United States District Court, E.D. Tennessee, Knoxville
MEMORANDUM AND ORDER
C. CLIFFORD SHIRLEY, Jr., Magistrate Judge.
All pretrial motions in this case have been referred to the undersigned pursuant to 28 U.S.C. § 636(b) for disposition or report and recommendation regarding disposition by the District Court as may be appropriate. This matter is before the Court on the Government's Petition to the Court for the Authorization of Involuntary Medication [Doc. 492], filed on April 23, 2015. The parties came before the Court on May 11, 2015, for a hearing on the Petition. Assistant United States Attorney Caryn L. Hebets appeared on behalf of the Government. Attorney James W. Clements, III, represented the Defendant Robert Hicks. Although the Court had arranged for the Defendant to participate in the hearing by video teleconference from the Federal Medical Center in Butner, North Carolina (FMC Butner), the Defendant declined to participate.
I. BACKGROUND AND POSITIONS OF THE PARTIES
The Defendant is charged with conspiracy to manufacture methamphetamine and possession of equipment, chemicals, products, and materials used to manufacture methamphetamine. On August 26, 2014, the Court committed [Doc. 149] Defendant Hicks for a mental evaluation of his competency to stand trial. On November 24, 2014, the Court found [Doc. 231] the Defendant to be incompetent and committed him for four months of evaluation and treatment to restore his competency. FMC Butner received the Defendant on December 23, 2014, and began his evaluation [see Doc. 448]. On March 30, 2015, the Warden at FMC Butner faxed a report entitled Forensic Evaluation by Dr. Robert Cochrane, forensic psychologist, and Dr. Byron Herbel, psychiatrist, to the undersigned. The report states that the Defendant has schizophrenia and recommends that he be involuntarily medicated and treated for an additional four months in order to restore his competency.
On April 23, the Government petitioned the Court to authorize involuntary medication of the Defendant. It argues that involuntary medication is appropriate in this case because (1) the Defendant is charged with a serious crime and no special circumstances diminish the need for prosecution, (2) the administration of psychotropic drugs is substantially likely to render the Defendant competent and substantially unlikely to have side effects that will interfere with his ability to assist with his defense at trial, (3) involuntary medication is necessary to further the Government's interests, and (4) administration of the psychotropic medication is in the Defendant's best medical interest. On May 8, the Defendant, through counsel, filed a response [Doc. 489] opposing involuntary medication. Specifically, he argues that the proposed medication has substantial side effects causing him to be unable to feel emotion or to connect to life or the outcome of his case. Also, he contends that measures short of involuntary medication, such as a court order, should be attempted before forcing him to take medicine against his will.
II. TESTIMONY AT MAY 11 HEARING
At the May 11 hearing, Dr. Robert Cochrane testified by video teleconference. His twenty-five (25)-page Forensic Evaluation was made an exhibit to the hearing. Dr. Cochrane testified that the medications listed in his Forensic Evaluation were all well established and FDA approved. He said that the overwhelming majority of individuals suffering from schizophrenia were restored to competency after taking psychotropic medication. He stated that an individual's treatment history shows how that individual will respond to psychotropic medications. He said that the Defendant had previously responded well to psychotropic medications and had been rendered competent while taking these medications pursuant to a state court order. He said that side effects, such as sedation, usually go away in a couple of weeks and, if not, can be managed by providing a lower dose of the medicine or switching medications. He stated that an eight-week course of treatment was common and that usually medical staff can tell if the individual is responding to the medication within a couple of weeks. Dr. Cochrane testified that, in his opinion, the Defendant's competency would not be restored if he were not treated with psychotropic medication. He stated that treatment of schizophrenia with these medications is the standard of care both in the community and in forensic situations.
On cross-examination, Dr. Cochrane testified that the proposed psychotropic medications help some patients express emotion, rather than stifling emotion. He agreed that these medications can sedate some patients and affect their neuromuscular ability, but he stated that these effects can be managed. He agreed that the medications could affect an individual's demeanor, if not managed. He said that individuals with schizophrenia often do not recognize that they have mental health issues and do not want to take psychotropic medication. He said that although Defendant Hicks had experienced positive results with previous treatment, Hicks had repeatedly told Dr. Cochrane that he does not want to be medicated.
Dr. Cochrane stated that during his employment at FMC Butner, court orders directing an inmate to take medication had been issued in three prior cases, with three different outcomes: one individual continued to refuse to take the medication, one person appeared to agree to take the medication but later refused, and one patient agreed to take the mediation voluntarily in light of the court order. He agreed that Hicks had not yet been ordered by the Court to take the medication. Dr. Cochrane stated that the Defendant was presently refusing to sign the paperwork necessary to be released into the general prison population. He said that while it might benefit Defendant Hicks to be around other people, it would not be a significant step toward treating his schizophrenia. He said that Mr. Hicks has a biological problem that needs a biological treatment in the form of medication. He agreed that other therapies, such as group therapy, might be effective after the Defendant received medication. He reiterated that group therapy without medication would not be an effective treatment for the Defendant.
Upon questioning by the Court, Dr. Cochrane testified that he proposed starting the Defendant's treatment with alonzapine, also known as Zyprexa. He said, if the Defendant is able to take the medication orally, he will start with 20 milligrams and adjust the dosage as needed. He stated that if the Defendant refused oral medication, he would move to injectable medication such as Respiradol. If the Respiradol was not effective, there were other medications he could try. Dr. Cochrane stated that if the Defendant experienced a feeling of being unable to connect or to feel emotion, this side effect would not affect his cognitive ability to deal with legal issues. He said that in some cases, the medication improved the patient's attention and other intellectual abilities.
"An individual has a constitutionally protected liberty interest in avoiding the unwanted administration of medication, and the Government may not deprive him of this liberty without an essential or overriding interest in doing so." United States v. Mikulich, 732 F.3d 692, 696 (6th Cir. 2013). The Supreme Court has held that the Constitution permits the Government to medicate a nonviolent, mentally ill defendant in a criminal case involuntarily in certain limited circumstances, in order to render the defendant competent to stand trial. Sell v. United States, 539 U.S. 166, 179 (2003). This is because the Government has a recognized countervailing interest in safeguarding the security of its citizens by the prompt administration of justice in criminal cases. Sell, 539 U.S. at 180; Mikulich, 732 F.3d at 696.
"Pursuant to Sell, the Government must present clear and convincing evidence of four factors in order to secure an order of involuntary medication: (1) the existence of an important' governmental interest; (2) that involuntary medication will significantly further' the government interest; (3) that involuntary medication is necessary' to further those interests; and (4) that administration of the drugs must be medically appropriate' for the individual defendant." United States v. Green, 532 F.3d 538, 545 (6th Cir. 2008) (quoting Sell, 539 U.S. at 180-81); Mikulich, 732 F.3d at 696. In Sell, the Supreme Court recognized that the involuntary administration of medication should be rare. 539 U.S. at 179. The Fourth Circuit has characterized forcibly medicating a nonviolent defendant as a "drastic resort' that, if allowed to become routine, ' could threaten an elementary imperative of individual liberty.'" United States v. Chatmon, 718 F.3d 369, 373 (4th Cir. 2013) (quoting United States v. White, 620 F.3d 401, 422 (4th Cir. 2010)). "While involuntary medication orders may sometimes be necessary, they carry an unsavory pedigree." Id. at ...