Source: http://jaapl.org/content/34/1/122
Timestamp: 2019-04-19 20:41:46+00:00

Document:
The Constitution's Fifth and Fourteenth Amendments liberty interest affords defendants the right to refuse psychotropic medications. For the liberty interest to be overcome, thus allowing such medications to be given involuntarily, four specific criteria laid out in Sell v. U.S., 539 U.S. 166 (2003) must be met; these criteria constitute the so-called Sell test.
In U.S. v. Evans, 404 F.3d 227 (4th Cir. 2005), the U.S. Court of Appeals for the Fourth Circuit was asked to determine if the “Sell test” had been met by the government, thereby allowing the defendant to be medicated against his will for the purpose of rendering him competent to stand trial.
The defendant appealed the trial court's finding that prosecuting him represented an important government interest (Sell criteria one), that involuntary medication would significantly further this interest (Sell criteria two), and that the administration of the medication was medically appropriate (Sell criteria four). The defendant did not challenge the trial court's finding on Sell criteria three, the state's need to show that involuntary medication is “necessary” to further the government's interest.
Herbert Evans, 74, went to the Rural Development Agency (RDA) office in Wytheville, Virginia, in November 2002, to complain about a housing loan. He became “extremely angry and loud” according to the agent with whom he spoke and allegedly made threats involving terrorist acts with chemical and biological weapons. He was later arrested and charged with a misdemeanor charge of “assaulting, resisting or impeding” a federal employee under 18 U.S.C.A. § 111(a)(1) with a maximum penalty of one year's imprisonment. At his detention hearing, the government's motion for a psychiatric examination was granted, and Mr. Evans was transferred to the Federal Correctional Institution in Butner, North Carolina (Butner). Mr. Evans was evaluated and determined to be incompetent to stand trial, but he refused medications to restore his competency. During the time of his pretrial confinement, the U.S. Supreme Court decided Sell v. U.S., and, under the strictures of this ruling, the government moved to have Mr. Evans medicated against his will for the sole purpose of rendering him competent to stand trial on the misdemeanor charge.
An evidentiary hearing in October 2003 reviewed the reports of the Butner medical staff concerning Mr. Evans’ competence to stand trial, an evaluation concerning his need for involuntary medication (IM report), and the report and testimony of Dr. Margaret Robbins, a forensic psychiatrist who testified for the defendant. At that hearing, the government's motion to medicate Mr. Evans involuntarily was denied. The court held that the importance of bringing him to trial was not enough to outweigh his liberty interest in refusing medication. The trial court noted that the motion for involuntary medication was based on the government's prosecutorial interest in bringing Mr. Evans to trial, not on a claim that Mr. Evans was dangerous. Another hearing was set for January 2004 to determine whether Mr. Evans was dangerous and might therefore continue to be involuntarily confined. Noteworthy at the initial hearing of October 2003 was the observation by the Butner staff that Mr. Evans did not appear to be dangerous.
On the very day of this scheduled hearing, the government filed a new felony criminal complaint against Mr. Evans charging him with violating 18 U.S.C.A. § 115(a)(1) for allegedly “threatening to murder a United States judge, with intent to retaliate against such judge, on account of the performance of official duties.” The complaint was supported by an affidavit that alleged that Mr. Evans had told fellow inmates that the magistrate judge was responsible for his continuing to be incarcerated and that he knew where she lived and once released would “get rid of her and her family.” The magistrate judge then recused herself from the case and it was reassigned.
The government renewed its motion to have Mr. Evans involuntarily medicated in a March 2004 district court hearing. The district court noted that the facts of the case had changed, with the new charge against Mr. Evans being a felony carrying a maximum penalty of 10 years’ imprisonment, thereby enhancing the government's interest in prosecuting Mr. Evans, and so authorized the government to medicate Mr. Evans against his will. Mr. Evans appealed the order to medicate him involuntary to the Fourth Circuit Court of Appeals.
During the pendency of the Evans proceedings, the United States Supreme Court decided Sell v. U.S., 539 U.S. 166 (2003). In that decision, the Court laid out the criteria for determining whether there is a sufficiently compelling reason to allow the involuntary medication of a defendant solely for the purpose of rendering him competent to stand trial. Sell also sets forth four requirements that the government must meet to medicate: (1) that “important governmental interests are at stake” in trying the defendant, (2) that involuntary medication will “significantly further” this interest, (3) that involuntary medication is “necessary” to further the government's interests, and (4) that the administration of the medication is “medically appropriate,” or that it is in the defendant's “best interest in light of his medical problems.” On appeal, Mr. Evans argued that the first, second, and fourth criteria of the Sell test had not been satisfied by the government in the district court hearing. Because Mr. Evans did not challenge the third Sell criteria on appeal, it was resolved in the government's favor.
The court of appeals disagreed with the district court's finding that the government had satisfied the second and fourth Sell criteria. Fault was found with the IM report, which spoke broadly of the class of “atypical antipsychotics” but did not note the specific medication that was to be given to Mr. Evans. Sell requires that the government propose a course of treatment that specifies the drug to be administered, to allow for an evaluation of possible side effects. The appellate court reasoned that since different antipsychotic medications have different side-effect profiles, speaking only of a class of medications is insufficient to meet the requirements of Sell.
The court of appeals further noted that while the IM report stated that involuntary medications would significantly further the government's interest by being “substantially likely” to restore Mr. Evans to competency, its omission of the specific medications to be administered amounted to a failure to demonstrate this point. Furthermore, the appellate court noted that the IM report did not address concerns regarding the delusions Mr. Evans was experiencing or whether side effects of the medications might impair Mr. Evans’ ability to assist counsel in his defense.
The appeals court further noted that the IM report did not discuss the impact that the medication (or medications) would have on Mr. Evans, given his unique medical history. Since no specific medication was discussed, the appeals court found that there was no way to determine the likely side effects from the medication and how they might affect Mr. Evans’ health. Thus, it would be impossible to demonstrate that the proposed treatment is “medically appropriate” with respect to Mr. Evans as an individual. The appellate court therefore found that the government had not satisfied the demands of the fourth criterion of Sell. The court of appeals, noting the deficiency of the government's proofs, vacated the trial court's findings on criteria two and four of Sell and remanded the case to the district court for reconsideration of the motion to medicate.
The liberty interest of all persons, including defendants, is closely guarded in the United States. By refusing medications, a defendant is invoking his or her liberty interest. Sell set forth specific guidelines under which this liberty interest would be weighed against the opposing government's prosecutorial interests. This case expands and clarifies the specificity necessary for an involuntary medication treatment plan to meet the criteria set forth in Sell.
It is important to point out that under Sell, the first criterion (“important interest”) is a legal argument. The remaining three criteria of Sell are matters that fall under the purview of medicine, specifically psychiatry. The second criteria of Sell specifies that in determining if involuntary medication will “significantly further” the government's interest in trying a defendant, the court must be able to determine if the proposed medication is “substantially likely” to restore the competency of the defendant and “substantially unlikely” to cause side effects that will interfere with the defendant's ability to assist counsel. In this case, the court of appeals made clear that Sell requires an involuntary medication treatment plan that includes the specific medications to be given, a dosage range, and the likely side effects. The Sell criteria also require a showing that involuntary medication would “significantly further” the government interest and that the treatment is “medically appropriate.” The treatment plan must demonstrate consideration for the particular mental and physical condition of the individual who is to be treated.
The appellate court noted that Sell allows for more than one treatment plan to be proposed in a motion for involuntary medication. If the initial treatment plan is ineffective for any reason, the government may file a second motion for involuntary medication and propose an alternate treatment plan. The court of appeals also explicitly stated that the government may set forth alternate treatment plans under the initial motion for involuntary medication. The order in which the treatment plans will be applied to the defendant must be specified, and information regarding how each alternate treatment plan will be applied to the particular defendant must be provided. Given the specificity of treatment planning that Sell requires, it can be anticipated that in some cases, as in the instant case, there will be “battles of the experts” concerning the proposed use of competency-restoring medications. The grist of these battles will no doubt involve current questions surrounding the efficacy and safety of psychotropic medications.

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