Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-caDC-99-03119/USCOURTS-caDC-99-03119-0/pdf.json

Parties Involved:
United States of America
Appellee
Russell Eugene Weston Jr.
Appellant

Document Text:

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United States Court of Appeals

FOR THE DISTRICT OF COLUMBIA CIRCUIT

Argued December 6, 1999 Decided March 24, 2000

No. 99-3119

United States of America,

Appellee

v.

Russell Eugene Weston, Jr.,

Appellant

Appeal from the United States District Court

for the District of Columbia

(No. 98cr00357-01)

Gregory L. Poe, Assistant Federal Public Defender, argued

the cause for the appellant. A. J. Kramer, Federal Public

Defender, and L. Barrett Boss, Assistant Federal Public

Defender, were on brief for the appellant.

David B. Goodhand, Assistant United States Attorney,

argued the cause for the appellee. Wilma A. Lewis, United

States Attorney, and John R. Fisher and Erik P. Christian,

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Assistant United States Attorneys, were on brief for the

appellee.

Before: Henderson, Rogers and Tatel, Circuit Judges.

Opinion for the court filed Per Curiam.

Circuit Judge Henderson filed a separate concurring

opinion.

Circuit Judge Rogers filed a separate concurring opinion.

Circuit Judge Tatel filed a separate concurring opinion.

Per Curiam: Appellant Russell Eugene Weston Jr. appeals

the district court's order authorizing the Bureau of Prisons

(Bureau) to forcibly medicate Weston with antipsychotic

drugs based on the Bureau's determination that the treatment is medically appropriate and essential for Weston's

safety and for the safety of others. Because the district

court's order relied on testimony supporting forced medication for the purpose of making Weston competent to stand

trial, an additional justification which the Bureau advanced

but the district court found unnecessary to reach, we reverse

the district court and remand for consideration of both of the

Bureau's justifications.

On October 9, 1998 Weston, a diagnosed paranoid schizophrenic, was charged in a six count indictment with the July

24, 1998 murder of two United States Capitol Police officers

and the attempted murder of a third.1 On April 22, 1999 the

district court found Weston, who is confined at the Federal

Correctional Institution in Butner, North Carolina (Butner),

__________

1 The indictment charged two counts of murder of a federal

officer while engaged in his official duties in violation of 18 U.S.C.

ss 1113 and 1111; one count of attempted murder of a federal

officer while engaged in his official duties in violation of 18 U.S.C.

ss 1114 and 1113; one count of carrying and using a firearm during

and in relation to a crime of violence in violation of 18 U.S.C.

s 924(c); and 2 counts of carrying and using a firearm during and

in relation to a crime of violence and causing a death thereby in

violation of 18 U.S.C. s 924(c) and 924(j)(1).

incompetent to stand trial and committed him for treatment

to restore his competency pursuant to 18 U.S.C. s 4241(d).

The incompetency order provided that, should medical personnel conclude antipsychotic injections were warranted, the

Bureau could seek involuntary medication authorization in

accordance with "the administrative procedures under 28

C.F.R. s 543 [sic],2 provided that counsel for Mr. Weston

receive reasonable notice before a hearing commences." Appendix vol. i (App. i) 47. The order further directed: "No

administration of psychotropic medications to defendant

against his will shall occur without the prior approval of this

Court in a written Order;...." Id.

On May 13, 1999 the Bureau conducted an involuntary

medication hearing without notifying Weston's counsel. Weston was represented at the hearing by Ray Pitcairn, the Day

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Watch Nursing Supervisor at Butner. Following the presentation of evidence the hearing officer, Bryon Herbel, M.D., a

psychiatrist, determined Weston should be forcibly medicated. Butner's warden affirmed the determination. The district court held a hearing on May 28, 1999 to review the

Bureau's decision and in an order dated June 18, 1999 remanded the matter to the Bureau because Weston's counsel

had not been notified of the hearing in accordance with the

April 22, 1999 incompetency order and because the Bureau

had neither sought nor presented at the hearing evidence

favorable to Weston.

The Bureau conducted a second hearing before Dr. Herbel

on July 8, 1999. Weston was again represented by Pitcairn

who presented the written report of Weston's expert witness,

Raquel E. Gur, M.D., also a psychiatrist. In addition, Pitc-

__________

2 Bureau regulation 549.43 requires that, before a patient's involuntary medication, a hearing be conducted by a psychiatrist, with

24-hour notice to the patient, at which he has the right to appear, to

have a staff representative, to present evidence and to request that

witnesses be questioned by his staff representative or by the

hearing officer. The hearing officer's determination regarding

medication may be appealed to the institution's mental health

division administrator.

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airn offered arguments suggested to him by Weston's counsel, who were not themselves permitted to attend the hearing.

The government offered the expert testimony of Sally C.

Johnson, M.D., Associate Warden for Health Services at

Butner and Weston's treating psychiatrist. At the conclusion

Dr. Herbel determined Weston "suffer[s] from a mental

illness, and that medication is an appropriate treatment for

[his] illness, and that [he] can be treated against [his] will."

App. ii 90-91. He explained his decision to Weston as

follows:

The reason is that you are gravely disabled, you pose a

risk of dangerousness to others and to yourself without

treatment, and that you need to become competent to

stand trial, and that no other inter--less intrusive intervention will be successful for them.

Id. at 91. Weston appealed to the warden who again affirmed

the hearing officer, stating:

Medical staff have diagnosed you with Schizophrenia,

Paranoid Type, Chronic. The record indicates that you

experience a variety of grandiose and paranoid delusions

including a belief that you are able to reverse time, and

that people who are killed are not really dead. Such

delusions have caused you to be dangerous to others, and

potentially to yourself, gravely disabled, and incompetent

for trial. This conclusion is supported by the record.

Mental Health staff have determined that you suffer

from a mental disease which may be treated with psychotropic medication, and restore your competency for trial.

Therefore, your appeal is denied and staff may proceed

accordingly.

App. ii. 3.

On August 20, 1999 the district court held a second judicial

review hearing. In a decision dated September 9, 1999 the

court upheld the Bureau's decision to medicate Weston on the

ground that "the proposed medication is medically appropriate and that, considering less intrusive alternatives, it is

essential for the defendant's own safety or the safety of

others." United States v. Weston, 69 F. Supp. 2d 99, 118

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(D.D.C. 1999). The court declined to review the Bureau's

additional justification, that medication was necessary to render Weston competent for trial, or to address Weston's claim

that forced medication would infringe his Sixth Amendment

right to a fair trial. These two issues, the court found, were

not then ripe "where the defendant has not yet been arraigned and where there is no record evidence to suggest that the

government's medical reasons are pretextual." Id. at 107.

In the court's opinion the issues could adequately be addressed later "[in] the event that medication successfully

renders the defendant competent to stand trial." Id. Weston contends the Bureau's decision is unsupported by the

record and that the Sixth Amendment argument is now ripe

for resolution. We agree on both points.

As an initial matter, Weston asserts the district court

applied the wrong standards in reviewing the Bureau's determination "that antipsychotic medication is medically appropriate and that, considering less intrusive alternatives, it is

essential for the defendant's own safety or the safety of

others." 69 F. Supp. 2d at 118. Following the Supreme

Court's opinion in Washington v. Harper, 494 U.S. 210, 223

(1990), the district court reviewed the Bureau's medical/safety

justification substantively under a "reasonableness" standard,

see 69 F. Supp. 2d at 116-18, and procedurally under the

Administrative Procedure Act's "arbitrary and capricious"

test, see 69 F. Supp. 2d at 107 (citing 5 U.S.C. s 706(2)(A)).

Weston maintains that the Supreme Court's decision in Riggins v. Nevada, 504 U.S. 127 (1992), in which the court

considered forced medication of a detainee, as here, rather

than of a convicted inmate, as in Harper, requires instead

review under the "strict scrutiny" and "de novo" standards.

It is true the Riggins Court recognized that decisions affecting a detainee's trial rights may warrant closer scrutiny than

those made for inmates who have already been tried and

convicted. See 504 U.S. at 135. ("Under Harper, forcing

antipsychotic drugs on a convicted prisoner is impermissible

absent a finding of overriding justification and a determination of medical appropriateness. The Fourteenth Amendment

affords at least as much protection to persons the State

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detains for trial.") (emphasis added; citations omitted). The

Court, however, declined to clarify the standards of review for

detainees. The opinion makes no mention of the applicable

procedural standard and the Court found "no occasion to

finally prescribe ... substantive standards." Id. at 136. We

likewise need not decide the issue at this point, given the lack

of support for the district court's medical/safety determination, preferring instead to await the district court's findings

on remand using the guidance that Riggins provides.

In Riggins the Supreme Court overturned the Nevada

state court conviction of a defendant who had been involuntarily medicated during trial. The Court acknowledged, as

did the district court below, that involuntary medication may

be justified by medical/safety concerns and might be justified

by the need to render a defendant competent for trial:

Nevada certainly would have satisfied due process if the

prosecution had demonstrated, and the District Court

had found, that treatment with antipsychotic medication

was medically appropriate and, considering less intrusive

alternatives, essential for the sake of Riggins' own safety

or the safety of others. See Harper, supra, 494 U.S., at

225-226, 110 S.Ct., at 1039; cf. Addington v. Texas, 441

U.S. 418, 99 S.Ct. 1804, 60 L.Ed.2d 323 (1979) (Due

Process Clause allows civil commitment of individuals

shown by clear and convincing evidence to be mentally ill

and dangerous). Similarly, the State might have been

able to justify medically appropriate, involuntary treatment with the drug by establishing that it could not

obtain an adjudication of Riggins' guilt or innocence by

using less intrusive means. See Illinois v. Allen, 397

U.S. 337, 347, 90 S.Ct. 1057, 1063, 25 L.Ed.2d 353 (1970)

(Brennan, J., concurring) ("Constitutional power to bring

an accused to trial is fundamental to a scheme of 'ordered liberty' and prerequisite to social justice and

peace").

504 U.S. at 135-36. Nevertheless, the Court overturned the

state court medication order for inadequate factual findings,

in part because it "did not adopt the State's view, which was

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that continued administration of Mellaril was required to

ensure that the defendant could be tried" and did not "indicate a finding that safety considerations or other compelling

concerns outweighed Riggins' interest in freedom from unwanted antipsychotic drugs." Id. at 136. The district court's

determination below suffers from similar defects.

First, although the district court, unlike the state court in

Riggins, made a finding that antipsychotic medication is not

only medically appropriate but also essential to safety, the

finding is not supported by the record. The evidence below

focused on the feasibility and desirability of restoring Weston's competency. Thus, while the record focused on whether

the administration of antipsychotic drugs was "medically appropriate" to make him competent to stand trial, there is

comparatively little evidence on the safety issue. Further,

what evidence there is indicates that in his current circumstances Weston poses no significant danger to himself or to

others. Dr. Johnson herself testified at the August 20, 1999

hearing that, given Weston's "immediate containment situation," she felt confident the Butner staff "can prevent him

from harming himself or others under his immediate parameters of incarceration where he is in an individual room with

limited access to anything that he could harm himself with or

anyone else with, and he remains under constant observation." JA ii 121. In her view, "those precautions are adequate to prevent risk--to prevent episodes of harm to himself

or to others." Id. In light of this testimony, we cannot

sustain the district court's determination that involuntary

medication is "essential for the defendant's own safety or the

safety of others." 69 F. Supp. 2d at 118. If the government

advances the medical/safety justification on remand, it will

need to present additional evidence showing that either Weston's condition or his confinement situation has changed since

the hearing so as to render him dangerous.

Second, the district court here (like the state court in

Riggins) failed to address the government's theory that medication is necessary to render Weston competent for trial,

describing the trial competency issue as "collateral" and not

yet "ripe." We disagree with this characterization. InvolunUSCA Case #99-3119 Document #505725 Filed: 03/24/2000 Page 7 of 24
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tary antipsychotic medication has the potential to adversely

affect the defendant's ability to obtain a fair trial as guaranteed under the Sixth Amendment. See United States v.

Brandon, 158 F.3d 947, 954 (6th Cir. 1998) (concluding forced

medication may implicate Sixth Amendment right); United

States v. Morgan, 193 F.3d 252, 264-65 (4th Cir. 1999)

(acknowledging same). Weston's challenge here, based on

this potential, is ripe for two reasons. First, as noted above,

the evidence, including Dr. Johnson's testimony and the

determinations of both the hearing officer and the warden,

see supra p. 4, focused on the need to restore Weston's

competency, placing the issue squarely before the district

court. Second, and more important, because antipsychotic

medication may affect the defendant's ability to assist in his

defense, see Riggins, 504 U.S. at 137; id. at 143 (Kennedy, J.,

concurring); Brandon, 158 F.3d at 954, post-medication review may come too late to prevent impairment of his Sixth

Amendment right. Accordingly, both the defendant, whose

right to present a defense may be infringed by involuntary

medication, and the government, whose eventual prosecution

of the defendant may be foreclosed because of the infringement, are entitled to pre-medication resolution of the Sixth

Amendment issue.

For the foregoing reasons, we reverse the district court's

September 9, 1999 memorandum opinion and order and remand for the court to assess each of the Bureau's justifications and to consider the potential impact of compelled

medication on Weston's Sixth Amendment fair trial right.3

Because the trial competency and Sixth Amendment issues

are legal rather than medical or penological issues, on remand the district court should retain jurisdiction to decide

them itself. See Brandon, 158 F.3d at 960 ("district court

[must] make the legal determination of whether [defendant]

if forcibly medicated, would be competent to participate in a

trial that is fair to both parties," which "is distinct from the

__________

3 The court should also consider whether there is any merit to

Weston's contention that medical ethics preclude ordering a patient

medicated in a potential capital case.

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medical determination that the medical experts [ ] discuss")

(emphasis original).

So ordered.

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Karen LeCraft Henderson, Circuit Judge, concurring:

I concur in the majority's opinion but write separately to

express my belief that the applicable standards for reviewing

an institution's medical/safety determination appear to me, at

least, to be the same for a detainee as for a convicted inmate.

In Washington v. Harper, 494 U.S. 210, 223 (1990), the

Supreme Court adopted a substantive "standard of reasonableness" under the Due Process Clause in deciding to involuntarily medicate a prison inmate because "[t]he extent of a

prisoner's right under the Clause to avoid the unwanted

administration of antipsychotic drugs must be defined in the

context of the inmate's confinement" and because the reasonableness standard satisfies "the need to reconcile [the court's]

longstanding adherence to the principle that inmates retain at

least some constitutional rights despite incarceration with the

recognition that prison authorities are best equipped to make

difficult decisions regarding prison administration." Id. at

222-24. Applying this standard, the Court concluded that,

"given the requirements of the prison environment, the Due

Process Clause permits the State to treat a prison inmate

who has a serious mental illness with antipsychotic drugs

against his will, if the inmate is dangerous to himself or

others and the treatment is in the inmate's medical interest,"

494 U.S. at 227. The same reasoning supports applying the

reasonableness standard before conviction and the Court

recognized as much in Riggins v. Nevada, 504 U.S. 127

(1992), noting that "in the trial or pretrial settings, Nevada

certainly would have satisfied due process if the prosecution

had demonstrated, and the District Court had found, that

treatment with antipsychotic medication was medically appropriate and, considering less intrusive alternatives, essential

for the sake of Riggins' own safety or the safety of others."

504 U.S. at 135 (citing Harper, 494 U.S. at 225-226).

Procedurally, the Harper Court concluded that the role of

the courts is simply "to ensure that the decision to medicate

an inmate against his will is neither arbitrary nor erroneous

under the [substantive due process] standards." 494 U.S. at

228. "An inmate's interests," the Court concluded, "are

adequately protected, and perhaps better served, by allowing

the decision to medicate to be made by medical professionals

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rather than a judge," id. at 232. Again, the Court's rationale

applies no less to a detainee than to a convicted inmate. I

therefore believe that the district court correctly adopted as

its procedural standard of review the one set forth in the

Administrative Procedure Act, 5 U.S.C. ss 551 et seq., which

permits agency action to be set aside only if it is " 'arbitrary,

capricious, an abuse of discretion, or otherwise not in accordance with law.' " See 69 F. Supp. 2d at 116. I further

believe that under this standard the district court properly

upheld the Bureau's determination that antipsychotic medication is "medically appropriate," a finding that is well supported by the record, although the majority opinion correctly

holds the evidence does not support the concomitant finding

that in his then-confinement situation Weston posed a safety

risk to himself or others.*

Finally, far from agreeing with Judge Tatel's apparent

concern over the defendant's "presentation" at trial, I see no

difference between his potentially altered state then, as compared to his conduct on the day of the murders, and the

status of a defendant whose defense to murder is of the "heat

__________

* I say "correctly" only because Johnson expressly opined that

Weston was not dangerous "under his immediate parameters of

incarceration where he is in an individual room with limited access

to anything that he could harm himself with or anyone else with,

and he remains under constant observation" See Maj. Op. at 7

(quoting JA ii 121). Other testimony from Johnson, however,

supports the court's finding of dangerousness. See 69 F. Supp. 2d

at 109 (citing Johnson's opinion that "when she and other staff

members go into his room, doing so 'poses some immediate risk of

potential harm' to herself and to those persons" and that "the

defendant now refuses to respond to questions regarding suicide")

(record citations omitted). I also note that in Harper the Supreme

Court questioned whether "physical restraints or seclusion are

acceptable substitutes for antipsychotic drugs, in terms of either

their medical effectiveness or their toll on limited prison resources."

Harper, 494 U.S. at 227 (footnote omitted). In the long term such

"alternatives" to medication may prove both harmful to Weston and

a drain on institutional resources, especially since, if he goes

unmedicated, Weston may very well be institutionalized indefinitely,

if not permanently.

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of passion" variety. No one would argue that due process

requires that the latter duplicate his "hot blood" in court. In

any event the testimony of both lay and expert witnesses,

whether on direct or cross, will suffice to address any differences in Weston's appearance.

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Rogers, Circuit Judge, concurring: I concur in the

judgment of the court reversing the district court's order and

remanding the case for further findings. I write separately

principally to note a reservation with regard to the proper

standard of review of a regulation of the Federal Bureau of

Prisons as applied to a pretrial detainee, and to clarify our

reasons for remanding. I also join Judge Tatel's concurring

opinion describing the "daunting task" faced by the district

court upon remand. See infra Tatel, J., concurring at 1.

Confronted with the question of whether a judicial hearing

is required before the State may treat a mentally ill convicted

prisoner with antipsychotic drugs against his will, the Supreme Court in Washington v. Harper, 494 U.S. 210 (1990),

held that, "[g]iven the requirements of the prison environment, the Due Process Clause permits the State to treat a

prison inmate who has a serious mental illness with antipsychotic drugs against his will, if the inmate is dangerous to

himself or others and the treatment is in the inmate's medical

interests" Id. at 227.1 Harper had been convicted of robbery,

was incarcerated for approximately four years during which

he was mostly housed in the prison's mental health unit, and

was then paroled on the condition that he participate in

psychiatric treatment. While incarcerated he had consented

to the administration of antipsychotic drugs, and while on

parole he continued to receive psychiatric treatment. Eventually, he was civilly committed, and his parole was revoked

after he assaulted two hospital nurses. Upon returning to

prison, he initially consented again to treatment but in November 1982 he refused to continue taking his medications.

He subsequently filed a civil action under 42 U.S.C. s 1983

for injunctive relief and monetary damages. Id. at 217. The

trial court denied relief and was reversed on appeal by the

Washington Supreme Court, which held that Harper had a

liberty interest in refusing antipsychotic medication and thus

was entitled to a hearing with full adversarial procedural

protections. Id. at 218.

__________

1 In so holding, the Supreme Court focused solely on the

protections afforded the prisoner under the Due Process Clause of

the Fourteenth Amendment. Id. at 213.

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The Supreme Court reversed. In the Supreme Court's

view, while Harper possessed "a significant liberty interest in

avoiding unwanted administration of antipsychotic drugs,"

due process was met where the State established by a

medical finding the existence of a mental disorder likely to

cause harm if not treated, and where the antipsychotic medication was prescribed by a psychiatrist, with the approval of a

reviewing psychiatrist. Id. at 221-22. The Court noted that

such protections "ensure[d] that the treatment in question

will be ordered only if it is in the prisoner's medical interests,

given the legitimate needs of his institutional confinement."

Id. at 222. Noting "[t]he legitimacy, and the necessity of

considering the States' interests in prison safety and security," the Harper Court concluded that "the proper standard

for determining the validity of a prison regulation claimed to

infringe on an inmate's constitutional rights is ... whether

the regulation is 'reasonably related to legitimate penological

interests.' " Id. at 223 (citation omitted). Most pertinent

here, the Supreme Court explained that this standard applies

"even when the constitutional right claimed to have been

infringed is fundamental, and the State under other circumstances would have been required to satisfy a more rigorous

standard of review." Id. (emphasis added). In other words,

the Supreme Court observed, while "inmates retain at least

some constitutional rights despite incarceration.... th[is]

standard of review ... applies to all circumstances in which

the needs of prison administration implicate constitutional

rights." Id. at 223-24.

Subsequently, in Riggins v. Nevada, 504 U.S. 127 (1992),

the Supreme Court addressed a claim by a pretrial detainee

on direct appeal from his convictions that his right to a fair

trial was denied under the Sixth and Fourteenth Amendments by the refusal to suspend the administration of an

antipsychotic drug during his trial. Shortly after his arrest,

Riggins had complained of hearing voices and a psychiatrist

prescribed Mellaril, an antipsychotic drug. The psychiatrist

later increased the dosage in response to Riggins' continued

complaints. Id. at 129. After he was found competent to

stand trial, and after a hearing at which the trial judge denied

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his motion to have the medication suspended until the end of

his trial, Riggins presented an insanity defense and testified

on his own behalf at trial. Id. at 130-31. The jury found him

guilty and he was sentenced to death. Id. at 131. The

Nevada Supreme Court affirmed his convictions, rejecting

Riggins' claims that forced administration of Mellaril denied

him the ability to assist in his own defense and prejudicially

affected his attitude, appearance, and demeanor at trial, and

that the State had neither demonstrated a need to administer

Mellaril nor explored alternatives to giving him 800 milligrams of the drug each day. Id. at 131. The Supreme Court

reversed and remanded, concluding that "[i]t is clearly possible that [the] ... side effects [of antipsychotic medication]

had an impact upon not just Riggins' outward appearance,

but also the content of his testimony on direct or cross

examination, his ability to follow the proceedings, or the

substance of his communication with counsel." Id. at 137.

In considering Riggins' "core contention that involuntary

administration of Mellaril denied him 'a full and fair trial,' "

the Supreme Court noted that its decision in Harper "provides useful background for evaluating this claim." Id. 134.

But contrasting the circumstances in Riggins with the

"unique circumstances of penal confinement" that had tempered its determination in Harper of what process is due a

convicted prisoner, the Supreme Court stated that "[t]he

Fourteenth Amendment affords at least as much protection to

persons the State detains for trial." Id. at 135 (emphasis

added). While the Court stated that it was not adopting a

standard of strict scrutiny, as it had "no occasion to finally

prescribe such substantive standards...." 507 U.S. at 136, it

nonetheless was clear that the Supreme Court did not simply

apply the Harper standard. Id. at 156-57 (Thomas, J.,

dissenting).2

__________

2 See Riggins, 504 U.S. at 156-57 (Thomas, J., dissenting)

("Either the Court is seeking to change the Harper standards or it

is adopting different standards for detainees without stating its

reasons.").

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The Constitution and the Supreme Court long have recognized that the rights of a convicted prisoner are different

from those of a pretrial defendant. See U.S. Constitution,

Amends. V & VI; Riggins, 504 U.S. at 135; Bell v. Wolfish,

441 US 520, 535-36 (1979). Similarly, the standards are

different depending on whether the commitment because of

mental illness occurs before or after a criminal trial. Compare Addington v. Texas, 441 U.S. 418, 428-29 (1979), and

Jackson v. Indiana, 406 U.S. 715, 738 (1972), with Jones v.

United States, 463 U.S. 354, 370 (1983). To the extent that

Weston is in custody by reason of his incompetency to stand

trial, the relevant issues are at least his dangerousness to

himself and others, and the government's ability to bring him

to trial. But until he is convicted, Weston's rights and the

relevant issues must be viewed through a somewhat different

prism than those for a convicted prisoner. Weston's custodial

status does not entail the relinquishment of all rights that a

person facing trial possesses, and Riggins' departure from

Harper signals as much. In other words, the issue raised by

Weston was not settled in Harper. But see concurring

opinion of Henderson, J., at 1-2.

The Supreme Court may ultimately articulate a standard

for pretrial detainees that is different from the one applied in

Harper to a prison inmate, particularly with regard to protection of a pretrial detainee's right to a fair trial. See, e.g.,

United States v. Brandon, 158 F.3d 947, 956-60 (6th Cir.

1998) (citing Bee v. Greaves, 744 F.2d 1387, 1393-94 (10th Cir.

1984)). Rather than foreclose the issue in this circuit at this

point, I agree that the court should await the decision of the

district court on remand to provide a record and analysis that

can be helpful for review on appeal. See opinion at 6. As the

record now stands, notwithstanding the district court's commendable effort to get a handle on a difficult issue, the

district court made insufficient findings and did not consider

all of the factors. And Riggins, while declining to enunciate

explicitly the applicable substantive standard, nonetheless

provides significant guidance to the district court on the

nature of the relevant inquiry. See opinion at 6 quoting

Riggins, 504 U.S. at 135-36.

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As suggested by the language comprising this guidance in

Riggins, the district court on remand must explore fully both

the dangerousness and trial competency rationales for granting the government's motion. The government sought forced

medication of Weston for two reasons: to address Weston's

dangerousness to himself and others, and to make him competent to stand trial. The evidence before the district court

focused on the latter, but the district court ruled that the

forced administration of the medication was justified because

of Weston's dangerousness. As a result, there was no searching inquiry into whether less intrusive alternatives would

have been sufficient to control any potential danger posed by

Weston to himself and to others. See opinion at 7. Insofar

as we hold that the question of whether forced medication is

necessary to achieve competency for trial is ripe for adjudication, the district court must also make a searching inquiry

into whether less intrusive alternatives would make Weston

competent to stand trial. There also remain the attendant

ethical issues Weston raises that the district court must

address.

In addition, the district court must address the effect of the

forced administration of drugs on Weston's right to a fair

trial. The district court noted that Weston had argued that

the Bureau of Prisons' "decision to medicate him against his

will implicates his Fifth Amendment liberty interest in being

free from unwanted medication, his Sixth Amendment rights

to a fair trial and to counsel, and his First Amendment right

to free expression." Concluding that where Weston had not

been arraigned and there was no evidence that the government's medical reasons were pretextual, the Due Process

Clause required the government only to satisfy Riggins'

"medically appropriate" standard, 504 U.S. at 135, the district

court further concluded that if the medication rendered Weston competent to stand trial the court could then address his

argument that the Due Process Clause or the Sixth Amendment required a heightened standard before he could be

forcibly medicated during trial. The issues of trial competency and fair-trial rights are distinct but they are not as

separate as the district court suggests. Weston raised a

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preliminary fair trial issue that is inextricably linked to the

determination of whether forced medication is necessary to

render him competent to stand trial and otherwise appropriate.

The district court, in ruling on the government's motion,

must consider several conflicting factors, including Weston's

right to trial and counsel, his right to be free from bodily

invasion, the government's interests in protecting his and

others' physical safety and in bringing him to trial. Whether

the underlying issue is described simply as a matter of

whether the government has met its burden of proof or as a

balance between the government's interests and Weston's

rights, the issue of whether Weston's right to a fair trial will

be unnecessarily or impermissibly infringed cannot be postponed altogether. His fair trial rights implicate the rights of

both parties, for the government has a right to know whether

by medicating Weston it will forfeit the right to bring him to

trial, and if not, what conditions are to be placed on his

medication in order to preserve the prosecution. Indeed,

Weston contends that ethical considerations preclude the

forced administration of psychotic drugs to make him competent in order to sentence him to death. While other issues on

the conduct of a trial are appropriately addressed at a later

time, as the district court acknowledged, that circumstance

does not make unripe the preliminary questions that Weston

has raised. As discussed in Judge Tatel's concurring opinion,

the district court must engage in a searching examination of

whether forced medication will impermissibly interfere with

Weston's right to a fair trial in light of the serious and

complicated issues raised by the effects that such medication

may have upon Weston's demeanor at trial and his ability to

assist in his own defense. See infra, Tatel, J., concurring at

3-6.

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Tatel, Circuit Judge, concurring:

Cure her of that.

Canst thou not minister to a mind diseas'd,

Pluck from the memory a rooted sorrow,

Raze out the written troubles of the brain,

And with some sweet oblivious antidote

Cleanse the stuff'd bosom of that perilous stuff

Which weighs upon the heart?

William Shakespeare, Macbeth, act 5, sc. 3.

Centuries after Macbeth pleaded with his doctor to cure

Lady Macbeth, a "sweet oblivious antidote" exists. Psychotropic drugs like Haldol and Mellaril, for example, are routinely prescribed for schizophrenia. Powerful enough to

"[r]aze out the written troubles of the brain," psychotropic

drugs can also adversely affect a criminal defendant's right to

a fair trial. See Riggins v. Nevada, 504 U.S. 127 (1992).

I agree with my colleagues that this case must be remanded for the district court "to assess each of the Bureau's

justifications [for forcibly medicating Weston] and to consider

the potential impact of compelled medication on Weston's

Sixth Amendment fair trial right." Op. at 8. I also agree

with Judge Rogers' standard of review discussion, as well as

with her explanation regarding why the fair trial issue is ripe.

I write separately to set forth some thoughts about the

daunting task the district court faces.

First, a little more about Russell Eugene Weston. Fortythree years old and having a history of mental illness, Weston

has lived with family members for most of his life. He has

worked for only brief periods as a laborer, maintenance man,

and mechanic. The prison psychiatrist who treated Weston

and who concluded that he was not competent to stand trial,

Dr. Sally Johnson, reported that Weston told her the following: While "working for NASA" in the early 1980's, he

developed a "Ruby Satellite System," a powerful reverse time

machine that enables users to "push time in reverse.... by

passing us through the Jurassic Sea, putting us into another

time frame." For those like Weston with access to the "Ruby

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Satellite System," nothing is permanent--the user can simply

reverse time. If convicted and executed, Weston will "simply

be time reversed, put into a safe in the Capitol, and be able to

resume his life at whatever point he chooses."

Weston gave Dr. Johnson considerable detail about the

Ruby Satellite System. Although the system was originally

used infrequently, "those who are now in control are basically

cannibals." They have overused the system and "worn time

down to 1/32 of one element of time," spawning the development and spread of "Black Heva," a disease similar to HIV or

the plague. Black Heva "result[s] from human corpses rotting, turning black, and spreading the most deadliest disease

known to mankind." Black Heva will soon reach "epidemic

proportions," killing thirty-five percent of the people in the

United States. System overuse also has resulted in "computers not working right, bones being irregularly shaped, telephone poles and electric poles being uneven, buildings leaning, ... rock structures distorting and swelling, [and] unequal

ground swelling and wide spread earthquakes." Users can

access the Ruby Satellite System through three different

consoles, one of which is on the first floor of the U.S. Capitol

and has the capacity to override the entire System. Located

in the "great safe of the U.S. Senate," the override console is

accessible through a "room that is entered by going in the

front of the Capitol and taking a door to the left, next to the

elevators." Because "time was running out," Weston had to

get to the override console in the Capitol so that he could

stem the spread of Black Heva and prevent further calamities.

On remand, the district court must answer the following

question: In pursuing its right to try Weston for murdering

two Capitol police officers, can the government, in order to

make Weston competent to stand trial, forcibly medicate him

without impairing his right to a fair trial as guaranteed by the

Fifth and Sixth Amendments? Weston's fair trial rights

include rights (1) not to be tried unless he is competent to

"consult with counsel, and to assist in preparing his defense,"

Drope v. Missouri, 420 U.S. 162, 171 (1975); (2) to testify and

"present his own version of events in his own words," Rock v.

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Arkansas, 483 U.S. 44, 52 (1987); (3) to be present in the

courtroom at every stage of the trial, see Illinois v. Allen, 397

U.S. 337, 338 (1970); and (4) to present a defense, including

an insanity defense. See 18 U.S.C. s 17 (setting forth requirements for insanity defense).

Forcible administration of psychotropic drugs can burden

these fair trial rights in several ways, one of which is through

the drugs' various side effects. See, e.g., Riggins, 504 U.S. at

141-44 (Kennedy, J., concurring); Washington v. Harper, 494

U.S. 210, 229-230 (1990). The medication can cause parkinsonism, which is "characterized by rhythmical muscular tremors, rigidity of movement, ... and [a] masklike" face or

expression, PDR Medical Dictionary 1301 (1995); akathisia, a

"syndrome characterized by an inability to remain in a sitting

posture, with motor restlessness and a feeling of muscular

quivering," id. at 41; and tardive dyskinesia, "a syndrome

consisting of potentially irreversible, involuntary dyskinetic

movements ... characterized by rhythmical involuntary

movements of tongue, face, mouth, or jaw (e.g., protrusion of

tongue, puffing of cheeks, puckering of mouth, chewing movements)." Physicians' Desk Reference 2000 at 2156; see also

Harper, 494 U.S. at 230. Should any of these side effects

occur, Weston could find it difficult if not impossible to focus

on the testimony of witnesses or to assist counsel with his

defense. Riggins, 504 U.S. at 137.

In addition, jurors' perceptions of Weston's character could

be adversely affected if as they watch him react to particularly emotional testimony--for example the testimony of the

officers' co-workers--his expression is "masklike" or he is

constantly rhythmically moving. The tendency of psychotropic medication to flatten or deaden emotional responses

could also be damaging, particularly if the government seeks

the death penalty, for the jury would then be especially

sensitive to Weston's character and any demonstrations of

remorse (or lack thereof). See Riggins, 504 U.S. at 144

(Kennedy, J., concurring). Justice Kennedy put it this way in

his concurring opinion in Riggins:

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[S]erious prejudice could result if medication inhibits the

defendant's capacity to react and respond to the proceedings and to demonstrate remorse or compassion. The

prejudice can be acute during the sentencing phase of

the proceedings, when the sentencer must attempt to

know the heart and mind of the offender and judge his

character, his contrition or its absence, and his future

dangerousness. In a capital sentencing proceeding, assessments of character and remorse may carry great

weight and, perhaps, be determinative of whether the

offender lives or dies.

Id. at 143-44.

Because the district court focused on the safety issue, the

record contains little information about the possible effects of

medication on Weston and nothing at all about their impact

on his fair trial rights. On remand, therefore, the district

court will need to explore questions like the following: How

likely is it that these side effects will actually occur? How

severe are they likely to be? Can side effects be mitigated or

controlled by reducing the dosage, changing the type of

medication, or administering medication to counteract these

effects, and if so, can this be accomplished without reducing

the drugs' potential for controlling delusions? Considering

the answers to such questions as well as Weston's previous

experience with psychotropic drugs, the district court will

have to determine whether it is likely that the drugs will so

adversely affect Weston and the jury's perception of him that

he will be unable to obtain a fair trial. Of course, the

difficulty inherent in predicting how a particular drug will

affect a particular individual may well lead the district court

to conclude that it cannot make this determination about

Weston without first medicating him. In that event, I see no

reason why the potential for side effects would preclude the

district court from ordering medication, provided that, should

Weston become competent to stand trial, the district court

conducts a second hearing to determine the extent to which

any side effects Weston is actually experiencing might affect

his fair trial rights.

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Regardless of how the district court resolves the side

effects issue, it will also have to consider the impact of the

drugs' intended effect--actually controlling Weston's delusions--on his fair trial rights. Rendering Weston nondelusional may impair his ability to mount an effective insanity defense. Anyone reading Dr. Johnson's description of

Weston's delusions might well doubt that Weston truly believes them, yet he convinced Dr. Johnson, an experienced

prison psychiatrist. Dr. Johnson, of course, interviewed Weston in the unmedicated, delusional state he was in when he

allegedly committed the crime. Will a jury that sees and

hears a different Weston, one who is medicated and nondelusional, be as likely to believe that he truly thought there

was a Ruby Satellite System? I think the answer is obvious.

A jury listening to a non-delusional Weston explain, perhaps

quite passively, that at the time of the crime he believed he

had to save the world from the Ruby Satellite System will be

considerably more skeptical than a jury that sees and hears

the person Dr. Johnson saw and heard: Russell Weston,

delusional and unmedicated, explaining in the present tense

that there is a "Ruby Satellite System" and that he in fact

went to the Capitol in search of the override console to save

the country from "human corpses rotting, turning black, and

spreading the most deadliest disease known to mankind."

Were Weston's testimony the only way for him to present

an insanity defense, I would thus have serious doubts about

whether the government could involuntarily medicate him.

Unlike requiring a defendant to shave or wear glasses at trial,

actions which merely restore a defendant's appearance to

what it was at the time of the crime, see United States v.

Emanuele, 51 F.3d 1123, 1132-33 (3d Cir. 1995), forcible

medication chemically alters the brain and deprives the jury

of the opportunity to observe the defendant in the delusional

state he was in at the time of the crime. To be sure, due

process does not require that a defendant presenting a "heat

of passion" defense "duplicate his 'hot blood' in court."

Henderson, J., concurring at 2-3. But because such a case

involves no action by the government, it has nothing to do

with the issue before us. Here the question is whether due

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process permits the government through involuntary administration of psychotropic drugs to alter the defendant so that it

becomes impossible for him to appear before the jury as he

was when he committed the crime. No one would suggest

that the government may prevent a defendant claiming insanity from presenting relevant evidence about his delusions.

From a due process perspective, forcibly administering psychotropic medication--what Justice Kennedy called "manipulat[ing] the evidence"--seems no different. Riggins, 504 U.S.

at 142 (Kennedy, J., concurring).

But Weston's testimony may not be the only way for him to

present an effective insanity defense. Although at one point

during oral argument defense counsel took the position that

compulsory medication, by rendering Weston non-delusional,

would necessarily violate Weston's fair trial rights, at another

point he suggested that an effective insanity defense might be

presented through the testimony of Dr. Johnson, perhaps

assisted by videotapes of Weston. On remand, therefore, the

district court should review the tapes to determine whether

they show Weston in his delusional state, and if so, whether,

when combined with psychiatric testimony, they would enable

defense counsel to mount an effective insanity defense.

A final point: In assessing whether compulsory medication

would deprive Weston of a fair trial, the district court should

keep in mind that "the Constitution entitles a criminal defendant to a fair trial, not a perfect one." Delaware v. Van

Arsdall, 475 U.S. 673, 681 (1986); see also Rock, 483 U.S. at

55 ("[T]he right to present relevant testimony is not without

limitation [and] may, in appropriate cases, bow to accommodate other legitimate interests in the criminal trial process.")

(internal quotation marks omitted); Allen, 397 U.S. at 342-45

(holding that although a defendant has a constitutional right

to be present at trial, expelling an obstreperous defendant

does not unconstitutionally infringe that right).

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