Court Adopts Standard of Review for Appeal from Order That Defendant Be Involuntarily Medicated to Restore Competency to Stand Trial

United States v. Palmer, No. 06-31018 (5th Cir. Oct. 31, 2007) (Garwood, Jolly, Stewart)

Palmer appealed an order that he be forcibly medicated with Haldol to restore his competency so he could stand trial on a charge of possession of a firearm by a person adjudicated mentally defective. (Haldol is a powerful anti-psychotic drug with some very unpleasant side effects.)

As the court explains,

In Sell v. United States, the Court explained that the involuntary medication of a defendant solely to render him competent to stand trial for a serious, but nonviolent, crime is permissible in rare circumstances, “but only if the treatment is medically appropriate, is substantially 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.” 539 U.S. 166, 179 (2003). The Court declared that lower courts, when making such a determination must consider four factors: (1) whether important governmental interests are at stake; (2) whether involuntary medication will significantly further those interests; (3) whether involuntary medication is necessary to further those interests; and (4) whether the administration of the drugs is medically appropriate. Id.

The first order of business in Palmer was to determine the standard of review for Sell cases. The court followed the lead of the Second Circuit, which has held that factor one is reviewed de novo, while the other three factors are reviewed for clear error.

The court went on to affirm the order for involuntary medication. On the first factor, it held that the government's interest was important, based on the particular allegations in Palmer's case, as well as the maximum punishment for the offense. It observed that other courts have held that when evaluating the seriousness of the charged offense, which is relevant to this factor, a court should look at the statutory maximum for the offense, rather than the applicable guideline range, and that anything over six months is "serious."

On the second factor, the court acknowledged that Haldol produces strong side effects, and that newer medications don't have as many or as severe side effects. It nevertheless held that "while [Palmer] has demonstrated that the side effects will be unpleasant, he has not shown how his ability to assist in his defense will be substantially undermined by the medication." (I'm not a doctor, nor have I ever played one on TV. But the court seems to be downplaying the severity of Haldol's side effects, and their effect on a person's ability to assist in a defense. For example, one of the side effects is akathisia, which the opinion describes as "restlessness." According to the Wikipedia article, "High functioning patients have described the feeling as a sense of inner tension and torment or chemical torture from the inside out." Then again, the court probably doesn't want to get involved in second-guessing both the district court and medical professionals when it comes down to the choice of one drug over another.)

The third factor wasn't in dispute here.

Finally, on the fourth factor, the court observed that, "It is undisputed that other treatment options, such as psychotherapy or education would be ineffective in restoring Palmer’s competency." Palmer urged that he should be re-evaluated for civil commitment, and that he would likely be found not guilty by reason of insanity if he were made competent and brought to trial. The court acknowledged that "there is some force to Palmer's contentions," but nevertheless found no clear error in the district court's finding on this factor. It noted that he was already found to be an unsuitable candidate for civil commitment in 2004 (when he was evaluated for competency in connection with an earlier charge that was later dismissed). It also pointed out that even if Palmer never serves a day of prison time, Sell said that the government's interest is in bringing him to trial, not in seeing him convicted.