Involuntary Medication to Render a Defendant Competent to Stand Trial

Facts of the Case

Jose Hernandez-Vasquez was indicted January 28, 2004, for illegal reentry after deportation, a U.S.C. § 1326 charge, subject to a maximum prison term of 20 years. Mr. Hernandez-Vasquez had previous convictions for aggravated assault on a corrections officer in Arizona and for lewd and lascivious acts with a minor child, for which he had received a three-year custodial sentence, and misdemeanor convictions for trespassing and annoying children. He was ordered to be deported August 1, 2003, and was removed from the United States on November 8, 2003.

Mr. Hernandez-Vasquez filed for a competency examination on May 6, 2004, and at a subsequent district court hearing was found incompetent to stand trial. He was then transferred to the United States Medical Center for Federal Prisoners in Springfield, Missouri. The government then filed a motion to medicate him forcibly, to render him competent to stand trial. The government also requested an order for Mr. Hernandez-Vasquez to be assessed for dangerousness. At a hearing on March 24, 2006, the district court granted the government's motion to medicate Mr. Hernandez-Vasquez involuntarily, for the sole purpose of rendering him competent to stand trial. Mr. Hernandez-Vasquez appealed the order and on April 5, 2006, the Ninth Circuit stayed the involuntary medication order, awaiting the outcome of the appeal.

Ruling and Reasoning

The Ninth Circuit found that the district court made a medication decision pursuant to factors in Sell, but first failed to address dangerousness as an appropriate alternative basis for forced medication under the conditions set forth in Washington v. Harper, 494 U.S. 210 (1990). In Sell, the U.S. Supreme Court held that only under limited circumstances could a court order involuntary administration of medication to render a defendant competent to stand trial. The Sell Court prescribed a four-factor test to be met before a defendant could be forcibly medicated: “important government interests [must be] at stake” (a legal criterion); there must be a substantial probability that the medication will enable the defendant to become competent without side effects that will undermine the defendant's ability to participate in his defense; medication must be necessary and an alternative and less intrusive procedure would not produce the same results; and the administration of the drugs must be medically appropriate.

In Washington v. Harper (1990), the Court held that forced medication could be ordered only when the defendant is a danger to himself or others and when the medication is in the defendant's best interest. In a similar case, Riggins v. Nevada, 504 U.S. 127 (1992), the U.S. Supreme Court held that forced medication of a defendant during trial violated the individual's Sixth and Fourteenth Amendment rights when there had been no finding that involuntary medication was necessary to a government interest. Although Sell created an independent basis for forced medication, the Court also directed that if the Sell hearing court does not first conduct a Harper-type inquiry then it should state on record why it is not doing so.

In the present case, a Sell inquiry was undertaken merely on the government's stating that it was not relying on the Harper-based grounds of dangerousness. Although both parties had agreed to proceed directly to a Sell hearing, the Ninth Circuit emphasized that the district court should separate the Sell inquiry from a Harper-type inquiry and that the hearing court “should not allow the two to collapse on each other” (Hernandez-Vasquez, p 919). The court noted that medical opinions under Sell testing are multipronged, hence more prone to error and therefore disfavored. “A defendant's liberty interest in avoiding unnecessary involuntary medication is too important to allow for situations in which the court is asked to undertake the more error-prone analysis for what may be arbitrary or tactical reasons” (Hernandez-Vasquez, p 915).

The Ninth Circuit Court also held that the district court failed to meet the Sell standard, in that its medication order lacked specificity and was too broad. The order provided only that “the method of treatment and type of medication to be used should be at the discretion of the treating medical professionals within the Bureau of Prisons” (Hernandez-Vasquez, p 917). The appellate court held that Sell requires the medication order to identify for the particular defendant the specific medication or range of medications, the maximum dosages to be administered, and the duration of time involuntary treatment can continue without updating the court on the defendant's mental state. It held that the district courts should not delegate unrestricted authority to physicians; however, their restrictions should be “broad enough to allow the treating physician flexibility in responding to changes in the defendant's condition” (Hernandez-Vasquez, p 917). The ruling also allowed for the government or the defendant to request a motion to alter the order as the defendant's clinical status changes.

The opinion also addressed the proper standard of review for both the first and second Sell factors. Noting a split among jurisdictions, the Ninth Circuit joined the Second Circuit in holding that the first Sell factor constitutes a legal question and so would be reviewed de novo. The second Sell factor was held to be a factual one to be reviewed by a clear-error standard.

Discussion

This case makes two important points: first, there must be a clearly defined procedure that the government should use when seeking to medicate a defendant involuntarily—a Harper-type dangerousness inquiry initially and then, if need be, a Sell inquiry. The appellate court explicitly stated that the consideration of a medication order based on dangerousness is preferable to a consideration of a medication order solely to render the defendant competent to stand trial. The court noted that dangerousness assessments are more objective and manageable than the multifactor fact-findings required by the Sell test.

The Ninth Circuit, in emphasizing the importance of first evaluating for dangerousness, noted that such an evaluation could help inform subsequent Sell inquiries. “Even if a court decided medication cannot be authorized on the alternative grounds, the findings underlying such decision will help inform expert opinion and judicial decision making in respect to a request to administer drugs for trial competence purposes” (Hernandez-Vasquez, p 914).

The court emphasized the challenge that Sell fact-finding presents to the psychiatric experts. While some of the discussion seemed solicitous of the doctors’ concerns, there was concomitant, though more subtle, concern with the risk of unreliability of medical opinion when it concerns the multifaceted considerations that Sell assessments require. The court's uneasiness with expert opinion is further indicated in their holding that Sell requires that doctors not be given free discretion to make medication plans absent close court supervision and clear specification of type, dosage, and duration of medication strategies. The court's words in this regard exemplify the oft-remarked-upon uneasiness that courts voice toward psychotropic medications: A broad grant of discretion to medical professionals also risks distracting such professionals from Sell's narrow purpose of restoring a defendant's competency for trial. See Sell, 539 U.S. at 185 (‘The failure to focus upon trial competence could well have mattered. Whether a particular drug will tend to sedate a defendant, interfere with communication with counsel, prevent rapid reaction to trial developments, or diminish the ability to express emotions are matters important in determining the permissibility of medication to restore competence, but not necessarily relevant when dangerousness is primarily at issue.’) (internal citation omitted). Sell appears to anticipate physicians’ resistance to specific judicial direction regarding treatments that are acceptable for the purpose of rendering a defendant competent to stand trial [Hernandez-Vasquez, p 916]. The courts prefer Harper to Sell as a legal basis for imposing forced medication because they are clearly uneasy about forcing medication for the sole purpose of making a person competent to stand trial. With a thinner reed for the government's intrusion on the liberty interest, the Ninth Circuit demonstrates a reluctance to impose forced medication and so urges lower courts to use Sell sparingly and compels psychiatrists to be constrained in the discretion they use in prescribing medications.