Involuntary Administration of Antipsychotic Medication May Not Be Court Ordered Without Finding an Important Government Interest in Prosecuting the Defendant
In United States v. Boima, 114 F.4th 69 (2d Cir. 2024), the Second Circuit Court of Appeals reviewed a district court’s order to involuntarily medicate a defendant for the purpose of competency restoration per Sell v. United States, 539 U.S. 166 (2003). The Second Circuit ruled that the district court did not discuss the government’s interest in prosecuting the defendant and vacated the Sell order.
Facts of the Case
Samuel Boima, who was held at the Buffalo Federal Detention Facility pending deportation, was charged with assault on federal officers engaged in the performance of official duties in violation of 18 U.S.C.A. § 111(a)(2) (2021). The complaint alleged that Mr. Boima was “resistant and verbally combative” and had spat saliva and blood on two officers. During his initial appearance, which was delayed because he had “refused to cooperate,” he exhibited symptoms suggestive of mental illness. The court subsequently ordered a psychological examination of Mr. Boima pursuant to 18 U.S.C. § 4241 (a) (2006) to determine his competency to stand trial. Dr. Kari Schlessinger, a forensic psychologist, evaluated Mr. Boima and documented that he appeared to be “actively psychotic” with “unspecified schizophrenia spectrum and other psychotic disorder” (Boima, p 73). Dr. Schlessinger further opined that Mr. Boima was not competent to stand trial. The district court subsequently found Mr. Boima incompetent to stand trial and ordered his hospitalization for an assessment to determine whether his competency to stand trial might be restored.
At the Federal Medical Center Butner, Dr. Kristina P. Lloyd, a forensic psychologist, evaluated Mr. Boima and offered the diagnosis of schizophrenia. She opined that Mr. Boima remained incompetent to stand trial but “a substantial probability exists” (Boima, p 73) that his competence could be restored with psychotropic medication. She further noted that, pursuant to Sell, the district court was required to determine, inter alia, that an important government interest was at stake prior to ordering involuntary medication to restore competency. The district court subsequently urged the Assistant U.S. Attorney to “consider withdrawing the complaint against Mr. Boima” because the assault on the officers was “unsettling, but no serious injuries occurred and such acts from an inmate who now has demonstrated mental health issues may not be all that uncommon in a prison setting” (Boima, p 74). The government did not withdraw the complaint and moved for a Sell hearing. The district court declined to answer the defense counsel’s request for the court to rule on whether the government had sufficient interest in prosecuting him. The district court explained “I think it’s sort of a balance and you might find the Governments interest is relatively low but there are other aspects of the so-called Sell factors that indicate maybe what the Government seeks here is not inappropriate” (Boima, p 74).
Dr. Lloyd testified that, because of Mr. Boima’s refusal of voluntary treatment, there was “no other way to restore him to competency” (Boima, p 74) without a Sell order. Dr. Charles Cloutier, a staff psychiatrist at Federal Medical Center Butner testified that Mr. Boima was diagnosed with schizophrenia and required medication to be restored to competency. The district court subsequently issued an order to administer antipsychotic medication to Mr. Boima, forcibly if necessary. The district court did not specifically address whether the government had significant interest in prosecuting the defendant other than to state that it had “considered the directives and recommendations” of Sell and Washington v. Harper, 494 U.S. 210 (1990) (Boima, p 75). Mr. Boima subsequently filed a motion to stay the Sell order, which the district court denied. He then appealed to the Second Circuit Court of Appeals.
Ruling and Reasoning
The U.S. Court of Appeals for the Second Circuit reviewed that the Supreme Court in Sell “held that the Government may involuntarily medicate a mentally ill defendant to render him competent for trial if: [i] there are important governmental interests in trying the individual; [ii] the treatment will significantly further those interests; [iii] the treatment is necessary to further those interests, considering any less intrusive alternatives; and [iv] the treatment is medically appropriate” (Boima, p 75, referencing discussion of Sell in United States v. Gomes, 387 F.3d 157 (2d Cir. 2004), p 159–60).
In its analysis, the court found that the district court had omitted discussion of the first Sell factor prior to issuing the order for involuntary administration of medication. The court noted that the district court’s order did address the other three Sell factors. Because the first Sell factor was not addressed by the district court, the appeals court vacated the Sell order and did not directly review the first factor de novo. The case was remanded back to the district court for consideration of the first Sell factor.
The court provided a framework by which government interest could be analyzed on remand to district court, taking into consideration the special circumstances of the case. In assessing the “seriousness” of the crime, the court suggested both the nature of the offense and the probable sentence were important factors to consider. Regarding civil commitment, the court again cited Sell in noting that civil commitment is not a substitute for criminal proceedings, but such a possibility may diminish the government’s interest. The Second Circuit further recommended that the district court consider the likelihood that Mr. Boima would remain in custody while awaiting deportation, as remaining in custody might reduce government interest. Finally, the court suggested that the substantial period of time (four years) that had passed since the original complaint was considered and again cited Sell in stating that significant pretrial confinement may mitigate government interest.
Discussion
In Boima, the U.S. Court of Appeals for the Second Circuit found that the first Sell factor had not been addressed by district court, vacated the Sell order, and remanded the case back to the district court for consideration of the special circumstances of Mr. Boima’s case. This decision reinforces the importance that the court ensure each Sell factor is satisfied prior to issuing a Sell order for involuntary administration of antipsychotic medication for the purpose of competency restoration. Understanding landmark cases and the situations in which they apply is also crucial, as Washington v. Harper was incorrectly cited in the district court’s case. The framework provided by the appeals court may assist future courts during Sell proceedings in thoroughly evaluating any special circumstances that may affect government interest.
As cited in Gomes, during Sell proceedings, evaluation of “[w]hether the Government’s asserted interest is important is a legal question that is subject to de novo review” (Gomes, p 160). The determination of important government interest is made by the court and falls outside the scope of practice for forensic psychiatry. Ethically, forensic evaluators should not opine on most elements of government interest, although they could be asked to opine on some narrow aspects that may assist the court. During a de novo review of government interest, a forensic psychiatrist could be asked to offer an opinion on whether or not an individual meets criteria for civil commitment in the individual’s respective jurisdiction, as this could lessen asserted interest. Forensic psychiatrists should be well versed in civil commitment statutes for the areas in which they conduct evaluations. Opining on the estimated time for competency restoration could also provide the court with needed information if it is weighing time spent in confinement versus the likely sentence for the alleged offense(s). Additionally, in some situations, an evaluation of risk factors related to release could strengthen or weaken the government’s asserted interest.
- © 2025 American Academy of Psychiatry and the Law
