The Supreme Court of Pennsylvania Held That the Government Does Not Have to Prove All Four Sell Factors if Medicating Inmates Would Promote Their Interests, Such as When They Wish to Participate in Post Conviction Relief Act Proceedings
In Commonwealth v. Sam, 952 A.2d 565 (Pa. 2008), the Pennsylvania Supreme Court reversed the Court of Common Pleas of Philadelphia County (the PCRA court) which had denied a request for an order to administer psychiatric medication to an inmate, Thavirak Sam, to render him competent to determine whether to proceed with his appeal under the Post Conviction Relief Act (PCRA).
Facts of the Case
On July 2, 1991, Thavirak Sam, a Cambodian immigrant, was convicted of three counts of first-degree murder in the deaths of his mother-in-law, brother-in-law, and two-year-old niece. He was given three death sentences. In 1993, the Supreme Court of Pennsylvania upheld his conviction and sentence. In 1994, the U.S. Supreme Court declined to hear his appeal.
On January 16, 1997, attorney Robert Brett Dunham (who was not retained by Sam) from the Center for Legal Education Advocacy and Defense Assistance (CLEADA) filed a petition for postconviction relief, alleging that Mr. Sam was not competent and did not have a rational understanding of postconviction relief proceedings or of his rights. (The case was filed by Dunham on the last day that the petitioner could appeal, as a 1997 amendment to PCRA limits appeals to one year after conviction.) Jules Epstein was subsequently appointed as Mr. Sam's PCRA attorney. On May 10 and 24, 2000, psychologist William F. Russell examined Mr. Sam for the defense. He found him to have bipolar disorder with active delusions. On October 4, 2000, John S. O'Brien II, MD, examined Mr. Sam for the commonwealth, found him to have delusions, and diagnosed schizophrenia (paranoid type). Both found Mr. Sam to be incompetent to proceed in the PCRA hearing.
On January 7, 2002, the commonwealth filed a motion to compel psychiatric medication, quoting the reports of Drs. Russell and O'Brien and citing the need for treatment and history of good response to such treatment. The defense then filed motions intended to forestall a hearing on forced medication. On April 4, 2003, the PCRA court held a hearing on the commonwealth's motion to compel psychiatric medication. Dr. O'Brien testified, “Mr. Sam would respond to treatment, psychiatric treatment for his current symptoms.” He also explained general treatment guidelines of psychiatric disorders, outlined courses of treatment, and described types of medications and their side effects. Dr. Russell also testified, agreeing with Dr. O'Brien that Mr. Sam's delusions are the “predominant issue at the present time that interferes with his competency.”
On October 20, 2005, the PCRA court issued an order denying the commonwealth's motion to compel psychiatric medication. The PCRA court reasoned that there was not yet a standard of competency for the purpose of authorizing and pursuing relief under the PCRA. They focused on Sell v. United States, 539 U.S. 166 (2003). In accordance with Sell, the PCRA court first made a determination as to whether Mr. Sam was a potential danger to himself or others and found no evidence that he posed a risk.
The PCRA court then reviewed the four factors of the Sell test: whether an important governmental interest has been established; whether the proposed treatment is substantially likely to render the defendant competent; whether alternative, less intrusive treatments are unlikely to achieve the same results; and whether the administration of the drugs is “medically appropriate.” The PCRA court analyzed the relevance of the first, second, and fourth prongs of the Sell test in regard to Mr. Sam. They concluded that the court was “prohibited from ordering forced medication solely to render the Defendant competent to proceed with his Petition for Post Conviction Relief.” They also asserted that the commonwealth had to provide full details of the type of medication and method of administration, and since none was provided, they found there was no way to predict response, or to monitor side effects. The commonwealth then appealed the ruling.
Ruling and Reasoning
The Pennsylvania Supreme Court reviewed the decisions in Sell, citing the four prongs of the Sell test, as well as the recognition that “an individual has a ‘significant’ constitutionally protected ‘liberty interest’ in ‘avoiding the unwanted administration of antipsychotic drugs.’ ” The Pennsylvania Supreme Court also discussed the Supreme Court's decision in Washington v. Harper, 494 U.S. 210 (1990), positing that “the Court did not hold that danger to self or others was the only permissible basis for involuntarily medicating mentally ill inmates …what is required under Harper is ‘a finding of overriding justification’ or an ‘essential state policy.’ ” The court noted that the Sell Court deemed forced antipsychotic medication appropriate when a particular government interest is at stake—chiefly, competency to proceed. The Pennsylvania Supreme Court related that, in the instant case, the commonwealth should not have to meet the four strict Sell conditions in their entirety, because the commonwealth is not seeking an end that is against the appellee's interest. The PCRA court is available for appellees to seek relief, and medicating the appellee to go forward on relief-seeking is not against his interest.
The court's opinion addresses all four Sell test prongs. The Pennsylvania Supreme Court found that governmental interests in finality are indeed at stake and that Mr. Sam's crime was very serious. They emphasized that Mr. Sam was in virtual limbo on his PCRA hearing and it is in the government's (and the appellee's) interest to assist him in moving it forward. The commonwealth argues that normally one assumes that counsel speaks for the appellee, yet in this case the PCRA petition was filed on his behalf without his initiation or consent. In fact, Mr. Sam never sought relief and apparently stated to the PCRA court that he would rather be executed than spend the rest of his life in prison. The Pennsylvania Supreme Court concluded that, for the purposes of appeal, Mr. Sam, if left untreated, would never be competent to decide whether to pursue postconviction relief.
Relying on testimony by a psychiatrist and psychologist, the Pennsylvania Supreme Court determined that the involuntary administration of antipsychotic medications was unlikely to have side effects that would significantly interfere with Mr. Sam's ability to assist counsel and that less intrusive treatment options were not likely to be efficacious. Further, the Pennsylvania Supreme Court held that the PCRA court erred in requiring the commonwealth to provide, as part of their forced-medication treatment plan, “concrete details” of medications and dosages to satisfy the second prong of the Sell test. Further, the Pennsylvania Supreme Court found that if such stringent requirements stood, the commonwealth would be presented with virtually insurmountable obstacles on all similar cases. Regarding the fourth prong of the Sell test, the Pennsylvania Supreme Court reiterated that treatment is appropriate if it would be in Mr. Sam's “best interest in light of his medical condition” (Sell, p 181).
The Pennsylvania Supreme Court concluded that forced medication of the appellee to determine whether he wishes to pursue PCRA relief and to assist the appointed counsel does not violate the federal Due Process Clause. Further inquiry was made regarding defense counsel's argument that the Pennsylvania Mental Health Procedures Act (MHPA) requires that the commonwealth's motion to compel medication be denied. The MHPA governs the provision of inpatient psychiatric treatment and involuntary outpatient treatment, to assure “the availability of adequate treatment to persons who are mentally ill, and to establish procedures to effectuate this purpose” (Section 102 of the MHPA, 50 Pa. Stat. Ann. 7102). The Pennsylvania Supreme Court also examined two previous cases, Commonwealth v. Jermyn, 652 A.2d 821 (Pa. 1995), and Commonwealth v. Edmunds, 586 A.2d 887 (Pa. 1991), and held that the MHPA does not provide alternate grounds to affirm the decision of the PCRA court.
Discussion
Another question looming over this case is competency to be executed (CTBE). The Pennsylvania Supreme Court refers to it early in the majority opinion as “a distinct and unripe question we do not address here.” But the court does return to CTBE indirectly late in the opinion. The court refers to Singleton v. State of S. Carolina, 437 S.E.2d 53 (S.C. 1993), and State of Louisiana v. Perry, 610 So.2d 746 (La. 1992), cases in which South Carolina and Louisiana, respectively, sought the right of involuntarily administering antipsychotic drugs to death row inmates, solely for the purpose of rendering said prisoners competent to be executed. The Pennsylvania Supreme Court posits that the sole aim of the proposed state action in these cases was the restoration of death row inmates to competency to be executed. The court asserted that the instant case separated from these other cases on the basis of aims. The commonwealth sought a forced medication order for the purpose of restoring a prisoner to competency to make decisions regarding available appeals. The question of Mr. Sam's competency to be executed was unripe at the time of this case. Still, as Mr. Sam's attorney later pointed out, this decision may mark the first occasion that an appellate court has approved the forcible medication of a death row inmate who does not pose a risk to himself or others.
Of note, after Mr. Sam's PCRA hearing, the Delaware Supreme Court defined competence for pursuing postconviction relief as having the ability to “understand the process and goals of PCRA proceedings and…to assist in that process to the extent required given the specific legal and factual issues which remain to be litigated” (quoted in Commonwealth v. Zook, 887 A.2d 1218 (Pa. 2005), pp 1224–5).
- American Academy of Psychiatry and the Law