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

Heading: The Fourth Sell Factor

Text: The fourth Sell factor requires the government to prove by clear and convincing evidence that “administration of the drugs is medically appropriate, i.e., in the patient’s best medical interest in light of his medical condition.” Sell, 539 U.S. at 181. In finding that the government had satisfied the fourth Sell factor by clear and convincing evidence, the district court relied upon the following: Dr. Lucking’s opinion that antipsychotic medication is substantially likely to render Curtis competent to stand trial and the basis for that opinion; Dr. Lucking’s opinion that treatment with antipsychotic medication is substantially unlikely to produce side effects that would interfere with Curtis’s ability to assist his attorney in preparing a defense; Dr. Lucking’s opinion that antipsychotic medication would not adversely interact with Curtis’s other medications; Dr. Lucking’s testimony that the possible symptoms of the side effects of risperidone can be addressed with medication; and Dr. Lucking’s testimony that patients treated at the facility are closely monitored for adverse reactions to medication. The district court also noted that it found compelling the fact that Curtis had been previously treated with risperidone at Western State Hospital without any indication of an adverse reaction. The foregoing evidence primarily supports the second Sell factor, which requires the district court to determine whether the medication is “substantially likely to render the defendant competent to stand trial” and “substantially unlikely to have side effects that will interfere significantly with the defendant’s ability to assist counsel in conducting a trial defense[.]” Id. In contrast, the fourth Sell factor requires the district court to consider all of the circumstances relevant to the particular defendant and to consider the entirety of the consequences of the proposed involuntary medication. See, e.g., Ruiz-Gaxiola, 623 F.3d at 704-05; United States v. Evans, 404 F.3d 227, 242 (4th Cir. 2005). The district court did not consider the circumstances -8- relevant to such a required finding, such as Curtis’s need for long-term treatment and Curtis’s current quality of life. See, e.g., Mackey, 717 F.3d at 576 (recognizing that as to the fourth Sell factor the testifying doctor opined that “the medication not only would restore [the defendant’s] competency to stand trial, but would allow the patient—who was not showering, recreating, or communicating with staff—to ‘have a better quality of life and to kind of move forward’”); Ruiz-Gaxiola, 623 F.3d at 705 (discussing the defendant’s positive quality of life and questioning the value of the medication’s potential benefits when weighed against the likelihood and severity of its potential harms over the course of the treatment). In the absence of a specific determination by the district court whether administering risperidone constitutes a medically appropriate treatment for Curtis, as required by the fourth Sell factor, there is no finding for us to review, and thus remand is required.