Opinion ID: 4524141
Heading Depth: 3
Heading Rank: 2

Heading: District of Columbia Statutory Provisions

Text: D.C. Code § 24-531.09 governs the involuntary medication of defendants in the District of Columbia who have been ordered held for competency restoration treatment. Following Sell and Harper, the statute provides for different standards and procedures to be followed depending on the purpose for which the involuntary medication is sought. Subsection (a) provides that if “the sole purpose” is to render the defendant competent, the involuntary administration of medication is prohibited “[e]xcept as set forth in subsection (b),” which requires a court to make specific findings that the governmental interest in bringing the defendant to competency 23 Id. at 179. 24 See id. at 180-81. 12 outweighs the defendant’s interest in refusing the medication. 25 The Judiciary Committee report on the statute explains that, “[t]his requirement is based on the Supreme Court’s decision in Sell. . . . Subsection (b) lists the factors enumerated in Sell that the court should find in weighing the two interests.” 26 Subsection (a) of § 24-531.09 goes on to state that “[f]or any other purpose, the defendant may be administered medication without his or her consent consistent with [D.C. Code] § 7-1231.08, and the regulations promulgated thereunder.” 27 25 Specifically, subsection (b) states that the court may order the involuntary administration of medication for the sole purpose of rendering the defendant competent only if it “determines that the government’s interest in bringing the defendant to trial or proceeding with sentencing, probation revocation, or transfer outweighs the defendant’s interest in refusing medication to render him or her competent.” § 24-531.09(b)(1)(B). In order to make that determination, the court “must find” that (1) the defendant has been charged with a dangerous crime or a crime of violence as defined elsewhere in the Code; (2) the medication is substantially likely to render the defendant competent; (3) the medication is substantially unlikely to have side effects that will significantly interfere with the defendant’s ability to assist counsel in conducting a defense; (4) involuntary medication is necessary to further the government’s interest because any less intrusive treatment alternatives are unlikely to render the defendant competent; and (5) the medication is medically appropriate. § 24-531.09(b)(2). 26 District of Columbia Council, Committee on the Judiciary, Report on Bill 15-967, the “Incompetent Defendants Criminal Commitment Act of 2004” (“Judiciary Committee Report”) at 9 (November 17, 2004). 27 The regulations implementing § 7-1231.08 are codified at 22A DCMR § 104 (2020). 13 Section 7-1231.08 governs the administration of medication to all “consumers,” i.e., persons who seek or receive mental health services or supports in the District of Columbia under Chapter 5 of Title 21 (“Hospitalization of Persons with Mental Illness”), “without regard to [their] voluntary, non-protesting, or involuntary status.” 28 The Judiciary Committee Report explains that, by its incorporation of § 7-1231.08, subsection (a) of § 24-531.09 “authorizes the involuntary administration of medication for any other purposes [i.e., other than restoration of competency] as long as the same procedures are followed for defendants as would be followed for any other consumer of mental health services.” 29 Those procedures do not require judicial authorization. Rather, § 7- 1231.08(c) states that a provider of mental health services may administer medication involuntarily to an incapacitated consumer “only after receiving approval for such action through an administrative procedure established by” the Department of Behavioral Health (DBH). The administrative procedure must include, among other things, 28 See D.C. Code § 7-1231.02(4) (2018 Repl.) (defining the term “consumers” for purposes of § 7-1231.08 and other sections of the Mental Health Consumers’ Rights Protection Act of 2001). 29 Judiciary Committee Report at 8. 14 notice to the consumer of available advocacy services; . . . [t]he right to a meeting convened by a neutral party . . . for the purpose of reviewing the necessity for involuntary administration of medication; . . . [t]he right of the consumer to be present and have representation during any such meeting; . . . [t]he opportunity, at the meeting, for the consumer . . . to present information and discuss the necessity of medication with the physician seeking to administer it; [and] [t]he right to appeal the decision of the neutral party to an independent panel[.][30] A decision to medicate without consent is valid for “no more than 30 days.” 31 The parties before us agree that such a decision is subject to judicial review in an appropriate equitable action in Superior Court. 32 30 D.C. Code § 7-1231.08(c); see also 22A DCMR § 104.9 et seq. A formal policy adopted by Saint Elizabeths and DBH implements this process for pretrial detainees. It requires a detainee’s treating psychiatrist to document (1) that due to a diagnosed mental illness, the detainee is “gravely disabled or poses a likelihood of serious harm or dangerousness to self, others, or property without the medication,” and (2) “after considering less restrictive intervention, that psychotropic medication is appropriate.” The request for medication must be approved, after a hearing (at which the detainee has a right to representation), by a neutral Medication Review Officer, and the detainee may appeal to a three-member Medication Review Panel. 31 D.C. Code § 7-1231.08(c)(6); 22A DCMR § 104.11. The Saint Elizabeths policy specifies that “[i]f the prescribing physician seeks to continue the involuntary administration of medication for an additional 30 days, the procedures set forth herein shall be repeated.” 32 See District of Columbia v. Sierra Club, 670 A.2d 354, 358 (D.C. 1996); Capitol Hill Restoration Soc’y Inc. v. Moore, 410 A.2d 184, 188 (D.C. 1979). We refrain from attempting to delineate the precise scope of such review in this opinion, beyond noting that the parties before us agree it is not de novo, because that question is not directly presented in these appeals. Cf. United States v. Morgan, 193 F.3d 15 The administrative process envisioned by § 7-1231.08(c) is not materially different from the administrative process upheld in Harper. 33 Thus, § 24-531.09(a) provides that defendants undergoing competency restoration may be approved for non-emergency involuntary medication through a Harper-compliant administrative process rather than by a court as long as the sole purpose of the medication is not to make the defendants competent. This non-judicial process is commonly referred to as a “Harper hearing.”