Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca8-08-03900/USCOURTS-ca8-08-03900-0/pdf.json

Parties Involved:
Salvatore Vincent Fazio
Appellant
United States of America
Appellee

Document Text:

United States Court of Appeals

FOR THE EIGHTH CIRCUIT

___________

No. 08-3900

___________

United States of America, *

*

Appellee, *

* Appeal from the United States

v. * District Court for the

* Eastern District of Missouri.

Salvatore Vincent Fazio, *

* 

Appellant. *

___________

Submitted: September 25, 2009

Filed: March 4, 2010 

___________

Before BYE, ARNOLD and SMITH, Circuit Judges.

___________

BYE, Circuit Judge.

Salvatore Fazio was indicted for transportation and possession of child

pornography and being a felon in possession of a firearm. After the district court1

determined Fazio was incompetent to assist in his own defense, the prosecution

brought a motion pursuant to Sell v. United States, 539 U.S. 166 (2003), to forcibly

medicate Fazio in order to restore his competency to stand trial. Applying the factors

set forth in Sell, the district court granted the prosecution's motion. Fazio appeals,

arguing the district court erred in its findings of fact and conclusions of law. Because

1

The Honorable E. Richard Webber, United States District Judge for the Eastern

District of Missouri.

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the district court did not clearly err in its findings of fact or misapply the law, we

affirm.

I

On August 18, 2005, a federal superseding indictment was returned by a grand

jury in the Eastern District of Missouri, charging Fazio with two child exploitation

offenses and one count of being a felon in possession of firearms.

On October 24, 2006, the district court found Fazio “presently suffers from a

mental disease or defect rendering him mentally incompetent to the extent he is unable

to assist properly in his defense.” Fazio was admitted to the United States Medical

Center for Federal Prisoners (MCFP) in Springfield, Missouri, on March 27, 2007. 

At the time he filed this appeal, Fazio was seventy years old. On April 11, 2007,

Fazio was transferred to a mental health unit. Roughly seven months later, Dr.

Christina Pietz, a Staff Psychologist at the MCFP, completed a Forensic Update. Dr.

Pietz reported that when Fazio arrived for treatment, he “was adamant that he did not

suffer from a mental illness and would not consider taking medication.” Fazio

persisted in his refusal to take antipsychotic medication. According to Dr. Pietz,

“[b]ecause [Fazio] is unwilling to take medication, his condition remains the same in

that he is not competent to participate in legal proceedings.”

The prosecution subsequently brought a motion requesting that Fazio be

forcibly medicated, and the district court held a hearing on May 20, 2008. At the

hearing, the Government presented two witnesses, both doctors from the MCFP in

Springfield, Missouri–Dr. Christina Pietz, Ph.D., ABPP, Staff Psychologist, and Dr.

Robert Sarrazin, M.D., Chief of Psychiatry. The defendant called one witness, Dr.

Stephen Peterson, M.D., a medical doctor specializing in psychiatry and forensic

psychiatry in St. Louis and Kansas City, Missouri.

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Dr. Pietz testified:

[Fazio] believes that he has special relationships with law enforcement. 

[Fazio] believes that he was . . . hired by Walmart to assist in capturing

child molesters on pornographic Internet sites. He has made comments

that he . . . has a special relationship with law enforcement regarding

access of computers, and he believes himself to be a very special person.

In Dr. Sarrazin’s prior assessment of Fazio in November 2007, Dr. Sarrazin

noted that Fazio “continued to assert[] that he was involved with the FBI, that he was

part of a law enforcement team that was addressing child pornography.”

The Government also introduced statements made by Fazio during a prior

forensic examination conducted by Dr. Gitry Heydebrand on July 25, 2006. In

sharing his version of the events leading to the federal Indictment, Fazio stated he

found websites containing child pornography and as a result:

[S]ent Ashcroft emails and called his office. They put me on record and

he said “I’ll take care of it.” I went back and they were still up. I called

Ashcroft’s office again and said I was going to extract those photos and

notify Yahoo. They were marked as evidence. It was my job as a legal

advocate for human decency and cleanliness.

Dr. Heydebrand noted Fazio “did not appear anxious, distressed or defensive

while discussing these topics.” When Dr. Heydebrand asked Fazio if he understood

the charges against him, Fazio replied “[t]he charges should be dismissed. I had child

porn–so what? I found it on the internet and sent it to law enforcement. They won’t

act on it. I was helping. I got people arrested–I found people.”

Dr. Pietz concluded Fazio suffers from paranoid schizophrenia. Dr. Peterson,

the psychiatrist hired by Fazio, conducted a diagnostic interview with Fazio on August

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11, 2005. Dr. Peterson concluded Fazio suffers from dementia due to other general

medical conditions.

When asked to explain the difference between schizophrenia and dementia, Dr.

Pietz explained:

[T]he best way to describe it is that schizophrenia refers to an individual

that has a loss of contact with reality. Either they have the delusions or

false beliefs or they are attending to internal stimuli. Dementia refers to

. . . cognitive deficits, and there are a number of things that you look for

in an individual to determine if they have cognitive deficits. Memory

impairment is probably the number one issue. Disturbances in what we

refer to as executive functioning–planning, organizing, that sort of thing. 

Disturbances in problem solving skills. Confusion, disorientation–you

may see a little bit of that, but the big issues are going to be the memory

impairment and then cognitive disturbances.

In regard to whether Fazio suffers from dementia, Dr. Pietz stated, “I do think

he has memory impairment. I do think he has cognitive disturbances but not to the

degree that he meets the criteria for that particular disorder.” She also stated:

We have patients here that are demented, that do have severe cognitive

deficits and cognitive disturbances and can’t do those things, so we have

an orderly that escorts them to meals and escorts them to their

appointments and ensures that they receive their medication and that they

shower regularly.

Fazio, on the other hand, manages these tasks independently, according to Dr.

Pietz.

Dr. Sarrazin prepared a psychiatric report on Fazio after reviewing Fazio's

medical history. Dr. Sarrazin testified he believes Fazio requires antipsychotic

medications to treat his psychotic symptoms in order to be competent to stand trial. 

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Dr. Sarrazin further testified there was a 75 to 87 percent chance the medications he

recommended would make Fazio competent to stand trial. Finally, Dr. Sarrazin

testified the risk of death to Fazio in antipsychotic treatment would be very small. All

three experts who testified at the Sell hearing were not aware of any other less

intrusive types of treatment that are available to assist Fazio in regaining competency.

The actual medications recommended by Dr. Sarrazin, in the order of

preference, include Abilify (generic is aripiprazole), Risperdal (generic is risperidone),

Zyprexa (generic is olanzapine), and Haldol (generic is haloperidol). Dr. Sarrazin

testified that “[s]tudies have shown that all across the board these medications are

equally effective treating psychotic disorders. Where they differ is tolerance and side

effects and how each individual tolerates the medication.”

Following the hearing, the district court entered an order granting the

Government's motion to forcibly medicate Fazio. The district court stated "[i]f

Defendant does not submit to this medication voluntarily within ten days of this

Memorandum and Order, involuntary administration of psychiatric medication is

ordered." Specifically, the court concluded the crimes charged in the superseding

indictment are serious and "an important Government interest is at stake," and the

government presented clear and convincing evidence showing "the administration of

medication is substantially likely to restore Mr. Fazio's competency to stand trial." 

Further, the court concluded "there is no evidence that the recommended medication

would interfere with Mr. Fazio's ability to aid in the preparation of his own defense,

and . . . the medications would have no prejudicial effects on Mr. Fazio's physical

appearance." Furthermore, the district court found the government presented clear and

convincing evidence showing "involuntary medication is necessary to further the

Government's important interests, and . . . there is no less intrusive means that could

accomplish substantially the same results." Lastly, the district court found the

government presented "clear and convincing evidence that Mr. Fazio suffers from

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paranoid schizophrenia" and that "the involuntary administration of antipsychotic

medication is medically appropriate."

Fazio timely appealed the district court’s forcible medication order.

II

In Sell v. United States, 539 U.S. 166 (2003), the Supreme Court considered

"whether the Constitution permits the Government to administer antipsychotic drugs

involuntarily to a mentally ill criminal defendant–in order to render that defendant

competent to stand trial for serious, but nonviolent, crimes." Id. at 169. The Court

concluded the Government could administer antipsychotic drugs involuntarily if four

criteria were met.

First, “a court must find that important governmental interests are at stake,”

though “[s]pecial circumstances may lessen the importance of that interest.” Id.

Second, “the court must conclude that involuntary medication will significantly

further those concomitant state interests.” Id. at 181. This includes finding that

“administration of the drugs is substantially likely to render the defendant competent

to stand trial,” and “[a]t the same time . . . 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.” Id. Third, “the court must conclude that involuntary medication is

necessary to further those interests” and that “any alternative, less intrusive treatments

are unlikely to achieve substantially the same results.” Id. Fourth, and finally, “the

court must conclude that administration of the drugs is medically appropriate, i.e., in

the patient's best medical interest in light of his medical condition.” Id. The Court

then emphasized that the goal of this test is “to determine whether involuntary

administration of drugs is necessary significantly to further a particular governmental

interest, namely, the interest in rendering the defendant competent to stand trial.” Id.

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The Sell Court did not specify a standard for reviewing Sell orders. Several

other circuits have, however, specified standards of review for each factor of the Sell

test. All courts of appeal that have addressed this issue have concluded the first Sell

factor presents a legal question subject to de novo review. See, e.g., United States v.

Hernandez-Vasquez, 513 F.3d 908, 915-16 (9th Cir. 2008); United States v. Green,

532 F.3d 538, 546 (6th Cir. 2008) (reviewing the first Sell factor de novo); United

States v. Palmer, 507 F.3d 300, 303 (5th Cir. 2007) (same); United States v. Bradley,

417 F.3d 1107, 1113-14 (10th Cir. 2005) (same); United States v. Evans, 404 F.3d

227, 236 (4th Cir. 2005) (same); United States v. Gomes, 387 F.3d 157, 160 (2d Cir.

2004) (same).

With respect to the remaining Sell factors, the overwhelming majority of courts

have held Sell factors two through four present factual questions subject to clear error

review. See, e.g., Hernandez-Vasquez, 513 F.3d at 915-16; Green, 532 F.3d at 551-52

(holding that Sell factors two, three, and four are factual questions reviewed for clear

error); Palmer, 507 F.3d at 303 (same); Evans, 404 F.3d at 240 (same); Gomes, 387

F.3d at 160 (same); but see Bradley, 417 F.3d at 1113-14 (holding that both Sell

factors one and two are legal, or mixed legal and factual, questions subject to de novo

review).2

 We agree with the majority of our sister circuits. Therefore, while we

2

The Supreme Court and this court have similarly not addressed the quantum

of proof the government bears at a Sell hearing. All other courts of appeals addressing

this issue have held, however, that the government bears the burden of proof on

factual questions by clear and convincing evidence. See, e.g., Gomes, 387 F.3d at 159

(applying and requiring the government to meet the “clear and convincing evidence”

standard previously articulated in Riggins v. Nevada, 504 U.S. 127, 134 (1992), as to

the factual findings in Sell factors two through four); Green, 532 F.3d at 545 (“A Sell

order requires the government to present clear and convincing evidence of [the factual

components of each of the four factors].”); Bradley, 417 F.3d at 1114 (agreeing that

Sell factors two through four are factual findings that the Government must prove by

clear and convincing evidence). We agree with our sister circuits that the government

bears the burden of proving the final three Sell factors by clear and convincing

evidence.

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review de novo the district court's determination that important governmental interests

are at stake, we review the district court's determinations with respect to the remaining

Sell factors for clear error.

Fazio first argues the district court erred when it held that the government

proved an important government interest is at stake. We disagree.

As the Sell Court concluded, “[t]he Government’s interest in bringing to trial

an individual accused of a serious crime is important.” Sell, 539 U.S. at 180. Fazio

is charged with crimes involving the transportation (Count I) and possession (Count

II) of child pornography, as well as being a felon in possession of nine firearms

(Count III). Furthermore, the government alleges Fazio is an armed career criminal

based on his convictions for assault with a deadly weapon (February 19, 1962), the

felonies of robbery and assault with a deadly weapon (July 26, 1965), and two

convictions for armed robbery (August 23, 1974). See 18 U.S.C. § 924(e). The

mandatory minimum sentence available for an armed career criminal is fifteen years. 

Should Fazio be convicted and sentenced as an armed career criminal, the result would

reflect Congress' judgment that the course of criminal conduct for which Fazio stands

accused is very serious.

Furthermore, child exploitation and firearms offenses have been recognized as

serious crimes. See United States v. Grape, 549 F.3d 591, 602 (3d Cir. 2008) (citing

United States v. Goff, 501 F.3d 250, 258-60 (3d Cir. 2007) (highlighting the

seriousness of and harm associated with the use of child pornography)); Gomes, 387

F.3d at 160-61 (concluding that simple possession of a firearm by a felon who also is

an armed career criminal “is a serious threat in itself”).

Thus, we have little difficulty concluding an important government interest is

at stake in this case.

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Fazio next argues the district court erred by concluding the medication plan

outlined by Dr. Sarrazin was substantially likely to restore Fazio's competency to

stand trial and substantially unlikely to have side effects. The district court accepted

the testimony of Dr. Sarrazin, who testified Fazio suffered from schizophrenia, there

was a 75 to 87 percent chance that the medications he recommended would make

Fazio competent to stand trial, and the risk of death to Fazio in antipsychotic treatment

would be very small.

Fazio contends Dr. Sarrazin's estimate was based on the general prison

population and not a specific analysis of Fazio. The record belies this claim. Dr.

Sarrazin made his claim specifically with respect to Fazio and after examining his

medical history.

The remainder of Fazio's arguments on this issue amount to disagreements with

the district court's acceptance of the testimony of Dr. Sarrazin, the Government's

expert, and rejection of the testimony of Dr. Peterson, Fazio's expert. The district

court, however, is entitled to resolve such evidentiary conflicts given the conflicting

expert testimony. There is nothing in the record suggesting the district court's

acceptance of Dr. Sarrazin's testimony was clear error. Once Dr. Sarrazin's testimony

is accepted, the government has met it burden of proving the medication plan outlined

by Dr. Sarrazin was substantially likely to restore Fazio's competency to stand trial

and substantially unlikely to have side effects. Compare United States v. Ghane, 392

F.3d 317, 319 (8th Cir. 2004) (holding that a finding that medication was 5 to 10

percent likely to restore competence was insufficient to show that restoring

competence was "substantially likely"). The district court therefore did not clearly err

by concluding involuntary medication will significantly further the prosecution's

interest in prosecuting Fazio.

Finally, Fazio argues the administration of antipsychotic drugs is medically

inappropriate in this case. Again, Fazio's argument on appeal amounts to a

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disagreement with the district court's resolution of an evidentiary conflict in favor of

the government. Dr. Pietz and Dr. Sarrazin, both of whom worked closely with Fazio,

concluded Fazio suffered from paranoid schizophrenia. Dr. Sarrazin recommended

medications in light of this diagnosis, and stated the proposed medications were

medically appropriate in light of the medical factors unique to Fazio. Dr. Peterson,

by contrast, testified that Fazio did not suffer from schizophrenia, but rather dementia. 

In light of Dr. Peterson's diagnosis, he opined that antipsychotic drugs were not

appropriate for Fazio. We conclude the district court did not commit clear error by

finding the course of action recommended by Dr. Pietz and Dr. Sarrazin medically

appropriate.

III

We affirm.

______________________________

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