Opinion ID: 2614565
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Heading: The State's Interest In Preventing A Defendant From Harming Himself Or Herself Or Others May Override The Defendant's Liberty Interest In Bodily Integrity And The Right, As A Matter Of Substantive Due Process, To Have His Or Her Mental Functions Unimpeded While Preparing For Trial. [16]

Text: Kotis next asserts that a trial court may never constitutionally authorize the administration of involuntary antipsychotic medication of a criminal defendant prior to, or during, trial. [17] In support, he cites the United States Supreme Court's decisions in Washington v. Harper, 494 U.S. 210, 110 S.Ct. 1028, 108 L.Ed.2d 178 (1990), and Riggins v. Nevada, 504 U.S. 127, 112 S.Ct. 1810, 118 L.Ed.2d 479 (1992). In Harper, the Supreme Court addressed the question whether the State of Washington had violated the right of a prison inmate to due process of law by forcibly administering antipsychotic drugs to him. 494 U.S. at 213, 110 S.Ct. 1028. The Harper Court recognized that the degree of the state's proposed intrusion on the prisoner's bodily integrity was substantial: The forcible injection of medication into a nonconsenting person's body represents a substantial interference with that person's liberty. Cf. Winston v. Lee, 470 U.S. 753 [105 S.Ct. 1611, 84 L.Ed.2d 662] (1985); Schmerber v. California, 384 U.S. 757, 772 [86 S.Ct. 1826, 16 L.Ed.2d 908] (1966). The purpose of the drugs is to alter the chemical balance in a patient's brain, leading to changes, intended to be beneficial, in his or her cognitive processes. While the therapeutic benefits of antipsychotic drugs are well documented, it is also true that the drugs can have serious, even fatal, side effects. One such side effect . . . is acute dystonia, a severe involuntary spasm of the upper body, tongue, throat, or eyes . . . . [I]t may be treated and reversed within a few minutes through use of the medication Cogentin. Other side effects include akath[i]sia (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); tardive dyskinesia, perhaps the most discussed side effect of antipsychotic drugs. Tardive dyskinesia is a neurological disorder, irreversible in some cases, that is characterized by involuntary, uncontrollable movements of various muscles, especially around the face.... [T]he evidence ... suggests that the proportion of patients treated with antipsychotic drugs who experience the symptoms of tardive dyskinesia ranges from 10% to 25%. According to the American Psychiatric Association, studies of the condition indicate that 60% of tardive dyskinesia is mild or minimal in effect, and about 10% may be characterized as severe. Id. at 229-30, 110 S.Ct. 1028 (some citations omitted). However, while recognizing that an inmate retains some constitutional rights, the Harper Court noted that the extent of those rights must be defined within the context of the inmate's confinement as a convicted person. Id. at 222-23, 110 S.Ct. 1028. Having balanced the inmate's liberty interest against the prison administrator's (1) obligation to provide prisoners with medical treatment consistent not only with their own medical interests, but also with the needs of the institution, (2) interest in ensuring the safety of prison staffs and administrative personnel, and (3) duty to take reasonable measures for the prisoners' own safety, the Harper Court concluded that 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 225, 227, 110 S.Ct. 1028. In Riggins, a criminal defendant moved for an order suspending the administration of antipsychotic drugs until the end of his trial. 504 U.S. at 130, 112 S.Ct. 1810. Riggins claimed that the effects of the medications on his demeanor and mental state during trial would deny him due process and that, because he planned to offer an insanity defense, continued treatment would prevent jurors from observing his true mental state. Id. The Nevada trial court denied the motion, and Riggins was tried and convicted of murder and sentenced to death. Id. at 131, 112 S.Ct. 1810. On appeal following the conviction, the United States Supreme Court noted 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. The Fourteenth Amendment affords at least as much protection to persons the State detains for trial. Riggins, 504 U.S. at 135, 112 S.Ct. 1810 (citation omitted). Accordingly, the Riggins Court held that the forced administration of antipsychotic drugs during Riggins's trial had violated his constitutional rights under the sixth and fourteenth amendments, because the trial court had not found that administration of antipsychotic medication was necessary to accomplish an essential state policy. Id. at 138, 112 S.Ct. 1810. However, the Riggins Court declined to prescribe substantive standards for the involuntary administration of antipsychotic drugs because the trial court had allowed the administration without making any determination of the need for this course or any findings about reasonable alternatives.... Nor did the order indicate a finding that safety considerations or other compelling concerns outweighed Riggins'[s] interest in freedom from unwanted antipsychotic drugs. Id. at 136, 112 S.Ct. 1810 (emphases in original). On the other hand, the Riggins Court noted that Nevada certainly would have satisfied due process if the prosecution had demonstrated . . . that treatment with antipsychotic medication was medically appropriate and, considering less intrusive alternatives, essential for the sake of Riggins'[s] own safety or the safety of others. Id. at 135, 112 S.Ct. 1810 (citing Harper, 494 U.S. at 225-26, 110 S.Ct. 1028, and Addington v. Texas, 441 U.S. 418, 99 S.Ct. 1804, 60 L.Ed.2d 323 (1979)). The Riggins Court also stated that Nevada  might have been able to justify medically appropriate, involuntary treatment with the drug by establishing that it could not obtain an adjudication of Riggins'[s] guilt or innocence by using less intrusive means. Id. (emphasis added) (citation omitted). We agree with Kotis that, although Riggins hinted that it might be permissible for a trial court to order the involuntary treatment of a defendant with antipsychotic drugs in order to render him fit to stand trial, it left that issue essentially unsettled. In any event, this court is not faced with that issue in the present appeal. Although the prosecution argued the need to render Kotis fit to stand trial during the hearing on the director's motion, the director invoked only the need to forestall the danger Kotis allegedly posed to himself and others. In its order granting the director's motion, the circuit court also relied solely upon that alleged danger and made no mention of the need to try Kotis on the charges against him. Thus, the sole issue before this court is whether, on the record before us, it was permissible for the circuit court to authorize involuntary medication to ameliorate the purported danger that Kotis posed to himself and others. In light of the narrow issue presented, Kotis's reliance upon Harper and Riggins for the extreme proposition that a pretrial detainee may never be forcibly medicated is therefore misplaced. As discussed supra, Harper concerned convicted prisoners and affirmed that it was possible for the state's penological interests to override an inmate's liberty interests with respect to involuntary medication. Riggins suggested that, although a criminal defendant, like any other mental health patient, possesses a fundamental right to refuse treatment threatening his bodily integrity, that right may be overridden by the state's interest in preventing him or her from causing physical harm to self or others. Similarly, although the Riggins Court recognized that involuntary administration of antipsychotic medication might have a prejudicial impact on a defendant's ability to prepare and assist in his own defense, trial prejudice can sometimes be justified by an essential state interest. Riggins, 504 U.S. at 138, 112 S.Ct. 1810 (citations omitted). In sum, we read Riggins to require the following three findings before a criminal defendant may constitutionally be involuntarily medicated with antipsychotic drugs, where it is alleged that the medication is necessary because the defendant poses a danger to himself or herself or others: (1) that the defendant actually poses a danger of physical harm to himself or herself or others; (2) that treatment with antipsychotic medication is medically appropriate, that is, in the defendant's medical interest; and (3) that, considering less intrusive alternatives, the treatment is essential to forestall the danger posed by the defendant. Cf. State v. Odiaga, 125 Idaho 384, 871 P.2d 801, 804 (1994) (construing Riggins to hold that the burden rests with the prosecution to show that medication is medically appropriate, essential to protect some significant interest, such as [the defendant's] safety or the safety of others, and that no less obtrusive means of protecting that interest exists), cert. denied, 513 U.S. 952, 115 S.Ct. 369, 130 L.Ed.2d 321 (1994); Harrison v. State, 635 So.2d 894, 905 (Miss.1994) (construing Riggins to hold that involuntary treatment of the criminally accused with antipsychotic medication is permissible only where medically appropriate and, considering less intrusive alternatives, essential for safeguarding a compelling state interest). [18] Kotis suggests that, notwithstanding the implications of Riggins upon his federal constitutional rights, this court should hold, as a matter of state law, that the circuit court's order was unconstitutional. This court has repeatedly recognized that it may accord greater protection to criminal defendants under the Hawai`i Constitution than that conferred under the United States Constitution. See, e.g., State v. Mendoza, 82 Hawai`i 143, 146, 920 P.2d 357, 360 (1996) (citing State v. Wallace, 80 Hawai`i 382, 397 n. 14, 910 P.2d 695, 710 n. 14 (1996) (citing State v. Texeira, 50 Haw. 138, 142 n. 2, 433 P.2d 593, 597 n. 2 (1967))). Certainly, as Kotis suggests, his liberty interest in bodily integrity and his right to a fair trial are protected by article I, section 5 of the Hawai`i Constitution (1978) (providing in relevant part that [n]o person shall be deprived of life, liberty, or property without due process of law ...). [19] However, Kotis offers no rationale justifying a departure from the Riggins due process analysis. Inasmuch as the Riggins test, as articulated above, succinctly and fairly directs the trial court's inquiry into the bases for the state's decision involuntary to medicate him for purposes of mitigating the harms associated with mental illness, we can discern no reason why the due process clause of the Hawai`i Constitution should require more. In the present case, the circuit court expressly found (1) that Kotis poses a danger to himself and to others, (2) that [t]he involuntary medication treatment plan ... is medically appropriate, and (3) that, [u]nder the circumstances, involuntary medication is essential for [Kotis's] benefit and for the benefit of others since no other less intrusive treatment is available[.] Accordingly, we hold that the circuit court correctly applied the Riggins test in arriving at its ruling on the director's motion.