures to legally 
incapacitated patients as provided in section (6) of this rule; 
 
"(B) Administration of significant procedures without informed 
consent in emergencies under OAR 309-114-0015; or 
17 
 
"good cause" exists when "the patient is being medicated because of the patient's 
1 
dangerousness or to treat the patient's grave disability," but not when requested "for the 
2 
sole purpose of restoring trial competency."19  Thus, consistently with Harper and Sell, 
3 
ORS 426.385(3) and related administrative rules permit a hospital to independently 
4 
administer antipsychotic medication against a patient's will when the patient is dangerous 
5 
or gravely disabled, but not when the medication is administered solely to enable the 
6 
patient to aid and assist at trial.  Those restrictions explain why, in this case, the hospital 
7 
did not administer the antipsychotic medication that it deemed appropriate, but instead 
8 
informed the court that the administration of that medication was necessary to enable 
9 
relator to gain capacity. 
10 
                                                                                                                                                  
 
"(C) Involuntary administration of significant procedures with good 
cause to persons committed to the Division under OAR 309-114-0020." 
19 
OAR 309-114-0020 provides, in part: 
 
"(1) Good cause: Good cause exists to administer a significant 
procedure to a person committed to the Division without informed consent 
if in the opinion of the treating physician or psychiatric nurse practitioner 
after consultation with the treatment team, the following factors are 
satisfied: 
 
"* * * * * 
 
"(e) Because of the preliminary nature of their commitment, the 
following additional findings must be made for patients under ORS 
161.370 jurisdiction in order to show good cause under this rule: 
 
"(A) Medication is not requested for the sole purpose of restoring 
trial competency; and 
 
"(B) The patient is being medicated because of the patient's 
dangerousness or to treat the patient's grave disability." 
18 
 
 
 
The question before us is whether Oregon trial courts have authority that 
1 
hospitals do not have -- authority to issue orders that, under Sell, permit hospitals to 
2 
administer appropriate treatment to enable defendants to regain capacity to stand trial.  
3 
Relator contends that trial courts are subject to the same limitations that ORS 426.385(3) 
4 
and related regulations impose on hospitals and that those provisions prohibit trial courts 
5 
as well as hospitals from ordering involuntary medication to restore trial competence. 
6 
 
 
ORS 426.385(3) was enacted in 1973 as part of revisions to Oregon's civil 
7 
commitment procedures.  Laird C. Kirkpatrick, Oregon's New Mental Commitment 
8 
Statute:  The Expanded Responsibilities of Courts and Counsel, 53 Or L Rev 245, 256 
9 
(1974).  ORS 426.385(3) applies to a "person with mental illness" 20  who is committed to 
10 
the Oregon Health Authority. 21  In this case, no court has found that relator meets the 
11 
                                              
 
20 
ORS chapter 426 was amended in 2013; the amendments, as relevant here, 
substituted the phrase "person with mental illness" for "mentally ill person" throughout 
the chapter.  See Or Laws 2013, ch 360.  The definition of that category of persons 
remains the same and we use the current statutory phrase for ease in understanding.  
21 ORS 426.005(1)(e) defines "person with mental illness" and provides, in 
part: 
 
"(e) 'Person with mental illness' means a person who, because of a 
mental disorder, is one or more of the following: 
 
"(A) Dangerous to self or others. 
 
"(B) Unable to provide for basic personal needs and is not receiving 
such care as is necessary for health or safety. 
 
"(C) A person: 
 
"(i) With a chronic mental illness, as defined in ORS 426.495; 
 
"(ii) Who, within the previous three years, has twice been placed in a 
19 
 
definition of a "person with mental illness," and no court has civilly committed him.22  
1 
Therefore, it is not clear that relator is included within the class of persons protected 
2 
                                                                                                                                                  
hospital or approved inpatient facility by the authority or the Department of 
Human Services under ORS 426.060; 
 
"(iii) Who is exhibiting symptoms or behavior substantially similar 
to those that preceded and led to one or more of the hospitalizations or 
inpatient placements referred to in sub-subparagraph (ii) of this 
subparagraph; and 
 
"(iv) Who, unless treated, will continue, to a reasonable medical 
probability, to physically or mentally deteriorate so that the person will 
become a person described under either subparagraph (A) or (B) of this 
paragraph or both." 
 
22  
The parties do not dispute that relator is mentally ill; however, being 
diagnosed as mentally ill is not the same as having been found to be a "person with 
mental illness" for the purpose of ORS chapter 426.  See Kirkpatrick, 53 Or L Rev at 256 
("The majority of persons generally considered to be mentally ill probably would not fit 
this new statutory definition.").   
 
 
Indeed, ORS 161.370 treats civil commitment as an alternative to 
commitment for the purpose of restoring trial capacity.  ORS 161.370(4) illustrates the 
distinction between a finding that a defendant lacks the capacity to stand trial and a 
finding that an individual is a "mentally ill person":  that statute indicates that one 
possibility for a court that has determined that a defendant is unfit to proceed is to civilly 
commit the defendant under the provisions of ORS chapter 426.  Because that course of 
action is optional, rather than mandatory, we know that the legislature did not intend that 
a finding that a defendant was unfit to stand trial be the equivalent of a finding that that 
person was a "person with mental illness."  See also Syphers v. Gladden, 230 Or 148, 
157, 368 P2d 942 (1962) (circuit court in one county is not "ousted of its jurisdiction over 
a person held by it to answer a criminal charge by the finding of another court in a civil 
proceeding that the person accused of crime was mentally ill").  
 
 
Under Sell, if relator were subject to civil commitment, that could be a 
reason for a court to refrain from issuing a Sell order.  In Sell, the Court held that the 
state's ability to civilly commit a defendant was a "special circumstance" that could 
mitigate the state's interest in bringing the defendant to trial.  539 US at 180 ("[a] 
defendant's failure to take drugs voluntarily * * * may mean lengthy confinement in an 
institution for the mentally ill [which] would diminish the risks that ordinarily attach to 
freeing without punishment one who has committed a serious crime"). 
20 
 
under ORS 426.385(3). 
1 
 
 
Furthermore, even if relator is entitled to the protections of ORS 
2 
426.385(3), it is not clear that that statute prohibits a trial court from entering an order for 
3 
involuntary medication.  The statute grants a right to be free from certain procedures 
4 
unless the person has given express and informed consent, but also allows a hospital 
5 
director to deny that right for good cause as defined in administrative rule.  Thus, one 
6 
interpretation of ORS 426.385(3) is as a limitation on a hospital's independent 
7 
decisionmaking authority requiring that, when a hospital acts independently, it act only in 
8 
accordance with administrative rule.  Under that interpretation, a hospital would not 
9 
violate the statute if it were acting pursuant to a court order rather than independently.  
10 
OHA's administrative rules also can be understood to govern hospitals when they act 
11 
independently, but not when they act pursuant to court order. 
12 
 
 
Those are not the only plausible interpretations of ORS 426.385(3) and 
13 
related regulations; however, we need not resolve that issue for purposes of deciding this 
14 
case.  OAR 309-114-0010 has been amended and now allows hospitals to administer 
15 
medication without the consent of a patient "pursuant to a valid court order."  OAR 309-
16 
114-0010(1)(b)(D).  Thus, even if ORS 426.385(3) applies and prohibits a hospital from 
17 
administering involuntary medication except in accordance with administrative rule, 
18 
current OHA rules permit a hospital to act pursuant to a valid court order.23 
19 
 
 
Having concluded that ORS 426.383(3) and related regulations do not 
20 
                                              
 
23  
Given our disposition in this case, the fact that that amendment did not 
occur until after the trial court issued the Sell order is not a factor in our analysis. 
21 
 
categorically prohibit Oregon trial courts from issuing Sell orders, the question remains 
1 
whether trial courts have the authority to do so.  We conclude that they do.  Under ORS 
2 
161.370, trial courts may commit defendants who are unable to aid and assist to a state 
3 
hospital and the hospital must provide such defendants with "appropriate" treatment.  See 
4 
ORS 161.370(5)(b)(C) (requiring hospital to inform court of time estimate in which 
5 
defendant, with appropriate treatment, is expected to gain or regain capacity).  More 
6 
particularly, a hospital must provide treatment that is "designed for the purpose of 
7 
enabling the defendant to gain or regain capacity."  ORS 161.370(6)(a).  When a hospital 
8 
determines that, to fulfill that obligation, the appropriate treatment is the involuntary 
9 
administration of antipsychotic medication, and that it cannot administer that treatment to 
10 
comport with due process or statutory or regulatory limitations without a valid court 
11 
order, then the hospital cannot carry out its treatment obligations unless the court has 
12 
authority to make such an order.  ORS 161.370 grants trial courts authority to commit 
13 
defendants to hospitals for treatment that is designed to restore their trial competency.  
14 
By implication, that statute also grants trial courts authority to issue Sell orders when 
15 
necessary to enable hospitals to provide that treatment. 
16 
 
 
We do not accept relator's argument that the absence of explicit authority to 
17 
issue Sell orders means that trial courts are precluded from acting.  ORS 161.370 grants 
18 
Oregon trial courts and hospitals, acting together in their respective roles, the power to 
19 
commit and treat defendants so that they will be able to aid and assist at trial.  "[W]here a 
20 
power is conferred by an act, everything necessary to carry out that power and make it 
21 
effectual and complete will be implied."  Pioneer Real Estate Co. v. City of Portland, 119 
22 
22 
 
Or 1, 10, 247 P 319 (1926).  See also Lane Transit Dist. v. Lane County, 327 Or 161, 168 
1 
n 4, 957 P2d 1217 (1998) (citing Pioneer Real Estate in support of the proposition that an 
2 
agency's power to appoint a manager "carries with it an implied power to fix the terms" 
3 
of the manager's employment).  When a hospital determines that involuntary treatment is 
4 
necessary to enable a defendant to regain trial capacity, we conclude that trial courts have 
5 
the power to order that such treatment be administered -- consistent, of course, with 
6 
statutory and constitutional limits on the exercise of that power. 
7 
 
 
STANDARDS FOR ISSUANCE OF A SELL ORDER 
8 
 
 
We now proceed to the second question:  whether the order that the trial 
9 
court issued in this case comported with the due process requirements of the federal 
10 
constitution.  In Sell, the United States Supreme Court explained that two of its prior 
11 
cases, Harper and Riggins, had established that an individual has a constitutionally 
12 
protected liberty interest in avoiding involuntary administration of psychotropic drugs 
13 
that only an essential or overriding state interest may overcome.  Sell, 539 US at 178-79.  
14 
The Court then concluded that the government's interest in bringing an individual 
15 
charged with a serious crime may be sufficiently essential or overriding when, in light of 
16 
the efficacy, the side effects, the possible alternatives, and the medical appropriateness of 
17 
a particular course of antipsychotic drug treatment, the government's need for the 
18 
treatment is sufficiently important to overcome the individual's protected interest in 
19 
refusing it.  Id. at 183. 
20 
 
 
As a threshold matter, a court must conclude that the involuntary treatment 
21 
is not otherwise authorized.  Id. at 181-82.  A court need not decide whether forced 
22 
23 
 
medication is permissible to restore a defendant's competency if forced medication is 
1 
warranted for another reason such as the fact that a defendant poses a danger to self or 
2 
others and may be medicated under Harper.  Id. 
3 
 
 
If the sole basis for an order for involuntary medication is restoration of 
4 
trial capacity, a court must make four findings.  Id. at 180-82.  As the parties 
5 
acknowledge, a court must conclude (1) that important state interests are at stake in 
6 
prosecuting the defendant; (2) that medication will significantly further those important 
7 
state interests, because it is substantially likely that the medication will restore the 
8 
defendant to competency and substantially unlikely that the medication will cause side 
9 
effects that will impair the fairness of the trial; (3) that the medication is necessary to 
10 
further those important state interests, because there are no less intrusive treatments that 
11 
would produce the same results; and (4) that the administration of the medication is 
12 
medically appropriate, because it is in the patient's best medical interest in light of his 
13 
medical condition.  Id.; United States v. Ruiz-Gaxiola, 623 F3d 684, 687-88 (9th Cir 
14 
2010) (summarizing Sell factors). 
15 
 
 
"The Sell factors do not represent a balancing test, but a set of independent 
16 
requirements, each of which must be found to be true before the forcible administration 
17 
of psychotropic drugs may be considered constitutionally permissible."  Ruiz-Gaxiola, 
18 
623 F3d at 691; United States v. Hernandez-Vasquez, 513 F3d 908, 913 (9th Cir 2008) 
19 
(four findings are "required").  Because of the important liberty interests at stake, to 
20 
comport with due process an order compelling involuntary administration of 
21 
antipsychotic medication requires "thorough consideration and justification" and 
22 
24 
 
"especially careful scrutiny," and must be based on "a medically-informed record."  Ruiz-
1 
Gaxiola, 623 F3d at 692. 
2 
 
 
We begin our review of the trial court's application of the Sell factors with 
3 
the threshold issue:  whether the order is warranted for a purpose other than restoring 
4 
relator's fitness for trial.  In this case, the hospital determined that relator was not 
5 
dangerous as that condition is defined in OHA rules and used in Harper, and the trial 
6 
court agreed.24  Although the trial court did not include in its order an express conclusion 
7 
that involuntary medication was not otherwise warranted, no party argues to the contrary 
8 
and the record does not disclose a basis for a different conclusion. 
9 
 
 
We therefore proceed to the first Sell factor -- the requirement that 
10 
important governmental interests be at stake.  In Sell, the Supreme Court explained that 
11 
bringing a defendant to trial on a "serious" charge is a sufficiently important 
12 
governmental interest to justify involuntary medication.  However, an analysis of the 
13 
facts of the individual case is required and the government's interest may be lessened by 
14 
"[s]pecial circumstances," such as the likelihood that the defendant will be civilly 
15 
committed if he or she is not tried or the fact that the defendant already has been confined 
16 
for a significant amount of time.  539 US at 180.  Accordingly, the Court commented, 
17 
instances of involuntary medication "may be rare."  Id. 
18 
 
 
Federal and state courts generally agree that the question whether a charge 
19 
is "serious" under Sell is a question of law.  See, e.g., United States v. Diaz, 630 F3d 
20 
                                              
 
24  
It also is undisputed that relator does not have a "grave disability" as that 
term is defined in OAR 309-114-005(11) and used in Harper.  
25 
 
1314, 1331 (11th Cir 2011); United States v. Fazio, 599 F3d 835, 840 (8th Cir 2010) ; 
1 
United States v. Green, 532 F3d 538, 546 (6th Cir 2008); Hernandez-Vasquez, 513 F3d at 
2 
915-16; United States v. Palmer, 507 F3d 300, 303 (5th Cir 2007); United States v. 
3 
Bradley, 417 F3d 1107, 1114, 1116 (10th Cir 2005); United States v. Gomes, 387 F3d 
4 
157, 160 (2d Cir 2004); State v. Seekins, 299 Conn 141, 156, 8 A3d 491 (2010); State v. 
5 
Cantrell, 143 NM 606, 611, 179 P3d 1214 (2008); State v. Barzee, 177 P3d 48, 56 (Utah 
6 
2007).  We agree. 
7 
 
 
In considering whether a charge against a defendant is "serious," most 
8 
federal courts have looked to the statutory maximum sentence that may be imposed 
9 
should the defendant be convicted as an indication of the seriousness with which the 
10 
legislature views the charge.  Some federal courts look only to the potential maximum 
11 
sentence that a defendant may face if convicted; others also consider the sentence that a 
12 
defendant would be likely to receive under the United States Sentencing Guidelines 
13 
(guidelines).  The Sixth and Fourth Circuits look to maximum statutory penalties rather 
14 
than to the guidelines to determine seriousness.  Green, 532 F3d at 546 (concluding that 
15 
the guidelines are not an objective measure of a crime's seriousness); United States v. 
16 
Evans, 404 F3d 227, 237-38 (4th Cir 2005) (concluding that, although consulting the 
17 
guideline range would "respect legislative judgments," such consultation would be 
18 
"unworkable because at this stage in the proceedings, there is no way of accurately 
19 
predicting what that range will be").  The Ninth and Tenth Circuits, however, rely, to 
20 
varying degrees, on the guidelines to help determine seriousness.  See Hernandez-
21 
Vasquez, 513 F3d at 918-19 (the guidelines are "the best available predictor of the length 
22 
26 
 
of a defendant's incarceration"); United States v. Valenzuela-Puentes, 479 F3d 1220, 
1 
1226 (10th Cir 2007) (considering both maximum statutory penalties and the guidelines). 
2 
 
 
In most of the cases in which federal courts have considered the 
3 
constitutionality of Sell orders, the crimes charged have been punishable by five or more 
4 
years in prison, and courts generally have concluded that such crimes are "serious" under 
5 
Sell.  See, e.g., United States v. Nicklas, 623 F3d 1175, 1178-79 (8th Cir 2010) 
6 
(maximum statutory penalty of five years); United States v. White, 620 F3d 401, 411 (4th 
7 
Cir 2010) (maximum penalty of over 10 years); Valenzuela-Puentes, 479 F3d at 1226 
8 
(maximum penalty of 20 years).  However, some courts have adopted a categorical 
9 
approach, deciding that crimes carrying a sentence of more than six months' 
10 
imprisonment are "serious" under Sell.  See United States v. Evans, 293 F Supp 2d 668, 
11 
674 (WD Va 2003); State ex rel DB, 214 SW3d 209, 213 (Tex App 2007). 
12 
 
 
Although the sentence that a defendant may receive is an important and 
13 
often determinative factor in determining the "seriousness" of charges under Sell, a 
14 
defendant's potential sentence is not the only factor that courts consider.  Courts also 
15 
consider the "nature of the crime."  See, e.g., United States v. Sanderson, 521 Fed Appx 
16 
232, 236 (4th Cir 2013) cert den, 134 S Ct 661 (2013) (considering "nature of the crime" 
17 
to conclude that failure to register as sex offender was "serious" for purposes of Sell 
18 
order); Hernandez-Vasquez, 513 F3d at 919 (examining other factors such as prior 
19 
offenses, predatory nature of offenses, and closeness in time of prior offenses to 
20 
determine that reentry of deported alien constituted "serious" crime); Valenzuela-Puentes, 
21 
479 F3d at 1226 (considering "nature or effect of the underlying conduct"). 
22 
27 
 
 
 
In this case, the trial court's order included a finding that relator was 
1 
charged with a Class C felony; it did not include a finding as to the maximum sentence 
2 
for that charge or the sentence that relator likely would face on conviction.  Although the 
3 
determination of whether a crime is "serious" is a question of law, the sentence that a 
4 
defendant likely will face if convicted may be, in some instances, a question of fact, and 
5 
it is helpful when a trial court specifically includes both the maximum and the likely 
6 
sentence that a defendant may face in its Sell order.  Because this and other questions we 
7 
later address are issues of first impression, we consult the record for edification. 
8 
 
 
At the Sell hearing, relator represented that, if convicted, he would be "a 7I 
9 
on the gridblock," which meant that "based on the amount of time he's already had in 
10 
* * * there is very little the State would be able to do to [relator] if convicted of this 
11 
crime, because he's almost * * * had an entire year in."  The prosecutor agreed that 
12 
relator’s charged offense was a "Level 7 presumptive probation grid."  The court stated 
13 
that "there's little that could be done by way of custody," and added that the penalty that 
14 
relator was facing "at least in terms of the incarceration that he's facing were he 
15 
convicted, is minimal * * * [or] nonexistent."  From that exchange, it seems that the 
16 
parties and the court assumed that the maximum sentence that relator would receive at 
17 
sentencing would likely result in confinement of no more than one year, but that, because 
18 
relator had already been confined for that period and would receive credit for time 
19 
served, he would not be sentenced to additional confinement if convicted.25  See ORS 
20 
                                              
 
25  
Under the Oregon Sentencing Guidelines grid, the presumptive sentence of 
a person who is a 7I on the gridblock is 90 to 180 days with a maximum departure of 18 
28 
 
161.370(12); ORS 137.320(4) (preconviction incarceration must be credited toward term 
1 
of sentence).  For purposes of this decision, we accept the trial court's understanding. 
2 
 
 
It also appears from the record that the court based its determination that 
3 
relator is "charged with a serious crime against a person," at least in part on the nature of 
4 
that crime.  The court reasoned that relator is alleged to have attempted to touch an eight-
5 
year-old child and that that is a "serious matter" from a public safety standpoint; the court 
6 
also noted, that, for relator, it is a "serious matter" from a "reputational standpoint."  
7 
Thus, the court continued, both the state and relator had a significant interest in 
8 
proceeding to trial. 
9 
 
 
From our review of the record, we can surmise that relator was charged 
10 
with a felony that typically carries a sentence not exceeding one year in confinement.  
11 
Although that charge may not be as "serious," at least in terms of potential sanction, as 
12 
the charges considered in other cases, it is a charge that, if proved, would establish that 
13 
relator subjected a child to a substantial risk of harm and would expose relator to 
14 
significant reputational consequences.  On this record, we therefore conclude that the trial 
15 
court did not commit legal error in concluding that attempted first-degree sexual abuse is 
16 
a "serious" crime under Sell. 26 
17 
                                                                                                                                                  
months.  OAR 213-004-0001 through OAR 219-004-0013.  Thus, it appears that the 
maximum sentence that the trial court could have imposed if relator were convicted 
would be 24 months, or two years.  Apparently, however, neither the trial court nor the 
state believed it likely that relator would receive that sentence. 
 
26 
During the Sell hearing, relator agreed that the crime with which he was 
charged was "serious" and, in this court, he does not contend otherwise.  
29 
 
 
 
The question remains, however, whether, in this particular case, the 
1 
government's interest in prosecuting relator is lessened by relator's "[s]pecial 
2 
circumstances."  Sell, 539 US at 180.  In Sell, the Court noted that the fact that a 
3 
defendant "has already been confined for a significant amount of time" may "affect[]" the 
4 
state's interest in prosecution.  Id. at 180.  Accordingly, some courts have relied on the 
5 
length of pretrial confinement as a basis for holding that Sell orders were not justified.  
6 
For instance, in United States v. Grigsby, 712 F3d 964, 974 (6th Cir 2013), the court 
7 
explained that, prior to conviction, the defendant had been held in detention for a period 
8 
roughly equivalent to the length of any prison sentence that he ultimately might receive, 
9 
and that, with credit for the time served, the defendant would not be subjected to 
10 
additional incarceration or conviction.  The court therefore concluded that the 
11 
government's interest in prosecuting the defendant was diminished such that a Sell order 
12 
was impermissible.  Similarly, in United States v. Weinberg, 743 F Supp 2d 234, 237-38 
13 
(WDNY 2010), the district court found that the government's interest was not sufficient 
14 
to justify a Sell order despite the fact that the defendant was accused of a crime with a 
15 
five-year maximum sentence.  The court reasoned that, because the defendant faced a 
16 
likely guidelines sentence of 6 to 12 months in prison and had already spent 21 months in 
17 
custody, the state's interest in prosecution was so diminished that a Sell order could not 
18 
be upheld. 
19 
 
 
However, as the state asserts, a government's interest in prosecution is not 
20 
limited to confinement but also may include rehabilitation, supervision, and deterrence.  
21 
See United States v. Gutierrez, 704 F3d 442, 451 (5th Cir 2013) cert den, 133 S Ct 2380, 
22 
30 
 
185 L Ed 2d 1094 (2013) (government's interest in prosecution not extinguished by a 
1 
defendant's confinement prior to trial because government retained interest in "exacting 
2 
retribution" against the defendant, "incapacitating" the defendant, "express[ing] society's 
3 
disapproval of such conduct and potentially deter[ring] others from engaging in it, * * * 
4 
[and] authoriz[ing] the district court to impose a term of supervised release"); United 
5 
States v. Bush, 585 F3d 806, 815 (4th Cir 2009) (pretrial detainment did not defeat 
6 
government's interest because prosecution "conveys a message about [the crime's] 
7 
seriousness and its consequences[,] * * * conviction may subject [defendant] to a period 
8 
of supervised release[,] * * * [and] the fact of a conviction would create certain 
9 
limitations on [the defendant's] subsequent activities, such as her ability to obtain and 
10 
own firearms"). 
11 
 
 
Courts generally consider the question whether the government's interest in 
12 
prosecution is lessened by a defendant's "special circumstances" such that an order for 
13 
involuntary medication is not justified in a particular case to be a component of the first 
14 
Sell factor and conduct review for legal error.  See Nicklas, 623 F3d at 1178 (first Sell 
15 
factor, including whether "special circumstances" existed, reviewed as a question of law); 
16 
Fazio, 599 F3d at 839 (same).  However, when underlying facts may bear on that 
17 
question, some courts have used a sufficiency of evidence standard of review.  United 
18 
States v. Dillon, 738 F3d 284, 291 (DC Cir 2013) (reviewing underlying facts for 
19 
sufficiency); Evans, 404 F3d at 236 (same).  We agree with that mode of analysis. 
20 
 
 
In this case, relator has been in custody for what was, at the time of the Sell 
21 
hearing, close to 12 months; he now has been in custody for more than 18 months.  At the 
22 
31 
 
time of the hearing, relator already had been confined for approximately the same length 
1 
of time that he would be confined if convicted.  Relator now has been confined for an 
2 
additional six months.  Relator argues that that "special circumstance" lessens the state's 
3 
interest in proceeding to trial, rendering that interest insufficient to justify a Sell order.  
4 
The state counters that relator's conviction would serve governmental interests beyond 
5 
confinement.  Those interests, the state argues, "include the ability to ensure that [relator] 
6 
receives supervision and treatment in the community if found guilty, thereby assisting 
7 
[him] in avoiding similar behavior in the future." 
8 
 
 
The trial court's order does not include factual findings that address either 
9 
side of that argument.  When we look beyond the court's order to the record, we see, as 
10 
noted, that the trial court recognized that relator's conviction would not advance the 
11 
state's interest in confinement:  the court remarked that the chances that conviction would 
12 
result in confinement beyond the time that relator already had served were "minimal" if 
13 
not "non-existent."  However, the court observed, conviction could result in probation or 
14 
"registration."  Those measures, the court explained, were "community safety-related 
15 
measures that would * * * and could be imposed." 
16 
 
 
Although the record therefore reveals that relator's prosecution and 
17 
conviction potentially could advance governmental interests beyond relator's continued 
18 
confinement, the record does not include relevant details about those interests.  For 
19 
instance, there is no evidence about the period of time that relator would be subject to 
20 
32 
 
probation,27 the conditions that would be imposed during probation, or the extent to 
1 
which relator would be supervised or treated.  We recognize that the trial court was 
2 
experienced in such matters and in all probability was aware of or could anticipate or 
3 
predict that information.  However, details about the "community safety-related 
4 
measures" that the court mentioned do not appear in the record and the state does not 
5 
argue what those measures might be.  What we do know is that by arresting, confining, 
6 
and treating relator for more than the time that relator would be confined on conviction, 
7 
the government already has satisfied, to a significant degree, the interests in retribution, 
8 
deterrence, and rehabilitation that confinement for criminal conduct is intended to 
9 
achieve. 
10 
 
 
Although courts have upheld Sell orders despite a substantial period of 
11 
pretrial confinement, the facts in this case are significantly different from the 
12 
circumstances in those cases.  In Gutierrez, 704 F3d at 450-51, the defendant was 
13 
charged with threatening to kill the President, a former President, and a federal law 
14 
enforcement officer; he was charged based on evidence of over 100 telephone calls made 
15 
over a two-month period.  Each charge carried a maximum sentence of at least five years, 
16 
and the court observed that the defendant could be sentenced to a maximum of 20 years.  
17 
The fact that the defendant potentially could receive a lesser guidelines sentence did not 
18 
                                              
 
27  
Under the Sentencing Guidelines Grid, it appears that a person who is a 7I 
on the gridblock typically will receive three years' probation.  OAR 213-004-0001 
through OAR 219-004-0013.  Whether relator would be sentenced to that period of 
probation is not clear from the record and we hesitate to assume that relator necessarily 
would be sentenced to probation according to our understanding of the Sentencing 
Guidelines Grid.  
33 
 
persuade the court that the crimes were not serious or that the government's interests were 
1 
extinguished.  Id. 
2 
 
 
In Bush, 585 F3d at 809, the defendant was charged with two counts of 
3 
threatening a federal judge.  Each charge carried a maximum 10-year sentence, although 
4 
the parties agreed that the defendant's sentence under the applicable sentencing guidelines 
5 
potentially could be no greater than the time that she likely would be confined until 
6 
competent.  Id. at 814-15.  The court decided that, because a conviction would carry an 
7 
important message about the crime's seriousness and allow the government to place 
8 
limitations on the defendant's ability to subsequently acquire a firearm, the government 
9 
retained an important interest in bringing the defendant to trial.  Id. at 815. 
10 
 
 
In those cases, the length of the maximum sentences for the charged crimes, 
11 
the heightened need for deterrence, and the specific restrictions that a conviction would 
12 
allow the government to impose indicated a substantial governmental interest in 
13 
defendants' convictions, despite the defendants' pretrial incarceration.  Here, neither the 
14 
trial court's order nor the record demonstrates that, after having arrested, treated, and 
15 
confined relator for more than 18 months, the state's continuing interest in restoring 
16 
relator's competence and potentially convicting him are so important that they justify 
17 
relator's involuntary medication.  On this record, the first Sell factor is not satisfied, and 
18 
the trial court erred in concluding otherwise.28 
19 
                                              
 
28 
Even if we had concluded that the first Sell factor was satisfied, we 
nonetheless would have vacated the Sell order.  In Sell, the Court required that trial courts 
make the four sets of findings based on an evaluation of the Sell factors in combination, 
but the Court also stated that those four factors  
34 
 
 
 
Although our conclusion on the first Sell factor requires vacation of the trial 
1 
court's Sell order, we nevertheless proceed to address the remaining Sell factors.29  We do 
2 
so because our decision today does not preclude the state from seeking another Sell order 
3 
in this or another case in the future, and we think that additional analysis may be of 
4 
benefit to the bench and bar in that eventuality.  We therefore turn to the second Sell 
5 
factor -- whether involuntary medication will significantly further the state's interest in 
6 
prosecution. 
7 
 
 
As the state acknowledges, to reach that conclusion, the trial court was 
8 
required to make two factual findings -- that the administration of medication is 
9 
substantially likely to render relator competent to stand trial and that such medication is 
10 
substantially unlikely to have side effects that will interfere significantly with relator's 
11 
ability to assist counsel.  See Sell, 539 US at 180-81 (requiring findings).  Because the 
12 
involuntary administration of medication implicates an individual's constitutional liberty 
13 
interests and carries a risk of error and potential harm in that important context, all of the 
14 
                                                                                                                                                  
"should help [the court] make the ultimate constitutionally required 
judgment.  Has the Government, in light of the efficacy, the side effects, the 
possible alternatives, and the medical appropriateness of a particular course 
of antipsychotic drug treatment, shown a need for that treatment 
sufficiently important to overcome the individual's protected interest in 
refusing it?" 
539 US at 182.  When we evaluate all of the Sell factors in combination, on the record in 
this case, the answer is "no." 
 
29  
We do not, however, find it necessary to reach or discuss amicus The 
American Civil Liberties Union of Oregon's contention that the entry of the Sell order in 
this case violated Article I, section 13, of the Oregon Constitution.   
35 
 
federal circuit courts that have addressed the issue, as well as many state courts, require 
1 
the state to prove the necessary facts, including the facts necessary to the second Sell 
2 
factor, by "clear and convincing" evidence.  Dillon, 738 F3d at 291; Diaz, 630 F3d at 
3 
1331; Fazio, 599 F3d at 840 n 2; Green, 532 F3d at 545; Bradley, 417 F3d at 1114; 
4 
Gomes, 387 F3d at 160.  See also Seekins, 299 Conn at 143-44; Cantrell, 143 NM at 612; 
5 
In re Robert S, 213 Ill 2d 30, 34, 820 NE2d 424 (2004).  We agree that due process 
6 
requires clear and convincing evidence. 
7 
 
 
In this case, the trial court's order includes findings that the 
8 
"[a]dministration of the medication is substantially likely to render [relator] competent to 
9 
stand trial" and that "[t]he medication to be administered is substantially unlikely to have 
10 
side effects that will interfere significantly with [relator's] ability to assist counsel in 
11 
conducting a trial defense."  However, the order does not expressly indicate that the court 
12 
evaluated the evidence presented to determine whether it was clear and convincing.  Our 
13 
review of the record discloses that the trial court "firmly believe[d]" the conclusions that 
14 
it reached, but that does not tell us that the trial court measured the evidence by the clear 
15 
and convincing standard that due process requires.  Without being able to ascertain that 
16 
the trial court applied the constitutionally required burden of proof, we conclude that the 
17 
trial court erred in its application of the second Sell factor.  See Bush, 585 F3d at 816-17 
18 
(remanding in part because district court did not appear to have applied clear and 
19 
convincing standard). 
20 
 
 
Although we need not further discuss the second Sell factor, we are, as 
21 
noted, cognizant that the issues raised in this case may arise in the future.  Accordingly, 
22 
36 
 
we mention concerns that we have about the sufficiency of the evidence in this case.  It is 
1 
uncontested that relator suffers from "delusional disorder, persecutory type," a rare form 
2 
of psychosis, affecting one to two percent of people with psychiatric illness.  In both 
3 
Ruiz-Gaxiola and Bush, the defendants suffered from that same disorder; both federal 
4 
circuit courts held that the evidence on which the trial courts had relied for entry of Sell 
5 
orders was insufficient to permit the orders.  Ruiz-Gaxiola, 623 F3d at 701; Bush, 585 
6 
F3d at 816-17.  In both cases, government experts testified that involuntary medication 
7 
would reduce the defendants' delusional thinking and cited a particular study, the Herbel 
8 
study, to support their conclusions.30  Ruiz-Gaxiola, 623 F3d at 697-98; Bush, 585 F3d at 
9 
812.  Both courts pointed out the weaknesses in the testimony and the study and neither 
10 
considered the evidence to be sufficient to establish that involuntary medication would be 
11 
likely to restore the defendant's mental competency.  Ruiz-Gaxiola, 623 F3d at 701; Bush, 
12 
585 F3d at 817.  Both courts explained that the government must make the required 
13 
showing with respect to the particular defendant it seeks to medicate and that evidence 
14 
that antipsychotic medication generally reduces mentally ill patients' delusional thought 
15 
processes was insufficient to meet the "clear and convincing" standard.  Ruiz-Gaxiola, 
16 
623 F3d at 700; Bush, 585 F3d at 816-17.  Accord United States v. Ghane, 392 F3d 317, 
17 
319 (8th Cir 2004) (reversing a Sell order for defendant with delusional disorder, based in 
18 
part on findings that the illness "resists treatment by * * * antipsychotic medication"). 
19 
                                              
 
30  
The court in Bush cited that study as Byron L. Herbel & Hans 
Stelmach, Involuntary Medication Treatment for Competency Restoration of 22 
Defendants with Delusional Disorder, 35 J Am Acad Psychiatry & L 47 (2007). 
37 
 
 
 
Obviously, the sufficiency of the evidence in a particular case depends 
1 
entirely on the evidence adduced in that case.  See Gomes, 387 F3d at 161-62 (affirming a 
2 
Sell order for defendant with delusional disorder where the defense did not present expert 
3 
testimony and both government experts opined that involuntary medication was 
4 
substantially likely to restore competency).  We do not mean to imply that the state 
5 
cannot establish, by clear and convincing evidence, that the involuntary administration of 
6 
antipsychotic medication likely will render a person diagnosed with delusional disorder, 
7 
persecutory type, competent to aid and assist.  However, the evidence that was adduced 
8 
in this case gives us pause. 
9 
 
 
In this case, the psychiatrist who testified recommended the involuntary 
10 
administration of specified medications.  He acknowledged that the likelihood of success 
11 
as a result of that treatment could be as low as 30 to 40 percent, but nevertheless stated 
12 
his opinion that the medications were "worth trying."  In explaining the basis for that 
13 
opinion, the psychiatrist referred to an article describing a study that, to the best of his 
14 
recollection, had a sample size of 20 to 30 inmates31 and to his own experience with the 
15 
involuntary medication of one patient with a "similar" diagnosis.  The psychiatrist also 
16 
testified that certain medications had known side effects that could affect a patient's 
17 
ability to communicate, but did not state an opinion as to whether the medications that 
18 
would be administered to relator would be substantially unlikely to interfere with his 
19 
                                              
 
31  
The psychiatrist did not give the title of the article or the study, but we note 
that the Herbel study, discussed in both Ruiz-Gaxiola, 623 F3d at 697-98, and Bush, 585 
F3d at 812, was a study of 22 inmates. 
38 
 
ability to assist his counsel in preparing a defense. 
1 
 
 
The due process clause does not condition a Sell order on a psychiatric 
2 
guarantee of success, and we take no position on whether the evidence adduced in this 
3 
case was sufficient to support a Sell order.  We do caution, however, that there may be a 
4 
cognizable difference between medication that is sufficiently effective to be medically 
5 
appropriate, and therefore a reasonable choice that is "worth trying" and medication that 
6 
meets the Sell standard.  The latter requires that that particular medication be both 
7 
"substantially likely" to achieve a particular result (a defendant's competency to stand 
8 
trial) and "substantially unlikely" to cause a particular consequence (side effects that will 
9 
impair the fairness of the trial).  Sell, 539 US at 181.  When medication is medically 
10 
appropriate, it often will meet those requirements.  However, a trial judge must expressly 
11 
find the necessary facts to support that determination by clear and convincing evidence. 
12 
 
 
Like the second Sell factor, the third and fourth Sell factors -- that there is 
13 
no less intrusive means for administering the medication, and that administration of the 
14 
medication would be medically appropriate -- also require factual determinations 
15 
supported by clear and convincing evidence.  See Ruiz-Gaxiola, 623 F3d at 701, 703; 
16 
Bradley, 417 F3d at 1114; United States v. Payne, 539 F3d 505, 508-09 (2008) (so 
17 
concluding).  In this case, the trial court's order reaches those factual conclusions, but 
18 
neither the order nor the record establish that the trial court evaluated the relevant 
19 
evidence to determine if it was clear and convincing. 32  Therefore, on this record, we 
20 
                                              
 
32 
 Relator did not argue at the hearing and does not argue here that the 
government's interest in prosecution is reduced because civil commitment is an available 
39 
 
conclude that the trial court also erred with regard to the third and fourth Sell factors. 
1 
 
 
In sum, we conclude that the trial court's order does not meet the four Sell 
2 
requirements and that the trial court therefore erred in entering it.  We grant relator's 
3 
petition and direct the trial court to vacate the Sell order. 
4 
 
 
A peremptory writ of mandamus shall issue. 
5 
                                                                                                                                                  
alternative.  The state contends that, although it is "very likely" that relator would qualify 
for civil commitment pursuant to ORS 426.005(1)(e), the availability of that alternative is 
uncertain.  Because neither party suggests that the availability of civil commitment 
should be a factor in our analysis, we do not consider it.