Opinion ID: 624293
Heading Depth: 4
Heading Rank: 1

Heading: Harper, Riggins, and Sell

Text: Washington v. Harper is the seminal involuntary medication case. 494 U.S. 210, 110 S.Ct. 1028. It involved a prisoner's substantive and procedural due process challenge to a Washington state prison regulation authorizing the forcible medication of an inmate suffering from a mental disorder if he was gravely disabled or pose[d] a likelihood of serious harm to himself, others, or their property. Id. at 215, 110 S.Ct. 1028 (internal quotation marks omitted). Harper argued that, under the Due Process Clause, the State of Washington could not override his choice to refuse antipsychotic drugs absent a finding of incompetence and substituted judgment that, if he were competent, he would consent to drug treatment. Id. at 222, 110 S.Ct. 1028. The Court framed the substantive issue as: what factual circumstances must exist before the State may administer antipsychotic drugs to the prisoner against his will. Id. at 220, 110 S.Ct. 1028. The Court began its analysis by recognizing that inmates possess a significant liberty interest in avoiding the unwanted administration of antipsychotic drugs under the Due Process Clause of the Fourteenth Amendment. Id. at 221-22, 110 S.Ct. 1028. This liberty interests stems from both the drugs' intended mind-altering effects and from their serious, even fatal, side effectsincluding acute dystonia (severe involuntary spasm of the upper body, tongue, throat, or eyes), akathisia (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 (a neurological disorder, irreversible in some cases, that is characterized by involuntary, uncontrollable movements of various muscles, especially around the face). [10] Id. at 229-30, 110 S.Ct. 1028. The Court recognized, however, that an inmate's liberty interest in avoiding unwanted medication must be defined in the context of the inmate's confinement. Id. at 222, 110 S.Ct. 1028. Specifically, the Court noted the need to reconcile our longstanding adherence to the principle that inmates retain at least some constitutional rights despite incarceration with the recognition that prison authorities are best equipped to make difficult decisions regarding prison administration. Id. at 223-24, 110 S.Ct. 1028. To accommodate this need, the Court reiterated that the proper standard for determining the validity of a prison regulation claimed to infringe on an inmate's constitutional rights is to ask whether the regulation is `reasonably related to legitimate penological interests.' Id. at 223, 110 S.Ct. 1028 (quoting Turner v. Safley, 482 U.S. 78, 89, 107 S.Ct. 2254, 96 L.Ed.2d 64 (1987)). Among the factors that determine the reasonableness of a prison regulation, the Court found three particularly relevant in the context of involuntary medication: (1) there must be a valid, rational connection between the prison regulation and the legitimate governmental interest put forward to justify it; (2) a court must consider the impact accommodation of the asserted constitutional right will have on guards and other inmates, and on the allocation of prison resources generally; and (3) the absence of ready alternatives is evidence of the reasonableness of a prison regulation. Id. at 224-25, 110 S.Ct. 1028 (internal quotation marks omitted). Applying these factors to the Washington regulation, the Court concluded that the policy comported with constitutional requirements. Id. at 225, 110 S.Ct. 1028. Having deprived inmates of their liberty, the State has an obligation to provide prisoners with medical treatment consistent with both the inmates' and the institution's needs. Id. Thus, when the root cause of the inmate's threat is his mental disability, the State's interest in decreasing the danger to others necessarily encompasses an interest in providing him with medical treatment for his illness. Id. at 225-26, 110 S.Ct. 1028. Therefore, the Court determined that involuntary medication is a rational means of furthering the State's legitimate objectives: the interest in ensuring the safety of prison staffs and administrative personnel, and the duty to take reasonable measures for the prisoners' own safety. Id. at 225, 110 S.Ct. 1028. Finally, the Court found that the government was not required to adopt the alternative means proffered by Harper (seclusion and physical restraints) because Harper failed to demonstrate that they were acceptable substitutes for antipsychotic drugs, in terms of either their medical effectiveness or their toll on limited prison resources. Id. at 226-27, 110 S.Ct. 1028. Accordingly, the Court held that given the requirements of the prison environment, the Due Process Clause permits the State to treat a prison inmate who has a serious mental illness with antipsychotic drugs against his will, if the inmate is dangerous to himself or others and the treatment is in the inmate's medical interest. Id. at 227, 110 S.Ct. 1028. In Riggins, the Court addressed a slightly different set of interests: a criminal defendant's challenge to his conviction on the grounds that Nevada forced him to take antipsychotic drugs during his trial. 504 U.S. at 128, 112 S.Ct. 1810. After being taken into custody, Riggins began voluntarily taking Mellaril because he was hearing voices and having trouble sleeping. See id. at 129, 112 S.Ct. 1810. As preparations for trial went forward, Riggins asked the court to suspend the medication until the end of the trial, arguing that the drugs infringed upon his freedom and would deny him due process because of their effect on his demeanor and mental state during trial. See id. at 130, 112 S.Ct. 1810. The court held an evidentiary hearing, in which three different doctors questioned the need for continued administration of the drugs, and then denied Riggins's motion, giving no indication for the court's rationale. See id. at 131-32, 112 S.Ct. 1810. Riggins continued to be medicated throughout the trial. See id. at 132, 112 S.Ct. 1810. In reviewing the forced medication of Riggins during trial, the Supreme Court began from the premise that [u]nder Harper, forcing antipsychotic drugs on a convicted prisoner is impermissible absent a finding of overriding justification and a determination of medical appropriateness. Id. at 135, 112 S.Ct. 1810. Noting that the Fourteenth Amendment affords at least as much protection to persons the State detains for trial, the Court held that the government must show both the need for and the medical appropriateness of antipsychotic medication. Id. (emphasis added). The Court denied that Harper had determined the full constitutional protections of pretrial detainees. Admitting that it had not had occasion to develop substantive standards for judging forced administration of such drugs in the trial or pretrial settings, the Court suggested that Nevada certainly would have satisfied due process if the prosecution had demonstrated, and the District Court had found, that treatment with antipsychotic medication was medically appropriate and, considering less intrusive alternatives, essential for the sake of Riggins' own safety or the safety of others. Id. The Court explained, however, that it did not have occasion to finally prescribe such substantive standards because the district court's involuntary medication order made no determination of the need for the medication and no findings about reasonable alternatives. Id. at 136, 112 S.Ct. 1810. In other words, [t]he [district] court did not acknowledge the defendant's liberty interest in freedom from unwanted antipsychotic drugs. Id. at 137, 112 S.Ct. 1810. The Court observed that this failure may have impaired Riggins's constitutionally protected trial rightsincluding the substance of his own testimony, his interaction with counsel, or his comprehension at trialand concluded that there was no basis for finding that, if Riggins had been affected by his involuntary medication, any prejudice was justified. Id. at 137-38, 112 S.Ct. 1810. The Court accordingly reversed the Nevada Supreme Court's decision upholding Riggins's conviction and remanded for further proceedings. Id. at 138, 112 S.Ct. 1810. Most recently, in Sell, the Supreme Court set out the substantive standards for when the government may administer antipsychotic drugs involuntarily to a mentally ill criminal defendant to render him competent for trial. 539 U.S. 166, 123 S.Ct. 2174. The Court adopted a more demanding standard for medicating a defendant facing trial to render that defendant competent than it required in Harper for medicating a convicted inmate to render that inmate nondangerous. The Court held that the government may forcibly medicate a mentally ill pretrial detainee for the purpose of rendering him competent to stand trial, but only if a court determines that there are important governmental trial-related interests at stake; that involuntary medication will significantly further these government interests, without causing side effects that will interfere significantly with the defendant's fair trial rights; that the medication is necessary to further the government's interests, taking into account less intrusive alternatives; and that the administration of the antipsychotic drugs is medically appropriate, i.e., in the defendant's best medical interest. Id. at 180-81, 123 S.Ct. 2174; see also Witt v. Dep't of Air Force, 527 F.3d 806, 818 (9th Cir.2008) (referring to Sell as an application of heightened scrutiny in the substantive due process context). Sell came with an important caveat, however. A court need not consider whether to allow forced medication for [trial competency purposes], if forced medication is warranted for a different purpose, such as the purposes set out in Harper related to the individual's dangerousness. Id. at 181-82, 123 S.Ct. 2174. The Court noted that there are three reasons for determining whether forced medication can be justified on alternative grounds before turning to the trial competency question: First, the inquiry into whether medication is permissible . . . to render an individual nondangerous is usually more `objective and manageable' than the inquiry into whether medication is permissible to render a defendant competent. Id. at 182, 123 S.Ct. 2174 (quoting Riggins, 504 U.S. at 140, 112 S.Ct. 1810 (Kennedy, J., concurring)). Second, courts typically address involuntary medical treatment as a civil matter, and justify it on these alternative, Harper -type grounds. Id. Finally, if medication is authorized on alternative grounds, the need to consider authorization on trial competence grounds will likely disappear. Id. at 183, 123 S.Ct. 2174. The Court explained why the purpose of the involuntary medication is relevant: Whether a particular drug will tend to sedate a defendant, interfere with communication with counsel, prevent rapid reaction to trial developments, or diminish the ability to express emotions are matters important in determining the permissibility of medication to restore competence, but not necessarily relevant when dangerousness is primarily at issue. Id. at 185, 123 S.Ct. 2174 (citation omitted).