Psychiatric Treatment in Prison

Facts of the Case

Frank and Robert Derbes, the officers of Derbes Brothers, a construction company, defrauded the government through federal tax evasion. Frank Derbes caused a governmental revenue loss of $500,000. Both brothers pled guilty, and sentencing guidelines ranged from 15 to 21 months of imprisonment. Frank Derbes (defendant) was granted a four‐level departure and sentenced to 9 months of home confinement with electronic monitoring and 15 months of probation.

The government appealed the downward departure in sentencing Frank Derbes. One of the sentencing departures for the defendant was for mental health concerns, and the other was the impact on employees of his small business. The defendant was under the care of a private psychiatrist, Dr. Chartock, for therapy and medication management. Dr. Chartock had treated the defendant's major depression and generalized anxiety disorder since 1997, and “it had taken several years to find the right combination of medications.” Prior to treatment, the defendant had suicidal thoughts, occasional hallucinations, and some difficulty functioning. Dr. Chartock reported that it was critical to maintain the defendant's medication regimen of paroxetine, venlafaxine, and oxazepam and warned that changing medications could “[cause] him to revert to a deep depression and significant panic and anxiety.” The defendant claimed that the specific medications might not be available in prison and that maintaining his relationship with Dr. Chartock was critical. The trial court judge stated, “The one thing I do not think the Bureau of Prisons could provide is the connection with Mr. Derbes' treating psychiatrist that has developed over time.”

Ruling and Reasoning

The First Circuit Court of Appeals vacated the defendant's sentence and remanded the case for resentencing. The court found that the defendant's asserted need for treatment by his private psychiatrist was not a reason for sentence departure in this case.

Though the Protect Act (April 30, 2003) became law a day after the defendant was sentenced, it applied to his case on appeal. The Protect Act gave a new standard of review for sentencing guideline departures. The government presented evidence that two of the three drugs (paroxetine and venlafaxine) were in the formulary of the Bureau of Prisons. Further, oxazepam had “appropriate substitutes listed in the formulary.” There was “little to show that it was the personal relationship that was essential to Derbes' mental health and nothing to show that some adequate substitute would be unavailable in prison.” They cited guidelines that “mental condition is a discouraged basis for departure under the guidelines…warranted only if circumstances are extraordinary.” There was no evidence that the defendant would not be able to receive adequate psychiatric medications and therapy in prison. However, sentence departures based on defendants' mental illnesses were not precluded in future cases.

Discussion

In this case, the First Circuit Court of Appeals did not allow a guilty defendant a downward sentence departure solely based on his asserted need for a continued personal relationship with his private psychiatrist. The defendant's medications or close substitute medications would be available in prison, and he had shown no evidence regarding the importance of his relationship with the single specific psychiatrist. However, the court did discuss the possibility that in other cases, with “extraordinary” circumstances, mental illness could be used for a departure from sentencing guidelines.

A lineage of landmark cases has established a right to treatment in prison. In Estelle v. Gamble, 429 U.S. 97 (1976), the U.S. Supreme Court found that “deliberate indifference by prison personnel to a prisoner's serious illness or injury constitutes cruel and unusual punishment.” Prisoners were not entitled to the best medical care, but had a right to adequate medical care. In Bowring v. Godwin, 551 F.2d 44 (4th Cir. 1977), prison inmates' rights to mental health treatment for serious psychiatric and psychological conditions were made explicit, through the Eighth Amendment. Mr. Derbes' diagnoses of depression, panic, and anxiety would therefore qualify him to receive mental health treatment in prison.

The Federal Sentencing Guidelines were a congressional effort to achieve uniformity in sentencing. Sentencing tables were devised to give a guideline range of incarceration length. Factors involved include the seriousness and characteristics of the offense, criminal history, and specific listed adjustments. The Supreme Court is hearing cases currently regarding enhanced sentencing departures under the sentencing guidelines—specifically, whether the sentencing judge's finding of a fact that was not found by a jury can allow such a sentencing departure.

The ruling in Derbes was quite logical. If the court had ruled otherwise and did allow a downward sentence departure in Mr. Derbes' hardly extraordinary case, then any wealthy white‐collar convicted criminal could expect a similar departure. It brings to mind Tony Soprano's crimes and the fact that he sees a psychiatrist (The Sopranos, HBO). If the court had allowed a sentence departure in this case, then theoretically when Tony Soprano would have charges under the Racketeer Influenced and Corrupt Organizations (RICO) Act brought against him, he could plead guilty. Then he could claim that his relationship with Dr. Melfi and treatment for depression and anxiety should allow him to stay out of prison, so that he could get his combination medication treatment and maintain his relationship with Dr. Melfi.