Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca4-07-04131/USCOURTS-ca4-07-04131-0/pdf.json

Parties Involved:
Philip A. Holman
Appellant
United States of America
Appellee

Document Text:

PUBLISHED

UNITED STATES COURT OF APPEALS

FOR THE FOURTH CIRCUIT

UNITED STATES OF AMERICA, 

Plaintiff-Appellee,

v.  No. 07-4131

PHILIP A. HOLMAN,

Defendant-Appellant. 

UNITED STATES OF AMERICA, 

Plaintiff-Appellee,

v.  No. 07-4132

PHILIP A. HOLMAN,

Defendant-Appellant. 

Appeals from the United States District Court

for the Eastern District of Virginia, at Norfolk.

Henry Coke Morgan, Jr., Senior District Judge.

(2:93-cr-00036-JCC; 2:95-cr-00198-HCM)

Argued: March 21, 2008

Decided: July 7, 2008

Before MOTZ, TRAXLER, and DUNCAN, Circuit Judges.

Affirmed by published opinion. Judge Traxler wrote the opinion, in

which Judge Motz and Judge Duncan joined. 

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COUNSEL

ARGUED: Joseph Barry McCracken, Norfolk, Virginia, for Appellant. Laura Marie Everhart, OFFICE OF THE UNITED STATES

ATTORNEY, Norfolk, Virginia, for Appellee. ON BRIEF: Chuck

Rosenberg, United States Attorney, Alexandria, Virginia, for Appellee. 

OPINION

TRAXLER, Circuit Judge: 

After Philip Holman was released from prison and began serving

his term of supervised release, the district court at the government’s

request imposed as a special condition of supervised release a requirement that Holman participate in mental health treatment and take all

prescribed medication, including intramuscular injections of an antipsychotic drug. Holman appeals, arguing that requiring him to submit

to the intramuscular injections violates his constitutionally protected

liberty interest in "avoiding the unwanted administration of antipsychotic drugs." Washington v. Harper, 494 U.S. 210, 221 (1990). We

find no error, and we therefore affirm the district court’s imposition

of the special condition of supervised release. 

I.

Holman pleaded guilty to various drugs and weapons charges in

1993 and 1996. Shortly after he began serving the sentence on the

1993 charges, Holman began exhibiting symptoms of serious mental

illness, and he was eventually diagnosed as suffering from schizoaffective disorder, bipolar type. 

During his time in prison, Holman cycled between cooperating

with his psychiatric treatment plan and voluntarily taking the prescribed oral antipsychotic medication and refusing to cooperate with

treatment or take his medication. These periods of refusal led to a

recurrence of his symptoms and manic or depressive psychotic epi2 UNITED STATES v. HOLMAN

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sodes. In 1997, after Holman again began refusing to take his medication, he was involuntarily committed to a psychiatric prison facility.

In July 2003, after several months of Holman refusing then agreeing then refusing to take the prescribed oral medication, prison officials convened an "Involuntary Medication Hearing" and received

permission to administer antipsychotic medication to Holman despite

his objections. By late 2003, Holman’s mental condition was deteriorating. He was again refusing to take his medication, and he began

threatening to kill himself and prison staff members. On January 14,

2004, "[a]fter a staff show of force," Holman "reluctantly accepted"

an injection of long-acting risperidone, an antipsychotic medication.

J.A. 179. Holman continued to receive injections of risperidone, along

with other oral medications, until September 2004, when he was

released after serving his prison term. 

When he was released, Holman’s prison psychiatrist provided him

with a supply of oral risperidone. In a memo to Holman outlining his

condition and treatment needs, the psychiatrist noted that future treatment decisions would be made by local mental health providers, but

recommended that Holman continue the risperidone injections, "to

prevent [Holman] from succumbing to the temptation to stop taking

the tablets." J.A. 174. Upon release from prison, Holman received

psychiatric care through the Community Services Board in Chesapeake, Virginia. His treating psychiatrist continued Holman on the

oral risperidone, but at higher dosage than had been prescribed while

Holman was in prison. 

The conditions of supervised release imposed when Holman was

sentenced did not require him to seek mental health treatment. In

November 2004, Holman’s probation officer filed a petition with the

district court requesting a hearing to determine whether the conditions

of supervised release should be modified to include a requirement that

Holman receive mental health care and take all prescribed medication.

The district court held the hearing in February 2005 and, in March

2005, issued an order imposing as a special condition of supervised

release a requirement that Holman comply with his mental health

treatment plan and take all prescribed medication. The order specifically required the use of intramuscular injections of risperidone, as

recommended by Holman’s prison psychiatrist.

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In late February 2005, after the hearing but before the issuance of

the district court’s order, Holman disappeared. He left his home without his medication, had no contact with his family, and missed several

appointments with his probation officer. Holman was arrested several

weeks later, after he was found wandering aimlessly and in a partially

catatonic state. Several months later, after treatment and medication

had stabilized his condition and he was deemed competent, Holman

was brought before the district court to answer for the violation of the

terms of his supervised release. The district court sentenced Holman

to eleven months imprisonment, to be followed by a forty-nine-month

term of supervised release. The district court re-imposed all prior special conditions of supervised release, including the requirement that

Holman receive intramuscular injections of risperidone. 

By June 2006, just a few months after he was released from prison,

Holman had again violated the terms of his supervised release by

refusing to take his prescribed medication. His probation officer filed

another petition alleging a violation of the conditions of supervised

release, and Holman was arrested. The court found Holman to be

incompetent and he was committed for evaluation and treatment. In

January 2007, after treatment and medication restored him to competency, Holman appeared before the district court. The district court

sentenced him to twelve months imprisonment to be followed by

thirty-seven months of supervised release with the same conditions

previously imposed. 

Holman now appeals the sentence, challenging the special condition of supervised release imposed by the district court.1

 While Holman does not object to the requirement that he receive mental health

1

In United States v. Johnson, 138 F.3d 115 (4th Cir. 1998), we held

that when a condition of supervised release was imposed as part of the

defendant’s original sentence, the condition could not be challenged in

an appeal from an order revoking the defendant’s supervised release, but

must instead be challenged on direct appeal from the original conviction

and sentence. See id. at 117-18. In the present case, the challenged special condition was not a part of Holman’s original sentence, and the special condition was imposed anew in 2005 and 2006 after Holman

violated the conditions of supervised release. Holman’s appeal is therefore timely. 

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treatment, nor to the general requirement that he take antipsychotic

medication, he does object to the requirement that he take antipsychotic drugs by way of intramuscular injections. Antipsychotic

medications generally have the potential for severe or even fatal side

effects2; for Holman, the side effects of the injectable medications are

more significant and unpleasant than those of oral medications. Holman argues that the government failed to establish that the injections

were medically necessary and that no less intrusive alternative would

suffice, and Holman therefore argues that the special condition of

supervised release imposed by the district court violates his constitutionally protected liberty interest in refusing the unwanted injections.

II.

District courts are required to impose certain conditions with every

term of supervised release and are permitted to impose other appropriate conditions. See 18 U.S.C.A. § 3583(d) (West 2000 & Supp. 2008).

A district court may impose any appropriate non-mandatory condition

of supervised release if the condition 

(1) is reasonably related to the factors set forth in [18

U.S.C.A. §] 3553(a)(1), (a)(2)(B), (a)(2)(C), and (a)(2)(D);

2The Supreme Court has explained the side effects of antipsychotic

medications: 

The purpose of the drugs is to alter the chemical balance in a

patient’s brain, leading to changes, intended to be beneficial, in

his or her cognitive processes. . . . While the therapeutic benefits

of antipsychotic drugs are well documented, it is also true that

the drugs can have serious, even fatal, side effects. One such side

effect . . . is acute dystonia, a severe involuntary spasm of the

upper body, tongue, throat, or eyes. . . . Other side effects

include akathesia (motor restlessness, often characterized by an

inability to sit still); neuroleptic malignant syndrome (a relatively

rare condition which can lead to death from cardiac dysfunction); and tardive dyskinesia, perhaps the most discussed side

effect of antipsychotic drugs. . . . Tardive dyskinesia is a neurological disorder, irreversible in some cases, that is characterized

by involuntary, uncontrollable movements of various muscles,

especially around the face. 

Washington v. Harper, 494 U.S. 210, 229-30 (1990). 

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(2) involves no greater deprivation of liberty than is reasonably necessary for the purposes set forth in section

3553(a)(2)(B), (a)(2)(C), and (a)(2)(D); and 

(3) is consistent with any pertinent policy statements

issued by the Sentencing Commission pursuant to 28 U.S.C.

994(a). 

Id. The § 3553(a) factors referred to in subsection (d)(1) are: the

defendant’s history and characteristics, and the nature and circumstances of the offense for which the defendant was convicted; see 18

U.S.C.A. § 3553(a)(1) (West 2000 & Supp. 2008); the need for adequate deterrence, see id. § (a)(2)(B); the need to protect the public

from further crimes, id. § (a)(2)(C); and the need to provide the defendant in the most effective manner with necessary medical care, vocational or educational training, or other correctional treatment, see id.

§ (a)(2)(D); see also United States v. Dotson, 324 F.3d 256, 260 (4th

Cir. 2003).

District courts "have broad latitude" with regard to special conditions of supervised release, and we review the court’s decision to

impose a condition of supervised release for an abuse of discretion.

See Dotson, 324 F.3d at 259, 260. 

The government argues that the special condition imposed by the

district court satisfies the statutory requirements set forth in

§ 3583(d). The government notes that Holman’s history establishes

that he suffers from a mental illness that is well controlled with medication. When Holman is off his medication, however, he may exhibit

violent behavior towards others and put his own health and safety at

risk. The government therefore contends that the medication requirement is reasonably related to the need to protect the public and the

need to effectively provide Holman with the proper medical care. And

because Holman has consistently demonstrated his inability to comply

with a treatment plan centered on oral medication, the requirement

that he take the medication by way of injection is the least intrusive

way of furthering these important governmental purposes. The government therefore contends that the district court properly required as

a special condition of supervised release that Holman receive injections of prescribed antipsychotic medication. 

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Holman, however, suggests that our inquiry should not be limited

to an application of § 3583(d)’s requirements that the special condition be reasonably related to a sentencing purpose and be no greater

a deprivation of liberty than is reasonably necessary to further that

purpose. The special condition at issue in this case implicates Holman’s fundamental liberty interest in refusing to take medications that

substantially change his personality and carry a significant risk of

dangerous side-effects. Holman thus contends that the nature of the

interest affected by the special condition requires us to scrutinize with

more care the district court’s decision to impose the condition. 

A.

The Supreme Court has made it clear that under the Due Process

Clauses of the Fifth and Fourteenth Amendments, individuals (including pre-trial detainees and convicted criminals) have "a constitutionally protected liberty interest in avoiding involuntary administration

of antipsychotic drugs—an interest that only an essential or overriding [governmental] interest might overcome." Sell v. United States,

539 U.S. 166, 178-79 (2003) (internal quotation marks omitted); see

also Washington v. Harper, 494 U.S. 210, 221-22 (1990) ("We have

no doubt that . . . respondent possesses a significant liberty interest

in avoiding the unwanted administration of antipsychotic drugs under

the Due Process Clause of the Fourteenth Amendment."). Among the

governmental interests that in a given case may be sufficiently important to support an order for involuntary medication are the need to

protect the individual and others from the individual’s potentially

dangerous behavior, see Riggins v. Nevada, 504 U.S. 127, 134-35

(1992); Harper, 494 U.S. at 225-26; and the government’s interest in

rendering a criminal defendant competent to stand trial, see Sell, 539

U.S. at 179-80. 

In general terms, an involuntary-medication order is constitutionally impermissible "absent a finding of overriding justification and a

determination of medical appropriateness." Riggins, 504 U.S. at 135.

The showing necessary to satisfy these requirements, however differs

depending on the context and reasons underlying the order. See

United States v. Baldovinos, 434 F.3d 233, 240-41 (4th Cir. 2006);

United States v. Evans, 404 F.3d 227, 235 n.3 (4th Cir. 2005). If the

involuntary-medication order is premised on the individual’s dangerUNITED STATES v. HOLMAN 7

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ousness (to himself or the public), the government can satisfy the dueprocess inquiry by demonstrating that "treatment with antipsychotic

medication [is] medically appropriate and, considering less intrusive

alternatives, essential for the sake of [the individual’s] own safety or

the safety of others." Riggins, 504 U.S. at 135; see Harper, 494 U.S.

at 225-26. In cases where the order is not premised on the individual’s

dangerousness, however, the inquiry is governed by the analysis set

forth in Sell. See Baldovinos, 434 F.3d at 240-41. In such a case, the

government must demonstrate that, in light of the individual facts of

the case, its interest in bringing the individual to trial is sufficiently

important. See Sell, 539 U.S. at 180 ("Special circumstances may

lessen the importance of [the interest in trying a defendant accused of

a serious crime]. The 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. . . . And it may be difficult or 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 government must also establish that

the involuntary-medication order will "significantly further" its interest, by demonstrating that "administration of the drugs is substantially

likely to render the defendant competent to stand trial" but yet "substantially unlikely to have side effects that will interfere significantly

with the defendant’s ability to assist counsel in conducting a trial

defense." Id. at 181. 

The standards set forth by the Supreme Court for determining

whether an involuntary medication order is constitutionally

permissible—particularly as those standards were applied in Sell—

arguably are more demanding (at least in formulation, if not application) than the statutory provisions generally governing conditions of

supervised release. Sell requires such an order to significantly further

a compelling governmental interest, while § 3583(d) requires only a

reasonable relationship to one of several specified sentencing goals.

Moreover, the statute seems to demand a looser fit between the special condition and the sentencing goal — § 3583(d)(2) requires only

that the condition of supervised release be no more restrictive than

reasonably necessary to further the sentencing goal, while Sell

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requires that there be no less intrusive means of treatment that likely

will achieve substantially the same results. 

There is some question as to whether the Harper-Riggins-Sell constitutional analysis supplants or supplements the statutory requirements set forth in § 3583(d). See United States v. Williams, 356 F.3d

1045, 1056-57 (9th Cir. 2004) (applying § 3583(d) factors to review

of involuntary medication order imposed as condition of supervised

release, but requiring district court to make "explicit, specific finding[s]" based on evidence reflected in "a medically-informed

record"); United States v. Schave, 186 F.3d 839, 843 (7th Cir. 1999)

("[A] court will not strike down conditions of [supervised] release,

even if they implicate fundamental rights, if such conditions are reasonably related to the ends of rehabilitation and protection of the public from recidivism."); United States v. Wilson, 154 F.3d 658, 667

(7th Cir. 1998) (applying § 3853(d) factors and concluding that the

district court did not abuse its discretion by requiring as a condition

of supervised release that the defendant participate in a mental health

treatment program and take all required medications). But see United

States v. Myers, 426 F.3d 117, 125-26 (2d Cir. 2005) (explaining that

in cases where the challenged condition of supervised release implicates "a fundamental liberty interest protected by due process," the

reviewing court’s application of the § 3583(d) factors "must reflect

the heightened constitutional concerns. If the liberty interest at stake

is fundamental, a deprivation of that liberty is ‘reasonably necessary’

only if the deprivation is narrowly tailored to serve a compelling government interest."). In this case, however, there is no need for us to

answer that question, because the special condition of supervised

release was properly imposed in this case even when analyzed under

the framework set out in Harper and Sell. 

B.

The district court imposed the involuntary-medication condition in

order to protect Holman himself and to protect the general public, and

the record clearly supports the district court’s determination that Holman is a danger to himself and others when off his medication. Holman had several episodes of violent behavior while he was in prison,

episodes that happened only during periods when he refused to take

his medication. Holman made threats against his prison psychiatrist

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and other prison staffers and threatened to commit suicide, actions

that again happened only during periods when he was refusing to take

the prescribed oral medication. The first time after his release from

prison that Holman quit taking his medication and vanished, he was

found several weeks later, "disoriented, disheveled, and partially catatonic," J.A. 197, which further demonstrates the danger Holman poses

to himself when off his medication. The government’s interest in protecting Holman from himself and protecting the general public from

Holman are essential or overriding interests sufficient to support an

order requiring the involuntary administration of antipsychotic drugs.

See Sell, 539 U.S. at 179; Harper, 494 U.S. at 225-26.

The evidence establishing Holman’s dangerousness also establishes

that the district court’s order was narrowly tailored to the circumstances of this case. As the district court noted, Holman became a

danger to himself and others when he was off his medication, and

injections of long-lasting antipsychotic drugs provide the only means

of insuring that Holman takes his medication. The special condition

of supervised release thus significantly furthers and is clearly necessary to further the government’s interests in protecting Holman and

the public. See Sell, 539 U.S. at 181 (explaining that an order to involuntarily medicate an individual must "significantly further" overriding

governmental interests and must be "necessary to further those interests" and that involuntary medication may be necessary if "any alternative, less intrusive treatments are unlikely to achieve substantially

the same results"). 

Finally, the record establishes that the involuntary-medication

requirement is medically appropriate. Prison officials generally were

required to use injections to stabilize Holman’s condition once he quit

taking his oral medications, and Holman’s prison psychiatrist

believed that the long-lasting injections were his best treatment

option, in part because the injections helped prevent Holman from

"succumbing to the temptation" to stop taking medication. J.A. 174.

Given Holman’s "absolute dependence on medication to maintain his

mental health," J.A. 80, and his inability to comply with his treatment

plan when on oral medication, we have no difficulty concluding that

the special condition requiring Holman to take the required antipsychotic drugs by way of intramuscular injections was medically necessary. 

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We therefore conclude the district court’s decision to require intramuscular injections of antipsychotic medications as a special condition of supervised release was consistent with the due-process

requirements set out by the Supreme Court in Harper and Sell. And

because the due-process standards are, if anything, more demanding

than the statutory requirements, it follows that the special condition

likewise complies with § 3583(d). The special condition is reasonably

related to the need to protect the public and the need to provide the

defendant with appropriate medical care, see 18 U.S.C.A. § 3583(d);

Dotson, 324 F.3d at 260, and the involuntary medication order

involves no greater deprivation of liberty than is reasonably necessary

to further these governmental interests. 

III.

Accordingly, for the foregoing reasons, we hereby affirm the district court’s decision to require intramuscular injections of antipsychotic medications as a special condition of Holman’s term of

supervised release. 

AFFIRMED

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