Opinion ID: 2803527
Heading Depth: 3
Heading Rank: 2

Heading: Applying Sell and Diaz Here

Text: The four-factor test of Sell was met by the government here. The government introduced sufficient evidence to show that the district court’s order of involuntary medication was not clear error. We review the Sell factors separately. First, the district court must find that important governmental interests are at stake. Sell, 539 U.S. at 180, 123 S. Ct. at 2184. “[B]ringing to trial an individual accused of a serious crime” is an important governmental interest. Id. Ruark is accused of, among other crimes, armed robbery of a bank and a retail market. These are serious crimes. Ruark rightly argues that special circumstances may lessen the importance of that interest. See id. Civil commitment may diminish the risks attached to releasing an accused criminal without punishment. So too may the length of pretrial detention if an individual serves time equal to or greater than his likely sentence if found guilty. See id. But these caveats do not apply to Ruark’s case. There is no evidence as to his likelihood of civil commitment, and the crimes with which he was charged carry mandatory sentences well in excess of the his current pretrial detention. Under the facts of this case, the district court did not err in finding important governmental interests at stake. 15 Case: 14-14469 Date Filed: 05/27/2015 Page: 16 of 18 Second, the district court must conclude that involuntary medication will significantly further those concomitant state interests. Id. at 181, 123 S. Ct. at 2184. It must find that administration of the drugs is substantially likely to render the defendant competent to stand trial. On the evidence presented at Ruark’s Sell hearing, the government met this burden too. Both Dr. Sarrazin and Dr. PrestonBaecht testified that, in their experience and according to studies, 75 to 80 percent of patients who are involuntarily medicated are restored to competency. In Diaz, this Court relied on precisely this evidence to conclude the district court did not clearly err as to the second Sell factor. 630 F.3d at 1332. We hold the same here. Within the second factor, the government must also show that the “administration of the drugs is substantially unlikely to have side effects that will interfere significantly with the defendant’s ability to assist counsel in conducting a trial defense, thereby rendering the trial unfair.” Sell, 539 U.S. at 181, 123 S. Ct. at 2184-85. Here, too, the government satisfied that burden. Dr. Sarrazin testified as to the limited side effect of the particular, intended antipsychotic medication as well as to the procedures for closely monitoring those side effects. Third, the district court must conclude that involuntary medication is necessary to further the government interests. Id. at 181, 123 S. Ct. at 2185. Specifically, the district court must find that any alternative, less intrusive treatments are unlikely to achieve substantially the same results. That is precisely 16 Case: 14-14469 Date Filed: 05/27/2015 Page: 17 of 18 what the district court did here, supported by ample evidence. Dr. Preston-Baecht noted that paranoid schizophrenia has a strong biological basis and that Ruark is unlikely to recover in the absence of medication. She testified that the variety of non-medication alternatives, such as the competency restoration group, counseling, and psychotherapy, would all be ineffective because of Ruark’s persistent paranoia. Fourth, as we have said, the district court must also conclude that administration of the drugs is medically appropriate. Id. Here, the government has presented an individualized treatment plan that details the drugs to be used and the relevant dosage ranges. Both Dr. Sarrazin and Dr. Preston-Baecht testified that the administration of antipsychotics would be medically appropriate in this case. Dr. Sarrazin, further, proposed a detailed treatment plan describing the procedure to be followed if a court orders Ruark to be involuntarily medicated. Additionally, Dr. Sarrazin testified that any dosage going beyond the range described in the PDR reflects the learned experience of the medical community with regard to dosing. The magistrate judge and district court were in the best position to make factual findings based on evidence presented at these two separate hearings. As this Court held in Diaz, we review these factual findings under the second, third, and fourth prongs of the Sell analysis only for clear error. Diaz, 630 F.3d at 133031. The record precludes our finding clear error in the decision of the district court 17 Case: 14-14469 Date Filed: 05/27/2015 Page: 18 of 18 not to upend the medical analysis offered in these hearings. This decision is necessarily limited to the facts of this case and the evidence presented before the magistrate judge and district court. Additionally, the only issue before this Court is Ruark’s involuntary medication. At this time, there is no claim seeking release from Springfield, release from BOP custody, or for dismissal of the indictment against Ruark. As the Supreme Court noted in Sell (and this Court repeated in Diaz), the instances in which involuntary medication is appropriate “may be rare.” 539 U.S. at 180, 123 S. Ct. at 2184. But where, as here, the government presents clear and convincing evidence that each of the four Sell requirements have been met, the district court does not clearly err in granting the government’s motion.