Opinion
No. CR 03-187294
July 30, 2004
MEMORANDUM OF DECISION ON STATE'S REQUEST FOR FORCED MEDICATION
I. FACTS AND PROCEDURAL HISTORY
On February 11, 2003, the defendant was arrested and charged with the crimes of assault on a peace officer, interfering with a peace officer, threatening and breach of peace in the second degree. These charges arose out of an altercation at the defendant's home in Manchester. The victims of the first three counts are various Manchester Police Department officers and the victim of the fourth count is the defendant's mother, Sonyetta Strickland.
On January 13 and 14, 2004, a jury was selected and on January 16, 2004, the state presented its first day of testimony. At the conclusion of the last witness' testimony on January 16, the court continued the trial until January 21, 2004.
During the evening of January 19, 2004, the defendant was brought to Manchester Memorial Hospital and admitted under a fifteen-day emergency certificate. On or about January 22, 2004, the defendant was released from Manchester Hospital.
On January 23, 2004, the court ordered that pursuant to Conn. Gen Stat. § 54-56d, the Office of Court Evaluations (OCE) conduct a competency examination of the defendant.
On March 3, 2004, a competency hearing was held at which Barbara Garvie, LCSW testified and a written report of the OCE team's findings was introduced as evidence. The court, thereafter, found the defendant incompetent to stand trial and committed him to the custody of the Commissioner of Mental Health and Addiction Services for a period of sixty days. The defendant was committed by the Commissioner to the Connecticut Valley Hospital — an inpatient institution for the mentally ill.
Director of the Office of Court Evaluations.
Marc Rosen, M.D., Fred Storey, Ph.D., Barbara Garvie, LCSW.
On May 6, 2004, a second competency hearing was held by the court (Norko, J.). At the hearing Tim Schumacher, PhD. testified that the defendant remained incompetent to stand trial, that the defendant was refusing to voluntarily take antipsychotic medication and that without the administration of such medication, the defendant would not be restored to competency within the statutory limit of eighteen months.
Clinical Psychologist/Competency Monitor, Department of Health and Addiction Services.
§ 54-56d(i)(1) of the General Statutes.
The court found that the defendant remained incompetent to stand trial, ordered the appointment of a health care guardian for the defendant, and continued the matter until June 25, 2004, for a hearing on the state's request that the defendant be forcibly medicated.
§ 54-56d(k)(3) of the General Statutes.
At the hearing on June 25, the court heard the testimony of Brenda L. Planck, M.D. and Kathleen Donovan. In addition a written report from Donovan was received in evidence.
Attorney Donovan was appointed by the court to be the defendant's health care guardian.
For purposes of this motion the court reviewed the report of OCE dated March 1, 2004 and a report of CVH dated April 30, 2004 and takes judicial notice of these reports. In addition the court sat through a day of trial on the criminal charges and heard testimony from Manchester officers William Young, Jerrad Johnson, Keith Dunnigan, Jr., Steven Koss, and Scott Plourde and from the defendant's mother. The court takes judicial notice of the evidence and testimony presented at the trial.
Hearing of March 3, 2004 exhibit 1.
Hearing of May 6, 2004 exhibit 1.
Brockett v. Jensen, 154 Conn. 328, 336 (1966) (trial court may take judicial notice of court file and proceedings in same case).
Id.
Having considered the arguments of counsel and having reviewed the record, the court grants the state's request for the forcible administration of antipsychotic medication to the defendant.
II. DISCUSSION A. Defendant's Competence to Stand Trial
The defendant suffers from a psychiatric illness which has been diagnosed as psychotic disorder NOS. This disorder is characterized in the defendant's case by paranoia, auditory hallucinations, impaired judgment and an inability to interact rationally with other people including his attorney. In addition the defendant harbors paranoid and persecutory beliefs about the legal system, the police and the incident for which he was arrested. The defendant has little or no insight into his illness and/or his need for medication. Since his commitment to CVH for restoration to competency, the defendant has repeatedly refused to meet with his competency monitor, his treating psychiatrist and a consulting psychiatrist and has repeatedly refused to participate in group therapy or competency education therapy. The defendant has also repeatedly refused to take any antipsychotic medication on the grounds that he does not need such medication. The defendant is guarded in dealing with CVH staff and has at times exhibited great hostility and apparent anger toward staff. The defendant has refused to allow OCE or CVH to obtain medical records of his prior psychiatric hospitalizations or to speak with collateral sources about his psychiatric illness. Reportedly when the defendant was hospitalized at Cedarcrest Hospital after his arrest on the present charges, the hospital attempted to have the defendant civilly committed but the request was denied by the Probate Court.
Planck believes that the defendant may in fact be suffering from a more specific disorder — schizophrenia — but due to the inability of CVH staff to obtain more information about the defendant, CVH has employed the broader diagnosis of psychotic disorder NOS.
An inpatient mental health facility for the treatment of persons with psychiatric disabilities operated by DMHAS.
It is Planck's expert opinion that as a result of the defendant's psychiatric symptoms, he presently remains unable to understand the proceedings against him and to assist his attorney in the preparation of a defense. Further according to Planck, the defendant will continue to remain incompetent to stand trial unless and until he is administered antipsychotic medication. Planck's opinions are corroborated by the CVH report dated April 30, 2004. Accordingly the court finds that the statutory presumption of competency has been overcome and finds by a fair preponderance of the evidence that the defendant is presently incompetent to stand trial. Further the court finds by clear and convincing evidence that the defendant will not be restored to competency without the administration of psychotropic medication.
General Statute § 54-56d(b).
B. Sell v. United States
An individual has a constitutionally protected liberty interest in rejecting the unwanted administration of antipsychotic medication. Washington v. Harper, 494 U.S. 210, 110 S.Ct. 1028, 108 L.Ed.2d 178 (1990). The United States Constitution, however, permits the government to involuntarily administer psychotropic drugs to a mentally ill defendant in order to render the defendant competent to stand trial if such treatment is medically appropriate, is unlikely to have side effects that may undermine the fairness of the trial and taking account of less intrusive alternatives, is necessary significantly to further important governmental trial-related interests. Sell v. United States, CT Page 11429 539 U.S. 166, 123 S.Ct. 2174, 2184-85, 156 L.Ed.2d 197 (2003). The Sell court delineated four factors for a trial court to consider in determining whether forced medication of a defendant is appropriate: (1) the importance of the government's interests in the prosecution; (2) whether involuntary medication will significantly further those interests; (3) whether involuntary medication is necessary to further those interests; and (4) whether involuntary medication is medically appropriate. Id.
The Sell standard has been adopted by the Connecticut supreme court. State v. Jacobs, 265 Conn. 396 (2003) (overruling State v. Garcia, 233 Conn. 44 (1995) on appeal after remand, 235 Conn. 671 (1996).
Before considering the issue of forced medication for the purpose of restoration to competency, trial courts are required to determine whether forced medication may be warranted for another purpose. As alternative reasons for permissible forced medication, the Supreme Court in Sell cited a defendant's dangerousness to himself or others or where such medication is necessary to avoid other grave health risks. Planck and Donovan testified that since the defendant's hospitalization there have been no instances of physically assaultive or other violent behavior on the part of the defendant. Additionally the records of CVH indicate that the defendant is a young healthy male with no known medical symptoms other than his psychiatric symptoms. Thus the court finds that forced medication of the defendant for a purpose other than restoration to competency is not warranted under the facts and circumstances present here.
Having determined that forced medication of the defendant, if permitted at all, is only justified for the purpose of restoration to competency, the court must go on to consider the various Sell factors applicable to restoration to stand trial.
1. The state's trial-related interests.
"The Government's interest in bringing to trial an individual accused of a serious crime is important. That is so whether the offense is a serious crime against the person or a serious crime against property. In both instances the Government seeks to protect through the application of the criminal law the basic human need for security." Sell v. United States, supra, 123 S.Ct. 2185.
In the present case the defendant has been charged, inter alia, with the crimes of assault on a peace officer, interfering with a peace officer and threatening in the second degree. Such crimes are considered by our courts to be serious crimes for purposes of a court's determination whether to forcibly medicate. See State v. Jacobs, 70 Conn.App. 488, 523-14, cert. den., 261 Conn. 929 (2002). Sell, however, requires more than a mere showing that the crimes are of a serious nature.
In evaluating the state's interest in prosecution, Sell also requires a consideration of the facts of the individual case. In the present case, the court heard an entire day of trial testimony consisting of the testimony of five Manchester police officers and the defendant's mother. From that testimony the court finds that on February 11, 2003, the defendant's mother called "911" and hysterically reported that the defendant — an individual who is over six feet tall and who weighs 285-300 pounds — had twice thrown her to the floor inside her home and was in the process of destroying her computer. When Manchester police officers Young and Johnson arrived at the house, the defendant's mother repeated these allegations and further reported that the defendant owns a BB gun and routinely carries a knife on his person. Based on the mother's allegations there was probable cause for the officers to believe that the defendant had committed a domestic violence crime and that they were required by our domestic violence statutes to arrest the defendant.
General Statutes § 46b-38b(a).
At the time of the officers' arrival at the house, the defendant was upstairs in a hallway eavesdropping on his mother and the officers. After speaking with the mother, the officers requested that the defendant come down to talk to them. When the defendant refused to comply with this request, Young went to the top of the stairs to meet the defendant. While Young was attempting to discuss the incident with the defendant, the defendant pushed him against a wall. The defendant then retreated into his bedroom. Johnson came upstairs to join Young and from the entrance to the defendant's bedroom they observed the defendant to be extremely angry, agitated and swearing at the officers. The defendant repeatedly told Young and Johnson to get out of his house, that he would not submit to arrest without a fight and that it would take more than two of them to remove him. All the while the defendant was observed to be searching through his bed covers and the officers feared that he was looking for a weapon. Unable to find what he was looking for, the defendant stood up picked up, a video cassette recorder and hoisted it over his head as if to throw it at the officers. Young warned the defendant that he would spray him with capstun, but the defendant indicated that he did not care. The defendant did not desist, was sprayed with the capstun and then tackled by the officers. After a several minute altercation in which it took four officers to bring the defendant under control, the defendant was subdued. During the altercation the defendant grabbed hold of Officer Koss' duty belt in an apparent effort to obtain control of the officer's firearm. Johnson sustained several physical injuries to his head and one hand.
A cayenne pepper based spray.
Seized from the defendant's bedroom were two knives, a set of nunchucks, a box cutter and a BB gun. Young testified that in his seven years as a police officer, this was one of the scariest and most threatening incidents in which he had been involved.
Based on these facts, the court finds that not only are the crimes charged inherently of a serious nature, but the facts underlying these crimes are also serious and were fraught with great potential for serious physical injury to the officers and to the defendant's mother.
Under Sell in gauging the importance of the state's interest in prosecution, the court must also consider whether the defendant's failure to take drugs would result in a lengthy civil commitment to a mental institution. Such a commitment diminishes the risk that ordinarily attaches to freeing without punishment one who has committed a serious crime. In her testimony, the defendant's mother indicated that in the period of time around the arrest the defendant was suffering from delusions, hallucinations, that he was paranoid and was talking to himself. Shortly after his arrest in the present case, the defendant was committed to Cedarcrest Hospital. Thereafter the hospital reportedly brought an action in probate court to civilly commit the defendant, but that request was denied. The symptoms reported by the defendant's mother as present in 2003 are many of the same psychiatric symptoms that Garvie, Schumacher and Planck found in 2004. Thus based on the fact that the defendant's present symptoms appear to be the same as those exhibited by him in 2003 and the fact that nonetheless a probate court in 2003 refused to civilly commit him, this court finds that it is highly unlikely that the defendant's present failure to take medication voluntarily will result in a civil commitment to an institution for the mentally ill.
In evaluating the state's interest in prosecution, the court is also required under Sell to consider the length of the defendant's pretrial confinement. In the present case the defendant has been confined to CVH since March 3, 2004 — a period of less than five months — while the maximum penalties for the crimes with which the defendant is charged is twelve years and six months.
On balance, therefore, considering the seriousness of the crimes with which the defendant has been charged, the likelihood of civil commitment and the present length of the defendant's pretrial confinement, the court finds that the state's legitimate interests in bringing the defendant to trial substantially outweigh the defendant's right not to be forcibly medicated.
2. Whether the forced medication of the defendant will significantly further the state's interests.
The court must next consider whether involuntary medication is substantially likely to render a defendant competent to stand trial. Planck testified that she is Board certified in general psychiatry and forensic psychiatry, that she has over ten years experience in the administration of antipsychotic medication to mentally ill persons, and that she is currently employed in the competency restoration unit of the Whiting Forensic Institute (WFI). Planck believes that the proposed administration of antipsychotic medication — in particular risperadol — would be very effective in reducing the psychotic symptoms of the defendant's illness including paranoia and auditory hallucinations as well as increasing his interest in the world around him, his interaction with people and his ability to make rational decisions. The defendant's mother reported to Planck that the defendant had in the past been treated with risperadol, that it was helpful to him and that other family members had also had a positive response to risperadol. It is Planck's opinion, therefore, that the administration of antipsychotic medication would be substantially likely to restore the defendant to competency.
WFI is a subdivision of the Connecticut Valley Hospital.
The court must also consider the impact on the defendant of any side effects of the medication. Planck testified that she would initially attempt to treat the defendant with risperadol — an oral antipsychotic medication that is usually well tolerated and with few side effects. The possible side effects, if any, would likely be minor and be limited to dry mouth, lightheadedness, and constipation. These side effects could be effectively treated with the addition of other medications, by altering the dosage or in many instances would ameliorate on their own.
If the defendant refused to take risperadol orally, Planck indicated that the defendant would be administered haldol intramuscularly by means of injection. Haldol is an older type of antipsychotic with more potential side effects. Prior to the administration of haldol, the defendant would continually be offered risperadol and only if he refused the risperadol would the haldol be administered. It is Planck's experience that once a defendant receives haldol for a short period of time his psychotic symptoms begin to diminish and he becomes amenable to continuing treatment with an oral antipsychotic. This transition usually takes two-four days. In the interim any side effects from haldol or another intramuscular antipsychotic would be dealt with by the administration of other medications to negate the side effects or by a medication change. Owing to the defendant's age and present physical health, Planck believes it highly unlikely that there would be any side effects from haldol which would be medically concerning or which could not be monitored and addressed. Donovan, the defendant's health care guardian, also testified that any potential side effects would not pose an unreasonable risk to the defendant's health.
Although the potential for adverse side effects exists, the defendant is housed in an inpatient psychiatric facility where he is constantly supervised and monitored. Thus should any untoward side effects manifest themselves, hospital staff would be able to immediately treat the defendant. Planck also testified that after the commencement of treatment it would likely take sixty to ninety days for the medication to take effect and for the defendant to participate in and complete the restoration process. By that time the side effects, if any, would be controlled or would ameliorate on their own so that they would not interfere with the defendant's understanding of the court proceedings or his ability to assist his attorney. To the contrary it is Planck's belief that treatment with antipsychotic medication would overall enhance the defendant's ability to understand the proceedings and assist his attorney. Donovan, who is an attorney as well as the defendant's health care guardian, concurred in this opinion.
Based on the evidence presented, therefore, the court finds that the planned regimen of treatment is substantially likely to render the defendant competent to stand trial and further that the proposed antipsychotic medications will likely reduce the defendant's psychotic symptoms. In addition the side effects of the planned treatment are substantially unlikely to interfere significantly with the defendant's ability to assist counsel in his defense and in fact will more than likely assist the defendant in understanding the proceedings and in preparing his defense.
Thus on balance, the court finds that involuntary medication will significantly further the state's interests in bringing the defendant to trial and will not significantly interfere with the defendant's right to fully participate in the trial.
3. Whether involuntary medication is necessary to further the state's significant interests.
The third prong of Sell requires the court to find that "any alternative less intrusive treatments are unlikely to achieve the same result." Sell v. United States, supra, 123 S.Ct. 2185.
In the present case CVH has attempted to restore the defendant to competency through repeated efforts to engage the defendant in group and individual psychotherapy and through the voluntary administration of antipsychotic medication. The defendant wholly refuses to participate in such therapy or to take any psychotropic medication. Thus at this point there are no therapies, other than involuntary medication, which will restore the defendant to competency.
In addition any court-ordered alternatives, such as a court order to the defendant backed by the court's power of contempt, is not likely to be successful here. The defendant lacks insight into his illness or his need for medication, firmly believes that he does not need medication and since March 2004, has repeatedly refused to take any antipsychotic medication. Both Planck and Donovan have made the defendant aware of the fact that the court may order forced medication. Nonetheless the defendant continues to refuse to take antipsychotic medication voluntarily. Further according to Planck, due to his psychotic symptoms the defendant is not able to rationally decide whether to take the medication or be held in contempt. Thus it is unlikely that a court order threatening contempt will change the defendant's mind. Such order will only serve to delay the defendant's receipt of an antipsychotic medication and his restoration to competency. Involuntary medication, therefore, is necessary to further the state's interest in this prosecution.
4. Whether the administration of drugs is medically appropriate CT Page 11435
Lastly under Sell the court must consider whether the administration of drugs is "medically appropriate, i.e., in the defendant's best medical interest in light of his medical condition." Id.
Planck testified that treatment with antipsychotic medication is medically appropriate for the defendant based upon his psychiatric diagnosis, his refusal to engage in alternative therapy, the likelihood that the medication will reduce his symptoms and the likely minimal impact of any side effects. Donovan also testified that treatment with such medications is medically appropriate for the defendant based upon his psychotic symptoms, the likelihood the medication will reduce his symptoms and enable him to work with his attorney and the absence of unreasonable risk to his health. Based on the reasonable likelihood that the administration of psychtropic medication will reduce the defendant's symptoms and the fact that such drugs will not pose an unreasonable risk to the defendant's health, the court finds that the administration of such medication to the defendant is in the defendant's best medical interest.
III. CONCLUSION
For the foregoing reasons, the court finds that the defendant remains incompetent to stand trial, that there is a substantial probability that the defendant will not be restored to competency without the administration of antipsychotic medication and that the administration of such medication is substantially likely to render the defendant competent to stand trial. Having considered the Sell factors, the court further finds that the state has proven by clear and convincing evidence that the defendant should be involuntarily medicated with antipsychotic drugs.
Accordingly the court orders that the defendant remain committed to the custody of the Commissioner of Mental Health and Addiction Services and that the Commissioner is authorized to administer antipsychotic medication to the defendant involuntarily if the defendant does not voluntarily submit. This case is continued until September 23, 2004 for further proceedings and a reevaluation of the defendant's competency.
BY THE COURT
PATRICIA A. SWORDS JUDGE OF THE SUPERIOR COURT