Involuntary Medication to Restore Competence to Stand Trial: Sell Revisited

Facts of the Case

Wayne Lee Palmer entered a Clerk of Court's office in Louisiana in October 2003 demanding to know why the pro se lawsuit he had filed was dismissed. He became irate and threatened to kill a court security officer who attempted to retrieve his visitor's badge. Authorities found a semi-automatic handgun in Mr. Palmer's back pocket when he was arrested.

Mr. Palmer was indicted on one count of threatening to murder a federal officer. He was found incompetent to stand trial, and he was committed to Butner Federal Medical Center for a psychiatric evaluation. He was found to have a delusional disorder and was referred for a civil commitment evaluation. Clinicians opined that Mr. Palmer's release would not endanger others. The indictment against him was dismissed in November 2004. One month later, he purchased a gun. On the purchase application, he falsely answered “no” to the question of whether he had ever been adjudicated mentally incompetent or committed to a mental institution.

On May 12, 2005, U.S. marshals found Mr. Palmer sitting in the driver's seat of a vehicle at Louisiana State University Law School. The marshals observed a gun in the front passenger seat and ordered him out of his car. He drove away but was later apprehended. Marshals also found a box of pistol ammunition.

Mr. Palmer was indicted on possession of a firearm by a person adjudicated mentally ill and possession of a firearm and ammunition by a person adjudicated mentally ill and committed to a mental institution. The court-appointed examiner opined that he was incompetent to stand trial because he did not have complete awareness of the charges against him and did not appreciate the seriousness of the charges. His diagnosis was schizophrenia, and it was opined that he presented a danger to the public. The report recommended that he be returned to Butner with an order for forced medication.

He was returned to Butner, where his evaluators recommended involuntary medication to render him competent to stand trial. A federal magistrate found him incompetent to stand trial and authorized involuntary medication to restore his competency. The United States District Court adopted the magistrate's findings.

Mr. Palmer appealed, claiming that in his case the U.S. District Court failed to assess properly the three factors described in Sell v. United States, 539 U.S. 166 (2003): that important governmental interests are at stake; that involuntary medication will further the government's interests; and that forced medication is necessary to further the government's interests. (Mr. Palmer did not dispute the fourth Sell criteria—that medication was medically appropriate.)

Ruling and Reasoning

The appellate court affirmed the district court's ruling. The court reasoned that important governmental interests were at stake because Mr. Palmer's crime was serious. Even though he may have received probation if convicted, he was eligible for a maximum sentence of 10 years in prison. Courts have held that crimes punishable by more than a 6-month sentence are serious. The court concluded that it was appropriate to consider the maximum penalty to determine if a crime is serious. Because Mr. Palmer threatened the life of a marshal and caused a disruption on the LSU campus, the court could decide on an upward departure from the sentencing guidelines. Therefore, an important government interest was at stake in bringing Mr. Palmer to trial.

The district court did not err in finding that involuntarily medicating Mr. Palmer would further the government's interest. It reasoned that administration of the medication must be substantially likely to render him competent to stand trial and substantially unlikely to cause side effects interfering with his ability to assist his counsel. Mr. Palmer argued that he would suffer side effects of antipsychotic medication, but the doctors who testified agreed that, no matter which drug was used, the side effects could be treated or minimized. Furthermore, Mr. Palmer failed to show that his ability to assist in his defense would be substantially undermined by the medication.

The appellate court found that forced medication was necessary to further the government's interest in bringing Mr. Palmer to trial. The Supreme Court had ruled that a defendant could be involuntarily medicated only if “alternative, less intrusive treatments are unlikely to achieve substantially the same result” (Sell, p 181). There was no dispute that treatment options such as psychotherapy and education would be ineffective in restoring Mr. Palmer to competency. Although Mr. Palmer may serve little or no time in prison, the government interest was in bringing him to trial, regardless of whether he was convicted or acquitted.

Discussion

The Supreme Court, in Washington v. Harper, 494 U.S. 210 (1990), stated that inmates have a liberty interest protected by the Due Process Clause that permitted them to refuse antipsychotic drugs unless certain preconditions are met. The Court also found in Washington v. Harper that involuntary medication does not violate the Due Process Clause if the inmate is a danger to himself or others, and treatment is in his/her best interest. In Sell v. U.S., involuntary medication for a defendant found incompetent to stand trial for a serious but nonviolent crime is permissible under rare circumstances. The Court declared that lower courts when making this determination must consider the following four criteria:

• Important governmental interests must be at stake.

• Involuntary medication must significantly further those interests.

• Involuntary medication must be necessary to further those interests.

• The administration of drugs must be medically appropriate.

These criteria are known as the Sell criteria. The majority in U.S. v. Palmer interpreted and applied the first three of the Sell criteria as described previously. The ruling and reasoning in this case are similar to those in U.S. v. Evans, 404 F.3d 227 (4th Cir. 2005). At issue in both was what constitutes a serious offense. The Court concluded that the seriousness of an offense is governed by the maximum term of imprisonment if found guilty, not what the actual sentence might be. The judge should have information about the proposed medication, the dosage range, and the side effects associated with the medications. Furthermore, the judge should have information about specific side effects and how those side effects would interact with the particular physical condition of the defendant.

Interestingly, Mr. Palmer argued that an important government interest was not at stake because he could have served little or no time in prison. Another argument used by the defense was that an important government interest may not be at stake if a defendant is likely to be found insane. For example, in U.S. v. Sherman, CR 04-1179-TUC-CKJ (D. Ariz. April 27, 2006), a 2006 case from the District Court of Arizona, there was evidence from a forensic evaluation that Mr. Sherman would be adjudicated insane. The court determined that because of this, there was no important government interest at stake.

In conclusion, a nondangerous pretrial detainee who is incompetent to stand trial but competently refuses treatment should be assessed according to the Sell criteria to determine whether involuntarily medicating the defendant to restore him or her to competency is warranted. The government's interest is to bring the defendant to trial, regardless of the likely outcome. The importance of the state's interest in bringing the defendant to trial is governed by the maximum potential sentence the defendant could receive if convicted and the dangerousness of the offense. For illnesses such as schizophrenia, there may be no less restrictive alternative for rendering a defendant competent than by administering antipsychotic medication. If defendants argue that the side effects of medication will impair their ability to assist in their defense, there must be an assessment as to whether the side effects are sufficiently severe as to impair their ability to assist in their defense and whether the side effects can be ameliorated.