Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca8-04-01769/USCOURTS-ca8-04-01769-0/pdf.json

Parties Involved:
Hessam Ghane
Appellant
United States of America
Appellee

Document Text:

United States Court of Appeals

FOR THE EIGHTH CIRCUIT

___________

No. 04-1769

___________

United States of America *

*

 Appellee, *

* Appeal from the United States

v. * District Court for the

* Western District of Missouri.

Hessam Ghane, *

*

 Appellant. *

___________

Submitted: September 17, 2004

Filed: December 20, 2004

___________

Before COLLOTON, HEANEY, and HANSEN, Circuit Judges.

___________

HEANEY, Circuit Judge.

Hessam Ghane is a 54-year-old naturalized United States citizen of Iranian

descent who suffers from delusional disorder. On February 4, 2003, Ghane was

admitted to an Overland Park Hospital emergency room, stating that he was suicidal

because he was depressed and out of work. He told a physician’s assistant that he

intended to kill himself using a solid form of cyanide, which he had acquired through

his years as a chemist, and stored in his home. The physician’s assistant notified the

Independence, Missouri Police Department, and detectives were sent to interview

Ghane, who consented to a search of his home. During the search, a bottle half-filled

with white powder was found under Ghane’s kitchen sink. The powder was later

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Sell v. United States, 539 U.S. 166 (2003).

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determined to be bicarbonate and seventy-five percent potassium cyanide. Ghane

stated he did not know it was illegal to possess potassium cyanide, and claimed he

intended to use it in teaching, to conduct experiments, or to commit suicide. He was

charged with criminal possession of potassium cyanide, in violation of 18 U.S.C. §§

229(a)(1) and 229A(a)(1).

On October 30, 2003, the court held a competency hearing and determined that

Ghane was incompetent to stand trial. The magistrate conducted a Sell1

 hearing on

January 12, 2004 and ordered Ghane to be involuntarily medicated with antipsychotic

medications in order to restore him to competency to stand trial. The magistrate

found that the recommended treatment is substantially likely to render Ghane capable

of standing trial because medical testimony indicated there was a ten percent chance

of success. Ghane appeals this order.

Appellate review of a district court’s findings of fact is for clear error. United

States v. Cook, 356 F.3d 913, 918 (8th Cir. 2004). An individual has a

constitutionally protected liberty interest in rejecting or avoiding the administration

of antipsychotic medications. Washington v. Harper, 494 U.S. 210, 221-22 (1990).

Before the court may authorize the involuntary administration of antipsychotic

medication for the purpose of rendering Ghane competent to stand trial, the

government must show: (1) important government interests are at stake; (2)

involuntary medication is substantially likely to render the defendant competent to

stand trial, and substantially unlikely to have side effects that will interfere

significantly with the defendant’s ability to assist counsel at trial; (3) involuntary

medication is necessary to further the government’s interests, and less intrusive

means are unlikely to achieve substantially the same results; and (4) the

administration of the drugs is medically appropriate. See Sell, 539 U.S. at 180-182.

Neither the Supreme Court nor our circuit has spoken on the standard of proof that

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attaches to Sell proceedings. In United States v. Gomes, 387 F.3d 157, 160 (2nd Cir.

2004), the Second Circuit determined that a clear and convincing standard should

apply. Ghane asks us to use the preponderance of the evidence standard, and the

district court applied a lesser standard. We need not determine which to use in this

case, however, because each of the standards would yield the same result: the

government has failed to sustain its burden.

The second and fourth Sell factors are at issue here: is the involuntary

administration of antipsychotic medication substantially likely to render Ghane

competent to stand trial; and is the administration of an increased dosage of

antipsychotic medication medically appropriate? The magistrate made the following

findings about Ghane’s psychotic disorder after considering testimony from at least

four psychiatrists:

Delusional disorder is characterized by the presence of one or

more fixed, nonbizarre, and unvarying delusions. Patients with

delusional disorder do not experience hallucinations or disorders

of thinking or perception. Rather, they maintain delusions, or false

beliefs, despite any amount of evidence to contradict those beliefs.

The delusions are “nonbizarre,” meaning they involve events or

situations that could conceivably occur in real life, rather than

supernatural agents or phenomena. In the Persecutory Type of

delusional disorder, individuals typically believe they are being

conspired against, spied on, poisoned or drugged, or otherwise

persecuted.

Delusional disorder resists treatment by both psychotherapy and

antipsychotic medication. Patients with delusional disorder are

fully intact individuals, and the delusions themselves are not

indicative of a thought disorder. The delusions are a fixed part of

the individual’s thought pattern, and, except in the mildest cases,

they cannot be convinced through behavioral therapy to ignore the

delusional beliefs or to recognize their falsity. Antipyschotic

medication is similarly ineffective at treating delusional disorder.

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Compare Gomes, 387 F.3d at 161-62 (finding that a seventy percent success

rate in restoring defendant’s competence through drug treatment was substantially

likely to render Gomes competent and substantially unlikely to have disabling side

effects).

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Approximately 10 percent of patients who receive antipsychotic

drugs experience a lessening of symptoms or remission. Of that 10

percent, about half, or 5 percent, are symptom-free after treatment.

The remainder are considered “improved,” meaning the patients are

less preoccupied with their delusions, either because the delusions

appear in the past tense or because they are able to adopt a

behavioral stance of acting as though the delusions are false.

Ninety percent of delusional disorder patients do not experience

improvement with treatment. 

United States v. Ghane, No. 03-00171-01-CR-W-ODS, slip op. at 5 (D. Mo. Feb. 12,

2004) (Report and Recommendation on Government’s Sell Mot.) (Citations omitted)

(Emphasis added). On the basis of these facts, the court below determined that

involuntarily medicating Ghane was substantially likely to restore his competency.

We cannot accept that a “glimmer of hope” for his restored competence rises to the

level of “substantial likelihood,” as mandated by the Supreme Court’s holding in Sell.

A five to ten percent chance of restored competence cannot be considered

substantially likely under any circumstances.2

 It was error for the court below to

hold that the government had met its burden in establishing the second Sell factor.

We therefore reverse the district court.

______________________________ 

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