Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca9-12-30264/USCOURTS-ca9-12-30264-0/pdf.json

Parties Involved:
Joseph Harvey Brooks
Appellant
United States of America
Appellee

Document Text:

FOR PUBLICATION

UNITED STATES COURT OF APPEALS

FOR THE NINTH CIRCUIT

UNITED STATES OF AMERICA,

Plaintiff-Appellee,

v.

JOSEPH HARVEY BROOKS,

Defendant-Appellant.

No. 12-30264

D.C. No.

3:11-cr-00074-HA-1

OPINION

Appeal from the United States District Court

for the District of Oregon

Ancer L. Haggerty, Senior District Judge, Presiding

Argued and Submitted

February 5, 2014—Seattle, Washington

Filed May 7, 2014

Before: Raymond C. Fisher, Ronald M. Gould,

and Morgan Christen, Circuit Judges.

Opinion by Judge Christen

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2 UNITED STATES V. BROOKS

SUMMARY*

Criminal Law

The panel vacated the district court’s order authorizing

involuntary medication in order to render the defendant

competent to stand trial, in a case in which the parties agree

that remand is necessary so that specific time limitations may

be added to the involuntary-medication order.

The panel held that the district court did not clearly err in

determining that the defendant suffered from a mental illness.

Because over a year has passed since the district court’s

order was entered, the panel believed that a new inquiry

pursuant to Sell v. United States is required, and took the

opportunity to provide additional guidance concerning the

procedures to be followed on remand. The panel instructed

the district court to make a specific determination that no

other basis for forcibly administering medication is

reasonably available before conducting a new Sell analysis.

Regarding the Sell requirement that important

governmental interests must be at stake, the panel wrote that

the district court must consider, on the one hand, the potential

for and anticipated length of future civil commitment in the

event the defendant is not medicated and the amount of time

the defendant has already been confined, versus the period of

confinement that could reasonably be expected if the

defendant were restored to competency and convicted of the

* This summary constitutes no part of the opinion of the court. It has

been prepared by court staff for the convenience of the reader.

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UNITED STATES V. BROOKS 3

charged offense. The panel wrote that the district court

should also consider any other significant factors that could

strengthen or weaken the governmental interests in

prosecuting the defendant, including the extent to which

delaying the prosecution could jeopardize the government’s

position at trial.

COUNSEL

C. Renée Manes (argued), Assistant Federal Public Defender,

Office of the Federal Public Defender, Portland, Oregon, for

Defendant-Appellant.

Stephen F. Peifer (argued), Assistant United States Attorney,

S. Amanda Marshall, United States Attorney, Kelly A.

Zusman, Appellate Chief, Office of the United States

Attorney, Portland, Oregon, for Plaintiff-Appellee.

OPINION

CHRISTEN, Circuit Judge:

Among the most weighty decisions our society can make

is to subject someone to a powerful medication against his or

her will. The government must meet the demanding standard

set by the Supreme Court in Sell v. United States, 539 U.S.

166 (2003), before involuntary medication may be

administered in an effort to restore a defendant’s competency

to stand trial. This case requires that we consider whether the

district court appropriatelyauthorized involuntarymedication

in order to render Joseph Brooks competent to stand trial for

arson. Brooks and the government agree that remand is

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4 UNITED STATES V. BROOKS

necessary so that specific time limitations may be added to

the district court’s order authorizing involuntary medication. 

Because over a year has passed since the district court’s order

was entered, we believe a new Sell inquiry is required, and

we take this opportunity to provide additional guidance

concerning the procedures to be followed on remand.

BACKGROUND

Joseph Harvey Brooks, age 53, has a lengthy history of

mental health issues including paranoid schizophrenia. This

is not the first time a government entity has sought to

medicate Brooks against his will. After he was charged with

assault in 2004, Brooks underwent several forensic

evaluations of his mental health. In 2004 and 2005, he was

hospitalized to restore his competency to stand trial for

assault. During this period, a Washington state court

authorized a hospital to treat Brooks with antipsychotic

medications if necessary, and he received such medications.

The current appeal relates to a different incident. The

government alleges that Brooks attempted to set fire to cables

connecting a radio antenna on a roof at Oregon Health

Sciences University. Brooks was indicted for arson in federal

district court in 2011. After reviewing Brooks’s forensic

mental health evaluations, the district court found Brooks

mentally incompetent to stand trial and ordered his

hospitalization pursuant to 18 U.S.C. § 4241(d)(1).1 On

1 Under 18 U.S.C. § 4241(d)(1), a federal court may hospitalize a

mentally incompetent defendant “for such a reasonable period oftime, not

to exceed four months, as is necessary to determine whether there is a

substantial probability that in the foreseeable future he will attain the

capacity to permit the proceedings to go forward.”

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UNITED STATES V. BROOKS 5

December 16, 2011, Brooks was admitted to the U.S. Medical

Center for Federal Prisoners in Springfield, Missouri.

An internal administrative hearing pursuant to 28 C.F.R.

§ 549.43 was held on March 5, 2012 at the federal medical

facility to determine if Brooks met the criteria for involuntary

administration of antipsychotic medication for reasons such

as grave disability or because he posed a danger to himself or

to others at the facility.

2 This proceeding is referred to as a

Harper hearing.

3

See Washington v. Harper, 494 U.S. 210

(1990). The hearing officer determined that Brooks did not

meet the Harper criteria, and he was not involuntarily

medicated.

The government then filed a motion seeking court

approval to medicate Brooks with antipsychotic drugs against

his will so that he would regain competency to stand trial,

pursuant to the Supreme Court’s decision in Sell. 539 U.S. at

177–83. In Sell, the Court reaffirmed that “an individual has

a significant constitutionally protected liberty interest in

avoiding the unwanted administration of antipsychotic

drugs.” Id. at 178 (citation and internal quotation marks

omitted). Sell also held that “the Constitution permits the

Government involuntarily to administer antipsychotic drugs

to a mentally ill defendant facing serious criminal charges in

order to render that defendant competent to stand trial,” but

only if a court determines that four conditions are met. Id. at

179. These conditions, which we refer to as the “Sell

2 The procedures that must be followed before medication may be

involuntarily administered to an inmate are outlined in 28C.F.R. § 549.46.

3 At oral argument for this appeal, the government agreed that the

March 5, 2012 internal administrative hearing was a Harper hearing.

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6 UNITED STATES V. BROOKS

factors,” are that: (1) there are “important governmental

interests” at stake; (2) “involuntary medication will

significantly further those concomitant state interests;”

(3) “involuntary medication is necessary to further those

interests;” and (4) “administration of the drugs is medically

appropriate, i.e., in the patient’s best medical interest in light

of his medical condition.” Id. at 179–81.

Under Sell, before a court orders involuntary medication

for purposes of restoring competency to stand trial, the court

must determine “whether the Government seeks, or has first

sought, permission for forced administration of drugs on . . .

other, Harper-type grounds; and, if not, why not.” Id. at

183.4

The Sell standard for involuntary medication is “more

demanding” than the Harper standard.5 United States v.

Loughner, 672 F.3d 731, 747 (9th Cir. 2012). Sell inquiries

are “disfavored,” United States v. Rivera-Guerrero, 426 F.3d

1130, 1137 (9th Cir. 2005), in part because they are less

“objective and manageable” than Harper inquiries, id.

(quoting Sell, 539 U.S. at 182). We have explained that,

4 Accordingly, our court has held that “prior to undertaking the Sell

inquiry, a district court should make a specific determination on the record

that no other basis for forcibly administering medication is reasonably

available,” and that “[i]f a district court does not conduct a dangerousness

inquiry under Harper, it should state for the record why it is not doing so.” 

United States v. Hernandez-Vasquez, 513 F.3d 908, 914 (9th Cir. 2007).

5 Harper held that “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; see Sell,

539 U.S. at 178.

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UNITED STATES V. BROOKS 7

under Harper, “an inmate . . . is being treated for reasons that

are in his and the institution’s best interests,” while under

Sell, “the inmate is being treated because of the government’s

trial interests, not the prison’s interests or the inmate’s

medical interests.” Loughner, 672 F.3d at 758–59. Put

another way, the Harper inquiry determines whether

medication may be involuntarily administered “to render an

individual nondangerous” during confinement, while a Sell

inquiry asks whether medication is necessary to allow the

government to prosecute the individual. Id. at 747.

In this case, on August 7, 2012, the district court held a

Sell hearing on the government’s motion for involuntary

medication. Brooks testified that a “Ku Klux Klan Mafia

mob organization” was trying to murder him, as foretold in

the Biblical Book of Revelations. He claimed that a contract

to kill him had been put out by the “kingpin” of the Ku Klux

Klan—allegedly “the owner manager of the Riverside Motel

in Vancouver, Washington.” He stated “I am not a violent

person,” and “I’m not psychotic or delusional.” In response

to the court’s questioning, he indicated his willingness to take

medications “as a last resort . . . until I get some appropriate

help from law enforcement” in fighting the Ku Klux Klan

mafia. But later in the hearing, referring to the Ku Klux Klan

or mafia conspiracy against him, he stated: “I don’t need no

medication to stop something that ain’t gonna be stopped by

medication.”

The court also heard testimony from Dr. Robert Sarrazin,

Brooks’s treating physician and the chief of psychiatry at the

Federal Medical Center in Springfield, Missouri. Dr.

Sarrazin testified that he had been involved in over fifty Sell

hearings. He stated that Brooks had been diagnosed with

paranoid schizophrenia, was “clearly . . . delusional” as

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8 UNITED STATES V. BROOKS

evidenced by his false beliefs regarding the mafia, and that

absent treatment with antipsychotic medications he “will not

become competent in the foreseeable future.” At the time of

the Sell hearing, Dr. Sarrazin testified that Brooks’s mental

illness had been ongoing for more than a year. In fact, from

medical records it appears that he has been mentally ill for

around a decade or longer.

Dr. Sarrazin opined that it was “substantially likely that

Mr. Brooks will be restored to competency in the foreseeable

future with treatment with antipsychotic medications.” Dr.

Sarrazin testified that similarly situated prisoners have been

“restored to competency over 70 percent of the time.” 

Because Brooks “ha[d] no insight into his illness” and “was

quite insistent that he has no mental illness and needs no

treatment,” Dr. Sarrazin indicated that there was no reason to

believe he would consent to voluntary medication. 

According to Dr. Sarrazin, medication was a “necessary

treatment” and the least intrusive treatment likely to achieve

success. He also concluded that there was nothing about

Brooks’s physical condition that would render medication

inappropriate.

Based on its consideration of the sealed record and the

evidence presented at the Sell hearing held on August 7,

2012, the district court granted the government’s motion for

authorization to medicate Brooks involuntarily. The court

found that each of the Sell requirements was met. Its written

order did not expressly explain how the government had

established the first prong of the Sell test, that important

governmental interests are at stake. At the hearing, however,

the court told Brooks: “For the record, I will find that the

governmental interests in this case are high from the

standpoint that if, in fact, you were not in custody, there’s a

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UNITED STATES V. BROOKS 9

likelihood that you would, in fact, cause harm to the members

of the public or property.” The written Sell order authorized

the Federal Bureau of Prisons to administer one or more

antipsychotic medications at specified dosages but did not

include a time limitation. The court authorized Brooks’s

continued commitment pursuant to 18 U.S.C.

§ 4241(d)(2)(A)6

“until further order of the court to set

another hearing to assess the status of defendant’s treatment

and to determine whether defendant may be returned to the

District of Oregon to participate in further proceedings.”

Brooks appealed to this court. The district court stayed

the involuntary medication order pending this appeal.

DISCUSSION

“Ordinarily, an appellate court may hear appeals only

from a district court’s final decision.” Loughner, 672 F.3d at

742 (citing 28 U.S.C. § 1291). Here, we have jurisdiction to

review the district court’s involuntarymedication order under

the collateral order doctrine. Id. at 743; see also Sell,

539 U.S. at 177 (holding that district court’s involuntary

medication order was an appealable collateral order). This

court has held “that the first Sell factor . . . is a legal question

subject to de novo review, and that the remaining Sell factors

are factual questions . . . reviewed for clear error.” 

Hernandez-Vasquez, 513 F.3d at 915–16.

6 This provision authorizes the Attorney General to hospitalize a

defendant for treatment in a suitable facility for a reasonable period of

time “if the court finds that there is a substantial probability that within

such . . . period of time he will attain the capacity to permit the

proceedings to go forward.” 18 U.S.C. § 4241(d)(2).

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10 UNITED STATES V. BROOKS

I. The Defendant’s Mental Incompetency

Brooks argues there is no need for involuntarymedication

to restore him to competency because he is not mentally ill. 

Brooks’s mental condition is a factual question, and the

district court’s determination that Brooks is mentally ill is

reviewed for clear error. Id.

Brooks’s statements at the hearing, the testimony of Dr.

Sarrazin, and the sealed forensic reports and evaluations

included in the record provide ample support for the district

court’s finding that Brooks suffered from a mental illness at

the time of the hearing. In particular, multiple psychiatrists

diagnosedBrooks with delusions and paranoid schizophrenia,

and Brooks’s statements at the hearing regarding the Ku Klux

Klan and the mafia were consistent with these diagnoses. 

The district court did not clearly err in determining that

Brooks suffered from a mental illness.

II. Consideration of AlternativeGroundsfor Involuntary

Medication

It appears that the district court reasonably concluded

there was no other basis for forcibly administering

medication because of the outcome of the March 5, 2012

Harper hearing; neither party contends otherwise. Given the

amount of time that has passed since the district court’s Sell

order, on remand the district court should make a specific

determination that no other basis for forcibly administering

medication is reasonably available before conducting a new

Sell analysis. The district court is not required to order or

conduct a new Harper hearing if one is not otherwise

indicated, but if the court does not conduct a dangerousness

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UNITED STATES V. BROOKS 11

inquiry, “it should state for the record why it is not doing so.” 

Id. at 914.

III. Governmental Interests in InvoluntaryMedication

Of the four Sell factors, Brooks only specifically

challenges the district court’s determination of the first factor,

the requirement that important governmental interests must

be at stake. Our review of this legal question is de novo. Id.

at 915–16. Brooks argues that the government’s interest is in

public safety and that involuntary medication is unnecessary

to serve this interest because, absent medication, he will

remain confined pursuant to 18 U.S.C. § 4246. This

provision states that a district court may order the continued

hospitalization of:

a person in the custody of the Bureau of

Prisons . . . who has been committed to the

custody of the Attorney General pursuant to

section 4241(d), or against whom all criminal

charges have been dismissed solely for

reasons related to the mental condition of the

person [if the person] is presently suffering

from a mental disease or defect as a result of

which his release would create a substantial

risk of bodily injury to another person or

serious damage to property of another.

18 U.S.C. § 4246(a).

Brooks claims that if he were restored to competency, “he

would present the defense that he was not guilty by reason of

insanity.” His argument, in essence, is that he was so clearly

incompetent at the time of the underlying offense that the

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12 UNITED STATES V. BROOKS

government has no independent interest in prosecution except

to keep him confined, which will be accomplished whether or

not he is prosecuted and convicted. See Clark v. Arizona,

548 U.S. 735, 768–69 (2006) (“‘A central significance of the

insanity defense . . . is the separation of nonblameworthy

from blameworthy offenders.’” (quoting D. Hermann, The

Insanity Defense: Philosophical, Historical and Legal

Perspectives 4 (1983))). Brooks argues that the government’s

interest in public safety may be adequately served by civil

commitment under 18 U.S.C. § 4246(a), which allows the

government to involuntarily hospitalize him so long as he

remains “a substantial risk of bodily injury to another person

or serious damage to property of another.”

As a threshold matter, we reject Brooks’s premise that the

district court is required to speculate about whether Brooks

would be found not guilty by reason of insanity if he pursued

that defense. We also decline to analyze the first Sell factor

as applied to Brooks’s case. Brooks’s contention that the

district court did not adequately address this factor is welltaken. But this is a fact-intensive analysis that the district

court is better suited to conduct in the first instance,

especially where, as here, the relevant considerations may

have changed with the passage of time. Instead, we

summarize below the Supreme Court and circuit authority

addressing the first Sell factor, and remand to the district

court to address Brooks’s argument when it conducts a new

Sell inquiry. Given that more than a year has passed since the

district court’s initial Sell hearing, the court should also

ascertain whether there have been significant changes in

Brooks’s mental and medical condition or in the relevant

standard of care for treatment aimed at restoring competency.

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UNITED STATES V. BROOKS 13

To evaluate the first Sell factor, the district court should

begin by considering “the seriousness of the underlying

crime.” Hernandez-Vasquez, 513 F.3d at 915; see United

States v. Gillenwater, No. 12-30379, 2014 WL 1394960, at

*4 (9th Cir. Apr. 11, 2014). Hernandez-Vasquez provides

guidance on how to analyze this question. 513 F.3d at

917–19. There, we held that the penalty for which the

defendant could be liable if convicted is a relevant factor, and

therefore “the likely guideline range is the appropriate

starting point for the analysis of a crime’s seriousness.” Id.

at 919. But the guideline range is the beginning of the

analysis, not the end. The Supreme Court has directed that

“courts must consider the facts of individual cases in

evaluating the government’s interest in prosecution.” Id. at

918; see also Sell, 539 U.S. at 180; Gillenwater, 2014 WL

1394960, at *4. “Such relevant circumstances include the

time a defendant has served while awaiting trial and the

possibility of future civil confinement.” Hernandez-Vasquez,

513 F.3d at 918 (citing Sell, 539 U.S. at 180).

In Sell, the Supreme Court acknowledged that “[s]pecial

circumstances may lessen the importance” of the

governmental interests in prosecution. Sell, 539 U.S. at 180. 

In particular, “[t]he defendant’s failure to take drugs

voluntarily, for example, may mean lengthy confinement in

an institution for the mentally ill—and that would diminish

the risks that ordinarily attach to freeing without punishment

one who has committed a serious crime.” Id. The Court went

on:

We do not mean to suggest that civil

commitment is a substitute for a criminal trial. 

The Government has a substantial interest in

timely prosecution. And it may be difficult or

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14 UNITED STATES V. BROOKS

impossible to try a defendant who regains

competence after years of commitment during

which memories may fade and evidence may

be lost. The potential for future confinement

affects, but does not totally undermine, the

strength of the need for prosecution. The

same is true of the possibility that the

defendant has already been confined for a

significant amount of time (for which he

would receive credit toward any sentence

ultimately imposed, see 18 U.S.C. § 3585(b)). 

Moreover, the Government has a concomitant,

constitutionally essential interest in assuring

that the defendant’s trial is a fair one.

Id.7

From this discussion of the first factor in Sell, we glean

the principle that the district court must consider, on the one

hand, the potential for and anticipated length of future civil

commitment in the event the defendant is not medicated and

the amount of time the defendant has already been confined,

versus the period of confinement that could reasonably be

expected if the defendant were restored to competency and

convicted of the charged offense. The district court should

also consider any other significant factors that could

7 The governmental interest in a fair trial is implicated by both the first

and second Sell factors. Under the second Sell factor, a court “must find

that administration of the drugs is substantially unlikely to have side

effects that will interfere significantly with the defendant’s ability to assist

counsel in conducting a trial defense, thereby rendering the trial unfair.” 

Sell, 539 U.S. at 181. An individual defendant’s past responses to

antipsychotic medications, if any, will bear upon the likelihood and

severity of side effects.

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UNITED STATES V. BROOKS 15

strengthen or weaken the governmental interests in

prosecuting Brooks, including the extent to which delaying

the prosecution could jeopardize the government’s position

at trial. It is not clear from the record that the district court

conducted this inquiry. Where the district court has yet to

explore all the facts relevant to the first Sell factor, we decline

to create additional rules or guidance beyond what has been

expressed through binding authority. We have confidence in

the district court’s ability to weigh these considerations in the

first instance, and we believe it is in the best position to do so.

IV. Time Limitations on Involuntary Medication

A Sell order must identify “the duration of time that

involuntary treatment of the defendant may continue before

the treating physicians are required to report back to the court

on the defendant’s mental condition and progress.” 

Hernandez-Vasquez, 513 F.3d at 917. The parties agree that

the district court’s order did not specify the time limitation. 

Remand is necessary on this issue.

CONCLUSION

Given that remand is necessary, a new Sell inquiry is

required because of the amount of time that has passed since

the district court’s order was entered. If the district court

determines on remand that no alternative basis for forcibly

medicating Brooks is indicated, it should proceed to consider

all four Sell factors anew.

VACATED AND REMANDED.

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