Court Opinion

ID: 9785309
Source: CourtListenerOpinion
Date Created: 2023-08-30 21:15:14.943606+00
Date Added: 2024-06-11T07:36:15.559808
License: Public Domain

DURRANT, Justice,
writing for the majority:
¶ 77 We concur in Chief Justice Durham’s opinion except her analysis with respect to the second Sell factor. As to this factor, we agree with Chief Justice Durham’s determination that “the district court did not clearly err in concluding that antipsychotic medication is substantially unlikely to interfere with Ms. Barzee’s right to a fair trial,”1 but we respectfully disagree with the remainder of the analysis.
¶ 78 We disagree with Chief Justice Durham’s analysis, set forth in Part III.A, as to the appropriate standard of review for the second Sell factor. Chief Justice Durham would apply a de novo review to the question of whether the administration of medication to Ms. Barzee is substantially likely to render her competent to stand trial — the first inquiry under the second Sell factor. Because this inquiry is essentially a factual one, we apply a clear error standard of review.
¶79 We also disagree with Chief Justice Durham’s substantive analysis, set forth in Part III.D.2, as to the first inquiry under the second Sell factor. Chief Justice Durham concludes that the State’s experts wholly disregarded the particular characteristics of Ms. Barzee’s psychosis and relied exclusively on reports and statistics regarding general populations. Our review of the record indicates that the State’s expert witnesses did, in fact, consider the particular characteristics of Ms. Barzee’s condition and based their conclusions, in part, on their assessment of those characteristics.
I. THE DISTRICT COURT’S FINDING THAT THE ADMINISTRATION OF ANTIPSYCHOTIC MEDICATION TO MS. BARZEE IS SUBSTANTIALLY LIKELY TO RENDER HER COMPETENT TO STAND TRIAL IS PRIMARILY A FACTUAL FINDING THAT SHOULD BE REVIEWED FOR CLEAR ERROR
¶ 80 As to the standard of review question, while the United States Supreme *74Court in Sell v. United States2 set forth four criteria to be considered in determining whether a defendant may be forcibly medicated to restore competency for the purpose of standing trial,3 it did not speak to the standard an appellate court should apply in reviewing a lower court’s decision as to these criteria. A number of federal circuit courts have, however, considered the question of the appropriate standard of review to be applied to a lower court’s determination regarding competency under the first part of the second Sell factor. The Second and Fourth Circuit Courts of Appeals have concluded that the second Sell factor addresses factual questions that should be reviewed for clear error.4 These courts have analyzed the second Sell factor in a way consistent with our traditional approach to review of lower court decisions. As to purely factual questions, we review the fact finder’s determinations for clear error.5 As to purely legal questions, we review the lower court’s determination for correctness (de novo).6 Only mixed questions of fact and law present a difficult challenge in determining the appropriate standard of review.7
¶ 81 Chief Justice Durham concludes that the question of competency under the second Sell factor is a mixed question and that because of the important constitutional right involved — the right to be free of forced medication — a de novo standard should be applied. But we conclude that this issue presents a predominantly factual question. Certainly, in a sense, even traditionally factual inquiries can be viewed as mixed questions. Issues such as reasonableness, knowledge, and proximate cause are fact questions to be resolved by the fact finder, but the definition of the terms themselves is a legal matter. For example, in a jury trial a judge will instruct a jury as to the legal definition of “reasonableness,” but the jury makes the factual determination as to whether a defendant was reasonable. So, too, in this case, the definition of “competency” requires a legal analysis, but whether a particular defendant is competent or is likely to be rendered so is a question of fact for the fact finder to answer.
¶ 82 In Utah, the Legislature has set forth various criteria to be considered by a court in determining whether a defendant is competent to stand trial;
(a) the defendant’s present capacity to:
(i) comprehend and appreciate the charges or allegations against him;
(ii) disclose to counsel pertinent facts, events, and states of mind;
(iii) comprehend and appreciate the range and nature of possible penalties, if applicable, that may be imposed in the proceedings against him;
(iv) engage in reasoned choice of legal strategies and options;
(v) understand the adversary nature of the proceedings against him;
(vi) manifest appropriate courtroom behavior; and
(vii) testify relevantly, if applicable;
(b) the impact of the mental disorder, or mental retardation, if any, on the nature and quality of the defendant’s relationship with counsel;
(c) if psychoactive medication is currently being administered:
(i) whether the medication is necessary to maintain the defendant’s competency; and
(ii) the effect of the medication, if any, on the defendant’s demeanor and affect *75and ability to participate in the proceedings.8
Each of these criteria presents the kind of question that we have traditionally considered factual in nature.9 Essentially, in assessing competency, a judge is required to consider whether the defendant understands her circumstances well enough to understand the crime with which she is charged, to assist her counsel in defending against those charges, and to understand the potential punishments.10 Thus, it is for the courts or the Legislature to define “competency,” but whether a particular defendant is competent as so defined is a factual determination that we review for clear error.
¶ 83 Although the question of competency involves predominantly empirical inquiries and requires a clear error standard of review on appeal, defining competency is, as we have noted, a legal matter. Even assuming that, therefore, the question of whether Ms. Barzee would likely be rendered competent by medication should be reviewed as a mixed question of fact and law, as Chief Justice Durham views it, our application of the three-part test under State v. Levin11 leads us to a different conclusion than that reached by Chief Justice Durham. Under the Levin test, to the extent the question before us is a mixed one, we would accord the trial court’s finding substantial deference.
¶ 84 As to the first Levin factor — “the degree of variety and complexity in the facts to which the legal rule is to be applied”12— we agree with Chief Justice Durham that the issue before us is complex. Indeed, this complexity is illustrated by the fact that Chief Justice Durham devotes a substantial number of pages to the issue of whether medicating Ms. Barzee is substantially likely to render her competent to stand trial. This factor, therefore, favors deferential review.13 We disagree with Chief Justice Durham, however, as to her assessment of the second and third Levin factors.
¶ 85 With respect to the second Levin factor — “the degree to which a trial court’s application of the legal rule relies on ‘facts’ observed by the trial judge, ‘such as a witness’s appearance and demeanor, relevant to the application of the law that cannot be adequately reflected in the record available to appellate courts’ ”14 — we disagree with Chief Justice Durham’s conclusion that “much of the necessary information concerning the diagnoses and research ‘generally can be adequately reflected in a cold record’ and will be supported by statistics and published research, unaffected by an individual’s appearance and demeanor while testifying.”15 Rather, we conclude that the district court’s assessment of the witnesses did involve some credibility determinations. The issue of whether medication is substantially likely to render Ms. Barzee competent to stand trial ultimately involves a disagreement among experts. “Because a trial court is in a better position to judge credibility and resolve evi-dentiary conflicts,” we review a trial court’s findings of fact for clear error.16
¶ 86 The district court carefully listened to evidence presented by competing experts for several days. Each of the experts was quali-*76ñed and took defensible positions as to Ms. Barzee’s potential competency. Thus, the district court ultimately had to make credibility determinations and resolve evidentiary conflicts. Although credibility assessment is not as critical here as it would be in many eases, we should give weight to the fact that the district court viewed the witnesses — and Ms. Barzee — first hand. It may well be possible for us to make an assessment as to the likelihood that Ms. Barzee will be rendered competent based on the record alone, but we are not as well positioned as the district court to make that assessment. Thus, our analysis under the second Levin factor also favors deferential review.17
¶ 87 Chief Justice Durham concludes that the third Levin factor — “other ‘policy reasons that weigh for or against granting discretion to trial courts’ ”18 — tips the balance in favor of de novo appellate review.19 Specifically, she explains that “constitutional liberty interests of the highest degree” are implicated when the state seeks to forcibly medicate a defendant for the purpose of rendering the defendant competent to stand trial.20 Although we have made a determination to grant less deference to factual findings in certain areas of the law that implicate constitutional interests, in our view we should do so rarely. For example, we apply nondeferential review “to the application of law to the underlying factual findings in search and seizure cases.”21 We do so because of our “interest in having uniform legal rules regarding consent to search, given the substantial Fourth Amendment interests lost as a result of such consents.”22 Furthermore, we have held that, although there may be varying fact patterns that are relevant to the permissibility of searches and seizures, they are “not so unmanageable in their variety as to outweigh the interest in having uniform legal rules.”23 For example, in reviewing the reasonableness of a traffic stop and protective search, we often need look only to a few objective facts, shared in many cases. As a result, we are well positioned to make the ultimate determination of reasonableness.24
¶ 88 But competency cases inherently involve case-by-case evaluations, and the facts presented by such cases are less manageable in their variety and less susceptible to categorization into recurring objective fact patterns than is the case in the Fourth Amendment context. Due to the different individual histories, diagnoses, drugs, treatments, and expert testimony that will likely be involved in every competency case, we are in no better position than the lower court to arrive at the ultimate determination of competency. Indeed, Chief Justice Durham’s opinion shows how complex and fact sensitive a competency evaluation can be with respect to a particular individual such as Ms. Barzee.
¶ 89 In the context of criminal trials, due process concerns are always present, so unless there is an overriding policy that would favor de novo review by an appellate court of a mixed question, as is the case in the Fourth Amendment context, we should defer to the fact finder. Such an overriding policy is not present here. The mere fact that the factual inquiry into whether Ms. Barzee is substantially likely to be rendered competent to stand trial if forcibly medicated implicates an important constitutional right does not warrant reviewing this inquiry with less deference than we review other factual issues. That is, the mere fact that this factual inquiry concerns a constitutional right *77does not alter the nature of that inquiry or the standard of review. Every criminal ease involves important constitutional rights, yet as to purely factual questions, we review for clear error. Moreover, the question of competency is, in other contexts, widely regarded as a factual issue.25 Thus, even viewed as a mixed question subject to the Levin test, the district court’s finding that it is substantially likely Ms. Barzee will be rendered competent by medication should be given substantial deference.
II. THE DISTRICT COURT’S FINDING THAT THE ADMINISTRATION OF ANTIPSYCHOTIC MEDICATION TO MS. BARZEE IS SUBSTANTIALLY LIKELY TO RENDER HER COMPETENT TO STAND TRIAL IS NOT CLEARLY ERRONEOUS
¶ 90 Under the second Sell factor, the district court found that the administration of antipsychotic medication is “substantially likely” to render Ms. Barzee competent to stand trial. Reviewing this finding de novo, Chief Justice Durham concludes that administration of antipsychotic medication is not “substantially likely” to render Ms. Bar-zee competent to stand trial. And Chief Justice Durham further concludes that, even under a deferential standard of review, the district court’s factual findings were clearly erroneous. We respectfully disagree.
¶ 91 Chief Justice Durham states that the district court “ignored the testimony of the defense experts and relied exclusively on the testimony of Drs. Jeppson and Whitehead,” thereby failing to properly weigh all of the evidence.26 Furthermore, she asserts that “the defense experts were the only witnesses in this case who gave due consideration to Ms. Barzee’s history and symptoms.”27 She states that, “[u]nlike the physicians from the state hospital, Drs. Amador and Morris focused on Ms. Barzee’s particular symptoms when rendering their opinions.”28 Chief Justice Durham further concludes that the State’s experts relied almost exclusively on federal and state reports from general hospital populations “without a showing of similarities in disorder, symptoms, and history” to Ms. Barzee.29 But our review of the record and the district court’s decision convinces us that the district court did not “ignore” the testimony of the defense experts and rely exclusively on the State’s experts. The district court’s opinion discusses the qualifications and conclusions of the key expert witnesses: Drs. Amador and Morris for the defense, and Drs. Jeppson and Whitehead for the State. The district court carefully noted the crucial differences in their testimony and discussed the relevant merit in each of their opinions.
¶ 92 Furthermore, we conclude that the State’s experts did not disregard Ms. Bar-zee’s particular ease, although it is true that they relied on federal and state statistics taken from general hospital populations. Dr. Whitehead was the clinical director of the forensic unit during much of the time Ms. Barzee was a patient, and he had frequent discussions with Dr. Jeppson concerning her diagnosis and symptoms. Dr. Jeppson was Ms. Barzee’s treating physician for over two years and testified that he met with her on a *78“weekly to monthly” basis. He was familiar with her particular psychosis and her particular symptoms, and his testimony reflected this experience. Moreover, Dr. Jeppson’s and Dr. Whitehead’s opinions were based on their own clinical experience, not only with patients suffering from psychosis generally, but with those patients whose symptoms were similar to those of Ms. Barzee. Indeed, Dr. Jeppson and Dr. Whitehead each had treated and restored to competency well over one hundred patients. And Dr. Whitehead testified that fifteen patients at the state hospital who had the same diagnosis as Ms. Barzee were all restored to competency through the administration of antipsychotic medication.30
¶ 93 The State’s experts did rely on reports regarding general populations in the federal hospital system and at the state hospital, in addition to other statistical information. These reports indicated that the success rate in restoring patients suffering from some form of psychosis to competency through the administration of antipsychotic medication was seventy to eighty percent. Chief Justice Durham maintains that the State’s experts’ reliance on these general statistics “should be given little, if any, weight.”31 She also argues that these restoration rates do not reflect Ms. Barzee’s particular symptoms and that the State’s experts almost exclusively relied on these restoration rates.32 But while the State’s experts used these restoration rates to support their conclusions, it is clear from the record that their opinions were formed by their own clinical experience and, in the case of Dr. Jeppson, his first-hand knowledge of Ms. Barzee as her treating physician.
¶ 94 Further, even though all of the patients in the reports relied on by the State’s experts did not share Ms. Barzee’s precise diagnosis or symptoms, the restoration rates indicated in the reports still have relevance. At the very least, the reports show success in treating patients with various forms of psychosis with antipsychotic medication. And the restoration rates are further relevant in light of Dr. Jeppson’s own experience with Ms. Barzee and restoring patients to competency in general, as well as those with symptoms similar to those of Ms. Barzee.
¶ 95 Ultimately, the district court was faced with complicated and conflicting expert testimony. In finding “the testimony of the State’s witnesses ... more persuasive,” the district court did not “ignore” the defense experts’ testimony, but carefully weighed and reviewed all of the evidence. Moreover, the district court’s decision is well reasoned and supported by the record. Therefore, we cannot say that the district court’s finding that the administration of antipsychotic medication was “substantially likely” to render Ms. Barzee competent to stand trial was “clearly erroneous.” We therefore affirm the district court’s order providing that the State may medicate Ms. Barzee.
¶ 96 Associate Chief Justice WILKINS and Justice PARRISH concur in Justice DURRANT’S opinion.

. Supra ¶ 46.

. 539 U.S. 166, 123 S.Ct. 2174, 156 L.Ed.2d 197 (2003).

. Id. at 180-81, 123 S.Ct. 2174.

. United States v. Gomes, 387 F.3d 157, 160 (2d Cir.2004) ("The district court’s findings with respect to the [second, third, and fourth] Sell factors are factual in nature and are therefore subject to review for clear error.''); United States v. Evans, 404 F.3d 227, 240 (4th Cir.2005) (“We review the district court's resolution of Sell’s second and fourth parts for clear error....”). Contra United States v. Valenzuela-Puentes, 479 F.3d 1220, 1224 (10th Cir.2007) ("Sell's first factor ..is reviewed de novo, as is the second factor....”).

. State v. Levin, 2006 UT 50, ¶ 20, 144 P.3d 1096.

. Id.

. Id. ¶ 21.

. Utah Code Ann. § 77-15-5(4) (2003).

. See State v. Pena, 869 P.2d 932, 935 (Utah 1994) (defining factual questions as "entailing the empirical, such as things, events, actions, or conditions happening, existing, or taking place, as well as the subjective, such as state of mind").

. See Dusky v. United States, 362 U.S. 402, 402, 80 S.Ct. 788, 4 L.Ed.2d 824 (1960) (explaining that the standard for whether a defendant is competent to stand trial is whether the defendant “has sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding — and whether he has a rational as well as factual understanding of the proceedings against him”) (internal quotation marks omitted).

. 2006 UT 50, 144 P.3d 1096.

. Id. ¶ 25.

. See id. ¶ 26 (“[T]he greater the complexity and variety of the facts, the stronger the case for appellate deference.”).

. Id. ¶ 25 (citing State v. Virgin, 2006 UT 29, ¶ 28, 137 P.3d 787).

. Supra ¶ 35.

. Levin, 2006 UT 50, ¶ 20, 144 P.3d 1096 (internal quotation marks and alterations omitted).

. See id. ¶ 26 ("[T]he greater the importance of a trial court’s credibility assessments that cannot be adequately reflected in the record, the stronger the case for appellate deference.”).

. Id. ¶ 25 (quoting Virgin, 2006 UT 29, ¶ 28, 137 P.3d 787).

. See id. ¶ 26 ("Even where a case for appellate deference is strong under the first two factors, policy considerations may nevertheless lead us to limit that deference.”).

.Supra ¶ 36.

. State v. Brake, 2004 UT 95, ¶ 15, 103 P.3d 699.

. State v. Pena, 869 P.2d 932, 939 (Utah 1994) (citing State v. Thurman, 846 P.2d 1256, 1271 (Utah 1993)).

. Id. (citing Thurman, 846 P.2d at 1271).

. See State v. Warren, 2003 UT 36, ¶ 1, 78 P.3d 590.

.See, e.g., Demosthenes v. Baal, 495 U.S. 731, 735, 110 S.Ct. 2223, 109 L.Ed.2d 762 (1990) (per curiam) (stating that "[a] state court’s determinations on the merits of a factual issue are entitled to a presumption of correctness on federal habe-as review" and that "a state court’s conclusion regarding a defendant's competency is entitled to such a presumption" in a case where the parents of an inmate filed a "next friend” federal habeas petition questioning the inmate’s competence to waive federal review of his claims); United States v. Cook, 356 F.3d 913, 918 (8th Cir.2004) (stating that a "competency determination is a factual finding we affirm unless clearly arbitrary or unwarranted, or clearly erroneous” (internal quotation marks and citation omitted)); United States v. Boigegrain, 155 F.3d 1181, 1189 (10th Cir.1998) ("Competency to stand trial is a factual determination that can be set aside only if it is clearly erroneous.”); United States v. Hogan, 986 F.2d 1364, 1372 (11th Cir.1993) (“[A] district court’s determination that a defendant is competent to stand trial is not reviewed de novo, it is not reviewed with a hard look, it is not reviewed under anything other than a clearly erroneous standard.”).

. Supra ¶ 51.

. Supra ¶ 60.

. Supra ¶ 69.

. Supra ¶ 69.

.Chief Justice Durham asserts that, while Dr. Whitehead has restored fifteen patients with PDNOS to competency, he does not claim to have restored a patient with Ms. Barzee’s specific symptoms. Because Ms. Barzee’s diagnosis is the matter of disagreement among the expert witnesses, the fact that Dr. Whitehead, who testified that PDNOS is "a very reasonable diagnosis” for Ms. Barzee, has not restored a patient with delusional disorder to competency does not render his experience irrelevant. Moreover, no two patients will ever display precisely the same symptoms, so the fact that Dr. Whitehead has not restored a patient with Ms. Barzee's specific symptoms to competency likewise does not render his experience irrelevant.

. Supra ¶ 53.

. Supra ¶ 54.