[Cite as State v. Jefferson , 2021-Ohio-2092.]



## IN THE COURT OF APPEALS FIRST APPELLATE DISTRICT OF OHIO HAMILTON COUNTY, OHIO

STATE OF OHIO, Plaintiff-Appellee,

VS

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LOUIS JEFFERSON, Defendant-Appellant. :

:

:

:

:

: APPEAL NO. C-200135 TRIAL NO. B-1907157

O P I N I O N.

Criminal Appeal From: Hamilton County Court of Common Pleas Judgment Appealed From Is: Affirmed Date of Judgment Entry on Appeal: June 23, 2021
Joseph T. Deters , Hamilton County Pros ecuting Attorney, and H. Keith Sauter , Assistant Prosecuting Attorney, for Plaintiff-Appellee, Raymond T. Faller , Hamilton County Public Defender, and Lora Peters , Assistant Public Defender, for Defendant-Appellant.OHIO FIRST DISTRICT COURT OF APPEALS

2 B ERGERON , Judge. 

### {¶1} In the wake of an incompetency determination, the trial court ordered that defendant-appellant Louis Jefferson be involuntarily medicated in order to restore his competency. Mr. Jefferson now appeals that involuntary-medication edict, challenging the court’s findings as ag ainst the manifest weight of the evidence. After reviewing the record, however, we conclude that the court’s findings were supported by at least some competent evidence and affirm its judgment.
I. 

### {¶2} Mr. Jefferson was indicted for mu rder, felonious assault, and tampering with evidence. Bu t this occurred against a documented history of mental health issues for Mr. Jefferson, including schizophrenia, and the trial court deemed him incompetent to stand trial. The court further determined that , with treatment, a substantial likelihood existed that Mr. Jefferson could be restored to competency within a year. He was accordingly committe d to Summit Behavioral Health for that purpose, but things didn’t go as planned be cause he refused to take any medication, opting instead to “cleanse” his body through a regiment of diet and exercise. 

### {¶3} Mr. Jefferson’s holistic approach failed to make progress, prompting Summit to petition the trial court for au thority to involuntarily medicate him, seeking authorization for 26 medications in total. The trial court soon convened a hearing, and Mr. Jefferson’s psychiatrist, Dr. Vanessa Doyle, explained that she hoped to use only one medication from that list: Invega, a drug that Mr. Jefferson had taken before with positive results. She requested authorization for the other medications only as contingencies in the event that Invega proved ineffective or starting producing negative side effects. For example, Dr. Doyle soughtOHIO FIRST DISTRICT COURT OF APPEALS

3 authorization for 11 or so additional antips ychotic drugs that could substitute for Invega. The remaining, non-antipsychotic medications would be available to treat issues such as mood-stabilization, agitation, insomnia, and depression—the goal being to ensure that Mr. Jefferson was feeling well and not laboring under any problematic side-effects. As the trial cour t put it, these medications represented Dr. Doyle’s “toolbox” for restoring Mr. Jefferson to competency. 

### {¶4} Mr. Jefferson now appeals the trial co urt’s decision, featuring a single assignment of error. He does not dispute Dr. Doyle’s credentials or any of her conclusions. Nor does he point to cont rary evidence in the record that might undermine her testimony. Instead, Mr. Jefferson argues narrowly that some of the trial court’s conclusions find no support in the record.
II. 

### {¶5} R.C. 2945.38(B)(1)(c) provides the procedural guidelines for involuntary administration of medica tion to incompetent defendants. State v. Ramey , 10th Dist. Franklin Nos. 19AP-642 and 19AP-643, 2019-Ohio-5087, ¶ 8. However, this statute does not shed light on whether a court should order involuntary medication. Id. at ¶ 9 (“R.C. 2945.38(B)(1)(c ) does not set forth specific standards for a trial court to apply in de termining whether to order the involuntary
administration of medication to restore a criminal defendant’s competence to stand trial.”); see State v. Brewer , 12th Dist. Clermont No. CA2008-04-040, 2008-Ohio6193, ¶ 9. Instead, Ohio courts follow four factors delineated in Sell v. United States , 539 U.S. 166, 123 S.Ct. 2174, 156 L.Ed.2d 197 (2003). See City of Cleveland v.
Tarver , 8th Dist. Cuyahoga No. 105522, 2017-Ohio-1165, ¶ 8 (“[T]he state of Ohio
has followed the standard set forth in Sell .”); see also State v. Upshaw , 166 OhioOHIO FIRST DISTRICT COURT OF APPEALS

4 App.3d 95, 2006-Ohio-1819, 849 N.E.2d 91, ¶ 20–30 (2d Dist.); Ramey at ¶ 9. The
Sell factors require the trial court to make four findings to ensure constitutional adequacy of the order: (1) “that important governmental interests are at stake”; (2)
“that forced medication will significantly further those concomitant state interests”; (3) “that involuntary medication is necessary to further those interests”; and (4) “that administration of the drugs is medically appropriate .” (Emphasis sic.) Sell at paragraph two of the syllabus. 

### {¶6} While Mr. Jefferson concedes that the trial court made the specific findings dictated by Sell , he attacks some of those findings as unsupported by the evidence. Thus, we will reverse only if the trial court’s findings are against the manifest weight of the evidence, i.e., not “supported by some competent, credible
evidence.” See Ramey at ¶ 11 (reviewing an evidentiary challenge to a Sell order using a manifest-weight standard). Mr. Jeffe rson challenges the tr ial court’s findings for only the second, third, and fourth Sell factors. 

### {¶7} The second Sell factor—whether the medica tions will significantly further the state’s interest—actually poses a two-pronged inquiry: (1) whether the “administration of the drugs is substant ially likely to render the defendant competent to stand trial”; and (2) whethe r the “administration of the drugs is substantially unlikely to have side effect s that will interfere significantly with the defendant’s ability to assist counsel in co nducting a trial defense, thereby rendering
the trial unfair.” Sell , 539 U.S. at 181, 123 S.Ct. 2174, 156 L.Ed.2d 197. Here, Mr. Jefferson contests only the second prong of this inquiry, pointing out that Dr. Doyle never specifically addressed whether the me dications might interfere with his ability to communicate with counsel. Although Dr. Doyle did not explicitly answer thisOHIO FIRST DISTRICT COURT OF APPEALS

5 precise question, she conveyed that Mr. Jefferson had previously taken Invega, that it worked well without yielding negative side effects, and that she believed Invega would likely render Mr. Jefferson competent for trial. Based on her medical judgment and his prior experience with Invega, Dr. Doyle was confident that Invega would help restore Mr. Jefferson’s competency. Furthermore, Dr. Doyle explained that, while she hoped not to use the rema ining medications, their benefits would outweigh any possible side effects. We also note that Mr. Jefferson points to no contrary evidence in the record, and neithe r did his cross-examination of Dr. Doyle bring anything to light that would cast do ubt on her testimony. Thus, we conclude
that the trial court had at least so me evidence supporting its second Sell finding. 

### {¶8} The third Sell factor asks whether the medications are necessary to further the state’s interests. And in so concluding, “[t]he court must find that any alternative, less intrus ive treatments are unlikely to achieve substantially the same
results.” Sell at 181. Furthermore, before considering more intrusive methods of administration (e.g., involuntary medication) , the court must consider less intrusive methods (e.g., a court order backed by contempt power). Id. Here, Mr. Jefferson does not suggest that the trial court failed to consider less intrusive means, instead contending that a less intrusive path existed. He stresses that counsel informed the
trial court that Mr. Jefferson would follow its orders. And because Mr. Jefferson professed to recognize the authority of th e court, he argues that a less intrusive means was in fact available. But the court observed that if Mr. Jefferson would orally agree to take his medication, “then there is no problem,” but that “up until this particular date, he has not.” Indeed, if it were that simple, we presumably would not be here. Mr. Jefferson’s attorney also asked the court to issue an order backed byOHIO FIRST DISTRICT COURT OF APPEALS

6 contempt power (a less intrusive means), bu t the court ultimately declined. Thus, we
conclude that the trial court satisfied the third Sell factor because it considered a less intrusive means and had at least some basis for concluding that involuntary medication was the only effective recourse in light of the totality of the record. 

### {¶9} The fourth and final Sell factor scrutinizes the medical appropriateness of the administration of the drugs. More specifically, this inquiry focuses on whether the medications are “in the patient’s best medical interest in light of his medical
condition.” Sell , 539 U.S. at 181, 123 S.Ct. 2174, 156 L.Ed.2d 197. Here, Mr.
Jefferson concedes that the evidence shows that Invega was in his best medical interest, but he protests that no evidence demonstrated that the same holds true for
the other medications

. 

### {¶10} In this regard, Mr. Jefferson relies upon Upshaw , 166 Ohio App.3d 95, 2006-Ohio-1819, 849 N.E.2d 91, at ¶ 31, where the Second District reversed an involuntary-medication order because the tr ial court failed to make the necessary
Sell findings and because the evidence failed to support the trial court’s order. Although the trial court in Upshaw authorized 33 medications in total, the record
contained no evidence about which medications would be used or their side effects.
Id. Applying Upshaw , Mr. Jefferson invites us to re verse because Dr. Doyle did not walk through each of the non-Invega medications or explain their potential side effects. Ultimately, we find Upshaw inapposite because Dr. Doyle testified about which medications she planned to use and th eir possible side effects. Dr. Doyle envisioned utilizing only Invega, to whic h Mr. Jefferson had previously responded well. And she further explained that she requested approval to use the other medications only in the event that Mr. Jefferson experienced unexpected side effectsOHIO FIRST DISTRICT COURT OF APPEALS

7 or encountered other unforeseen problems with Invega. She also offered specific reasons for potentially using the non- antipsychotic medications, including addressing mood swings, insomnia, and agit ation. And finally, Dr. Doyle testified
that the benefits of all the medications on her list would outweigh any possible side effects, adding that none of them have an y physiological or psychological addiction potential. One of Mr. Jefferson’s chief conc erns, based on her interactions with him, was consuming a drug that would lead to addiction, and Dr. Doyle capably explained why these drugs would not yield that effect. As a result, we conclude that the trial
court’s fourth Sell finding was also supported by the evidence.

* * * 

### {¶11} In light of the foregoing analysis, we overrule Mr. Jefferson’s sole assignment of error and affirm the judgment of the trial court. Judgment affirmed. 

### Myers, P. J., and Hendon, J., concur.
S YLVIA S IEVE H ENDON , retired, from the First Appellate District, sitting by assignment. Please note: The court has recorded its entry on the date of the release of this opinion