Fourth Circuit Decides Involuntary Medication Case

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A former School of Government law fellow blogged here about the involuntary medication of death-sentenced prisoners. A recent Fourth Circuit case has moved me to think about the somewhat more common issue of the involuntary medication of incompetent defendants.

Sell v. United States, 539 U.S. 166 (2003), held that the state is permitted “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,” in other words, is likely to work, “is substantially 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.” As to the last consideration, the Court noted that the government’s interest in trying a defendant for a serious crime – whether against persons or property – is normally significant, but that it may be lessened if, for example, the defendant’s refusal to accept medication is likely to result in a lengthy period of involuntary commitment. The Court stated that it will be “rare” that involuntary medication is permissible on competency grounds, and suggested that many involuntary medication issues are better addressed under the dangerousness analysis of Washington v. Harper, 494 U.S. 210 (1990) (holding that a prison inmate may be involuntarily medicated if necessary to stop the inmate from being a danger to himself or others).

No reported North Carolina case has been decided under Sell, but the Fourth Circuit just decided United States v. White, in which it reversed a district court’s order authorizing involuntary medication. The defendant in White was charged with credit card fraud and identity theft. She apparently suffers from a delusional disorder that, several experts agreed, rendered her incompetent to stand trial. She refused both “competency classes” and medication to treat the disorder, so the government sought permission to have the medication administered involuntarily. The district court judge received testimony from two psychiatrists who described both the process of involuntary medication and the risks and benefits of the available antipsychotic drugs. Because the experts indicated that the defendant was not dangerous, involuntary medication was not justified under Harper, but the judge found that the Sell standard was met and ordered that the defendant be medicated. She appealed.

A divided panel of the Fourth Circuit reversed, holding that “the special circumstances present in this case reduce the government’s interest in prosecuting [the defendant] to the point that infringement on her constitutionally protected liberty interest in freedom from forcible medication cannot be sustained.” The majority relied on several considerations to reach this conclusion, including that the charged offenses were non-violent; that the defendant had already been in custody for 29 months, which it viewed as a substantial portion of her likely sentence if convicted; and that “the drugs proposed . . . have rarely, if ever, been tested on individuals with [the defendant’s] condition,” and might be ineffectual or carry significant side effects. In all, the majority did not believe that this case was the “rare” case contemplated by Sell, and viewed the district court’s decision as coming “perilously close” to making forcible medication routine.

Judge Niemeyer, in dissent, praised the district judge’s work as “especially careful and thorough.” (Having had some experience with the district judge in question, I am certain that Judge Niemeyer is correct on that point, at least.) He argued that crimes against property can be just as serious as crimes against persons; that the majority’s suggestion that the defendant had already been in custody for a substantial portion of her likely sentence was grounded in improper speculation about what her sentence might be; and that in any event, the government has interests other than the confinement of a defendant, such as “the message a prosecution sends to the public.”

I don’t follow this area of the law closely enough to know for certain if White is in the mainstream or outside of it. My vague sense is that this issue doesn’t come up so often that the law is completely settled, and that different jurisdictions interpret Sell pretty differently. In fact, a comment over at Sentencing Law and Policy says that “Texas uses forced medication to restore competency even for petty misdemeanors.” If that’s right, there may be a very wide range of views that the North Carolina courts might adopt when this issue is litigated here. If you’ve had experience litigating in this area, or if you know of a pending case that may lead to an appellate ruling on point, please post a comment.

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