Opinion
Case No. 2:00-CR-90C
May 3, 2001
John R Bucher, Salt Lake City, UT; Rebecca C. Hyde, UTAH FEDERAL DEFENDER OFFICE SALT LAKE CITY, UT., for defendant AMADOR SANTONIO (1) aka Kenneth Morales.
Michele M. Christiansen, US ATTORNEY'S OFFICE Attorneys for U.S.
ORDER
This matter is before the court on the United States' motion to compel Defendant Amador Santonio to take antipsychotic drugs in order to render him competent to stand trial. The court held hearings on this matter on March 20 and 29, 2001. For the reasons set forth below, the court denies the government's motion.
Background
Following a hearing on October 17, 2000, the court concluded that Mr. Santonio was not competent to stand trial. Mr. Santonio was then sent to the Springfield, Missouri, medical center for a psychological evaluation and hearing, conducted pursuant to 28 C.F.R. § 549.43. The hearing psychiatrist, Dr. Carlos Tomelleri, found that Mr. Santonio suffered from a delusional disorder. (See Involuntary Medication Report at 1, attached as Ex. A to Def.'s Mem. On Issue of Forced Medication.) Dr. Tomelleri also found that, despite his mental illness, Mr. Santonio was not "gravely disabled" and that he was not "dangerous to self or others." (Id. at 2.) Regarding treatment, Dr. Tomelleri wrote that "psychotropic [antipsychotic] medication is the treatment of choice for Mr. Santonio's condition and there is a reasonable likelihood that it will result in sufficient improvement as to restore him to competency." (Id. at 4.) Mr. Santonio has not consented to taking this medication.
Discussion
I. Interests at stake
The private interests at stake in this case are substantial. First, there is the substantive due process right, under the Fifth Amendment, to be free from bodily intrusion. After all, the purpose and effect of antipsychotic medications is to alter the chemical balance in the patient's brain. See Washington v. Harper, 494 U.S. 210, 221 (1990); Bee v. Greaves, 744 F.2d 1387, 1393-1394 (10th Cir. 1984). Antipsychotic drugs often have severe and irreversible side-effects. The Supreme Court has repeatedly recognized that these side-effects include: tardive dyskinesia, characterized by uncontrollable muscle movements, which develops in 10-25% of the patients receiving these drugs; acute dystonia, a severe involuntary spasm of the upper body, tongue, throat, or eyes; drowsiness; excitement; bizarre dreams; restlessness; salivation; dry mouth; blurred vision; perspiration; headaches; constipation; impotency; and neuroleptic malignant syndrome, a relatively rare condition that leads to death from cardiac dysfunction in 30% of the people who develop it. See Harper, 494 U.S. at 230; Riggins v. Nevada, 504 U.S. 127, 134 (1993); United States v. Brandon, 158 F.3d 947, 954 (6th Cir. 1998); see also Joanne R. Propst, "Restoring Competency: Does the state have the right to force anti-psychotic medications on the mentally ill pretrial-detainee?", 49 Drake L. Rev. 147, 162-63 (2000). The Tenth Circuit has described this Fifth Amendment right as the "freedom from physical and mental restraint of the kind potentially imposed by antipsychotic drugs." Bee, 744 F.2d at 1393; accord Woodland v. Graves, 820 F. Supp. 1497, 1504-05 (D.Utah 1993).
Second, there is the First Amendment interest in free expression: the drugs may interfere with Mr. Santonio's ability to communicate ideas. "Antipsychotic drugs have the capacity to severely and even permanently affect an individual's ability to think and communicate." Bee, 744 F.3d at 1393-94; see also Harper, 494 U.S. at 230. Third, the Tenth Circuit has identified a constitutionally protected privacy interest "in independence in making certain kinds of important decisions," such as "whether to accept treatment with antipsychotic drugs." Bee, 744 F.2d at 1393, quoting Whalen v. Roe, 429 U.S. 589, 599-600 (1977); accord Woodland, 820 F. Supp. at 1505-06. Finally, there is the Sixth Amendment right to a fair trial. "By administering medication, the State may be creating a prejudicial negative demeanor in the defendant — making him look nervous and restless, for example, or so calm or sedated as to appear bored, cold, unfeeling, and unresponsive." Riggins, 504 U.S. at 143 (Kennedy, J., concurring), quoted in Brandon, 158 F.3d at 954.
Although the private interests in refusing unwanted administration of antipsychotic drugs are substantial, they are not absolute and must be balanced with interests of the government. See Bee, 744 F.2d at 1394. In this case, the government has an interest in prosecuting a defendant charged with a felony. See Riggins, 504 U.S. at 143. The government also shares an interest with the defendant in making sure that the resulting trial is fair to both parties. See id.
II. Standard to be applied to the issue of forced medication of antipsychotic drugs
The Supreme Court has held that the government may forcibly administer antipsychotic drugs to prison inmates who are dangerous to themselves or others, so long as the treatment is in the inmate's medical interests. See Washington v. Harper, 494 U.S. 210, 227 (1990). The government may also forcibly medicate pre-trial detainees, if this medication is "essential for the sake of [the pretrial detainee's] own safety or the safety of others." Riggins v. Nevada, 504 U.S. 127, 135 (1992). Furthermore, the Tenth Circuit has concluded that this line of cases "implicitly authorizes the forced medication of involuntarily-committed individuals designated as 'gravely disabled' . . ." See Jurasek v. Utah State Hospital, 158 F.3d 506, 513 (10th Cir. 1998) (forced medication of civil committee). The standard applied by the courts where a pre-trial defendant is dangerous to himself or others or gravely disabled, akin to a "rational basis" test, is whether the forced medication is 'reasonably related to legitimate penological interests.'"Harper, 494 U.S. at 223; accord Woodland v. Angus, 820 F. Supp. 1497, 1509 (D.Utah 1993) (describing Harper test as whether or not forced medication of a detainee is required "for the needs of the institution"). These cases do not control the issue of forced medication here, however, because Mr. Santonio was determined tonot be "dangerous to self or others" or "gravely disabled" by the evaluating psychiatrist. (See Involuntary Medication Report at 2, attached as Ex. A to Def.'s Mem. on Issue of Forced Med.)
Woodland v. Angus, 820 F. Supp. 1497 (D.Utah 1993), a thorough, well-reasoned opinion by the Honorable David K. Winder, presents the factual situation most similar to that of Mr. Santonio. In Woodland, the state trial court determined that the defendant, who was charged with second-degree murder, was incompetent and ordered him committed to the Utah State Hospital. The state, seeking to bring the defendant to trial, sought to have him forcibly medicated with antipsychotic drugs. The three-person administrative review committee refused to approve the medication because it found that "plaintiff did not pose a threat of serious harm to himself, others, or their property." Id. at 1500. A few months later, however, the hospital rewrote its forced medication policy, removing the dangerousness requirement, so that forced medication could be performed if it were merely in the patient's medical best interests. With this new policy in place, the hospital held another hearing and determined that the defendant could be forcibly medicated. See Id.
The hospital does not seem to have made a finding on whether or not Woodland was "gravely disabled." See Id.
Judge Winder noted that the facts differed from Supreme Court precedent: The issue before the court is not like Harper, however, in which the purpose of the involuntary medication was to insure that the incarcerated person ceased to be a physical danger to himself or others. Rather, defendants do not seek to medicate plaintiff for the needs of the institution, but to render him competent to stand trial. Thus, the reduced standard of review applied by the Court in Harper is not appropriate in resolving this case.Id. at 1509; see also id. at 1508 (discussing Riggins). Rather than apply the rational basis test outlined in Harper, Judge Winder adopted a standard akin to strict scrutiny, stating that "it would be error for the court to allow the State of Utah to forcibly medicate the plaintiff unless the court find's [sic] the State's interest in so acting is 'compelling.'" Id. at 1510; see also id. at 1509.
Other case law supports the application of a strict scrutiny standard where the pre-trial detainee is neither dangerous nor gravely disabled. Justice Kennedy, the author of the majority opinion in Harper, later wrote a concurrence expressing doubt whether it could ever be appropriate to forcibly administer antipsychotic drugs solely for the purpose of rendering a pre-trial detainee competent to stand trial.
I file this separate opinion . . . to express my view that absent an extraordinary showing by the State, the Due Process Clause prohibits prosecuting officials from administering involuntary doses of antipsychotic medicines for purposes of rendering the accused competent for trial, and to express doubt that the showing can be made in most cases, given our present understanding of the properties of these drugs. . . . [Where] [t]he avowed purpose of the medication is not functional competence, but competence to stand trial, . . . elementary protections against state intrusion require the State in every case to make a showing that there is no significant risk that the medication will impair or alter in any material way the defendant's capacity or willingness to react to the testimony at trial or to assist his counsel. Based on my understanding of the medical literature, I have substantial reservations that the State can make that showing.Riggins, 504 U.S. at 138, 141 (Kennedy, J., concurring). InUnited States v. Brandon, 158 F.3d 947 (1998), the Sixth Circuit also held that the government would have to overcome a strict scrutiny standard in order to forcibly medicate a non-dangerous pretrial detainee for the purpose of restoring his competence to stand trial. See Id. at 960; see also Id. at 958-59 (citing consistent cases from other jurisdictions); but see United States v. Sanchez-Hurtado, 90 F. Supp.2d 1049, 1055 (S.D.Cal. 1999) (adopting rational basis standard for motion to forcibly medicate a non-dangerous pre-trial detainee).
As in Woodland, Mr. Santonio has been determined to be neither a danger to himself or others nor gravely disabled. Forced medication of Mr. Santonio, therefore, cannot be justified for "legitimate penological interests." In this case, the government's only interest relates to its desire to render Mr. Santonio competent to stand trial. For these reasons, the court will apply the standard of strict scrutiny to the determination of whether Mr. Santonio may be forcibly medicated.
"To survive strict scrutiny, the disputed policy must be narrowly tailored to serve a compelling government interest."Buchwald v. University of New Mexico Sch. of Med., 159 F.3d 487, 498 (10th Cir. 1998); accord Timmons v. Twin Cities Area New Party, 520 U.S. 351, 358 (1997) ("Regulations imposing severe burdens on plaintiffs' rights must be narrowly tailored and advance a compelling state interest."); Brandon, 158 F.3d at 960. In order to show that forced medication is narrowly tailored, the government must show that it is the "least harmful means of satisfying the government's goal." Id. The government bears the burden of proof and must prove its case "by clear and convincing evidence." Id. at 961; Woodland, 560 F. Supp. at 1516, 1517 (citing with approval other courts' usage of this evidentiary burden); Sanchez-Hurtado, 90 F. Supp.2d at 1055. In determining in this case whether the government has overcome its burden, the following factors must be considered: (1) whether, to a reasonable degree of medical certainty, the treatment would render the pretrial detainee competent; (2) whether the prosecution has shown that it cannot obtain an adjudication of the pretrial detainee's guilt or innocence using any other means; (3) the extent to which the procedure may threaten the pretrial detainee's safety, health, or privacy interests; (4) the community's interest in fairly and accurately determining guilt or innocence; and (5) the seriousness of the crime with which the defendant is charged. See Woodland, 820 F. Supp. at 1511 (citingHarper, 494 U.S. at 222-23, Riggins, 504 U.S. at 135, and Winston v. Lee, 470 U.S. 753, 759 (1985)); Brandon, 158 F.3d at 960.
III. Has the government met its burden?
The first factor to be considered is whether, to a reasonable degree of medical certainty, the treatment would render the pretrial detainee competent. Dr. Tomelleri stated in his report of his evaluation of Mr. Santonio that "there is a reasonable likelihood that [the administration of antipsychotic drugs] will result in sufficient improvement as to restore him to competency." (See Involuntary Medication Report at 4, attached as Ex. A to Def.'s Mem. On Issue of Forced Medication.) Dr. Tomelleri did not state the basis for his opinion, however, and did not discuss either the medical research on this issue or the medical research as it applied to Mr. Santonio's particular condition. The government did not introduce any further evidence on this point during the hearings on this matter. Accordingly, the government has not demonstrated this factor by "clear and convincing evidence," and this factor therefore weighs against the forcible administration of drugs.
The second factor to be considered is whether the prosecution has shown that it cannot obtain an adjudication of the pretrial detainee's guilt or innocence using any other means. As the government did not introduce any evidence with regard to this factor, this factor weighs against the forcible administration of drugs.
The third factor is the extent to which the procedure may threaten the pretrial detainee's safety, health, or privacy interests. The medical literature, as discussed by the Supreme Court, suggests that antipsychotic drugs affect a patient's ability to communicate, and that they can have frequent and serious physical side-effects. See Harper, 494 U.S. at 229-35;Riggins, 504 U.S. at 133-35; accord Bee, 744 F.2d at 1393-1394. As the government has not sought to rebut this evidence in this case, this factor weighs against forced medication.
The fourth factor to be considered is the community's interest in fairly and accurately determining guilt or innocence. The community's interest is not merely in proceeding with a trial but in proceeding with a trial that is fair to both the government and the defendant. See Woodland, 820 F. Supp. at 1513. "It is a fundamental assumption of the adversary system that the trier of fact observes the accused throughout the trial, either while the accused is on the stand or sitting at the defense table."Riggins, 504 U.S. at 142 (Kennedy, J., concurring), quoted in Woodland, 820 F. Supp. at 1513; Coy v. Iowa, 487 U.S. 1012 (1988) ("there is something deep in human nature that regards face-to-face confrontation between accused and accuser as essential to a fair trial in a criminal prosecution"). As discussed above, antipsychotic drugs may create a prejudicial negative demeanor in Mr. Santonio, either by making Mr. Santonio appear restless and nervous, or by making Mr. Santonio appear bored and unfeeling. "If the plaintiff were to exhibit side effects as a result of his medication with psychotropic medication, significant and decisive prejudice could result that would render any trial unconstitutional." Riggins, 504 U.S. at 142 (Kennedy, J., concurring). Moreover, antipsychotic drugs could hamper Mr. Santonio's ability to communicate ideas at trial, either to his counsel or while testifying, thus limiting his ability to fully participate in his own defense. See, e.g., id.; Bee, 744 F.2d at 1393-1394. The government has not demonstrated through clear and convincing evidence that, if Mr. Santonio were forcibly medicated and brought to trial, the trial would be fair to Mr. Santonio and would accurately determine Mr. Santonio's guilt or innocence. This factor thus weighs against forced medication.
The final factor to be considered is the seriousness of the crime with which the defendant is charged. Here, Mr. Santonio is accused of two counts of impeding, intimidating, or interfering with federal law enforcement officers engaged in the performance of their official duties. See 18 U.S.C. § 115(a)(1)(b). The government alleges that, between February 1999 and February 2000, Mr. Santonio sent threatening letters to two F.B.I. agents. Although a felony, the crime with which Mr. Santonio is charged is nonviolent, and Dr. Tomelleri concluded that Mr. Santonio was not a danger to other persons. Moreover, the charge of sending threatening communications to federal officers is far less serious than the charge of second-degree murder in Woodland, a case in which the court found insufficient state interest to override the constitutional interests of the defendant. This prong therefore weighs against the forcible administration of antipychotic drugs, as well.
Accordingly, the government has not met its burden of demonstrating that forcibly medicating Mr. Santonio with antipsychotic drugs is "narrowly tailored to serve a compelling government interest." Buchwald, 159 F.3d at 498. The United States' motion to compel medication is denied.
The court concludes that Mr. Santonio remains incompetent and is not likely to regain competency. Mr. Santonio is therefore remanded to the Springfield, Missouri, medical center for a risk assessment evaluation to be conducted pursuant to 18 U.S.C. § 4246.
DATED this 3rd day of May, 2001.