Document: 112 S.Ct. 1810 504 U.S. 127 118 L.Ed.2d 479 David RIGGINS, Petitionerv.NEVADA. No. 90-8466. Argued Jan. 15, 1992. Decided May 18, Syllabus When petitioner Riggins, while awaiting a Nevada trial on murder and robbery charges, complained of hearing voices having sleep problems, psychiatrist prescribed the antipsychotic drug Mellaril. After he was found competent to stand trial, Riggins made motion suspend Mellaril's administration until after his arguing that its use infringed upon freedom, effect demeanor mental state during would deny him due process, had right show jurors true when offered an insanity defense. testimony doctors who examined court denied with one-page order giving no indication rationale. At Riggins' presented defense testified, convicted, sentenced death. In affirming, State Supreme Court held, inter alia, expert at sufficient inform jury testimony. Held: The forced medication violated rights guaranteed by Sixth Fourteenth Amendments. Pp. 133-138. (a) record narrowly defines issues in this case. Administration Mellaril involuntary once terminate denied, but medically appropriate. addition, Eighth Amendment argument drug's opportunity condition sentencing not raised below or petition for certiorari and, thus, will be considered Court. P. 133. (b) A pretrial detainee has interest avoiding drugs is protected under Due Process Clause. Cf. Washington v. Harper, 494 210, 110 1028, 108 178; Bell Wolfish, 441 520, 545, 99 1861, 1877, 60 447. Once moved treatment, became obligated establish both need medical appropriateness. supra, U.S., 227, 1039. process certainly have been satisfied shown treatment appropriate considering less intrusive alternatives, essential own safety others. also might able justify if appropriate, showing adjudication guilt innocence could obtained using means. However, allowed continue without making any determination course findings about reasonable it failed acknowledge liberty freedom from drugs. 133-137. (c) There strong possibility court's error impaired constitutionally rights. Efforts prove disprove actual prejudice before futile, guesses as trial's outcome granted speculative. While precise consequences forcing cannot transcript, establishes impaired. side effects may impacted only outward appearance, testimony's content, ability follow proceedings, substance communication counsel. Thus, even assess fairly, unacceptable risk remained compromised 137-138. (d) can sometimes justified interest, here contains finding support conclusion necessary accomplish policy. 138. 107 Nev. 178, 808 P.2d 535, (1991) reversed remanded. O'CONNOR, J., delivered opinion Court, which REHNQUIST, C.J., WHITE, BLACKMUN, STEVENS, SOUTER, JJ., joined. KENNEDY, filed concurring judgment. THOMAS, dissenting opinion, SCALIA, joined except Part II-A. Mace J. Yampolsky, Las Vegas, Nev., petitioner. James Tufteland, respondent. Justice O'CONNOR 1 Petitioner challenges convictions ground unconstitutionally trial. Because courts make drug, we reverse. 2 * During early hours November 20, 1987, Paul Wade dead Vegas apartment. An autopsy revealed died multiple stab wounds, including wounds head, chest, back. arrested killing 45 later. 3 few days being taken into custody, told Dr. R. Edward Quass, private treated patients Clark County Jail, head trouble sleeping. informed Quass successfully past. trade name thioridazine, drug. consultation, level 100 milligrams per day. continued complain problems following months, gradually increased prescription 800 received Dilantin, antiepileptic 4 January 1988, competence App. 6. Three court-appointed psychiatrists performed examinations February March, taking 450 daily. William O'Gorman, anxiety 1982, Franklin Master concluded third psychiatrist, Jack Jurasky, incompetent. District determined legally sane id., 13, so preparations went forward. 5 June, suspending Dilantin end Id., 20. Relying Constitution, argued these drugs' process. asserted that, because offer "true state." 22. response, noted law prohibits incompetent persons, see Nev.Rev.Stat. § 178.400 (1989), therefore authority compel take ensure competence. 31-32. 6 On July 14, held evidentiary motion. hearing, "guess[ed]" off noticeably alter behavior render Record 412. testified Mellaril, noticeable continued. 443-445. Finally, O'Gorman defendant calmer more relaxed excessive dose cause drowsiness. 464-466. unable predict how behave medication, yet questioned give high receiving. 474-476. written report Jurasky earlier view predicted "would most likely regress manifest psychosis become extremely difficult manage." 19. 7 gave 49. receive each day through completion November. 8 behalf. He indicated night Wade's death used cocaine going admitted fighting Wade, claimed trying kill said justifiable homicide. guilty deadly weapon weapon. penalty same set sentence 9 several claims among them assist prejudicially affected attitude, This justified, opening brief, neither demonstrated administer nor explored alternatives 1020. amplified claim reply objecting intruded options. argued: 10 "In United States Bryant, 670 F.Supp. 840, 843 (Minn.1987)[,] court, reference medicating prisoners against their will, stated 'courts recognized protectable . avoid unwanted such drugs.' stating cited Bee Greaves, 744 F.2d 1387 (10th Cir.1984)[,] addressed issue pre-trial detainees 'less restrictive segregation controversial like tranquilizers sedatives, should ruled out resorting case bar, were utilized, proposed." 1070-1071 (emphasis original). 11 affirmed sentence. 535 (1991). With respect "was testimony." ----, P.2d, 538. although relevant defense, denial defense's abuse discretion violation Rose suggested whether "absolutely necessary" ordering suspension medication. 540 (concurring opinion). Springer dissented, never criminal solely allow prosecution. 541 (dissenting 12 We certiorari, 502 49, 116 27 (1991), decide II 13 us. parties subsequent involuntary. See, e.g., Brief (medication "forced"); Respondent 22, 28 (describing "unwanted," "over objection," "compelled"). understanding accords See 537 "involuntary" "forced"). Given parties' positions point absence evidence contrary, adhere 14 presume Although counsel stressed very did suggest improper client. 15 dispositive hearing. do address here. 16 considerations mind, turn core contention "a full fair trial." Pet. Cert. i. Our discussion 178 (1990), provides useful background evaluating claim. prison inmate alleged various individuals other will. prevail, agreed Amendment's "The forcible injection nonconsenting person's body," said, "represents substantial interference liberty." 229, S.Ct., 1041. particularly severe: 17 purpose chemical balance patient's brain, leading changes, intended beneficial, her cognitive processes. therapeutic benefits are well documented, serious, fatal, effects. One identified acute dystonia, severe spasm upper body, tongue, throat, eyes. within minutes Cogentin. Other include akathesia (motor restlessness, often characterized inability sit still); neuroleptic malignant syndrome (a relatively rare lead cardiac dysfunction); tardive dyskinesia, perhaps discussed Tardive dyskinesia neurological disorder, irreversible some cases, involuntary, uncontrollable movements muscles, especially around face. [T]he proportion exhibit symptoms ranges 10% 25%. According American Psychiatric Association, studies indicate 60% mild minimal effect, severe." 229-230 [110 1041] (citations omitted). 18 Taking account unique circumstances penal confinement, however, allows mentally ill involuntarily where there "the dangerous himself others inmate's interest." 1040. 19 Under convicted prisoner impermissible absent overriding justification affords least much protection persons detains 447 (1979) ("[P]retrial detainees, crimes, retain those constitutional enjoyed prisoners"); O'Lone Estate Shabazz, 482 342, 349, 2400, 2404, 96 282 (1987) ("[P]rison regulations judged 'reasonableness' test than ordinarily applied infringements fundamental rights"). appropriateness 20 occasion develop substantive standards judging settings, prosecution sake 225-226, 1039; cf. Addington Texas, 418, 1804, 323 (Due Clause civil commitment clear convincing dangerous). Similarly, establishing obtain Illinois Allen, 397 337, 347, 90 1057, 1063, 25 353 (1970) (Brennan, concurring) ("Constitutional power bring accused scheme 'ordered liberty' prerequisite social justice peace"). note contend tried discontinuation rendered 424-425, 496, 500. question refuse cessation 21 Contrary dissent's understanding, "adopt standard strict scrutiny." Post, 156. finally prescribe mentioned above, since alternatives. laconic denying adopt State's view, required tried; fact, casts considerable doubt argument. 130-131. Nor compelling concerns outweighed 22 Were divine Court's logic conclude simply weighed prejudiced changes appearance chance struck favor ("[T]hat nervous forth all brought [through testimony]. And you start weighing possibly revert situation, I don't think good experiment"). defendant's 23 invokes. consider terminating dosage administered toxic range, 483, "uptight," 484. patient suffer drowsiness confusion. 416. Association Amicus Curiae 10-11 ("[I]n extreme sedation-like [of medication] enough (akinesia) affect thought processes"). It clearly possible just content direct cross examination, 24 us different purely accordingly reject suggestion demonstrate proceeded differently given post, 149-150. Like wear clothing, Estelle Williams, 425 501, 504-505, 1691, 1693, 48 126 (1976), binding gagging 344, 1061, transcript. What establishes, what ignore, persuaded allowing present nothing cure testimony, interaction counsel, comprehension Even (as dissent argues, 147-149) remained. ---- - 537-538. 26 To sure, interest. Holbrook Flynn, 475 560, 568-569, 106 1340, 1345-1346, 89 525 (1986); 1061 (binding permissible situations "fairest way" control disruptive defendant); 505, 1693 (compelling defendants clothing furthers policy). policy, basis saying probability justified. judgment reversed, remanded further proceedings inconsistent opinion. ordered. 29 30 pharmacological data amicus briefs sources poses serious threat us, well-developed point, whole subject treating incompetence somewhat new law, medicine. sparse consideration issue. file separate express my extraordinary State, prosecuting officials administering doses medicines purposes rendering made, our properties 31 outset, agreement one medicated challenge conviction. commands phases avowed changing behavior, manipulated material evidence. Brady Maryland, 373 83, 87, 83 1194, 1196-1197, 215 (1963) (suppression favorable violates process); Arizona Youngblood, 488 51, 58, 109 333, 102 281 (1988) (bad faith failure preserve potentially constitutes violation). accept premise THOMAS' comprises procedure, unrelated foreclosed inquiry review proceeding itself. allegations pertain 32 agree majority legitimate attempting restore otherwise defendants. Its derives holding Pate Robinson, 383 375, 378, 86 836, 838, 815 (1966), conviction Unless competent, put Competence rudimentary, depends main part deemed effective assistance summon, confront, examine witnesses, testify one's behalf remain silent doing so. Drope Missouri, 420 162, 171-172, 95 896, 903-904, 43 103 (1975). correct does require waive general rule permitting waiver withstand scrutiny Clause, holdings Drope. cast exercise privileges 33 conducting insure assuming sound treatment. remand, seems little considered. understandable respects, briefing argument; underscore reservations propriety explain ought qualifications required. 34 incarcerated person ceased physical danger context objective manageable. Here merely treat grave psychiatric disorders enable function way others, rather last objective, bringing causes concern. If bare functional induced, matter itself, far reaching concerns. competence, elementary protections intrusion every significant impair capacity willingness react Based literature, showing. Indeed, itself elusive, assumes baseline normality experts difficulty particular defendant, they all. These uncertainties serve terrain must traverse enters domain. 35 concrete, addressed. First introduced 1950's, wide acceptance community psychotic disorders. Press Textbook Psychiatry 770-774 (J. Talbott, Hales & S. Yodofsky eds. 1988) (Textbook Psychiatry); 6-7. medications normal processes clearing hallucinations delusions. Psychiatry, 774. ("The health produced from, inauthentic alien than, medications, penicillin pneumonia"). For many patients, alternative exists illnesses. 7, n. 3. 36 changed lives documented 229-230, 1041, again More appears, compromise two principal ways: 1) altering manner reactions presentation courtroom, 2) unwilling 37 assumption adversary system trier fact observes throughout either sitting table. Confrontation Taylor States, 414 17, 19, 94 194, 195, 38 174 (1973) (per curiam). stages manner, facial expressions, emotional responses, absence, combine overall impression powerful influence takes stand, did, great bearing credibility, persuasiveness, degree evokes sympathy. confrontation Coy Iowa, 487 1012, 1016-1020, 2798, 2800-2802, 101 857 (emphasizing importance face-to-face encounter between accuser). facets Serious implicated manipulates way. restless still. 10. induce called Parkinsonism, which, Parkinson's disease, tremor limbs, diminished range expression, slowed speech. Ibid. Some subtle. Antipsychotic "sedation-like effect" cases tranquilizer effect." 752. ibid. ("If dealing someone sick then up very, high. mean tranquilize elephant milligrams"). listed large Mellaril: "Drowsiness, constipation, lack alertness, blood pressure. Depression psychomotor functions. lot stoned practical barely function." 753. 39 potential disturbing patient; me diminish As points out: 40 "By creating prejudicial negative defendant—making look restless, example, calm sedated appear bored, cold, unfeeling, unresponsive. That subtle real influential." 41 13. attorney attest, result inhibits respond remorse compassion. phase sentencer attempt know heart mind offender judge character, contrition future dangerousness. capital proceeding, assessments character carry weight perhaps, determinative dies. Geimer Amsterdam, Why Jurors Vote Life Death: Operative Factors Ten Florida Death Penalty Cases, Am.J.Crim.L. 1, 51-53 (1987-1988). 42 Concerns extend cooperation cooperate active lawyer. Massiah 377 201, 84 1199, 246 (1964); Geders 80, 1330, 47 592 (1976) (trial directing consult lawyer overnight recess deprive counsel). provide needed information lawyer, participate decisions hamper attorney-client relation, preventing willing interferes relation administers dull cognition. National Criminal Defense Lawyers ("[T]he flattening loss self-determination undermining desire self-preservation engage preparation trial"). established behalf, system, re Oliver, 333 257, 273, 68 499, 507, 92 L.Ed. 682 (1948). implicit Compulsory Amendment. Rock Arkansas, 483 44, 2704, 97 (1987). Rock, excluding aided refreshed hypnosis observed barring contradict conduct person: " 'It accused, "informed nature accusation," "confronted witnesses him," accorded "compulsory obtaining favor." ' 52, 2709, quoting Faretta California, 422 806, 819, 2525, 2533, 562 recognition words, related Fifth choice speak "in unfettered will." 53, 2710. type imposing constraints reason legitimacy doubt. 44 resort commitment, unless becomes Constitution requires society bear cost integrity knowledge evolving produce Until comes, permit alterations raising enumerated observations, concur reversing 46 whom SCALIA joins II-A, dissenting. killed stabbing times knife. took cash, drugs, items home. first-degree affirmed. reverses conviction, deprived respectfully dissent. conflates distinct questions: improperly case, asking, ask, reversal seeking, seek, injunction damages infringement personal opinions Court: truly actionable legal nonetheless fundamentally Constitution. affirm 49 contended 'full fair' trial" reasons, first relating exclusion second concerning 1018. extent arguments involved federal issues, believe correctly rejected them. A. 50 prevented presenting demeanor. notes, suffers illness believed attacked difference misjudge sanity. existed time crime, requested permission unmedicated state. 20-24, 42-47. request 51 questions admissibility law. McGuire, 475, 385 limited decision exclude form Except involving specific provision see, Ohio Roberts, 448 56, 2531, 65 597 (1980), reverse "trial judge's action admission evidence" ruling "so infuse[s] unfairness law." Lisenba 314 219, 228, 62 280, 286, 166 (1941). Marshall Lonberger, 459 422, 438, 6, 843, 853, 74 646 (1983); Burgett 389 109, 113-114, 88 258, 261, 319 (1967). concluding 52 declines actually appearance. speculates looked uptight, drowsy, confused Ante, 137. possibility. "be notice [Riggins] compared period drug." 445. Yet, demeanor, fails why medication's unfair. 53 crime instead condition. advantage explaining history health, usage 739-740. arrest crime. 747-748. explained affecting him. 752-753, 760-761. 54 "testimony analysis comports suffice clarify apparent Law, 270 S.C. 664, 673, 244 S.E.2d 302, 306 (1978); Jojola, N.M. 489, 493, 553 1296, 1300 (1976). Pray, 133 Vt. 253, 257-258, 336 A.2d 174, 177 (1975) (reversing medicine appearance). Having reviewed whole, disturb facts introduce desired 55, 11, 2711, (1987); 64-65, 2715-2716 (REHNQUIST, dissenting). B 55 interfered alleged, particular, tended limit powers perception. accepts contention, stating: "It examination cross-examination, counsel." 137 added). disagree. 56 All occur tries lacks certain comprehend proceedings. guarantees elements fairness trial," Spencer 554, 563-564, 87 648, 653, 606 (1967), "conviction process," (1966). 57 specifically statute requiring "sufficient mentality understand charges him, aid interposed 178.400(2) (1989). assert imposes higher standard. 58 reveal purported allege effectively directed cross-examine differently. instructions understand. record, moreover, assertion worse off. below: "Two helpful Additional ability. ." 540. Hayes, N.H. 458, 461, 1379, 1381 (1978) (holding perception adequate "[a]ll support[ed] ha[d] beneficial function").1 tends confirm N.M., 492, 1299 (presuming, evidence, fully trial). thus 59 argues 221, 1036, protects "liberty interest" asserts agrees, drug" 129. improper. deprivation Harper version facts. Shortly arrest, jail sleep. eliminate problem, sought dosage. began voluntarily. 61 concludes motion, medication.2 Moreover, though alleges physicians order, allegation. admits drugged attempts observing assumed occurred. assumption, change argue consistently maintained "full 20-24 motion); 42-47 reply); 1018-1021 (appellate brief); 1068-1071 brief). oral argument: initially really strategy. Mr. Harper-type want medicated." Tr. Oral Arg. 23.3 63 merit, altered theory therefore, condemn "did drugs." make. quite recently "[i]n reviewing judgments jurisdictional grant U.S.C. 1257, has, exceptions, refused petitionrs' below." Yee Escondido, 503 1522, 1531, 153 (1992). "we expressed views prudential arising courts," ibid., departure 64 determine "[w]hether answer other, "may invokes." stated, outside certiorari." 1532. issue, event, warrant states Harper. differs respect. drugging 1983. 217, 1034. complains seeking expand remedy. 66 plaintiffs remedies violations Dennis Higgins, 498 111 865, 969 kinds deprivations: "which occu[r] case" "structural defect framework" Fulminante, 499 1246, 113 302 considers fall category reversible error. failure, more, constitute flaw mechanism. (Rose, concurring). entitled remedies, reversed.4 67 similar challenged grounds garb jury. challenge, ask select attire. Instead, "fair 503, 1692. ultimately declined reach merits waived 512, 1697, lower overturned ground." 504, 1. validity Williams depend (either structural evidence) apply cases. violate forcibly kind defendant. surely aspirin. Perhaps general, greater likelihood perceptions substances. unfairly Riggins. 69 undervalue whim. instances, seek injunctions actions 1983, reviews undo already occurred punish responsible. proper free errors recognized. C 70 foregoing find unnecessary governing Whether standards, note, troubling questions. purports rely applies differ respects. 71 today, instance, appears scrutiny. faults failing "continued tried," ante, 1816 added), "other drugs," furthering 218, 1035. "erred refusing reasonableness." 223, 1037. 72 today departs says erred "considering alternatives." 1815. presumably believes smaller therapies. imposed requirement. "[t]he means proferred [the prisoner] accommodating rejecting invalidity policy." 226, 73 involves prisoner. inmates distinction departing Harper; instead, applying detainees. 1814. Either adopting reasons. interpretation previously '[p]sychotropic widely accepted extraordinarily chronic psychoses, schizophrenia.' 9, 1039, (1990) (quoting et al. Amici Curiae, O.T.1989, 88-599, pp. 10-11). confirmed "QUESTION: [D]id ever go stop medication? won't intervene enjoin medication[.] "MR. YAMPOLSKY: Yes. So well, I'm it, wouldn't order? Apparently not." brief (Minn.1987), (CA10 1984), 1070-1071. asked "violated [his] jury." 1068. substantially faculties thereby E. Coke, Institutes *34 (1797) felons come judgement answer, shall irons, bonds, pain away reason, constrain will"); Resolutions Judges Case Regicides, Kelyng's Report Divers Cases Pleas Crown (1708) (Old Bailey 1660) ("It resolved Prisoners Bar tryed, Irons off, Torture Crime great"), reprinted How.St.Tr. 971, 979-980 (1816); Trial Christopher Layer, 94, (1812) [K.B. 1722] defendant] 'in vinculis' free, advantages innocence"); Wash. 47, 49-51, 580, 581 (1897) (" 'the shackles may, extent, faculties' ") Kring, Mo. 591 (1877)). (much proved) allegation Court; indeed, indicates enhanced

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