Opinion ID: 4568407
Heading Depth: 2
Heading Rank: 1

Heading: Brown’s Early Medical History

Text: Eric Brown served in the United States Navy for twenty-one years as an Information Systems Technician. 1 During his military service, Brown experienced his first psychotic episode. In 2000, Brown was hospitalized for schizophrenia and prescribed a combination of two antipsychotic drugs, chlorpromazine and olanzapine. Brown’s medical records indicate he had elevated liver enzymes during his hospitalization and his doctors at the time recommended that he not be put on olanzapine again. 2 Brown was discharged from the 1 Brown’s military service is relevant to the charges against him. The indictment alleges that Brown abducted Billie from a Blimpie’s fast food restaurant on a naval base in Norfolk, Virginia. Brown had participated as a laborer in the construction of the restaurant and frequently ate there after it opened, using his access to the base as a military retiree. The indictment further alleges that Brown is tied to Billie’s death by, among other evidence, the presence of his DNA on clothes found with her body, which was discovered eleven days after her disappearance near a wooded area outside of Charlotte, North Carolina, near Brown’s childhood home. 2 There is a dispute among the most recent testifying medical experts based on Brown’s medical records whether that side effect might be attributable to the chlorpromazine rather than the olanzapine. 4 hospital mentally stable and on no medications and went on to serve in the Navy on active duty for eleven more years, retiring in 2011. His second psychiatric episode occurred in 2011 and 2012, when Brown’s sister reported paranoid behavior that led her to petition for his involuntary psychiatric evaluation. B. Arrest, Commitment and Initial Medication under Harper The government filed a criminal complaint charging Brown with kidnapping on November 7, 2017, and he was arrested the next day. 3 While in federal pretrial detention, Brown attempted suicide and exhibited bizarre behavior, which led the government to move for a psychiatric exam on December 1, 2017. The district court granted the government’s motion on December 15, 2017, and, pursuant to 18 U.S.C. § 4247(b), ordered Brown to be committed to an appropriate Bureau of Prison (“BOP”) facility for an initial competency assessment. That assessment diagnosed Brown with “[s]chizophrenia, with catatonia, and paranoid and disorganized features” and noted that Brown has “consistently refused psychiatric medication.” Then, with the agreement of Brown’s counsel, the district court ordered Brown to be committed to the custody of the Attorney General and hospitalized pursuant to 18 U.S.C. § 4241(d) on January 25, 2018. Pursuant to this order and 18 U.S.C. § 4241(d)(1), Brown was admitted to Butner on February 8, 2018. 3 Following Brown’s commitment and the related proceedings discussed, infra, the grand jury returned a three-count indictment against Brown on December 19, 2018, and a six-count superseding indictment on October 2, 2019. The superseding indictment charged Brown with kidnapping resulting in death; three assault charges, including assault with intent to commit aggravated sexual abuse and sexual abuse; theft; and stalking. 5 On May 25, 2018, Brown slipped out of a chain restraint, postured as if to strike it at an officer, and refused to return the restraint. Butner staff then administered a single emergency dose of haloperidol, a psychiatric medication, which calmed Brown. After an administrative hearing on June 1, 2018, BOP determined that involuntary medication was appropriate because Brown was “dangerous to self or others” and “gravely disabled.” Brown contested the BOP’s decision, and the district court held a hearing on June 21, 2018, at which it found that forcible medication was warranted under Harper. After the Harper hearing, Brown began receiving 100 milligrams of haloperidol once every two weeks. A series of reports and hearings then followed over the next six months during which Brown’s commitment was extended, but he did not attain competency. In December 2018, a BOP doctor submitted a report opining that Brown had attained competency. She noted that Brown had been moved to open population, was functioning independently, and took the biweekly 100 milligram Haldol injections without resistance. Butner’s warden then filed a certificate of restoration of competency under 18 U.S.C. § 4241(e) on December 10, 2018. A competency hearing was scheduled for March 27, 2019. Prior to that hearing, Brown’s haloperidol dosage was briefly reduced to 75 milligrams which led to “a significant decline in his mental functioning” and a quick return to the higher dosage. Also, Brown’s pre-competency hearing interviews with both his own and the government’s medical experts revealed that he “continue[d] to manifest symptoms of serious psychiatric illness,” and the BOP withdrew its certification of competency. Without objection from 6 either party, the district court cancelled the competency hearing and ordered Brown committed to Butner for an additional 120 days, through July 18, 2019. C. The Sell Order On July 10, 2019, Butner’s warden requested that the district court hold a hearing to determine whether Brown should be forcibly medicated for competency under Sell. The government explained that Brown “has reached a level of psychiatric treatment that has been successful in addressing the concern that he is gravely disabled or an imminent risk of danger to himself or others;” however, “increasing medication or adjusting medication without his consent would only be to address the issue of competency to stand trial,” so “the only mechanism by which the BOP is able to pursue his treatment is for this Court to make a ruling within the parameters established in Sell v. United States.” Again, without objection from Brown, the district court extended Brown’s commitment for an additional 120 days, ordered the government to file its proposed treatment plan under Sell and scheduled a Sell hearing. Prior to the Sell hearing, the government notified the district court that it would not seek the death penalty. The Sell hearing was held on December 10, 2019. The two witnesses at the full-day Sell hearing were Dr. Logan Graddy, Butner’s chief psychiatrist, and Brown’s medical expert, Dr. George Corvin, a psychiatrist. Among other options, Dr. Graddy proposed to treat Brown with a combination of two antipsychotic medications, administered by injection. One medication was haloperidol, which was to be maintained on Brown’s then current regimen of a biweekly 100 milligram dose of long-acting medication. The second medication was olanzapine. Dr. Graddy proposed beginning with daily injections of a 7 short-acting olanzapine, carefully monitoring any side effects, and then only if appropriate, transitioning to a long-acting formulation. The two experts disagreed on whether this two drug medication plan was, under the Sell test, “substantially likely” to bring Brown to competency, when taking haloperidol to treat his schizophrenia 4 for approximately a year and a half had not restored him to competency. Also, the doctors disagreed on whether the addition of olanzapine would cause Brown to be sedated to a point where he would not be able to assist counsel in his defense (and thus would not be competent to stand trial). Finally, the doctors disagreed on whether the government’s proposed Sell treatment plan was medically appropriate. In particular, Dr. Corvin questioned whether administering olanzapine to Brown would raise his liver enzymes to a dangerous level based on Brown’s earlier experience with the drug. Broadly crediting Dr. Graddy’s testimony, the district court entered a Sell order on December 23, 2019, permitting the government to involuntarily medicate Brown in accordance with Dr. Graddy’s proposed two drug treatment of haloperidol and olanzapine. The district court found that this treatment plan was “substantially likely” to restore Brown’s competency and that the plan, which included careful monitoring of potential side effects, was medically appropriate. On that final issue, the court noted that it “reject[ed] the contention that allowing Brown to languish in a state of controlled delusion is in his 4 According to Dr. Graddy, Brown’s diagnosed schizophrenia is a “severe mental illness” that often causes hallucinations, delusions, and disorganized speech and behavior. He further testified that left untreated schizophrenia is associated with a thirty-year reduction in life expectancy. 8 best medical interest.” 5 The district court thereafter granted Brown’s request to stay its Sell order pending appeal, and Brown noted this appeal on January 2, 2020. D. Brown’s Further Medication under Harper According to medical records provided to the government’s counsel on May 13, 2020, beginning in April 2020, the staff at Butner observed that Brown’s functioning had significantly deteriorated and they transferred him to a more restrictive housing unit in midApril. When his condition did not improve, Dr. Graddy ordered additional medication to be given to Brown “for his health and the safety of others” under the district court’s earlier Harper order. Specifically, he prescribed 10mg of olanzapine to be administered daily by injection for two weeks, in addition to his continued biweekly 100mg dose of haloperidol. Brown received his first dose of olanzapine on May 12, 2020. The Government notified the Court of this information on May 14, 2020, and oral argument was held in this appeal on May 18, 2020.