Case Title: State v. John A. Wood

Citation: 2010 WI 17

Docket Number: 2007AP002767-CR

State: wisconsin

Court: Wisconsin Supreme Court

Date: 2010-03-19T00:00:00Z

Document:
2010 WI 17 
 
SUPREME COURT OF WISCONSIN 
 
 
 
 
 
CASE NO.: 
2007AP2767-CR 
COMPLETE TITLE: 
 
 
State of Wisconsin, 
          Plaintiff-Respondent, 
     v. 
John A. Wood, 
          Defendant-Appellant. 
 
 
 
 
ON CERTIFICATION FROM THE COURT OF APPEALS 
 
 
OPINION FILED: 
March 19, 2010   
SUBMITTED ON BRIEFS: 
        
ORAL ARGUMENT: 
November 3, 2009   
 
 
SOURCE OF APPEAL: 
 
 
COURT: 
Circuit   
 
COUNTY: 
La Crosse   
 
JUDGE: 
Michael J. Mulroy   
 
 
 
JUSTICES: 
 
 
CONCURRED: 
        
 
DISSENTED: 
ABRAHAMSON, C.J., dissents (opinion filed). 
BRADLEY, J., joins dissent.   
 
NOT PARTICIPATING:         
 
 
 
ATTORNEYS: 
 
For the defendant-appellant there were briefs by Kristen E. 
Lehker and Wessel, Lehker & Fumelle Inc., Madison, and oral 
argument by Kristen E. Lehker. 
 
For the plaintiff-respondent the cause was argued by R. 
Duane Harlow, assistant attorney general, with whom on the 
briefs was J.B. Van Hollen, attorney general. 
 
An amicus curiae brief was filed by Kristin Kerschensteiner 
and Disability Rights Wisconsin, Madison, and Michael Balch, 
James Grohsgal, New York, N.Y., on behalf of Disability Rights 
Wisconsin, the National Disability Rights Network, and the Judge 
David L. Bazelon Center for Mental Health Law, and oral argument 
by James Grohsgal. 
 
 
 
 
2010 WI 17
NOTICE 
This opinion is subject to further 
editing and modification.  The final 
version will appear in the bound 
volume of the official reports.   
No.    2007AP2767-CR 
(L.C. No. 
1998CF59) 
STATE OF WISCONSIN  
 
 
   : 
IN SUPREME COURT 
 
 
State of Wisconsin   
 
 
Plaintiff-Respondent,   
 
 
v. 
 
John A. Wood   
 
 
Defendant-Appellant   
FILED 
 
MAR 19, 2010 
 
David R. Schanker 
Clerk of Supreme Court 
 
 
 
 
 
APPEAL from orders of the circuit court for La Crosse 
County, Michael J. Mulroy, Judge.  Affirmed.   
 
¶1 
N. PATRICK CROOKS, J.   This case is before this court 
on certification from the court of appeals pursuant to Wis. 
Stat. § (Rule) 809.61 (2005-06).1  The defendant, John A. Wood 
(Wood), is committed to the custody of the Department of Health 
and Family Services (DHFS), after having been found not guilty 
of a crime by reason of mental disease or defect (hereinafter 
described as "NGI").  DHFS placed him at Mendota Mental Health 
Institute (Mendota), where he has been a patient since 1999.   
                                                 
1 All references to the Wisconsin Statutes are to the 2005-
06 version unless otherwise noted. 
No. 2007AP2767-CR 
 
2 
 
¶2 
In September 2006, Mendota filed a motion with the La 
Crosse County Circuit Court seeking an order authorizing it to 
administer psychotropic medication to Wood without his consent, 
pursuant to Wis. Stat. § 971.17(3)(c).  The circuit court, Judge 
Michael J. Mulroy presiding, found Wood incompetent to refuse 
medication and issued the requested order.  Wood filed a motion 
for relief from the circuit court order.  The circuit court 
denied that motion.  Wood then appealed the denial of that 
motion and the order compelling medication to the court of 
appeals, which certified the following questions to us:  Whether 
Wis. Stat. § 971.17(3)(c), which authorizes the involuntary 
medication of committed persons who are found NGI of a crime and 
who are found to be incompetent to refuse treatment or 
medication, violates due process in two respects:  (1) by 
allowing 
involuntary 
medication 
without 
a 
finding 
of 
dangerousness and (2) by failing to provide a mechanism for 
periodic review of the medication order.2  In addition to the 
constitutional 
questions, 
Wood 
raises 
several 
claims 
of 
ineffective assistance of counsel based on his trial attorney's 
failure to raise the constitutional due process arguments, along 
with other alleged failings.  He asks that the order compelling 
involuntary medication be vacated. 
                                                 
2 The court of appeals certified——and we accepted review of—
—this case based on the issues as Wood raised them on appeal.  
Accordingly, we focus our analysis on the questions as Wood 
raised them to us and to the court of appeals. 
No. 2007AP2767-CR 
 
3 
 
¶3 
After this court accepted certification, but before 
oral argument, the State filed a motion to supplement the record 
with evidence pertaining to an April 22, 1997, administrative 
directive 
(hereinafter 
described 
as 
"AD-11-97" 
or 
"the 
directive").  The directive sets forth the procedure for Mendota 
staff to follow when assessing whether to seek an order for 
compelled 
involuntary 
medication 
and 
treatment 
and 
when 
administering medication and treatment pursuant to such an 
order.  We remanded this case to supplement the record with that 
evidence, and the La Crosse County Circuit Court, Judge Ramona 
A. Gonzalez presiding, held a hearing in order to supplement the 
record in accordance with our remand order.  Subsequent to that 
hearing, Wood submitted a supplemental brief to this court 
arguing that, to the extent that an internal policy such as AD-
11-97 has the force of law, it likewise is invalid on 
substantive and procedural due process grounds because it fails 
to require a finding of dangerousness and to provide a mechanism 
for periodic review of the order. 
¶4 
We are satisfied that Wis. Stat. § 971.17(3)(c) and 
AD-11-97 comport with the due process provisions of the 
Fourteenth Amendment to the United States Constitution and 
Article I, Section 1 of the Wisconsin Constitution for two 
reasons.  First, we conclude that due process does not require a 
finding 
of 
dangerousness 
to 
issue 
an 
order 
compelling 
involuntary medication of a person committed under Wis. Stat. 
ch. 971.  Even if due process required such a finding, there 
would be no violation because the statutory language of Wis. 
No. 2007AP2767-CR 
 
4 
 
Stat. § 971.17(3)(c), along with AD-11-97, effectively provide 
for such a finding.  Second, we conclude that due process 
requires periodic review of the compelled involuntary medication 
order, and that Wis. Stat. § 971.17(3)(c) and AD-11-97 satisfy 
that requirement as well.  Additionally, we are satisfied that 
Wood 
did 
not 
receive 
ineffective 
assistance 
of 
counsel.  
Accordingly, we hold that Wis. Stat. § 971.17(3)(c), along with 
AD-11-97, comport with substantive and procedural due process 
facially and as applied here.  We also affirm the circuit 
court's orders compelling involuntary medication and denying 
Wood's motion for relief from the involuntary medication order. 
I. FACTUAL BACKGROUND AND PROCEDURAL HISTORY 
¶5 
Wood, who is 55 years old, has suffered from paranoid 
schizophrenia since at least his early twenties.  In January 
1978, while delusional from his mental illness, he beat his 
stepfather to death with a brick.  He was found not guilty by 
reason of mental disease or defect (NGI) in regard to the charge 
of second-degree homicide and was committed to the custody of 
the Department of Health and Social Services, which placed him 
in institutional care at Mendota for 13 1/2 years.3  He was 
                                                 
3 We take that description of Wood's first commitment from 
the State's first brief to us.  However, we note that the record 
does not include the judgment and commitment order from the 
proceedings related to the murder of Wood's stepfather.  The 
only indication of the outcome of that case in this record comes 
from psychiatric reports detailing Wood's medical and criminal 
history.  In those reports, the examiner explained that Wood was 
found NGI of second-degree homicide and "served 13 1/2 years at 
Mendota."   
No. 2007AP2767-CR 
 
5 
 
granted conditional release in 1991 and lived in a supervised 
housing situation in Madison and then in Florida for several 
years.  During that time, he initially remained on his 
medication and held a job, but, as he later told an examiner, he 
eventually stopped working and tapered off his medication.  By 
the time Wood returned to Wisconsin in 1998, his mental health 
had deteriorated significantly.  According to reports from 
examiners at Mendota, in January of that year, Wood was arrested 
in Viroqua, Wisconsin for disorderly conduct after exhibiting 
"bizarre" and potentially threatening behavior. 
¶6 
Following that arrest, Wood was admitted to Franciscan 
Skemp Medical Center in La Crosse "in an obvious psychotic 
state," according to the psychiatrist who treated him.  Within 
less than a month, he sexually assaulted a female patient in the 
same facility.  In January 1999, he was found NGI for that 
crime, and the La Crosse County Circuit Court held a commitment 
hearing pursuant to Wis. Stat. § 971.17(3) (1997-98).  The court 
concluded that Wood posed a significant risk of danger to others 
and committed him to the custody of DHFS for a period of up to 
160 months——two-thirds the maximum sentence for that crime 
pursuant to Wis. Stat. § 971.17(1)(a) (1997-98)——or not beyond 
                                                                                                                                                             
The parties do not appear to dispute that Wood was in fact 
committed under Wis. Stat. ch. 971 to the Department of Health 
and Social Services (the agency equivalent to DHFS at the time) 
for that murder, and that the agency placed him in Mendota for 
care for 13 1/2 years.  Hence, absent evidence in the record to 
the contrary, we accept the parties' characterization of those 
events and proceed on the assumption that Wood was committed for 
that murder. 
No. 2007AP2767-CR 
 
6 
 
September 2011. Wood remains at Mendota, which is where DHFS 
placed him in April 1999. 
¶7 
Since the start of that second commitment period, Wood 
has filed seven petitions for conditional release, none of which 
the circuit court granted.4  For each of those petitions, the 
circuit court appointed counsel and received reports from social 
workers and psychiatrists involved in Wood's treatment regarding 
Wood's condition, progress in treatment, and potential ability 
to function safely outside of Mendota.  The information 
contained in the reports was consistent in four respects.  
First, the examiners believed that Wood was undermedicated; they 
indicated that he steadfastly refused to increase dosages 
despite staff recommendations to do so.  Second, the reports 
indicated that although Wood's condition had not deteriorated 
enough to require a compelled medication order, his perpetually 
undermedicated state prevented him from being a candidate for 
conditional 
release. 
 
Third, 
Wood 
continued 
to 
deny 
responsibility for his past crimes and showed little insight 
into his treatment needs.  Fourth, the evaluators consistently 
                                                 
4  The La Crosse County Circuit Court held hearings on the 
first five of those petitions and denied each of them on grounds 
that Wood would pose a risk if granted conditional release.  
Wood voluntarily sought dismissal of his sixth petition, 
conceding that he had "received two negative psychiatric reports 
and could not meet the requisite burden of proof."  As to Wood's 
seventh petition, which he filed in September 2005, the record 
contains a psychiatric evaluation in which the examiner opined 
that Wood remained a poor candidate for conditional release and 
a social worker's neutral report on Wood's condition and 
progress in treatment, but it does not appear that the court 
held a hearing or issued an order relating to that petition. 
No. 2007AP2767-CR 
 
7 
 
opined that Wood lacked the emotional stability necessary to be 
successful if granted conditional release. 
¶8 
In September 2006, Dr. Brad Smith, the forensic 
clinical director at Mendota, petitioned the circuit court to 
issue an order authorizing the administration of medication and 
treatment 
without 
Wood's 
consent 
pursuant 
to 
Wis. 
Stat. 
§ 971.17(3)(c).  Dr. Smith cited Wood's declining mental state, 
the escalation of his symptoms, and evidence that he had stopped 
taking his medication entirely.  After holding a hearing on the 
petition, the La Crosse County Circuit Court, Judge Michael J. 
Mulroy 
presiding, 
found 
that 
the 
medication 
would 
have 
therapeutic value and that Wood was not competent to refuse 
treatment or medication.  It issued an order authorizing DHFS to 
administer medication to Wood without his consent.  Wood filed a 
motion for relief,5 arguing that Wis. Stat. § 971.17(3)(c) is 
unconstitutional and that his trial counsel was ineffective for 
failing to raise that argument and for other reasons.  The 
circuit court denied that motion.  
¶9 
Wood appealed to the court of appeals, which certified 
the matter to this court.  After filing briefs with this court, 
the State filed a motion to supplement the record with AD-11-97, 
which is an administrative directive maintained by DHFS that 
sets forth the procedure for staff at Mendota to follow when 
seeking an order to compel medication and treatment of forensic 
NGI patients and administering medication and treatment to them 
                                                 
5 Wis. Stat. § (Rule) 809.30(2). 
No. 2007AP2767-CR 
 
8 
 
pursuant to such an order.6  Wood agreed that AD-11-97 was 
germane to the issues presented.  We remanded the matter.  The 
La Crosse County Circuit Court, Judge Ramona A. Gonzalez 
presiding, held a hearing in May 2009 to supplement the record 
with evidence related to AD-11-97.7   
¶10 At that hearing, Dr. Smith testified that Mendota 
staff followed the protocol set forth in AD-11-97 before seeking 
the October 2006 order to involuntarily medicate Wood.  Mendota 
had established a treatment team made up of a psychiatrist (Dr. 
Smith), a psychologist, a member of the nursing staff, the 
manager for Wood's residential unit, and a social worker.  Dr. 
Smith further testified that that team considered four criteria 
required by AD-11-97 when it determined that (1) Wood was not 
competent to refuse medication; (2) an increased dosage of 
medication was in Wood's medical interest; (3) Wood presented a 
current risk of harm to himself or others if medication was not 
administered involuntarily; and (4) there were no alternative 
means to address Wood's dangerousness.  Dr. Smith also testified 
that Mendota has not actually implemented the order to medicate 
                                                 
6 The procedures in the directive also apply to forensic 
patients housed at Winnebago Mental Health Institute. 
A copy of the full directive appears in the appendix to the 
State's first brief to us.  See infra note 10.  We cite, for 
convenience, the directive when referring to or quoting relevant 
portions of it. 
7 That supplemental hearing did not produce any orders or 
judgments, and the parties do not challenge any aspect of that 
proceeding. 
No. 2007AP2767-CR 
 
9 
 
Wood involuntarily, because Wood consented to take an increased 
oral dosage of medication.  However, Dr. Smith explained that 
Wood did so with the knowledge that "there was an order to treat 
[using an injectable form of a different medication] that could 
be instituted if he did not take [the oral medication]."8 
II. ISSUES PRESENTED 
¶11 Wood raises two primary challenges.  First, he argues 
that Wis. Stat. § 971.17(3)(c) and AD-11-97 are unconstitutional 
because 
permitting 
involuntary 
medication 
without 
first 
requiring a finding of dangerousness violates his rights to (a) 
substantive due process and (b) procedural due process under the 
Fourteenth Amendment to the United States Constitution and 
                                                 
8 Neither party argues that Wood's current compliance with 
the oral medication regimen renders this appeal moot.  Indeed, 
there is support in case law for the parties' apparent position 
that the case is not moot, given that Wood continues to suffer 
from paranoid schizophrenia, has shown a pattern of refusing 
recommended treatment, and remains in the custody of DHFS, where 
he is still subject to the order he challenges here should he no 
longer consent to voluntarily take his medication.  See 
Washington v. Harper, 494 U.S. 210, 218-19 (1990) (live 
controversy 
existed 
even 
though 
the 
state 
had 
ceased 
administration of antipsychotic drugs to the prisoner who 
continued to suffer from schizophrenia, continued to remain in 
the prison system, and remained subject to the challenged 
policy); Vitek v. Jones, 445 U.S. 480, 486-87 (1980) (live 
controversy existed where, but for injunction, nothing clearly 
prevented the challenged action from recurring).  Additionally, 
it is not clear that Wood's compliance is truly "voluntary," 
given that he appeared to comply only when faced with an 
involuntary medication order.  Moreover, even if this case were 
moot, we would decline to dismiss on that basis.  The issues 
presented here are likely to arise again and resolution by this 
court will help avoid future uncertainty.  State v. Leitner, 
2002 WI 77, ¶15, 253 Wis. 2d 449, 646 N.W.2d 341. 
No. 2007AP2767-CR 
 
10 
 
Article I, Section 1 of the Wisconsin Constitution.  Second, he 
argues that his trial counsel was ineffective for failing to 
raise those constitutional issues as well as for other alleged 
failings. 
¶12 We note here that Wood claims that Wis. Stat. 
§ 971.17(3)(c) and AD-11-97 violate due process both facially 
and as applied.  Given the distinctions between those two types 
of challenges, this is a sensible point to frame the standards 
for evaluating a facial and an as-applied challenge under these 
circumstances. 
¶13  A party may challenge a law or government action as 
being unconstitutional on its face.  Under such a challenge, the 
challenger must show that the law cannot be enforced "under any 
circumstances."  See Olson v. Town of Cottage Grove, 2008 WI 51, 
¶44 n.9, 309 Wis. 2d 365, 749 N.W.2d 211 (explaining differences 
between facial and as-applied challenges).  If a challenger 
succeeds in a facial attack on a law, the law is void "from its 
beginning to the end."  State ex rel. Comm'rs of Pub. Lands v. 
Anderson, 56 Wis. 2d 666, 672, 203 N.W.2d 84 (1973) (Anderson).  
In contrast, in an as-applied challenge, we assess the merits of 
the challenge by considering the facts of the particular case in 
front of us, "not hypothetical facts in other situations."  
State v. Hamdan, 2003 WI 113, ¶43, 264 Wis. 2d 433, 665 
N.W.2d 785.  Under such a challenge, the challenger must show 
that his or her constitutional rights were actually violated.  
If a challenger successfully shows that such a violation 
No. 2007AP2767-CR 
 
11 
 
occurred, the operation of the law is void as to the party 
asserting the claim.  See Anderson, 56 Wis. 2d at 672. 
¶14 Given those approaches, Wood generally frames the 
issues 
before 
us 
as 
follows: 
 
(1) 
whether 
Wis. 
Stat. 
§ 971.17(3)(c) and AD-11-97 are facially invalid because they 
permit compelled medication of a person without requiring a 
finding of dangerousness or requiring periodic review of the 
order in violation of his substantive and procedural due process 
protections and (2) whether the statute and directive are 
invalid as applied to him, to the extent that Mendota and the 
circuit court did not make findings of Wood's dangerousness 
before authorizing Mendota to medicate him without his consent, 
and that there are no adequate mechanisms in place for periodic 
review of the order.  We assess each of those challenges in 
order and then address Wood's ineffective assistance of counsel 
claim.  
III. STANDARDS OF REVIEW 
¶15 The constitutionality of a statute is a question of 
law that we review de novo.  State v. Hansford, 219 Wis. 2d 226, 
234, 580 N.W.2d 171 (1998).  Although case law does not appear 
to address specifically the standard of review to be applied to 
an administrative directive, we apply that same de novo standard 
to questions of whether a defendant has been denied due process.  
See, e.g., State v. Sorenson, 2002 WI 78, ¶25, 254 Wis. 2d 54, 
646 N.W.2d 354.  Further, we review a statute under the 
presumption that it is constitutional.  Hansford, 219 Wis. 2d at 
234.  Accordingly, the party raising the constitutional claim——
No. 2007AP2767-CR 
 
12 
 
in this case, Wood——must prove that the challenged statute is 
unconstitutional 
beyond 
a 
reasonable 
doubt. 
 
Id. 
 
That 
presumption and burden apply to facial as well as to as-applied 
constitutional 
challenges. 
 
See, 
e.g., 
Riccitelli 
v. 
Broekhuizen, 
227 
Wis. 2d 100, 
119, 
595 
N.W.2d 392 
(1999) 
(stating presumption and burden for an as-applied due process 
challenge); Hansford, 219 Wis. 2d at 234 (stating presumption 
and burden for facial due process challenge). 
¶16 A claim for ineffective assistance of counsel is a 
mixed question of fact and law.  See State v. Doss, 2008 WI 93, 
¶23, 312 Wis. 2d 570, 754 N.W.2d 150.  We defer to the circuit 
court's factual findings unless they are clearly erroneous.  See 
id.  The conclusions as to whether an attorney's performance was 
deficient or prejudicial, however, are questions of law that we 
review independently.  Id. 
IV. DUE PROCESS CHALLENGES 
¶17 An individual's substantive and procedural due process 
rights are rooted in the Fourteenth Amendment to the United 
States Constitution, and Article I, Section 1 of the Wisconsin 
Constitution.9  Kenosha County Dep't of Human Servs. v. Jodie W., 
2006 WI 93, ¶39 & n.17, 293 Wis. 2d 530, 716 N.W.2d 845.  "The 
right to substantive due process addresses 'the content of what 
                                                 
9 The United States and Wisconsin constitutions generally 
provide due process guarantees with no substantive differences.  
Compare U.S. Const. Amend. XIV with Wis. Const. Art. I, § 1.  
Accordingly, we do not distinguish between those constitutional 
protections in this case.  State v. Laxton, 2002 WI 82, ¶10 n.7, 
254 Wis. 2d 185, 647 N.W.2d 784. 
No. 2007AP2767-CR 
 
13 
 
government may do to people under the guise of the law.'"  Dane 
County Dep't of Human Servs. v. Ponn P., 2005 WI 32, ¶19, 279 
Wis. 2d 169, 694 N.W.2d 344 (quoting Reginald D. v. State, 193 
Wis. 2d 299, 307, 533 N.W.2d 181 (1995)).  An individual's 
substantive due process rights protect against a state action 
that is arbitrary, wrong, or oppressive, without regard for 
whether the state implemented fair procedures when applying the 
action.  Ponn P., 279 Wis. 2d 169, ¶19 (citing Monroe County 
Dep't of Human Servs. v. Kelli B., 2004 WI 48, ¶19, 271 
Wis. 2d 51, 678 N.W.2d 831).  In contrast, the question of 
fairness is addressed as a matter of procedural due process.  In 
other words, even if a challenge that a government action 
deprives "'a person of life, liberty, or property survives 
substantive due process scrutiny, it must still be implemented 
in a fair manner.'"  State v. Laxton, 2002 WI 82, ¶10 n.8, 254 
Wis. 2d 185, 647 N.W.2d 784 (quoting United States v. Salerno, 
481 U.S. 739, 746 (1987)).  We begin with Wood's challenge under 
substantive due process principles. 
A. Substantive Due Process Requirements 
¶18 A court's task in a challenge based on substantive due 
process "involves a definition of th[e] protected constitutional 
interest, as well as identification of the conditions under 
which competing state interests might outweigh it."  Washington 
v. Harper, 494 U.S. 210, 220 (1990) (internal quotation marks 
and citing reference omitted).  The precise context presented 
here——the constitutionality of a statute authorizing an order to 
compel medication of a person committed pursuant to ch. 971——is 
No. 2007AP2767-CR 
 
14 
 
one of first impression for Wisconsin state courts.  Wood urges 
us to find persuasive guidance in Enis v. Department of Health 
and Social Services, 962 F. Supp. 1192, 1202-03 (W.D. Wis. 
1996), in which the federal district court held that Wis. Stat. 
§ 971.17(3)(c) was unconstitutional.  As an initial matter, 
federal district court cases are not binding authority on this 
court.  See State v. Mechtel, 176 Wis. 2d 87, 94-95, 499 
N.W.2d 662 (1993).  Moreover, in our view, Enis is not 
persuasive.  Although we agree with aspects of that court's 
analysis, we decline to adopt much of its reasoning or its 
bottom line, for the reasons explained herein.  Rather, we look 
to several of the United States Supreme Court's cases assessing 
orders to compel medication in other contexts. 
¶19 In Washington v. Harper, Harper, a mentally ill 
prisoner, 
challenged the constitutionality on due process 
grounds of a Washington state prison policy that authorized an 
order 
to 
compel 
medication 
of 
incompetent 
mentally 
ill 
prisoners, if the state established "by a medical finding, that 
a mental disorder exists [that] is likely to cause harm if not 
treated" and that the medication sought was "in the prisoner's 
medical interests."  494 U.S. at 222. 
¶20 The United States Supreme Court first defined Harper's 
substantive right, finding that he had a "significant" liberty 
interest in refusing the administration of antipsychotic drugs.  
Id. at 221.  That right, however, was tempered by other 
interests, including his medical needs and the legitimate needs 
of the institution in maintaining security and safety within its 
No. 2007AP2767-CR 
 
15 
 
prisons.  In light of those interests, the court held that the 
policy 
is 
a 
rational 
means 
of 
furthering 
the 
State's 
legitimate objectives.  Its exclusive application is 
to inmates who are mentally ill and who, as a result 
of their illness, are gravely disabled or represent a 
significant danger to themselves or others.  The drugs 
may 
be 
administered 
for 
no 
purpose 
other 
than 
treatment, and only under the direction of a licensed 
psychiatrist.  There is considerable debate over the 
potential side effects of antipsychotic medications, 
but there is little dispute in the psychiatric 
profession that proper use of the drugs is one of the 
most effective means of treating and controlling a 
mental illness likely to cause violent behavior. 
Id. at 226. 
¶21 Two years later, the United States Supreme Court in 
Riggins 
v. 
Nevada, 
504 
U.S. 
127 
(1992), 
addressed 
the 
constitutionality of an order compelling medication to a person 
detained for trial.  In that case, the detainee, Riggins, was 
charged with murder and robbery and was subject to an order to 
compel medication during the trial.  Id. at 129-30.  Riggins 
sought 
to 
suspend 
the 
order 
during 
his 
trial, 
where 
administration of the drug was not necessary to render him 
competent to stand trial and where he sought to show the jury 
his demeanor and "true mental state."  Id. at 130.  The district 
court denied that motion.  At trial, Riggins presented an 
insanity defense, but the jury found him guilty and set his 
sentence at death.  Id. at 131.   
¶22 The Court in Riggins extended the application of the 
holding in Harper to pretrial detainees, concluding that the 
state cannot compel administration of antipsychotic medication 
No. 2007AP2767-CR 
 
16 
 
to such persons absent a finding of the state's overriding 
justification to administer the drugs and a determination of 
medical appropriateness.  Because the state did not demonstrate 
such an overriding justification, the Court reversed the 
defendant's conviction.  Id. at 135.  However, the Court 
indicated that, given the "unique circumstances of penal 
confinement," id. at 134, one way that a state could demonstrate 
an overriding justification was if it proved that the treatment 
was medically appropriate and, in light of less intrusive 
alternatives, that it was necessary for the detainee's or 
others' safety, id. at 135. 
¶23 The federal district court in Enis largely relied on 
Harper and Riggins in reaching its conclusion that Wis. Stat. 
§ 971.17(3)(c) was unconstitutional.  In that case, Enis, who 
was mentally ill, had been found NGI and was subsequently 
determined 
to 
be 
incompetent 
to 
refuse 
medication 
under 
§ 971.17(3)(c).  He brought suit under 42 U.S.C. § 1983 and 
moved for summary judgment on his claim for injunctive and 
declaratory relief.  The district court granted Enis's motion, 
concluding that a finding of "present dangerousness and present 
need for medication [to] justify the significant intrusion 
represented 
by 
the 
forced 
administration 
of 
psychotropic 
medication" is required under a statutory scheme providing for 
the forced medication of committed individuals based on a 
finding of NGI.  Enis, 962 F. Supp. at 1199.  The district court 
held that Wis. Stat. § 971.17(3)(c) was unconstitutional to the 
No. 2007AP2767-CR 
 
17 
 
extent that it did not require a finding of the person's present 
dangerousness or that no such finding was made as to Enis.  Id. 
¶24 Thirteen years after the Supreme Court decided Harper, 
eleven years after it decided Riggins, and seven years after the 
district court issued Enis, the United States Supreme Court 
again addressed requirements for compelled medication orders in 
Sell v. United States, 539 U.S. 166 (2003).  At issue in Sell 
was the constitutionality of a law permitting a court to order 
forcible antipsychotic medication to a defendant in order to 
restore him to competency to stand trial for a nonviolent crime.  
In that case, the Court determined that Harper and Riggins stood 
for the standard that a court could order a mentally ill 
defendant to be medicated without his or her consent if (1) the 
treatment was medically appropriate, (2) the treatment was 
substantially unlikely to have side effects that could undermine 
the fairness of trial, and (3) less intrusive alternatives had 
been considered.  Sell, 539 U.S. at 179.  In other words, a 
finding of dangerousness was just one way to support a forced 
medication order; however, it was not a required element of an 
involuntary medication statutory scheme in all contexts.   
¶25 To summarize, Harper, Riggins, and Sell compel the 
following conclusions.  First, a person competent to make 
medical decisions has a "significant" liberty interest in 
avoiding forced medication of psychotropic drugs.  See Harper, 
494 U.S. at 221.  Second, in light of that interest, the state 
may not order the administration of psychotropic drugs to a 
mentally ill individual unless it demonstrates an overriding 
No. 2007AP2767-CR 
 
18 
 
justification to administer the drugs and a determination of 
medical appropriateness.  See Riggins, 504 U.S. at 135.  The 
incursions that substantive due process permits largely depend 
on what the state's overriding interest entails.  For example, 
in the context of a mentally ill inmate or detainee in a jail or 
prison, where the safety and security of the institution is the 
state's interest, one way the state can establish an overriding 
justification addressing that interest is to demonstrate that 
the person is dangerous to self or others and, considering less 
intrusive alternatives, that medication is in the person's 
medical interest.  See Riggins, 504 U.S. at 134-35; Harper, 494 
U.S. at 225-26.  In other contexts, however, such as when the 
state seeks to administer medication to render a nonviolent 
detainee competent to stand trial, dangerousness need not be 
demonstrated; rather, a finding that the administration of drugs 
will 
affect the defendant's rights to a fair trial is 
sufficient.  See Sell, 539 U.S. at 180-81. 
¶26 Here, Wood argues that Wis. Stat. § 971.17(3)(c) 
violates due process facially and as applied.  He asserts that, 
as the court of appeals noted in its certification opinion, the 
state has not fully articulated what its overriding interest is 
in medicating a committed person who has been found NGI of a 
crime.  He acknowledges that the State has an interest in 
maintaining safety in an institutional context such as Mendota, 
but argues that to invoke that interest, the State would first 
need to demonstrate the person's present dangerousness within 
the facility, a finding that the statute does not require and 
No. 2007AP2767-CR 
 
19 
 
that the circuit court did not expressly make in this instance.  
He further argues that an institution such as Mendota is 
equipped to deal with patients who would be a danger beyond its 
confines.  Because of that, Wood argues that the State needs to 
show that a patient is dangerous in the context of the 
institution. 
¶27 The State responds that it has at least two overriding 
interests in medicating an individual adjudged NGI for a violent 
crime.  First, the State has a prospective interest in 
protecting society, inasmuch as individuals adjudged NGI are 
committed precisely because their mental illness caused them to 
engage in criminal behavior.  Given that premise, the State 
argues that its interest is to treat that person in a manner 
that prepares him or her for a safe return to society.  Second, 
the State argues that it has an interest in maintaining the 
safety and functionality of the institutional environment, which 
it cannot and should not be forced to address solely by 
equipping the institutions to deal with people who behave 
unpredictably and dangerously.   
¶28 Given those justifications, the State further argues 
that in cases involving a person committed after being found 
NGI, a finding of dangerousness is not necessary because the 
judgment of NGI and decision to institutionalize that individual 
demonstrates that the person suffers from a mental illness that, 
if left untreated, causes him or her to be dangerous.  See Wis. 
Stat. § 971.15(1)(d) (no culpability for criminal conduct where 
a mental disease causes the person to lack "substantial capacity 
No. 2007AP2767-CR 
 
20 
 
either to appreciate the wrongfulness of his or her conduct or 
conform his or her conduct to the requirements of law"); 
§ 971.17(3)(a) ("The court shall order institutional care if it 
finds by clear and convincing evidence that conditional release 
of the person would pose a significant risk of bodily harm to 
himself or herself or to others or of serious property 
damage.").  Further, it argues that even if a finding of 
dangerousness is required, the record here is sufficient to 
support such a finding in this case based on Wood's past crimes 
and consistent unsuitability for conditional release. 
1. Facial Challenge to Wis. Stat. § 971.17(3)(c) on Substantive 
Due Process Grounds 
¶29 Before we address the parties' arguments, a brief 
overview of Wisconsin's involuntary medication and treatment 
statutes is helpful to aid the discussion.  There are several 
contexts in which a court may order the involuntary medication 
of a committed person in Wisconsin.  For example, Wis. Stat. 
§ 51.20 governs the involuntary medication and treatment of 
civilly committed individuals as well as criminal commitments.  
See also Wis. Stat. § 51.37.  Wis. Stat. § 971.14(3)(dm) 
provides for the involuntary medication of defendants where 
there is a question of competency to stand trial.  Wis. Stat. 
§ 971.17(3)(c), 
the 
provision at issue here, specifically 
applies to the involuntary medication of persons committed after 
being adjudged NGI for a crime.  We briefly consider that 
process. 
No. 2007AP2767-CR 
 
21 
 
¶30 A defendant charged with a criminal offense may plead 
NGI.  Wis. Stat. § 971.06(1)(d).  If the defendant is so found, 
the court enters a judgment of NGI and issues a commitment order 
under § 971.17.  In the order, the court commits the defendant 
to the custody of DHFS and specifies that he or she is to be 
placed in an institution if the court "finds by clear and 
convincing evidence that conditional release of the person would 
pose a significant risk of bodily harm to himself or herself or 
to 
others 
or 
of 
serious property damage."  Wis. Stat. 
§§ 971.165(2), 971.17(3)(a).  In making that determination, the 
court may consider, among other things,  
the nature and circumstances of the crime, the 
person's mental history and present mental condition, 
where the person will live, how the person will 
support himself or herself, what arrangements are 
available to ensure that the person has access to and 
will take necessary medication, and what arrangements 
are possible for treatment beyond medication.   
Wis. Stat. § 971.17(3)(a).  If the court does not make such a 
finding of "a significant risk," it must order conditional 
release.  Id.  
¶31 After the person has been committed to an institution, 
it sometimes becomes necessary to make a decision about forcibly 
medicating him or her.  If the state proves by clear and 
convincing evidence that the committed person is not competent 
to refuse medication, the court may issue an order permitting 
the institution to administer medication and treatment without 
the person's consent.  Wis. Stat. § 971.16(3) sets forth the 
No. 2007AP2767-CR 
 
22 
 
circumstances under which the institution may obtain such an 
order  
if, 
because 
of 
mental 
illness, 
developmental 
disability, alcoholism or drug dependence, and after 
the advantages and disadvantages of and alternatives 
to accepting the particular medication or treatment 
have been explained to the defendant, one of the 
following is true:   
(a) The defendant is incapable of expressing an 
understanding of the advantages and disadvantages of 
accepting 
medication 
or 
treatment 
and 
the 
alternatives.  
(b) 
The 
defendant is substantially incapable of 
applying 
an 
understanding 
of 
the 
advantages, 
disadvantages and alternatives to his or her mental 
illness, developmental disability, alcoholism or drug 
dependence in order to make an informed choice as to 
whether to accept or refuse medication or treatment.   
¶32 With that statutory context in mind, we address the 
parties' arguments.  Given the case law, we agree with the 
parties that the scope of substantive due process protections 
required depends upon what the State's overriding interest is in 
administering psychotropic medications to a patient against his 
or her will.  As an initial matter, it appears that the parties 
agree that the State has an interest in maintaining safety, 
security, and functionality within the institution.  Indeed, 
that interest is well-established.  See Riggins, 504 U.S. at 
135; Harper, 494 U.S. at 225-26.  We agree with the State, 
however, that it has at least one other interest in medicating 
NGI individuals.  Based on the operation of the statutory 
scheme, adjudging an individual NGI has the effect of holding 
that, because of mental illness, the individual commits crimes 
No. 2007AP2767-CR 
 
23 
 
for which he or she lacks "substantial capacity either to 
appreciate the wrongfulness of his or her conduct or conform his 
or her conduct to the requirements of law."  Wis. Stat. 
§ 971.15(1).  In that way, institutions holding individuals 
adjudged NGI have a somewhat different interest than a prison 
would.  In an institution such as Mendota, that interest is in 
treating the underlying mental illness in order to prevent more 
criminal behavior and prepare the individual for conditional 
release and for eventual release from the commitment.  
¶33 In light of that overriding interest and the nature of 
original proceedings in which a defendant is adjudged NGI, we do 
not believe that a finding of present dangerousness is required 
when considering whether to issue an order to forcibly medicate 
such an individual.  See Sell, 539 U.S. at 181-82 (a finding of 
dangerousness is not required where the relevant state interest 
is unrelated to institutional safety and security).  The express 
findings required in Wis. Stat. § 971.17(3)(c) and articulated 
in 
§ 971.16(3) 
are 
that 
the 
person 
cannot 
express 
an 
understanding of the advantages, disadvantages, and alternatives 
to medication or treatment or that he or she has such an 
understanding but cannot apply it to his or her mental illness 
in order to make an informed choice.  We are satisfied that 
those findings strike the appropriate balance between the 
State's overriding interest in medicating a forensic NGI patient 
and that patient's interest in having the ability to refuse 
medication or treatment. 
No. 2007AP2767-CR 
 
24 
 
¶34 Even if we were to conclude that the State's interest 
in preparing NGI patients for conditional release was not 
acceptable, there remains its overriding interest in the safety 
and security of the institution.  Assuming, based on Harper, 
that that interest requires a finding of present dangerousness, 
we are satisfied that Wis. Stat. § 971.17(3), at a minimum, 
implicitly provides for such a finding.  We reach that 
conclusion based on the language of § 971.17(3)(a) that includes 
requirements for a determination of dangerousness at the time of 
commitment, the language of § 971.17(3)(c) requiring a doctor's 
examination and report when an institution seeks an order to 
medicate 
the 
patient 
involuntarily, 
and 
the 
language 
of 
§ 971.17(4)(d) setting forth requirements for periodic reviews, 
which include a dangerousness determination.  Those express 
requirements, taken together, provide for at least an implicit 
finding of dangerousness that serves as a basis for a court 
considering whether to issue an order to medicate. 
¶35 The statutory language of Wis. Stat. § 971.17(3)(a) 
requires 
a 
finding 
that 
is 
the 
equivalent 
of 
one 
of 
dangerousness at time of commitment.  As we noted previously, 
that statute provides:   
The court shall order institutional care if it finds 
by clear and convincing evidence that conditional 
release of the person would pose a significant risk of 
bodily harm to himself or herself or to others or of 
serious property damage.   
Wis. Stat. § 971.17(3)(a).  In other words, a person found NGI 
will be placed in institutional care in the first place only if 
No. 2007AP2767-CR 
 
25 
 
the court finds clear and convincing evidence of "a significant 
risk," which appears to be the equivalent of dangerousness.   
 
¶36 Additionally, if the institution files a motion 
seeking an order to compel medication, the statute further 
requires a licensed physician to examine the individual and to 
issue a written report indicating that the person "needs 
medication or treatment and that the person is not competent to 
refuse medication or treatment."  Wis. Stat. § 971.17(3)(c).  We 
are satisfied that such an assessment further encompasses an 
assessment of "a significant risk."  Considering that absent a 
finding of substantial risk——the equivalent of dangerousness——
individuals committed under § 971.17(3) are granted conditional 
release, the doctor's examination and report under paragraph (c) 
necessarily requires at least an implicit finding that the 
person 
remains 
dangerous 
enough 
to 
justify 
continued 
institutional care. 
¶37 Finally, the court must reassess dangerousness when 
the committed individual petitions for conditional release, 
which the statute permits such an individual to do every six 
months.  When a committed individual petitions for conditional 
release, Wis. Stat. § 971.17(4)(d) provides that the court must 
grant the petition for such release:  
unless it finds by clear and convincing evidence that 
the person would pose a significant risk of bodily 
harm to himself or herself or to others or of serious 
property damage if conditionally released.  
Again, making that determination, the court considers the same 
factors as it did with the initial commitment, such as the 
No. 2007AP2767-CR 
 
26 
 
nature of the crime and that person's history of mental illness 
to inform its determination. 
¶38 Those requirements, taken together, create at least an 
implicit finding of dangerousness, if not an express finding, 
that serves as a basis for a court to consider granting a motion 
for an involuntary medication order.  In other words, those 
findings of dangerousness based on the original commitment under 
§ 971.17(3) and based on the denial of a petition for 
conditional release under § 971.17(4)(d) continue to be present 
until they are changed or upset.  With such a basis present, a 
court evaluating a motion for an involuntary medication order 
need not make separate or independent findings of dangerousness.   
¶39 For those reasons, we are satisfied that Wis. Stat. 
§ 971.17(3)(c) 
facially 
satisfies 
substantive 
due 
process 
protections. 
2. Facial Constitutionality of AD-11-97 on Substantive Due 
Process Grounds 
¶40 Wood further argues that AD-11-97 fails to comport 
facially with substantive due process because it does not 
adequately 
require 
a 
finding 
of 
dangerousness 
before 
institutional staff may seek an order to medicate or administer 
medication pursuant to such an order.  The State disagrees.  It 
asserts that due process does not require an express finding of 
dangerousness 
before 
seeking 
an 
order 
or 
administering 
psychotropic medications to persons committed under ch. 971.  It 
further contends that, to the extent that due process does 
require such a finding, the directive sets forth standards for a 
No. 2007AP2767-CR 
 
27 
 
finding of dangerousness that comport with the requirements set 
forth in Harper.  We agree with the State.  Due process does not 
require a finding of dangerousness under the circumstances 
presented here; however, if it did, we are satisfied that AD-11-
97 provides adequate standards for a finding of dangerousness, 
as explained herein. 
¶41 As noted previously, AD-11-97 is the protocol for 
staff at Mendota and Winnebago Mental Health Institute to follow 
when deciding whether to seek an order to medicate a patient at 
one of those facilities and whether to administer medication to 
that patient pursuant to such an order.  The directive first 
requires a treatment team, made up at least of "the patient's 
psychiatrist, a non-physician clinician and a member of the 
Nursing Staff," to assess the patient's situation before seeking 
the order.10  The team must conclude that the patient meets all 
four of the following criteria:  (1) the patient is not 
competent to refuse medication; (2) medication serves the 
patient's 
medical 
interests; 
(3) 
the 
patient 
meets 
"the 
'dangerousness' standard"; and (4) no acceptable alternative 
means are available "to address the patient's dangerousness."11 
Furthermore, AD-11-97 requires the treatment team, should it 
begin medicating a patient pursuant to an order, to conclude 
                                                 
10 Dep't of Health & Family Servs., Administrative Directive 
AD-11-97 1 (Apr. 22, 1997), reproduced in Brief & Appendix on 
Behalf of Plaintiff-Respondent State of Wisconsin at R. App. 
101-09, State v. John A. Wood, No. 07AP2767-CR (Wis. Nov. 3, 
2008) [hereinafter AD-11-97]. 
11 Id. at 2-3. 
No. 2007AP2767-CR 
 
28 
 
that the patient continues to satisfy all four criteria "at the 
appropriate review schedule," which is to occur six months after 
the ordered treatment begins and annually thereafter.12 
¶42 Those four required findings, like the requirements in 
Wis. Stat. § 971.17(3)(c), more than adequately address the 
concern of protecting the individual's liberty interest, while 
recognizing the State's interest in medicating and treating 
individuals who are not competent to make their own treatment 
decisions.  Indeed, Wood does not argue otherwise; rather, as 
noted previously, he focuses on the requirement for a finding of 
dangerousness and argues that the standards found in AD-11-97 
are inadequate.  Again, even if we were to assume that due 
process requires an express finding of dangerousness, the third 
requirement provides a more than adequate standard. 
¶43 To satisfy the third requirement, the treatment team 
is to determine "that there is a current risk of harm to self or 
others if medication [is] not administered."13  The directive 
then provides six "possible consequences" that the treatment 
team, if it concludes they are likely to occur, must use as a 
basis for the finding of dangerousness: 
a. 
The patient may suffer significant psychological 
harm, for example[,] mental anguish, pain, suffering, 
fear, anxiety or desperation, if medication was not 
administered; 
                                                 
12 Id. at 4-5. 
13 Id. at 2. 
No. 2007AP2767-CR 
 
29 
 
b. 
The patient may cause physical harm to others in 
the facility if medication was not administered, 
considering the patient's history of physical violence 
and treatment history; 
c. 
There may be harm to the prospects for successful 
treatment 
of 
the 
patient's 
mental 
condition 
if 
medication was not administered, for example, the 
patient's mental condition may become increasingly 
resistant to treatment the longer the patient does not 
take medications; 
d. 
The patient may cause self-harm if medication was 
not administered, considering the patient's history of 
self-abuse, 
treatment 
history 
and 
the 
potential 
effectiveness 
of 
medication 
in 
addressing 
the 
behavior; 
e. 
The patient may suffer significant deterioration 
to his or her health or safety if medication was not 
administered, considering the effect of the patient's 
mental 
condition 
on 
the 
patient's 
ability 
or 
willingness to receive care that is essential for 
health or safety; AND/OR 
f. 
The patient may cause physical harm to others 
outside 
the 
facility 
if 
medication 
was 
not 
administered, considering the patient's history of 
physical violence, the patient's treatment history, 
the proximity of the patient's probable release date, 
the likelihood of adequately treating the patient's 
mental condition without medications before release, 
and the adequacy of means available in the community 
to prevent the patient from causing harm to others.14 
                                                 
14 Id. at 2-3. 
No. 2007AP2767-CR 
 
30 
 
¶44 Wood argues that the standards are facially overbroad 
and vague in several respects.15  Essentially, Wood objects to 
the (1) breadth of general symptoms considered, particularly in 
consequences a and e; (2) the content of consequence c, which he 
argues does not relate to a finding of dangerousness; and (3) 
the permissible consideration of past physical violence in 
consequences b, d, and f. 
¶45 We disagree with Wood that the symptoms listed are 
overbroad.  While the symptoms in consequences a and e, listed 
singly, may be not uncommon symptoms, those paragraphs frame the 
symptoms as causing a risk of "significant psychological harm" 
and "significant deterioration" to the patient's health and 
safety.  That context, in our view, raises those symptoms to a 
level beyond those occurring in patients not in need of 
involuntary medical intervention.  Moreover, the content of 
consequence c, which addresses whether medication is necessary 
to ensure the future effectiveness of medication and treatment, 
                                                 
15 We note that generally, when a court reviews a facial 
vagueness challenge, provided it does not implicate protected 
conduct, a court upholds "the challenge only if the enactment is 
impermissibly vague in all of its applications."  Hoffman 
Estates v. Flipside, Hoffman Estates, Inc., 455 U.S. 489, 494-95 
& n.7 (1982).  Courts therefore look to the application of the 
challenged law or action to the challenger before considering 
hypothetical applications.  See id. at 495; see also United 
States v. Mazurie, 419 U.S. 544, 550 (1975)("[V]agueness 
challenges to statutes [that] do not involve First Amendment 
freedoms must be examined in the light of the facts of the case 
at hand.").  Accordingly, we would need to reach Wood's facial 
challenge on vagueness grounds only if he could demonstrate that 
the directive was impermissibly vague as applied to him.  We are 
satisfied that he is unable to do that here. 
No. 2007AP2767-CR 
 
31 
 
is related to dangerousness, inasmuch as unsuccessful treatment 
of the patient's mental illness results in a risk to the 
patient's safety, as well as the public's, given that the 
patient will be released eventually from the institution.  
Finally, past violence is relevant to a finding of current 
dangerousness.  Although we agree with the district court's 
statement in Enis that when a finding of dangerousness is 
required, that finding must show present dangerousness, nothing 
in Harper, Riggins, or Sell precludes a court from considering 
the 
individual's 
past 
crimes 
when 
assessing 
present 
dangerousness.  Indeed, where a person's past acts of violence 
were products of mental illness, consideration of the nature and 
seriousness of those past violent crimes is vital to assessing 
the level of danger posed when the mental illness is untreated. 
¶46 In summary, we are satisfied that a finding of 
dangerousness 
is 
not 
required 
to 
order 
the 
involuntary 
medication of an individual committed under Wis. Stat. § 971.17.  
By that reasoning, Wis. Stat. § 971.17(3)(c) and AD-11-97 cannot 
be deemed to be facially invalid based on substantive due 
process 
requirements. 
 
Moreover, 
even 
if 
a 
finding 
of 
dangerousness is required, the directive requires an express 
finding of dangerousness and the statute implicitly contains the 
equivalent of an express requirement.  Hence, they are not 
facially invalid. 
No. 2007AP2767-CR 
 
32 
 
3. As-Applied Challenges to Wis. Stat. § 971.17(3)(c) and AD-11-
97 on Substantive Due Process Grounds 
¶47 We next turn to Wood's argument that, based on 
substantive due process grounds, the provisions in question here 
are invalid as applied to him.  We disagree with his position.  
As an initial matter, given our determination herein that a 
finding of dangerousness is not required in this situation, and 
that Wis. Stat. § 971.17(3)(c) and AD-11-97 comport with 
substantive due process requirements, nothing in the record 
indicates that the court did not take the steps required by 
§ 971.17(3)(c) in issuing its order.  Additionally, nothing 
contradicts evidence that Mendota staff established all four 
criteria required by AD-11-97 when determining whether to file a 
motion for the hearing to compel medication.  Moreover, there is 
nothing specific to Wood's situation or any of the facts 
presented here that suggests that the application of the statute 
or directive violated his substantive due process rights. 
¶48 Additionally, we are persuaded that the treatment 
team's finding of dangerousness is supported by evidence in the 
record, and that that standard was not vague.  As noted above, 
the directive requires the treatment team at Mendota to agree 
that the person for whom it is seeking the order is dangerous, 
based on the six provided consequences.  Dr. Smith testified 
that the team considered all six consequences listed in the 
directive, but found three to be most applicable and of most 
concern, notably, consequence a, related to Wood's history of 
serious dangerousness based on his criminal behavior that 
No. 2007AP2767-CR 
 
33 
 
occurred 
when 
his 
illness 
was 
not 
adequately 
treated; 
consequence b, related to the significant mental anguish and 
anxiety caused by the increased delusions his illness was 
causing; and consequence c, related to the fact that the 
symptoms of schizophrenia, if left untreated, grow progressively 
more difficult to treat and eventually become untreatable. 
¶49 Wood asserts that consequence a is an improper 
consideration in assessing his present dangerousness.  He argues 
that the only evidence of his propensity to act violently comes 
from two crimes committed over 10 and 31 years ago.  Further, he 
emphasizes that there is no evidence that he has engaged in 
violent incidents in his past 10 years residing at Mendota.  In 
Wood's view, those circumstances cannot lead to an adequate 
finding of present dangerousness. 
¶50 The fact that Wood may not have engaged in overtly 
violent acts while at Mendota certainly could mitigate against a 
finding of present dangerousness; however, that evidence alone 
is not dispositive.  Indeed, the evidence in the record is 
sufficient to support the treatment team's conclusion that Wood 
is presently dangerous.  Wood's past crimes were unquestionably 
violent.  He was found NGI for a brutal murder——beating his 
stepfather to death with a brick——while suffering from delusions 
caused by his then-untreated mental illness.  He was also found 
NGI of sexual assault of another patient in an institutional 
setting.  Except for a period of seven years, he has been 
institutionalized for the past 30 years, and he continues to 
deny culpability for his crimes.  Moreover, his history in 
No. 2007AP2767-CR 
 
34 
 
dealing with his mental illness further supports the conclusion 
that he remains dangerous.  He has a pattern of refusing to 
increase medication to levels needed to manage his symptoms and 
he has shown a severe lack of insight regarding his needs and 
behavior.  Most compellingly, he was deemed by staff at Mendota 
to be deteriorating rapidly.  Dr. Smith cited evidence that Wood 
had surreptitiously stopped taking all medication and was 
beginning to engage in behavior that, if it continued to 
escalate, would jeopardize staff and other patients.  Finally, 
each of the seven petitions for conditional release that Wood 
filed during his time at Mendota failed, chiefly because of 
evidence that he remains a risk. 
¶51 Accordingly, 
we 
are 
satisfied 
that 
Wis. 
Stat. 
§ 971.17(3)(c) and AD-11-97 are valid on substantive due process 
grounds, both facially and as applied to Wood. 
B. Procedural Due Process Challenges 
¶52 As noted previously, patients have a liberty interest 
in avoiding the administration of medication against their will.  
State v. Anthony D.B., 2000 WI 94, ¶27, 237 Wis. 2d 1, 614 
N.W.2d 435.  The primary procedural due process protection 
required in light of that liberty interest is periodic review of 
the order to compel medication.  Id.  That review need not be 
judicial, so long as there are adequate alternative procedures 
in place.  See Harper, 494 U.S. at 231-33.   
¶53 For example, in Harper, the United States Supreme 
Court upheld a medication policy applied to mentally ill 
prisoners that required several aspects of review.  First, at 
No. 2007AP2767-CR 
 
35 
 
the time that the institution seeks the order to compel 
medication, an inmate is entitled to a hearing before a special 
committee made up of a psychiatrist, a psychologist, and the 
superintendent of the institution, none of whom are involved in 
the inmate's treatment or diagnosis.  Id. at 215.  Second, the 
committee is required to review the inmate's case within 14 days 
of involuntary treatment.  Id. at 216 & n.4.  Thereafter, the 
treating psychiatrist is required to prepare and submit biweekly 
reports to the department medical director, and a new hearing is 
required every six months.  Id. 
¶54 In light of Harper, this court in Anthony D.B. 
evaluated whether a statute authorizing orders to compel 
medication of persons committed pursuant to Wis. Stat. ch. 980 
satisfied procedural due process requirements.  237 Wis. 2d 1, 
¶8.  In that case, we held that the annual review of the 
commitment order itself necessarily must include a review of the 
order to medicate.  In doing so, we emphasized several points 
that are relevant here:  First, invoking Harper, we noted the 
importance of "an independent review of the medical order."  
Id., ¶30.  Second, we held that the patient has a right to 
petition for judicial review of the order.  Id., ¶33.  Finally, 
we concluded that an order for compelled medication would expire 
if it did not receive periodic review.  Id., ¶34. 
¶55 Here, Wood argues that Wis. Stat. § 971.17(3)(c) 
contains no provision for periodic review and hence must fail 
facially and as applied.  He likewise argues that to the extent 
that AD-11-97 contains provisions requiring periodic review, 
No. 2007AP2767-CR 
 
36 
 
those provisions are constitutionally inadequate, both facially 
and as applied.  We disagree.  
1. Facial Challenge:  Wis. Stat. § 971.17(3)(c) on Procedural Due 
Process Grounds 
¶56 We are satisfied that Wis. Stat. § 971.17(3)(c) is 
facially valid on procedural due process grounds for two primary 
reasons. 
¶57 First, the statute requires that the court grant a 
conditional release hearing, which the committed person may 
request every six months.  Wis. Stat. § 971.17(4).  Although 
that review is not specific to the medication order, we are 
satisfied that it must necessarily include a review of the 
medication order.  See, e.g., Anthony D.B., 237 Wis. 2d 1, ¶31 
(holding that by reading the statute governing involuntary 
medication of prisoners under ch. 51 together with ch. 980, a 
review of an order to compel medication is required).   
¶58 Second, we believe that other language in Wis. Stat. 
§ 971.17 implicitly requires periodic review.  Specifically, the 
portions of the statute requiring that "whoever administers the 
medication or treatment to the person shall observe appropriate 
medical standards," Wis. Stat. § 971.17(3)(b)-(c), would include 
periodic review of the order.  As a general matter, we assume 
that a doctor observing "appropriate medical standards" will not 
administer medication without a patient's consent if the patient 
is capable of consenting, the medication is not in the patient's 
best interest, the patient is not dangerous, or there are less 
intrusive means to treat the patient.  Accord Harper, 494 U.S. 
No. 2007AP2767-CR 
 
37 
 
at 222 n.8 ("[W]e will not assume that physicians will prescribe 
[antipsychotic] drugs for reasons unrelated to the medical needs 
of the patients[.]").  The ethical code governing the medical 
profession supports that assumption in its general statement 
that "[p]hysicians should not provide, prescribe or seek 
compensation 
for 
medical 
services 
that 
they 
know 
are 
unnecessary."  Am. Med. Ass'n, Code of Medical Ethics, Current 
Opinions, Opinion 2.19 at 81 (2008-09 ed.).  More specifically, 
in relation to court-initiated medical treatment, the code 
provides,  
Physicians 
can 
ethically 
participate 
in 
court-
initiated medical treatments only if the procedure 
being mandated is therapeutically efficacious and is 
therefore undoubtedly not a form of punishment or 
solely 
a 
mechanism 
of 
social 
control. . . . In 
accordance with ethical practice, physicians should 
treat patients based on sound medical diagnoses, not 
court-defined behaviors.   
Id., Opinion 2.065 at 28 (emphasis added). 
¶59 At the very least, we understand "appropriate medical 
standards" to require compliance with internal practice policies 
of the institution, which in this case are embodied in AD-11-97.  
As we explain herein, AD-11-97, facially and as applied by the 
No. 2007AP2767-CR 
 
38 
 
staff at Mendota in practice, more than adequately safeguards 
procedural due process protections.16 
2. Facial Challenge:  AD-11-97 on Procedural Due Process Grounds 
¶60 We begin by looking at the relevant provisions 
contained 
within 
AD-11-97. 
 
The 
directive 
provides 
that 
administrative review of the order must occur six months after 
the order to treat was issued (regardless of whether staff 
actually began administering the medication).17  After that 
initial review, reviews are to occur annually.18  The treatment 
                                                 
16 This is of course not to say that AD-11-97 would render a 
statute 
valid 
if 
that 
statute 
were 
otherwise 
facially 
constitutionally defective.  Again, we emphasize that Wis. Stat. 
§ 971.17(3)(c) 
is 
not 
facially 
unconstitutional 
based 
on 
procedural due process requirements.  AD-11-97 is not a "rule" 
adopted under rulemaking standards.  Wis. Stat. § 227.01(13)(a).  
Because of that, it can be changed or amended at any time.  
Thus, it cannot be said to be part of the statutory or 
administrative scheme.  
However, to the extent that the directive comports with due 
process 
requirements 
and 
that 
staff 
complied 
with 
the 
directive's requirements that evidence goes to the analysis of 
whether the State constitutionally applied the statute to Wood.  
Moreover, if DHFS or Mendota were to change substantively or 
eliminate the directive as it has been presented to us, those 
changes could affect an as-applied analysis in subsequent cases. 
17 AD-11-97, supra note 10, at 4. 
18 Id.  That is the protocol for situations where the court 
issues an order to treat and all four of the criteria are 
"clearly established in [the] order."  If the court issues an 
order and all four criteria were not clearly established in the 
order, the directive requires administrative review before any 
involuntary administration of psychotropic medications, at which 
point the treatment team must conclude that all four criteria 
are satisfied.  If that is the case, the team may begin 
administering the medication.  A second administrative review 
must then occur six months after that medication commences. 
No. 2007AP2767-CR 
 
39 
 
team conducts those reviews, during which the team must conclude 
that all four criteria are met, thus justifying the patient's 
involuntary medication.19 
¶61 The directive also sets forth patient appeal rights.  
If a court issues an order to treat a patient involuntarily and 
the four criteria are clearly established in the order, the 
patient has a right to judicial review, not administrative 
review, for the first six months after the order is issued.20  
Thereafter, when the treatment team holds administrative reviews 
of the order——as we noted previously, initially six months after 
the court issues the order and annually thereafter——the patient 
may appeal the treatment team's determination at those reviews 
to an independent review panel.21  The directive requires that 
panel to be made up of: 
at least [three] members consisting of a combination 
of the following facility staff, none of whom are 
members of the patient's treatment team:  a physician; 
a 
psychologist; 
and, 
the 
facility 
Director 
or 
designee.22 
At that hearing, the treatment team has the burden to show by a 
preponderance of the evidence that all four criteria required 
either to begin or to continue administration of psychotropic 
medication have been satisfied.  The panel may further ask 
                                                 
19 Id. 
20 Id. at 7. 
21 Id. 
22 Id. at 2. 
No. 2007AP2767-CR 
 
40 
 
questions of the patient and of a member of the treatment team.  
The panel then issues its decision within five days.  If it 
concludes by a majority that includes the physician member that 
all four criteria have been met, the panel will uphold the order 
to medicate.  Otherwise, it will reverse or modify the decision 
to medicate the patient involuntarily.23 
¶62 Wood asserts that AD-11-97 does not comport with 
procedural due process requirements facially in two respects.  
First, in his view, the directive fails because the treatment 
team, which is made up of staff involved with the patient's day-
to-day 
care, 
conducts 
the 
initial 
determination 
and 
administrative review.  He argues that due process requires an 
independent decisionmaker to review the order.  He cites for 
support Harper, 494 U.S. at 233, in which the United States 
Supreme Court observed that the policy in question adequately 
addressed the "independence of the decisionmaker . . . . None of 
the hearing committee members may be involved in the inmate's 
current treatment or diagnosis."  He also invokes Anthony D.B., 
237 Wis. 2d 1, ¶¶30-31, in which we emphasized the importance of 
an independent review of the medical order. 
¶63 Second, Wood asserts that the frequency of the review 
is inadequate to safeguard procedural due process protections.  
He compares the reviews required here (at six months and then 
annually thereafter) with those mandated by the policy in Harper 
(initial review within 14 days and then every six months 
                                                 
23 Id. at 7-9. 
No. 2007AP2767-CR 
 
41 
 
thereafter, with the administering physician submitting biweekly 
reports) to support his proposition that the reviews here do not 
occur with sufficient frequency to satisfy procedural due 
process. 
¶64 As to the first argument related to independent 
review, we disagree that due process requires the type of 
independent decisionmaker that Wood advocates.  As the State 
points out, reading on from that portion of Harper that Wood 
quotes, the Supreme Court expressly explains that it did not 
require an independent decisionmaker to review the decision to 
medicate.   
In the absence of record evidence to the contrary, we 
are not willing to presume that members of the staff 
lack the necessary independence to provide an inmate 
with a full and fair hearing . . . .  In previous 
cases involving medical decisions implicating similar 
liberty interests, we have approved use of similar 
internal 
decisionmakers. . . . [I]t 
is 
only 
by 
permitting persons connected with the institution to 
make these decisions that courts are able to avoid 
"unnecessary 
intrusion 
into 
either 
medical 
or 
correctional judgments." 
Harper, 494 U.S. at 233-35 (quoting Vitek v. Jones, 445 U.S. 
480, 496 (1980)) (citations omitted).  Moreover, even if an 
independent decisionmaker is required, we are satisfied that 
that requirement is addressed by the directive's provision for 
further 
review 
of 
the 
treatment 
team's 
decisions 
by 
an 
independent panel, "none of whom are members of the patient's 
treatment team." 
¶65 As to the alleged infrequency of review, we also 
reject that argument.  The fact that the reviews required by the 
No. 2007AP2767-CR 
 
42 
 
policy in Harper occur more frequently than they do under the 
policy here does not necessarily compel the conclusion that less 
frequent reviews violate procedural due process.  Indeed, we 
have held that periodic annual review of orders to compel 
medication on persons committed under Wis. Stat. chap. 980 
sufficiently satisfies due process.  See Anthony D.B., 237 
Wis. 2d 1, ¶31.  We are persuaded that the review protocol 
required by the directive occurs with sufficient frequency.   
¶66 In sum, we are satisfied that AD-11-97 is not facially 
invalid on procedural due process grounds.  Here, the directive 
requires that the treatment team members agree that the patient 
is not competent to refuse medication, that medication is in his 
or her best interest to medicate voluntarily, that without it he 
or she presents a current risk of harm to self or others, and 
that there are not acceptable alternative means to address the 
dangerousness.  More significantly, once the order is in place, 
the team implements it only after again being satisfied that 
those four criteria have been met.  Administrative review occurs 
six months after the issuance of the order, regardless of 
whether the patient has been administered the medication, and 
annually thereafter.  Further, the patient has the right to 
appeal the initial order to a circuit court and to appeal the 
administrative reviews to an independent panel.  In our view, 
those requirements adequately provide procedural due process 
No. 2007AP2767-CR 
 
43 
 
protections to a patient who is subject to an order for 
involuntarily medication.24 
3. As-Applied Challenge:  Wis. Stat. § 971.17(3)(c) and AD-11-97 
on Procedural Due Process Grounds 
¶67 Wood does not develop a separate argument from his 
facial 
challenge 
that 
Wis. 
Stat. 
§ 971.17(3)(c) 
is 
unconstitutional on procedural due process grounds as applied to 
him.  He does not put forth any evidence that Mendota did not 
comply with the review provisions, as we identified them above, 
or that application of those review provisions to him is 
unconstitutional.  Hence, we cannot conclude that the statute 
was applied unconstitutionally to him. 
¶68 Likewise, Wood does not put forth any evidence that 
Mendota staff did not follow the protocol for seeking the order 
to medicate involuntarily or for review of that order as set 
forth in AD-11-97, or that application of that protocol to him 
would in any way violate his rights to procedural due process.  
The record contains evidence that the treatment team at Mendota 
properly did all that the directive required of it.  Further, 
Dr. Smith testified that he and the nursing staff monitor a 
                                                 
24 We note that both the statute and the directive contain 
both automatic and patient-initiated mechanisms for review.  In 
Wis. Stat. § 971.17(4), review occurs when the physicians 
administer the medication in accordance with appropriate medical 
standards (automatic) and when the patient petitions for 
conditional release (patient-initiated).  In AD-11-97, treatment 
team reviews occur after six months and then annually thereafter 
(automatic) and when the patient seeks either administrative or 
judicial 
review 
of 
the 
treatment 
team 
reviews 
(patient-
initiated). 
No. 2007AP2767-CR 
 
44 
 
patient's reaction to medication on a daily basis.  He stated 
that in Wood's case, Wood consistently identifies the side 
effects he experiences, the staff responds to those complaints, 
and the staff further regularly tests Wood's blood to ensure 
that he is not experiencing one rare, but serious, potential 
side effect that his particular medication may produce.   
¶69 Accordingly, we are satisfied that neither Wis. Stat. 
§ 971.17(3)(c) nor AD-11-97 violates procedural due process as 
applied to Wood. 
V. INEFFECTIVE ASSISTANCE OF COUNSEL CLAIM 
¶70 Wood also argues that the order should be vacated 
because his trial counsel provided ineffective assistance at the 
hearing regarding the forced medication order.  To prevail on a 
claim for ineffective assistance of counsel, the challenging 
party 
must 
establish 
that 
trial 
counsel 
(1) 
performed 
deficiently, 
i.e., 
below 
an 
objective 
standard 
of 
reasonableness, and (2) that the deficient performance was 
prejudicial.  Strickland v. Washington, 466 U.S. 668, 687 
(1984); 
State 
v. 
Johnson, 
133 
Wis. 2d 207, 
216-17, 
395 
N.W.2d 176 (1986).  Wood asserts that his trial counsel's 
performance was deficient and prejudicial in three respects:  
(1) counsel failed to argue that Wis. Stat. § 971.17(3)(c) is 
unconstitutional; (2) counsel failed to obtain an independent 
psychological evaluation of Wood or discuss that possibility 
with Wood; and (3) counsel failed to make arrangements at the 
hearing that would have permitted Wood to consult with him 
confidentially.  The State responds that Wood has failed to 
No. 2007AP2767-CR 
 
45 
 
demonstrate, in all three respects, that counsel performed 
deficiently or that any deficient performance was prejudicial.  
We agree with the State. 
¶71 First, we are satisfied that counsel's failure to 
raise the constitutional issue was not ineffective.  We need not 
assess whether counsel performed deficiently in that respect.  
Given our conclusion herein that Wis. Stat. § 971.17(3)(c) does 
not violate substantive or procedural due process, Wood cannot 
show that the failure to raise such issues prejudiced him. 
¶72 Second, trial counsel in this situation was not 
required to seek an independent psychological evaluation of 
Wood.  At the hearing, Dr. Smith provided the only testimony; 
Wood's attorney cross-examined the doctor but did not seek to 
enter a written or testimonial independent evaluation of Wood at 
the hearing.  Wood argues that trial counsel's failure to seek 
an independent evaluation, or at least consult with Wood 
regarding the possibility, was deficient performance. 
¶73 It is within an attorney's discretion to call or not 
call a particular witness, if the circumstances of the case 
reasonably support such a decision.  See Whitmore v. State, 56 
Wis. 2d 706, 715, 203 N.W.2d 56 (1973); see also State v. 
Wright, 
2003 
WI 
App 
252, 
¶¶34-35, 
268 
Wis. 2d 694, 
673 
N.W.2d 386.  As a general policy, we do not second-guess an 
attorney's discretionary decisions at trial, if those decisions 
were rational given the applicable law and the facts of the 
case.  State v. Felton, 110 Wis. 2d 485, 502-03, 329 N.W.2d 161 
(1983). 
No. 2007AP2767-CR 
 
46 
 
¶74 Here, the record strongly supports the inference that 
an independent evaluation would not have been a beneficial 
option for Wood.  Past psychiatric reports in the record 
indicate that Wood frequently refused to speak with examining 
physicians or, when he chose to speak, would make inappropriate 
comments to the physicians.  Moreover, the record indicates that 
Wood's behavior had grown worse in the months leading up to the 
hearing.  Accordingly, counsel's decision to attack the Mendota 
evaluation rather than seek an independent evaluation appears 
reasonable.  Further, we do not believe that, under those 
circumstances, counsel was deficient to the extent that he did 
not discuss the option to have an independent evaluation by a 
psychologist.  Accordingly, Wood's counsel was not ineffective 
in that regard. 
¶75 Third, and finally, we are satisfied that Wood's 
attorney was not ineffective for failing to provide for private 
communication with his client during the hearing.  Wood appeared 
at the hearing by video conference and his attorney appeared in 
person.  When offered an opportunity to testify, Wood remained 
silent.  Later, Wood claimed that he had wanted to testify but 
did not do so because he could not privately consult with 
counsel.  Wood asserts that counsel should have arranged for a 
separate phone line or some other arrangement to permit them to 
consult privately during the hearing.  He invokes for support 
Van Patten v. Deppisch, 434 F.3d 1038, 1046 (7th Cir. 2006) 
(Deppisch), in which the Seventh Circuit Court of Appeals held 
that 
an 
attorney 
who appeared on speaker phone at the 
No. 2007AP2767-CR 
 
47 
 
defendant's plea hearing presumptively provided ineffective 
assistance of counsel. 
¶76 Deppisch offers no assistance here.  In that case, the 
defendant, pursuant to 28 U.S.C. § 2254, collaterally challenged 
an unpublished Wisconsin Court of Appeals opinion in which that 
court held that the telephonic participation of the defendant's 
attorney at the plea hearing did not violate his right to 
counsel.  The Seventh Circuit Court of Appeals reversed the 
Wisconsin Court of Appeals.  Deppisch, 434 F.3d at 1041-42.  
However, in Wright v. Van Patten, 552 U.S. 120 (2008), the 
United States Supreme Court reversed the Seventh Circuit's 
judgment in Deppisch.  In so doing, the Supreme Court observed 
that its "precedents do not clearly hold that counsel's 
participation by speakerphone should be treated as a complete 
denial of counsel, on par with total absence."  Id. at 125 
(quotation marks omitted).  The Court held that, based on the 
posture of the case, the Seventh Circuit Court of Appeals was 
not authorized to grant the defendant relief on the merits 
unless the state court's decision contradicted or was an 
unreasonable application of clearly established United States 
Supreme Court law.  See id. at 125-26 (describing requirements 
for review in 28 U.S.C. § 2254(d)(1)). 
¶77 Even if we were to determine that Deppisch offers any 
support to Wood's argument, Wood nevertheless fails to show that 
any alleged deficiency was prejudicial.  He never requested, 
either before or during the hearing, an opportunity to confer 
privately with counsel.  Wood further does not indicate what 
No. 2007AP2767-CR 
 
48 
 
testimony he would have offered that, had he been given the 
chance to confer during the hearing, might have changed the 
outcome.25   
¶78 In summary, Wood's ineffective assistance of counsel 
claim fails because he has not shown deficient performance or 
prejudice.  The circuit court did not err in denying his motion 
in that regard.  
VI. CONCLUSION 
¶79 We are satisfied that Wis. Stat. § 971.17(3)(c) and 
AD-11-97 comport with the due process provisions of the 
Fourteenth Amendment to the United States Constitution and 
Article I, Section 1 of the Wisconsin Constitution for two 
reasons.  First, we conclude that due process does not require a 
finding 
of 
dangerousness 
to 
issue 
an 
order 
compelling 
involuntary medication of a person committed under Wis. Stat. 
ch. 971.  Even if due process required such a finding, there 
would be no violation because the statutory language of Wis. 
Stat. § 971.17(3)(c), along with AD-11-97, effectively provide 
for such a finding.  Second, we conclude that due process 
requires periodic review of the compelled involuntary medication 
order, and that Wis. Stat. § 971.17(3)(c) and AD-11-97 satisfy 
that requirement as well.  Additionally, we are satisfied that 
                                                 
25 To clarify, we conclude that Wood's argument fails due to 
lack of prejudice.  Because of that, we do not reach the 
important issue of what requirements the Sixth Amendment imposes 
on telephonic appearances to protect a defendant's ability to 
privately consult with counsel and how those requirements apply 
to the first prong of the Strickland analysis.  
No. 2007AP2767-CR 
 
49 
 
Wood 
did 
not 
receive 
ineffective 
assistance 
of 
counsel.  
Accordingly, we hold that Wis. Stat. § 971.17(3)(c), along with 
AD-11-97, comport with substantive and procedural due process 
facially and as applied here.  We also affirm the circuit 
court's orders compelling involuntary medication and denying 
Wood's motion for relief from the involuntary medication order. 
By the Court.—The orders of the circuit court are affirmed. 
No.  2007AP2767-CR.ssa 
 
1 
 
¶80 SHIRLEY 
S. 
ABRAHAMSON, 
C.J.   (dissenting). 
 
I 
disagree with the majority opinion in three respects:  (1) I 
conclude that a finding of present dangerousness is required.  
Section 971.17(3)(c) does not require this finding and therefore 
is facially unconstitutional as a matter of substantive due 
process.  (2) I conclude, as does the majority opinion, that 
procedural 
due 
process 
requires 
periodic 
review 
of 
the 
medication decision.  Section 971.17(3)(c) does not provide 
periodic review of the medication decision.  Accordingly, I 
conclude that the statute is facially unconstitutional as a 
matter of procedural due process.  (3) I conclude that the 
Administrative Directive, a nonbinding internal statement of 
policy, 
cannot 
and 
does 
not 
repair 
the 
substantive 
and 
procedural constitutional defects of § 971.17(3)(c).   
I 
¶81 The majority opinion concludes that due process does 
not require a finding of dangerousness to issue an order 
compelling 
involuntary 
administration 
of 
antipsychotic 
medication to a person who is found not guilty of a crime by 
reason of mental disease or defect and who is incompetent to 
refuse medication or treatment.  I disagree.  I am persuaded by 
the reasoning of the federal district court in Enis v. 
Department of Health & Social Services, 962 F. Supp. 1192 (W.D. 
No.  2007AP2767-CR.ssa 
 
2 
 
Wis. 
1996), 
that 
a 
finding 
of 
present 
dangerousness 
is 
constitutionally required.1   
¶82 All 
persons 
have 
a 
significant 
constitutionally 
protected liberty interest in avoiding the forced administration 
of antipsychotic medication.  Sell v. United States, 539 U.S. 
166, 178 (2003); Riggins v. Nevada, 504 U.S. 127, 134 (1992); 
Washington v. Harper, 494 U.S. 210, 221, 229-30 (1990); State v. 
Anthony D.B., 2000 WI 94, ¶27, 237 Wis. 2d 1, 614 N.W.2d 435; 
majority op., ¶25. 
¶83 Only an "essential" or "overriding" state interest can 
overcome this liberty interest to permit the involuntary 
administration of antipsychotic medications.  Sell v. United 
States, 539 U.S. 166, 178-79 (2003).  Possible essential or 
overriding state interests are not set forth in the statute; the 
circuit court did not consider the state interest in the present 
case.  If the state interest is the order and safety of the 
institution, the State must adduce evidence to support its 
contention that the person is dangerous to himself or to others 
within the setting of the institution.  See Sell, 539 U.S. at 
174, 178 (citing Harper, 494 U.S. at 222).  As the court of 
appeals queried in its certification memorandum: "If, given the 
                                                 
1 Other 
statutes 
provide 
that 
dangerousness 
must 
be 
considered.  Dangerousness is a consideration in involuntary 
commitment for treatment under Wis. Stat. § 51.20(1) and in 
commitments 
by 
the 
department 
of 
corrections 
under 
§ 51.37(5)(b).  Wisconsin's Patients' Rights law provides that 
patients have the right to refuse medication except, for 
example, in a situation in which the medication is necessary to 
prevent serious physical harm to the patient or to others.  See 
§ 51.61(1)(g)1. 
No.  2007AP2767-CR.ssa 
 
3 
 
security controls in place at Mendota, Wood does not actually 
present a danger to himself or others in his current unmedicated 
state, exactly what interest does the State have in compelling 
him to take medication?"  The State has not proved a state 
interest that meets the constitutional requirement.   
¶84 Dangerousness has to be considered at the time the 
administration 
of 
the 
medication 
is 
requested. 
 
The 
determination that dangerousness can be inferred from prior 
proceedings, as the majority opinion argues, ¶¶35-37, is not, in 
my opinion, sufficient.  Over seven years have passed since the 
defendant in the present case was sentenced/committed and the 
court determined he posed a risk of danger.  The most recent 
circuit court denial of the defendant's petition for conditional 
release, including the finding that the defendant "would pose a 
significant risk of bodily harm to himself or others or of 
serious property damage if conditionally released," was almost 
three years before the present proceedings involving involuntary 
medication.  For a summary of the petitions (both before and 
after the one I describe) and their dispositions, see majority 
op., ¶7 & n.4.    
¶85 Another aspect of substantive due process in weighing 
the legitimacy of the state's involuntary administration of 
antipsychotic drugs is the availability of less intrusive 
alternative treatments.  Sell, 539 U.S. at 179, 181; Riggins, 
504 U.S. at 135; Harper, 494 U.S. at 225; majority op., ¶24.  
The statute is silent about the consideration of alternatives.  
The circuit court, in authorizing involuntary medication, made 
No.  2007AP2767-CR.ssa 
 
4 
 
no findings or determination about less intrusive alternative 
treatments.    
¶86 For the reasons stated, I conclude that substantive 
due process requires a finding of present dangerousness to issue 
an order compelling involuntary administration of antipsychotic 
medications to a person found not guilty of a crime by reason of 
mental disease or defect and determined to be incompetent to 
refuse medication or treatment. 
II 
¶87 The 
majority 
opinion 
concludes 
(¶¶4, 
51) 
that 
procedural due process requires periodic review of the compelled 
involuntary medication order.  I agree.  Section 971.17(3)(c), 
however, contains no provision for such periodic review.  The 
majority opinion does not establish a procedure for periodic 
review.   
¶88 Rather, the majority opinion concludes that this 
procedural constitutional deficiency is rectified by two aspects 
of the statute: First, a committed person may petition for 
conditional release every six months and the court will hold a 
hearing upon such petition.  Majority op., ¶57.  Second, the 
statutory 
requirement 
that 
medical 
professionals 
"observe 
appropriate medical standards" includes the concept of periodic 
review.  Majority op., ¶¶58-59. 
¶89 Thus, to fulfill the constitutional requirement of 
periodic review, the majority opinion puts the onus on an 
incompetent institutionalized person to request and pursue a 
hearing and on medical professionals whose concept of review for 
No.  2007AP2767-CR.ssa 
 
5 
 
medical purposes may or may not be the same as the concept of 
periodic review for constitutional law purposes.      
¶90 In my view, neither of these statutory provisions 
satisfies the procedural due process requirement of a periodic 
review.   
III 
¶91 The 
majority 
concludes 
that 
any 
statutory 
constitutional deficiencies are remedied by an Administrative 
Directive 
and 
interprets 
the 
statutory 
requirement 
of 
"appropriate medical services" to require compliance with this 
Directive. 
 
The 
Administrative 
Directive 
is 
an 
internal 
statement of policy, not a rule or regulation of the Department.   
¶92 This Administrative Directive was obviously adopted to 
comply with the Enis case.  The majority opinion declares the 
Enis case is "unpersuasive" (majority op., ¶18).  The continued 
viability of the Administrative Directive is problematic.   
¶93 The 
court's 
obligation 
is 
to 
determine 
the 
constitutionality of a statute, not the constitutionality of an 
Administrative Directive.   
¶94 For the reasons set forth, I dissent. 
¶95 I am authorized to state that Justice ANN WALSH 
BRADLEY joins this opinion.    
 
 
 
No.  2007AP2767-CR.ssa 
 
1