Opinion ID: 4524141
Heading Depth: 3
Heading Rank: 1

Heading: The Requirements of Due Process

Text: Washington v. Harper has been called “the seminal involuntary medication case.” 7 Mr. Harper was medicated against his will with antipsychotic drugs while he was imprisoned in a state correctional facility for convicted felons with serious mental disorders. 8 The facility had established an administrative hearing process for approving such medication to treat inmates whose mental disorders rendered them 6 D.C. Code § 24-531.09(a). 7 United States v. Loughner, 672 F.3d 731, 744 (9th Cir. 2012). 8 Harper, 494 U.S. at 214. 6 gravely disabled or seriously dangerous to themselves or others. This process afforded inmates like Harper an evidentiary hearing before an independent medical review committee and other procedural protections, with judicial review ultimately available in state court. 9 Harper brought a civil rights action in which he challenged the administrative process as violative of due process. The Washington Supreme Court agreed with him, holding that the Due Process Clause entitled Harper to a judicial hearing with the “full panoply of adversarial procedural protections,” at which the State would have to prove not only that Harper was mentally ill and dangerous, but also that his involuntary medication was “necessary and effective for furthering a compelling state interest.” 10 The United States Supreme Court reversed. Acknowledging the “significant liberty interest in avoiding the unwanted administration of antipsychotic drugs,” 11 9 Id. at 215-16. 10 Id. at 218. 11 Id. at 221-22; see also id. at 229 (“The forcible injection of medication into a nonconsenting person’s body represents a substantial interference with that person’s liberty. The purpose of the [antipsychotic] 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 7 the Court held that the state facility’s non-judicial procedures satisfied both the substantive and the procedural requirements of due process. On the substantive question, the Court explained that, in light of the state’s important interests in prison safety and security, the constitutionality of prison regulations must be “judged under a ‘reasonableness’ test less restrictive than that ordinarily applied to alleged infringements of fundamental constitutional rights.” 12 The Court concluded that the state policy was “a rational means of furthering the State’s legitimate objectives.” 13 “[G]iven the requirements of the prison well documented, it is also true that the drugs can have serious, even fatal, side effects.” (Internal citations omitted.)). 12 Id. at 224 (quoting O’Lone v. Estate of Shabazz, 482 U.S. 342, 349 (1987)). “[T]he proper standard for determining the validity of a prison regulation claimed to infringe on an inmate’s constitutional rights is to ask whether the regulation is reasonably related to legitimate penological interests.” Id. at 223 (internal quotation marks omitted). 13 Id. at 226. In affirming the reasonableness of the policy at issue, the Court cited (1) the state’s important prison safety concerns; (2) the policy’s “exclusive application . . . to inmates who are mentally ill and who, as a result of their illness, are gravely disabled or represent a significant danger to themselves or others”; (3) the fact that “[t]he drugs may be administered for no purpose other than treatment and only under the direction of a licensed psychiatrist”; and (4) the wide agreement “in the psychiatric profession that proper use of the drugs is one of the most effective means of treating and controlling a mental illness likely to cause violent behavior.” Id. at 225-26. 8 environment,” the Court held, “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.” 14 The Court went on to hold that the administrative hearing procedures comported with procedural due process. 15 Because the decision was essentially a medical one, the Court concluded, “an inmate’s interests are adequately protected, and perhaps better served, by allowing the decision to medicate to be made by medical professionals rather than a judge.” 16 Under the state’s policy, the Court explained, the decisionmaker is asked to review a medical treatment decision made by a medical professional. That review requires two medical inquiries: first, whether the inmate suffers from a “mental disorder”; and second, whether, as a result of that disorder, he is dangerous to himself, others, or their property. . . . The risks associated with antipsychotic drugs are for the most part medical ones, best assessed by medical professionals. A State may conclude with good reason that a judicial hearing will not 14 Id. at 227. 15 Id. at 228. 16 Id. at 231. 9 be as effective, as continuous, or as probing as administrative review using medical decisionmakers.[17] The Court further held that the procedures adopted to implement the policy – which included notice, the right to be present at an adversary hearing before an independent decisionmaking body, the assistance of a lay advocate, and the right to present and cross-examine witnesses – sufficed to meet the requirements of due process “in all other respects.” 18 Thirteen years later, in Sell v. United States, 19 the Court considered the involuntary antipsychotic medication of a mentally ill pretrial detainee who was held for competency restoration at the United States Medical Center for Federal Prisoners. Following an administrative process like that approved in Harper, the Medical Center concluded that medication would be appropriate both to alleviate Mr. Sell’s dangerousness and to help him attain competency. However, when Sell appealed this decision, the federal district court and the court of appeals upheld it 17 Id. at 232-33. 18 Id. at 235. The Court rejected Harper’s contentions that due process required a right to representation by legal counsel, a hearing conducted in accordance with the rules of evidence, and proof by clear and convincing evidence. Id. at 235-36. 19 539 U.S. 166 (2003). 10 only on the latter, competency restoration ground. The Supreme Court granted certiorari to consider Sell’s argument that “allowing the government to administer antipsychotic medication against his will solely to render him competent to stand trial for non-violent offenses” violated his due process rights.20 In its decision, the Sell Court reiterated Harper’s holding that the requirements of due process are satisfied where the government demonstrates antipsychotic medication is “medically appropriate and, considering less intrusive alternatives, essential for the sake of [the pretrial defendant’s] own safety or the safety of others.” 21 But where the only asserted governmental interest is to bring a defendant to trial, the Court held, the Constitution requires other conditions to be met before the government may override the defendant’s liberty interest in refusing psychotropic medication. 22 Specifically, the Court stated, the Constitution permits the Government involuntarily to administer antipsychotic drugs to a mentally ill defendant facing serious criminal charges in order to render that defendant competent to stand trial, but only if the treatment is medically appropriate, is substantially 20 Id. at 175. 21 539 U.S. at 179 (quoting Riggins v. Nevada, 504 U.S. 127, 135 (1992); emphasis added in Sell; internal quotation marks omitted). 22 Id. at 169. 11 unlikely to have side effects that may undermine the fairness of the trial, and, taking account of less intrusive alternatives, is necessary significantly to further important governmental trial-related interests.[23] The Court strongly implied, if it did not explicitly hold, that such “trial-related” determinations must be made by a court. 24