United States Court of Appeals

For the Eighth Circuit 

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No. 23-1164

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United States of America

 Plaintiff - Appellee

v.

Felipe Lorthridge

 Defendant - Appellant

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Appeal from United States District Court 

for the Eastern District of Missouri - St. Louis

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Submitted: September 22, 2023

Filed: December 5, 2023

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Before COLLOTON, GRASZ, and KOBES, Circuit Judges. 

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KOBES, Circuit Judge.

Felipe Lorthridge, Sr., was indicted for being a felon in possession of a 

firearm, 18 U.S.C. § 922(g)(1). He was found incompetent to stand trial and later 
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diagnosed with schizophrenia. The district court1 ordered that he be involuntarily

medicated to restore his competency. Lorthridge appeals, and we affirm. 

I. 

The Government alleges that Lorthridge fled a traffic stop before ditching his

car and a gun. He has been detained pending trial since his 2019 arrest. 

After Lorthridge moved for a mental competency examination, a forensic 

psychologist concluded that a mental disorder impaired his ability to understand the 

nature and consequences of his trial and to assist counsel. She noted in her report

that he believed in a widespread conspiracy involving the police, his fellow inmates, 

the prosecutor, his attorney, and the judiciary. The magistrate judge2 found 

Lorthridge incompetent and ordered further treatment and evaluation to determine 

whether he would attain competency in the foreseeable future. 

Lorthridge was transferred to the U.S. Medical Center for Federal Prisoners 

in Springfield, Missouri, where two more psychologists evaluated him and issued

another report. The psychologists diagnosed him with schizophrenia and found that

without antipsychotic medication, he was substantially unlikely to be restored to 

competency in the foreseeable future. Lorthridge refused to participate in 

competency restoration treatment and declined to take antipsychotic medication. In 

an administrative hearing, the facility found that Lorthridge was not a danger to 

himself or others in a correctional setting, so he could not be involuntarily medicated 

under Washington v. Harper, 494 U.S. 210 (1990). 

The Government moved to involuntarily medicate Lorthridge to restore his 

competency under Sell v. United States, 539 U.S. 166 (2003). The magistrate judge 

1

The Honorable Stephen R. Clark, Chief Judge, United States District Court 

for the Eastern District of Missouri.

2

The Honorable Nannette A. Baker, United States Magistrate Judge for the 

Eastern District of Missouri.
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held a Sell hearing by video conference, which Lorthridge refused to join, and 

recommended granting the motion. Lorthridge objected, and the district court held 

a de novo, in-person hearing. Fearing that the in-person hearing was a veiled attempt 

to get him in a position vulnerable to attack, Lorthridge again refused to attend until 

the court ordered him to do so. 

Three doctors from the Springfield facility testified: Dr. Gary Sarrazin, then

Chief of Psychiatry; Dr. Elizabeth Tyner, Chief of Psychology; and Dr. Amanda 

Reed, one of the Springfield report’s authors. Drs. Tyner and Reed interacted with 

Lorthridge during weekly rounds and described his behavior and condition. They 

said that his delusions kept him confined to his cell and sometimes unwilling to eat

for fear of poisoning. Dr. Sarrazin, who retired before the Sell hearing, met with 

Lorthridge monthly and testified about a proposed treatment plan he developed. All 

agreed that Lorthridge suffers from schizophrenia and that he is unlikely to attain 

competency without antipsychotic medication. Dr. Sarrazin testified that in his 20 

years at the facility, involuntary administration of antipsychotic medication restored 

competency to over 75% of people with psychotic disorders. And he believed that

medication would improve Lorthridge’s life by helping him function better, leave 

his cell, and interact with others. 

The court found that the Government carried its burden under Sell, and it 

ordered that Lorthridge be involuntarily medicated consistent with Dr. Sarrazin’s

treatment plan. Lorthridge timely appealed, and we have jurisdiction under the 

collateral order doctrine. United States v. Coy, 991 F.3d 924, 926 (8th Cir. 2021). 

II. 

Lorthridge has “a significant constitutionally protected liberty interest in 

avoiding the unwanted administration of antipsychotic drugs.” Sell, 539 U.S. at 178

(cleaned up) (citation omitted). But the Government may forcibly medicate a

defendant if it shows “(1) that an important governmental interest is at stake; (2) that 

involuntary medication will significantly further that governmental interest; (3) that 
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involuntary medication is necessary to further that interest; and (4) that 

administration of the drugs is medically appropriate.” United States v. Mackey, 717 

F.3d 569, 573 (8th Cir. 2013) (citing Sell, 539 U.S. at 180–81). 

Lorthridge challenges the district court’s conclusions on the first, second, and 

fourth Sell elements. We review the first element de novo and the remaining

elements for clear error. Id. 

Bringing “an individual accused of a serious crime” to trial is an important 

governmental interest. Sell, 539 U.S. at 180. And possessing a firearm as a felon, 

for which Lorthridge faces a ten-year statutory maximum sentence, is a serious 

crime. See Mackey, 717 F.3d at 573 (finding a crime with “a maximum term of ten 

years’ imprisonment . . . [was] ‘serious’ under any reasonable standard” (citation 

omitted)); United States v. Fazio, 599 F.3d 835, 840 (8th Cir. 2010) (being a felon

and an armed career criminal in possession of a firearm is “very serious”). 

Lorthridge’s suggestion that it is a “victimless, non-violent status offense” does not 

make it less serious, nor does it weaken the governmental interest in prosecution. 

See Mackey, 717 F.3d at 573–74. 

We do not think the “special circumstances” Lorthridge cites undermine this

interest. See Sell, 539 U.S. at 180 (“Special circumstances may lessen the

importance of [the Government’s interest in prosecution].”). Two of those 

circumstances attempt to undermine governmental interests that the district court did 

not rely on. He says that the court should have considered the lack of connection 

between his mental disease and alleged crimes, which we said in United States v. 

Nicklas is relevant to a different interest—“protecting the public from [an accused’s] 

future crimes.” 623 F.3d 1175, 1179 (8th Cir. 2010). He also argues that the court

should have considered the Harper finding that he was not a danger to himself or 

others. But a Harper finding goes to yet another interest—“reduc[ing] danger that 

an inmate poses to himself or others while incarcerated.” Mackey, 717 F.3d at 575. 

Neither the risk of recidivism nor an inmate’s dangerousness while confined bears 
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on the important governmental interest at stake here—bringing an accused to trial 

for a serious crime. So the district court was not required to consider them. 

We leave for another day whether the length of Lorthridge’s pre-trial 

detention, which he estimates is over half the maximum sentence, is “significant” 

such that it weakens the governmental interest. See Sell, 539 U.S. at 180 (holding 

“significant” pre-trial detention is a special circumstance that may affect the 

governmental interest). Even if it were, it would “not totally undermine[] the 

strength of the need for prosecution.” Id.; see also Mackey, 717 F.3d at 574–75. 

With no other special circumstances lessening the interest, the Government has 

satisfied the first Sell element. 

And the record supports the district court’s findings on the second and fourth 

Sell elements. The court carefully considered the experts’ testimony, psychologists’ 

reports, and proposed treatment plan. It reasonably credited testimony that 

involuntary medication with antipsychotics was substantially likely to restore 

Lorthridge to competency and that his treatment team could manage the risks of 

negative side effects and of his condition deteriorating when he is transferred for 

trial. It did the same in finding that involuntary medication was medically 

appropriate and in his best medical interest. Lorthridge may disagree with the 

experts’ opinions, but the court’s reliance on them was not clearly erroneous. 

Nicklas, 623 F.3d at 1180–81.

III. 

The district court’s judgment is affirmed.

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