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 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 [
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.
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."
"Pursuant to
The Defendant opposes involuntary medication primarily because he states that the medication causes substantial side effects that will interfere with his ability to participate in his defense. He contends that the psychotropic medication causes him to feel emotionally detached from his life and the outcome of his case. He asserts that he has discontinued using psychotropic medication in the past because it prevents him from feeling any emotion or having "any true connection to his life[.]"
Once the Court finds that an important Government interest exists, it must find that involuntary medicating the Defendant will significantly further that interest.
The Defendant contends that the Government has failed to meet the second half of this test, because the psychotropic drugs cause him side effects that prevent him from caring emotionally about the outcome of his case. The Court finds that the evidence before it contradicts this argument. First, the Forensic Evaluation states that, a review of the Defendant's mental health records since 2012, reveals that the Defendant "responded rather favorably to treatment with antipsychotic medication, with no evidence of significant side effects." [Exh. at p.5] Second, although Dr. Cochrane testified that psychotropic medications can have side effects and that some people experience "sedation" as a side effect of psychotropic medication, if the Defendant experienced sedation with the psychotropic medication, Dr. Cochrane and his staff could adjust the dosage or type of medication until they arrived at dose or medication that did not cause side effects in the Defendant. Third, Dr. Cochrane testified that even 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.
The Court heard no evidence to contradict the Forensic Evaluation or Dr. Cochrane's testimony. Thus, the Court finds that the Defendant is unlikely to experience any lasting side effects and that, in any event, the side effect about which the Defendant is concerned, namely a numbed emotional response, would not substantially interfere with his ability to participate in his defense. Accordingly, the Court finds that the Government has shown by clear and convincing evidence that involuntarily medicating the Defendant will significantly further the important Government interest.
The Defendant also argues that the Government has failed to show that other, less intrusive measures would not be successful in bringing about his competence. Specifically, he argues that the Government has not shown that a Court Order, directing him to take the psychotropic medication and enforced by the Court's contempt power, would not be effective. He contends that his history demonstrates that he has previously voluntarily agreed to take medication once facing a court's order that he be involuntarily medicated. Citing to the Fourth Circuit in
Elaborating upon the third
The Defendant proposes that the Court order him to take the antipsychotic medication recommended by the staff at FMC Butner and give him an opportunity to comply with the Court's Order, prior to ordering that he be involuntarily medicated. In support of this procedure, he contends that he has voluntarily taken antipsychotic medication in the past when presented with a court order that he be involuntarily medicated. The Court finds that the evidence before it does not quite bear this out. The Forensic Evaluation states that the Defendant was involuntarily medicated in Florida in the spring or early summer of 2012. [Exh. at p.3] After the involuntary medication commenced, he continued to disagree with taking psychotropic medication "and often voiced his intention to hurt someone if medications were forced on him."
The medical staff at FMC Butner believe that a Court Order is unlikely to result in the Defendant voluntarily taking the antipsychotic medication. The Forensic Evaluation states that three nonviolent incompetent pretrial detainees have been presented with court orders. [Exh. at 16] In one case, the defendant ignored the order; in the second case, the defendant at first agreed to take the medication voluntarily but ultimately refused; and in the third case, the defendant complied with the court order in order to avoid being involuntarily medicated.
Based on the Forensic Evaluation and Dr. Cochrane's testimony, the Court finds compelling evidence that a Court Order backed by the threat of contempt will have little effect in this case. However, the cost of using a modified order that provides the Defendant a brief opportunity to take the medication voluntarily before the order to involuntarily medicate him is enforced seems small. Accordingly, the Court finds that although the Government has provided clear and convincing evidence of the third
In summary, the Court finds that the Government has shown clear and convincing evidence of all four
The Court finds by clear and convincing evidence that Defendant Robert Hicks should be involuntarily medicated in order to restore his competency. Therefore, it is
With regard to factor four, Dr. Cochrane testified that treatment with psychotropic medication was the standard of care for treating schizophrenia in both forensic and non-forensic cases. He said that the overwhelming majority of schizophrenic defendants who were treated with psychotropic medications were restored to competency and that the Defendant had previously been restored to competency with this medication. Finally, he testified that the proposed psychotropic medication has few side effects and that these side effects could be addressed by changing dosage or medication, if they emerged in Defendant Hicks. The Court finds that the Government has shown by clear and convincing evidence that administering the psychotropic medication is medically appropriate for Defendant Hicks.