Opinion ID: 624293
Heading Depth: 5
Heading Rank: 1

Heading: Judicial hearing

Text: The Court in Harper rejected the argument that an involuntary medication decision based on dangerousness grounds must be made by a judicial decision maker after a judicial hearing. Indeed, the Court concluded that an inmate's interests are adequately protected, and perhaps better served, by allowing the decision to medicate to be made by medical professionals rather than a judge. Id. at 231, 110 S.Ct. 1028. Nevertheless, citing the rhythmically insistent pulse of Sell 's refrain, the dissent argues that  Sell [] and its progeny require the district court to determine whether a pretrial detainee may be involuntarily drugged on dangerousness grounds. Dissenting Op. at 784. But the passage that the dissent relies on, and our subsequent cases dealing with the Sell/Harper distinction, is premised on the assumption that the involuntary medication are being sought solely for trial competence purposes. Sell, 539 U.S. at 180, 123 S.Ct. 2174. When this is the case, Sell clearly mandates that the district court, using a higher substantive standard, make the involuntary medication determination. The dissent reads Sell to mean that the district court, applying the demanding standard of Sell, may consider whether there might be alternative means (dangerousness) of justifying the involuntary medication. Because the issue of dangerousness could be raised before the court at that point, it would be the district court that determines whether medication might be justified on Harper -type grounds. The dissent thus concludes that whenever the government's ultimate aim is restoration of competency the court must itself address the involuntary medication issue. Dissenting Op. at 782. The dissent reads too much into Sell. Sell tells us that [a] court need not consider whether to allow forced medication for [trial competency purposes], if forced medication is warranted for . . . the purposes set out in Harper.  Sell, 539 U.S. at 181-82, 123 S.Ct. 2174. In such a case, the need to consider authorization on trial competence grounds will likely disappear. Id. at 183, 123 S.Ct. 2174. When read in connection with the analysis in Harper, Sell provides that a district court may authorize involuntary medication on dangerousness grounds, using the substantive standard outlined in Harper, not that the district court must make this determination. Sell thus incorporates Harper into its structure, but nothing in Sell requires the district court to revisit the dangerousness inquiry de novo. Loughner offers a slightly different perspective. He argues that there would be substantial added value to having judicial decision makers and a judicial hearing in the pretrial context because the administrative review is not very probing, the prison doctors are charged with conflicting goals, and the medical expertise of the judicial decision maker would be advanced by allowing the defense to present additional evidence at a judicial hearing. Nothing about Loughner's status as a pretrial detainee renders administrative review more or less probing, or affects the medical expertise of a potential judicial decision maker. Harper rejected these claims, and they are equally unpersuasive when applied to pretrial detainees. See id. at 233, 110 S.Ct. 1028 (A State may conclude with good reason that a judicial hearing will not be as effective, as continuous, or as probing as administrative review using medical decisionmakers.). The structural conflict of interest argument was also considered and rejected in Harper. See id. at 233-34, 110 S.Ct. 1028 (noting that prior cases involving similar deprivations of liberty have approved the use of internal decision makers (citing Vitek v. Jones, 445 U.S. 480, 496, 100 S.Ct. 1254, 63 L.Ed.2d 552 (1980); Parham v. J.R., 442 U.S. 584, 613-16, 99 S.Ct. 2493, 61 L.Ed.2d 101 (1979); Wolff v. McDonnell, 418 U.S. 539, 570-71, 94 S.Ct. 2963, 41 L.Ed.2d 935 (1974))). In fact, the Court has made clear that it is only by permitting persons connected with the institution to make these decisions that courts are able to avoid `unnecessary intrusion into either medical or correctional judgments.' Id. at 235, 110 S.Ct. 1028 (quoting Vitek, 445 U.S. at 496, 100 S.Ct. 1254). The dissent disagrees, pointing to possible confusion in this particular case as to what FMC-Springfield's role was in administering involuntary medication, and arguing that courts may be better situated to render objective decisions in the pretrial context. Dissenting Op. at 787-88. We maintain, however, that the decision to medicate involuntarily a pretrial detainee based on dangerousness grounds is a penological and medical decision that should be made by the medical staff. Although it is conceivable that a situation might arise in which a conflict of interest exists, we will not assume that physicians will prescribe these drugs for reasons unrelated to the medical needs of the patients. Harper, 494 U.S. at 222 n. 8, 110 S.Ct. 1028. Although the medical staff may have an interest in curing the patient or restoring competency, even when charged merely with determining if restoration is possible, we trust that these professionals will act within the pretrial detainee's and prison's best interests, within the limits of their charge. Therefore, any conflict of interest argument should be dealt with on a case-by-case basis and not deemed a bar to leaving the involuntary medication decision to the prison medical staff. Finally, Loughner contends that a judicial determination will not be unduly burdensome because a pretrial detainee is already subject to ongoing judicial proceedings. Additional judicial proceedings, however, always have costs. Judicial determinations of medical issues occasion unnecessary intrusion into both medical and custodial judgments, see id. at 235, 110 S.Ct. 1028; see also Brief for Am. Psychiatric Ass'n & Am. Acad. of Psychiatry & the Law as Amici Curiae Supporting Affirmance (APA Br.) at 24, and divert scarce prison resources, both money and the staff's time, from the care and treatment of mentally ill inmates, Harper, 494 U.S. at 232, 110 S.Ct. 1028; see Parham, 442 U.S. at 606, 99 S.Ct. 2493; APA Br. at 24-25 (discussing increase of judicial resources after Massachusetts began requiring state courts to review involuntary medication orders). This is so regardless of whether the inmate has already been through the judicial process or is still in the pretrial phase. The Due Process Clause requires that we measure the cost of additional procedures against the risk of error in the existing procedures and the private interest at stake. Mathews v. Eldridge, 424 U.S. 319, 335, 96 S.Ct. 893, 47 L.Ed.2d 18 (1976). Thus, the mere fact that a party can design a set of more expansive procedures does not entitle him to such process. The fact that Loughner can conceive of more process does not entitle him to it as the process that is due. Loughner has made no argument beyond his own comfort level to demonstrate the superiority of judicially directed hearings over medically directed hearings. He has offered no explanation for why there is an unacceptable risk of error by allowing the decision to medicate to be made by medical professionals rather than a judge. Harper, 494 U.S. at 231, 110 S.Ct. 1028. Thus, the Due Process Clause does not require a judicial determination or a judicial hearing before a facility authorizes involuntarily medication.