Application of Sell v. United States

Facts of the Case

In February 2003, Jay Richard Morrison was charged with two federal counts of transmitting Internet communications that threatened the lives of the First President of the Church of Jesus Christ of Latter Day Saints and the members of the church's Quorum of the Twelve Apostles. At the Government's request, the magistrate judge ordered an examination of Mr. Morrison's competency to stand trial. The psychiatric evaluation found Mr. Morrison incompetent to stand trial and most likely insane at the time of the offense. The magistrate judge determined that Mr. Morrison was incompetent to stand trial and committed the defendant for treatment.

Initially, Mr. Morrison refused to take any medications but later consented to take quetiapine and continued to take the medication for four weeks. Subsequently, Mr. Morrison refused the medication, stating that it caused him to have “heart attacks.”

The clinical psychologist treating Mr. Morrison stated that antipsychotic medication was necessary to restore competency. The psychologist addressed the last three prongs of the Sell test, stating that there was a substantial probability that the medication would render the defendant competent to stand trial without producing side effects that would affect his ability to assist counsel, that his symptoms were unlikely to improve without medication, and that medication was medically appropriate for his condition, schizophrenia.

In January 2004, the government moved for an order to administer the medication involuntarily. One month later, the magistrate judge authorized the use of involuntary medication, but Mr. Morrison continued to refuse to take the medication. In April 2004, the magistrate judge held a hearing regarding the motion to compel medication. The Government relied on the testimony of the treating psychologist to address the last three prongs of the Sell test and contended that the first prong of Sell was satisfied by “the defendant's [being] accused of a serious crime” and “facts [showing] that the [defendant] is a danger to the community…that there's a serious governmental interest in bringing the defendant to trial because of the victims that have been involved, good members of society.”

In response, defense counsel agreed that medication was likely to restore competency but argued that side effects (“kidney pain, heart palpitations, and frequent sweating”) would interfere with Mr. Morrison's ability to assist counsel and could affect his appearance in front of a jury. In addition, defense counsel argued that the medication was medically inappropriate because of the side effects experienced by Mr. Morrison. However, the main contention of the defense was that the first prong of Sell was not satisfied. The government's interest was diminished because Mr. Morrison had a likely insanity defense and had been confined for almost the entire term to which he would be sentenced if found guilty. If Mr. Morrison were to be found not guilty by reason of insanity, he would undergo a hearing for civil commitment based on dangerousness. Thus, the defense argued that a hearing to determine civil commitment based on dangerousness should be held instead of ordering involuntary medication.

The magistrate judge ruled in favor of the government and concluded that all four prongs of the Sell test were satisfied by a preponderance of the evidence. The magistrate judge also noted that, since the outcome of a civil commitment hearing could not be predicted, he could not appropriately balance the government's interest in prosecution against the possibility of a lengthy civil commitment. Mr. Morrison appealed to the district court, which ruled that the magistrate judge had not erred in ordering the involuntary administration of medication. Mr. Morrison then appealed to the Tenth Circuit.

Ruling

The Tenth Circuit vacated the order to force medication and remanded the case for further proceedings. The Tenth Circuit directed the district court to require the government to proceed under a Harper inquiry or explain why it chooses not to.

Reasoning

In Sell, the United States Supreme Court reasoned that the forcible administration of medications can be achieved by means other than using the Sell criteria: A court need not consider whether to allow forced medication for [the purpose of rendering the defendant competent to stand trial], if forced medication is warranted for a different purpose, such as the purposes set out in Harper related to the individual's dangerousness or purposes related to the individual's own interests where refusal to take drugs puts his health gravely at risk. There are often strong reasons for a court to determine whether forced administration of drugs can be justified on these alternative grounds before turning to the trial competence question (emphasis in original) [Sell, 539 U.S. 166, pp 181–2].

The Court added that courts “should ordinarily determine whether the Government seeks, or has first sought, permission for forced administration of drugs on…Harper‐type grounds; and if not, why not.”

In Harper, the Court held that a prisoner's right to refuse medications could be overcome if the prisoner had a mental illness and posed a risk of danger to himself or others. In the current case, the Tenth Circuit concluded that a Harper inquiry should have preceded a Sell inquiry because it is more “objective and manageable” for psychiatric evaluators to determine the involuntary administration of medications based on dangerousness rather than on Sell criteria. The Tenth Circuit reasoned that conducting a Harper inquiry and assessing the level of dangerousness posed by Mr. Morrison would have informed the court whether he could be civilly committed, thereby diminishing the government's interest in pursuing a criminal trial. In addition, the Tenth Circuit noted that a Harper inquiry would have provided information to the magistrate judge on the possible outcome of a civil commitment hearing, since the issue of dangerousness would have been addressed.

The Tenth Circuit concluded: There may be occasions when it is appropriate to resolve whether the four‐part Sell test justifies an order for involuntary administration of psychotropic drugs without first determining whether there is an alternative ground for such an order. But it would be good practice to assume otherwise [415 F.3d at 1186].

Discussion

The Sell decision has had a large impact on the adjudication of defendants found incompetent to stand trial. The ruling has generated appellate level reviews in the Federal and State systems. In California, statutory changes involving incompetent defendants reflect the impact of the Sell decision. In the California Penal Code, if a person is found incompetent to stand trial, the evaluator must consider whether the person lacks capacity to make decisions about taking medications and assess the person's level of dangerousness to self and others. The current case reinforces, through the judiciary, the hierarchy of considerations that should be examined when the issue of forcible medication arises. As set out in Harper, the involuntary administration of psychiatric medications can be justified on the grounds of decreasing the risk of danger to self or others in an incarcerated population. In its decision, the Tenth Circuit reiterates the Court's qualification in Sell that the new criteria should be applied only after more easily answered grounds for forcing medication are exhausted.