Opinion ID: 590886
Heading Depth: 2
Heading Rank: 3

Heading: Constitutionally Adequate Procedural Protections

Text: 52 Having determined that state law recognizes a liberty interest, also protected by the Due Process Clause, which permits refusal of antipsychotic drugs unless certain preconditions are met, we address next what procedural protections are necessary to ensure that the decision to medicate an inmate against his will is neither arbitrary nor erroneous under the standards we have discussed above. Harper, 494 U.S. at 228, 110 S.Ct. at 1040. As the Court has repeatedly stressed, [t]he procedural protections required by the Due Process Clause must be determined with reference to the rights and interests at stake in the particular case. Id. at 229, 110 S.Ct. at 1040-41 (collecting cases). This inquiry requires us to assess the relative weight of several factors: 53 First, the private interest that will be affected by the official action; second, the risk of an erroneous deprivation of such interest through the procedures used, and the probable value, if any, of additional or substitute procedural safeguards; and finally, the Government's interest, including the function involved and the fiscal and administrative burdens that the additional or substitute procedural requirement would entail. 54 Mathews v. Eldridge, 424 U.S. 319, 335, 96 S.Ct. 893, 903, 47 L.Ed.2d 18 (1976). In the setting of this case, the application of this analytical model requires that we accommodate a parolee's liberty interest in avoiding the forced administration of antipsychotic drugs and the State's interests in providing appropriate medical treatment to reduce the danger that [a parolee] suffering from a serious mental disorder represents to himself and to others. Harper, 494 U.S. at 236, 110 S.Ct. at 1044. 55 As we undertake this analysis, we again note, as a threshold matter, that we perceive little reason to distinguish the parole situation from the prison situation. In terms of the Mathews factors, the relationship of the parties--both in terms of their responsibilities and prerogatives--remains essentially unaltered. Consequently, we find the Supreme Court's analysis in Harper to be a very important guide. Nevertheless, it deserves emphasis that, while the Supreme Court found adequate the Harper decision-making mechanism, 7 its decision did not announce a rigid constitutionally-based model to be followed throughout the Nation. However, the Court's analysis does distill the basic factors that must guide our inquiry.
56 First, we consider Mr. Felce's interest in avoiding unwanted and unnecessary antipsychotic drug treatment. As the Harper court noted, this interest is significant: The forcible injection of medication into a nonconsenting person's body represents a substantial interference with that person's liberty. The purpose of the 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. Harper, 494 U.S. at 229, 110 S.Ct. at 1041 (citations omitted). The Physicians' Desk Reference, 1728 (45th ed. 1991) describes Prolixin, the drug currently administered to Mr. Felce, as a highly potent behavior modifier with a markedly extended duration of effect. Moreover, [w]hile the therapeutic benefits of antipsychotic drugs are well documented, it is also true that the drugs can have serious, even fatal side effects. Harper, 494 U.S. at 229, 110 S.Ct. at 1041. These potential adverse side effects include involuntary muscle spasms, motor restlessness, neuroleptic malignant syndrome--a relatively rare condition which can lead to death from cardiac dysfunction--and tardive dyskinesia, a neurological disorder, irreversible in some cases, that is characterized by involuntary, uncontrollable movements of various muscles, especially around the face. Id. at 229-30, 110 S.Ct. at 1041; see also Riggins, --- U.S. at ---- - ----, 112 S.Ct. at 1814-15. Thus, Mr. Felce's interest in avoiding antipsychotic drug treatment is significant.
57 Next, we consider the risk of an erroneous deprivation of this interest through the procedures used by the defendants, and the probable value, if any, of additional or substitute procedural safeguards. The defendants stress at this juncture that the decision to require Mr. Felce to take antipsychotic drugs was arrived at only after a thorough review of his prison records, his medical records, as well as communication with Mr. Felce's family, prior parole officers, social workers, and physicians. In particular, Agent Schansberg points to the letter of October 8, 1990, that he received from Dr. Taman, a psychiatrist who examined Mr. Felce once in 1975 and a second time in February 1990. Dr. Taman wrote that, based upon a review of his prior examinations and of Mr. Felce's medical and prison records, he recommended that Mr. Felce undergo antipsychotic drug treatment. The defendants submit that the decision to require Mr. Felce to take antipsychotic drugs as a condition of parole was thus not the product of unsophisticated north woodsmen who took it upon themselves to decide that it would be a good idea to require plaintiff to be involuntarily injected with an antipsychotic drug, but the product of professional medical judgment by Dr. Taman and a thorough review of Mr. Felce's medical and prison records. Appellee's Br. at 28. 58 Our review of the record indicates that the defendants had a substantial basis for concern that Mr. Felce might engage in antisocial, and perhaps violent, behavior upon release. Mr. Felce had made numerous threats of violence to prison officials and had repeated his desire to injure his ex-wife. In addition, more than one medical professional had recommended antipsychotic drug treatment in the six years or so that Mr. Felce had been in custody. Nevertheless, other evidence in the record suggests that the defendants were aware that Mr. Felce was not committable and thus, under Wisconsin law, could not be forced to undergo antipsychotic drug therapy as an inmate. In November 1989, before Mr. Felce was originally scheduled for mandatory release, Thomas Biever, the clinical services director at Mr. Felce's prison, arranged for Mr. Felce to be transferred to the Wisconsin Resource Center for an evaluation as to whether Mr. Felce could be involuntarily committed. In his report on this transfer, Biever acknowledged doubt that Mr. Felce met the standard for involuntary commitment: 59 There has been question about whether or not Mr. Felce is a person who could be recommended for civil commitment under chapter 51. The record clearly indicates that although Mr. Felce has serious personality problems, he is not necessarily a person who meets the criteria for civil commitment. However, in the interest of having a second opinion, he has been recommended for transfer to the Resource Center for that evaluation and opinion. 60 R.43 Ex.113. On November 22, 1989, following a psychological examination of Mr. Felce, Wisconsin Resource Center officials determined that he was not a candidate for involuntary commitment under Wis.Stat.Ann. § 51.20. R.28 Ex.L. Three months later, Becky Mladnick, who was then Mr. Felce's parole agent, scheduled an appointment for Mr. Felce to meet with Dr. Taman. Agent Mladnick wrote a letter to Dr. Taman in advance of the examination, in which she informed the doctor that, among his many threats of violence, Mr. Felce had threatened to kill her. Agent Mladnick told Dr. Taman that she hoped he could recommend treatment with antipsychotic drugs. 61 I had hoped to get a commitment for this man prior to his release from prison and with the court's backing force medication. The client's mother, father, and ex-wife all say that the medication he received in the past (I believe it was a monthly injection of Prolixen [sic] markedly improved his behavior. The family believes it is the only way he will be able to stay out of trouble. 62 .... 63 What I want is for this guy to get treatment so he is not a danger. 64 R.43 Ex.115. Dr. Taman examined Mr. Felce, diagnosed him as suffering from probable delusional disorder, past persecutory type and recommended, [b]ased on the fact that he has responded to antipsychotics in the past, I believe that a trial of the same would be beneficial. R.42 Ex.126 at 2-3. Two months later, on April 6, 1990, Mr. Felce was examined by Robert DeYoung, Ph.D., a staff psychologist at the Waupun Correctional Institution. Dr. DeYoung's professional opinion was that, although Mr. Felce was showing symptoms of a paranoid personality disorder, he was not mentally ill. 65 Although there is some evidence in this individual's record that he has manifested paranoia to the point of being psychotic, he currently does not manifest the symptoms of a mental illness. He is seen as manifesting the characteristics of a paranoid personality disorder. He also has a history of alcohol and drug abuse which have significantly contributed to his problems. He is currently not amenable to any type of treatment. It is recommended that he be placed within a regular prison population and that he be monitored by Clinical Services. If significant deterioration should occur, he may be in need of psychiatric medication. 66 R.43 Ex.117 at 2. Thus, there was evidence in Mr. Felce's medical record to suggest that his personality problems were not severe enough to require antipsychotic drug therapy. Furthermore, the recommendation from Dr. Taman followed specific requests from Agent Mladnick and Agent Schansberg--both of whom were apparently threatened by Mr. Felce--for such a recommendation. 67 Thus, the record reflects that the procedure followed by the defendants was insufficiently neutral and independent to guard against an erroneous determination that Mr. Felce was an appropriate subject for antipsychotic drug treatment. The parole plan, while devised with medical advice, was not subject to independent medical evaluation. Therefore, there was no safeguard against the imposition of a plan that was not justified medically. While medical opinions are present, they vary significantly in their assessment and, given the time span involved, in their relevance. At no time was this data subject to evaluation by a neutral decisionmaker. 68 Nevertheless, the defendants point to two procedural safeguards that were in place to protect Mr. Felce against an erroneous deprivation of his liberty interest: the parole grievance procedure, and the parole revocation process. The grievance procedure was brought to Mr. Felce's attention through the last line on the Probation/Parole Rules sheet he was given by Agent Schansberg, which read: 69 As established by Administrative Rule DOC 328.11, you have an opportunity for administrative review of certain types of decision through the client complaint process. 70 R.28 Ex.N. The state provides us with little information on the procedure in its brief. Appellee's Br. at 23 n. 1. However, from our independent review of the regulations, we have obtained sufficient information to make it clear that, in this context, this procedure does not comply with due process. The grievance procedure, as set forth in Wis.Admin.Code § DOC 328.11, allows a parolee to file a complaint with the parole agent, and have that complaint reviewed by three levels of administrators: the parole agent's supervisor (e.g., defendant Dhein, supervisor to Agent Schansberg), the regional chief (e.g., defendant Brunk), and the administrator of probation and parole. The administrator's decision is final and non-appealable. The process is all done in writing and all within the parole division of the Wisconsin Department of Corrections; there is no opportunity for an independent or neutral decisionmaker to pass judgment. This procedure provides only minimal opportunity for the parolee to present his case, see Harper, 494 U.S. at 235, 110 S.Ct. at 1044; Vitek v. Jones, 445 U.S. 480, 494-96, 100 S.Ct. 1254, 1264-65, 63 L.Ed.2d 552 (1980), and has no provision for review by persons not currently involved in his diagnoses or treatment. None of the decisionmakers need possess any medical qualifications. Finally, the procedures of the Department explicitly require that the condition (i.e., medication with antipsychotic drugs) be met while the review process is underway. Therefore, even assuming expedited consideration, see DOC 328.11(10), this procedure affords Mr. Felce no adequate way of avoiding the administration of the drugs. 71 The defendants also suggest that the parole revocation process provided sufficient procedural protection to Mr. Felce's liberty interest. The parole revocation process is governed by Wis.Stat.Ann. § 304.06(3) and Wis.Admin.Code §§ DOC 331.01 to 331.16. Neither the statute nor the regulations contain any provision concerning a challenge to the conditions of parole; both focus the attention of the process on a determination whether the parolee has violated the condition of parole and, if so, if revocation should result. As a general rule, the only issue at a parole revocation hearing is whether the parolee has violated a condition of parole and, if so, whether that violation is serious enough to require that parole be revoked. 8 The defendants have not submitted to us, nor have we uncovered any legal reference which states that Wisconsin parole revocation hearings are an exception to this rule. 72 Turning to the third Mathews factor, we next consider the probable value, if any, of additional or substitute procedural safeguards. We begin by noting that the Court has repeatedly emphasized the value of an independent decisionmaker in a context such as this. Harper, 494 U.S. at 233, 110 S.Ct. at 1043 (Adequate procedures exist here. In particular, independence of the decisionmaker is addressed to our satisfaction by these procedures.); Vitek, 445 U.S. at 494-96, 100 S.Ct. at 1264-65; Morrissey, 408 U.S. at 489, 92 S.Ct. at 2604. Of course, a decisionmaker need not be external to an institution to be independent; a panel of prison officials (including prison medical professionals) was approved in Harper, 494 U.S. at 233-35, 110 S.Ct. at 1042-44. But under the procedure described by the defendants, the persons who make the decision whether to condition mandatory release parole on antipsychotic drug treatment are not independent, but involved in Mr. Felce's diagnosis and treatment. Agent Schansberg, the primary decisionmaker, may have felt threatened by Mr. Felce; Mr. Felce had threatened to kill his previous parole agent, Agent Mladnick. The physician whose recommendation was relied upon, Dr. Taman, was not entirely independent. He treated Mr. Felce with antipsychotic drugs in 1975, was asked by Agent Mladnick in February 1990 to diagnose Mr. Felce and to prescribe antipsychotic drug therapy, was asked by Agent Schansberg in October 1990 for a similar recommendation, and has treated Mr. Felce since his release on parole. The remaining defendants formed a direct line of supervisors above Agent Schansberg and thus had individual interests in supporting his decision. In contrast, the procedure approved in Harper involved a committee composed of a psychologist, a psychiatrist, and the Associate Superintendent of the Special Offender Center, none of whom may be, at the time of the hearing, involved in the inmate's treatment or diagnosis. 494 U.S. at 215, 110 S.Ct. at 1033. A majority vote, including the psychiatrist, is necessary before the inmate can be involuntarily medicated. Id. at 215-16, 110 S.Ct. at 1033. Independence such as this provides a significant added dimension of procedural protection to the liberty interest at stake. 73 Finally, we consider the fourth Mathews factor: the Government's interest, including the function involved and the fiscal and administrative burdens that the additional or substitute procedural requirement would entail. As the defendants remind us, the state's interest is substantial: the protection of the public--including a parolee's family and community--from antisocial acts of a parolee, as well as the parolee's reassimilation and rehabilitation. The function involved in mandatory release parole is the early release of a prisoner into the community, with parole conditions and supervision to motivate the parolee to avoid past mistakes (and thereby continue on parole) and adjust to life outside prison. Mandatory release parole also saves the state money and alleviates prison overcrowding. 74 With respect to the fiscal and administrative burdens that an additional or substitute procedural requirement would entail, the parties have failed to offer evidence of the potential burdens of utilizing an independent decision-maker in deciding which parolees are proper candidates for antipsychotic drug treatment. Certainly, the burdens would be no greater than those required when the state seeks to medicate an inmate against his will and, pursuant to state law, must pursue involuntary commitment. 75 Upon balancing the Mathews factors, we are persuaded that the involvement of an independent decisionmaker would benefit significantly the protection of the liberty interest at stake without a significant burden upon either the resources of the state or the substantial interests that the state has in protecting the public and rehabilitating its parolees. Therefore, we conclude that the defendants' current procedure--with its heavy emphasis upon the judgment of the individual parole agent--is constitutionally inadequate.