Opinion ID: 2670154
Heading Depth: 2
Heading Rank: 1

Heading: The Second Sell Factor

Text: To show that involuntary medication will “significantly further” the government’s interest under the second Sell factor, the government must establish by clear and convincing evidence that involuntary medication is both (1) “substantially likely to render the defendant competent to stand trial” and (2) “substantially unlikely to have side effects that will interfere significantly with the defendant’s ability to assist counsel in conducting a trial defense[.]” Sell, 539 U.S. at 181. We conclude that the district court did not clearly err in finding that the involuntary administration of risperidone would significantly further the government’s interest in prosecuting this case. The district court accepted the testimony of Dr. Lucking that antipsychotic medication is substantially likely to render Curtis competent to stand trial. Dr. Lucking based his opinion on the following evidence. -5- First, Curtis was treated with two milligrams of risperidone daily when he was hospitalized at Western State Hospital, and at discharge Curtis “was described as being able to carry on a reality based conversation without evidence of paranoid ideas.” Dr. Lucking found this to be direct evidence from which to infer that Curtis would respond to antipsychotic medication. Second, Dr. Lucking relied on recent medical studies and literature that indicate that psychotic illnesses, including delusional disorder, can be treated effectively with antipsychotic medication. Dr. Lucking also opined that treatment with risperidone is substantially unlikely to produce side effects that would interfere with Curtis’s ability to assist his attorney in preparing a defense. Curtis contends that Dr. Lucking’s opinion that antipsychotic medication is substantially likely to render him competent to stand trial is unsubstantiated and contrary to medical studies and literature. Curtis first asserts that “it is impossible to definitively conclude that [he] benefitted from risperidone during his . . . hospitalization” at Western State Hospital. Curtis also asserts that medical studies and literature demonstrate that antipsychotic medication is ineffective in treating delusional disorder. Curtis points to United States v. Ghane, 392 F.3d 317 (8th Cir. 2004), in which we reversed the district court’s Sell order because the expert testimony provided by Dr. Lucking and other psychiatrists established that antipsychotic medication was ineffective in treating delusional disorder and had only a five to ten percent chance of restoring competency. Curtis’s counsel cross-examined Dr. Lucking at great length on the considerations that formed the basis of his opinion. Curtis’s counsel explored the possibility that Curtis’s ability to carry on a reality based conversation at the end of his nine day hospitalization at Western State Hospital was not the result of his being treated with risperidone. Dr. Lucking acknowledged that his report stated that risperidone “does not begin to exert its therapeutic effect for several weeks after the first injection” but explained that the length of time it takes for risperidone to exert its -6- effect varies on an individual basis and that he has seen patients respond with only one dose. Further, Dr. Lucking stated that it was unlikely that Curtis had deluded the evaluator. Dr. Lucking also acknowledged that he had held a different opinion about the effectiveness of antipsychotic medications in treating delusional disorder when he testified in Ghane. But he explained that he had changed his opinion as a result of reviewing recent medical studies and literature. Dr. Lucking’s report pointed to recent medical studies and literature that provide evidence that individuals with delusional disorder achieve positive results after being treated with antipsychotic medication. Among the studies that Dr. Lucking cited was a 2007 article by Drs. Herbel and Stelmach (the Herbel Study), which found that after involuntary treatment with antipsychotic medication, seventy-seven percent of defendants with delusional disorder were restored to competency.1 We are charged with deciding whether the district court’s findings were clearly erroneous based on the evidence and testimony before it. Dr. Lucking substantiated his opinion before the district court that risperidone would be effective in restoring Curtis to competency, and the district court found him credible. Dr. Lucking also substantiated his opinion that treatment with risperidone is substantially unlikely to produce side effects that would interfere with Curtis’s ability to assist his attorney in preparing a defense. Notwithstanding the Ninth Circuit’s skepticism regarding the Herbel Study, we conclude that the district court’s decision to credit Dr. Lucking’s report and testimony was not clearly erroneous, since it constituted a permissible view of the evidence presented to it. 1 As Curtis points out in his Reply Brief, the Ninth Circuit concluded that “the findings of the Herbel Study are both limited and tentative” and that “they do not constitute clear and convincing evidence that involuntarily medicating [the defendant] . . . is substantially likely to restore him to competency[.]” United States v. RuizGaxiola, 623 F.3d 684, 698 (9th Cir. 2010). -7-