A steady stream of judicial rulings continues to be issued that addresses the parameters of the United States Supreme Court's ruling in Sell v. United States, 539 U.S. 166 (2003), that under limited circumstances the government may treat over objection a criminal defendant in an effort to restore the defendant's competence to stand trial. These rulings, however, have tended to focus on different aspects of the Sell decision, as exemplified by the recent rulings of three federal district court judges in Virginia.
Western District of Virginia. In United States v. Evans, 404 F.3d 227 (4th Cir. 2005), the Fourth Circuit reversed an order by the United States District Court for the Western District of Virginia that had authorized such treatment. The Fourth Circuit held that the lower court had erred because the government had failed to articulate with sufficient particularity the medications it planned to administer to the defendant, the potential side effects specific to the defendant's medical condition, and a plan for responding to the onset of such side effects.
Following this ruling, the government developed a more extensive and detailed proposal for treating the defendant and submitted it to the district court for review. The district court, for the most part, found that this proposal met the requirements of Sell and, with minor modifications, authorized its implementation.
The defendant, Herbert G. Evans, is charged with forcibly interfering with a United States Department of Agriculture employee and threatening to murder a magistrate judge. He suffers from paranoid schizophrenia and has refused antipsychotic medication to restore his competence since 2003. Pursuant to the directions of the Fourth Circuit, the district court focused on the second and fourth prongs of the Sell test in evaluating the proposal, namely, whether the government had adequately demonstrated that its prosecutorial interest was significantly furthered by involuntary medication and whether involuntary medication was medically appropriate.
The district court found that the proposal set forth a carefully detailed treatment plan, a specific plan for monitoring and responding to side effects, and a literature review supportive of its position. The proposal provided a number of empirical studies indicating a substantial success rate following the involuntary medication of patients like the defendant and cited the 2004 guidelines of the American Psychiatric Association for treating schizophrenia (with its statistics related to the successful treatment of schizophrenia). Although the defendant countered with a report of his own that disputed these studies as applied to the defendant, the court generally found the government's report persuasive.
The court further determined that, although the burden of proof was on the government to show that the Sell criteria for treatment over objection were met by clear and convincing evidence, this burden had been met. The court ruled that the proposed involuntary medication was substantially likely to render the defendant competent to stand trial and substantially unlikely to produce side effects that would significantly interfere with the defendant's defense.
As for the side effects, the court acknowledged that troublesome side effects, mainly metabolic in nature, are common with second-generation antipsychotics, but concluded that they are generally not so serious as to inhibit the defendant's assistance with his own defense.
The court also found that the proposed treatment was generally medically appropriate. Because the defendant had expressed his intention to refuse medication, the court found it appropriate for the government to choose a long-acting antipsychotic, risperidone, to reduce the necessity for forceful encounters in administering the medication. The court also supported the use of this second-generation antipsychotic to avoid the neuromuscular side effects the defendant had experienced previously with haloperidol and noted that risperidone is the only second-generation antipsychotic available in a long-lasting form. …