Some questions about Sell V. United States.

[paperbackwriter]

There is a current case in Kansas where a murder defendant has been ordered to take anti-psychotic medication to render him competent to stand trial. The news story implies that this is the first case to apply the recent Supreme Court decision about involuntary medication.

I went to find the case, Sell v. United States. I wanted to see what conditions the Court placed on ordering involuntary medication. It left me with some questions that I don’t have the legal background to understand, and I was hoping for some help here.

1: Is the Kansas case actually an application of Sell? That defendant, Marc Sappington, is accused of a violent crime (murder). Although Sell was also accused of attempted murder, the proceedings that lead to the Supreme Court decision concentrated on the Medicaid fraud charges. I am not sure how that happened (reasoning for which would be also appreciated), but the first part of the decision clearly states that the question concerns nonviolent crimes.

2: The standards seem very fuzzy; are the criteria clear to most courts? I ask this because criteria such as “important government interests are at stake” and “involuntary medication will significantly further those concomitant state interests” must have a more precise meaning than I am aware of in order to be usable. Put another way: the other two criteria of medical necessity and medical appropriateness are clearer to me, but only because I know some of the “back story” behind those terms. To me, “important government interests” is especially vague, and could be stretched to ludicrous lengths.

2A: Semi-related observation: I found it amusing that the Court got itself caught in the crossfire of the psychology-psychiatry wars. The American Psychological Association and American Psychiatric Association filed competing briefs on effectiveness of drug and non-drug therapies in treating psychoses. I’ll leave as an exercise for the reader to decide where each brief came down

3: Did this opinion create a new “collateral order” exemption? Is that a significant thing? Scalia’s dissent seems to imply that it does and it is very significant. I am aware of his general views on common law and “judicial activism”. In this case, however, wouldn’t the practical effect of his proposed resolution (remand with instruction to dismiss) be to force Sell to take the medication? For those who may not know, anti-psychotics have high side-effect profiles. Some of these side effects are major, and some can be permanent, even after the medication is withdrawn. From the Merck Manual

Conventional antipsychotic drugs are associated with adverse effects, such as sedation, dystonia and muscle stiffness, tremors, elevated prolactin levels…Akathisia (motor restlessness) is particularly unpleasant and is often associated with drug refusal and outpatient noncompliance. These drugs may also cause tardive dyskinesia, an involuntary movement disorder most often characterized by puckering of the lips and tongue and/or writhing of the arms or legs. … In about 2%, tardive dyskinesia is severely disfiguring. … patients … should be evaluated at least q [every] 6 mo… Neuroleptic malignant syndrome, a rare but potentially fatal adverse effect… emphasis mine

One of my wife’s relatives has this tardive dyskinesia, which is extremely distracting when talking to him, and the medicine that caused it was changed long ago. I would think that this side effect, not to mention the sedation, tremors and death, could definitely have an effect at trial. Is it that Scalia’s dissent does not understand that risk or does not care that it is there? Or am I understanding the practical effect incorrectly?

Thanks in advance. I know I bring a lot of these questions to the Legal Doper community, and I appreciate your collective willingness to help.

[Nametag]

IANAL (IAALSDO), but I’ll take these on; in reverse order:

3. Did this opinion create a new “collateral order” exemption? Not at all. Scalia’s dissent turns upon his perception that the order was reviewable upon appeal of the final verdict, and he’s right, in a sense – the entire case could be dismissed, and the judgement vacated, if an appeals court finds that the medication order was improper and that Sell was, and should have remained, incompetent to stand trial. The majority ruled that the intrusive nature and permanent side effects of the forced medication make the order unreviewable in fact. Scalia finds this irrelevant, but that’s Scalia for you. The practical effect of the decision on the individual is often irrelevant, or at least secondary to the letter of the law, but there is long-standing precedent for making exactly this sort of exception in other constitutional cases.

4. What you’re looking at here is called a “balancing test.” The court must balance the governements legitimate interest in proceeding with the trial with the defendant’s legitimate right to refuse medical treatment. The four criteria given in the decision are implied in the standard given in preceding cases, and are not intended to be interpreted alone, but in conjunction with the entire history of constitutional law; there is a huge amount of precedent as to wat is an important government concern and what isn’t, and a good judge is supposed to take it all into account (and a good lawyer is supposed to point out the relevant cases).

5. The facts of the case needn’t be exactly the same. Just because the issue in this case was addressed to non-violent crimes, that doesn’t mean that Sell isn’t precedential for a similar case involving violent crimes. The legal reasoning must be applied to a new set of facts, portions of the decision may be irrelevant, and there may be new factors to consider, but in the absence of a more similar precedent, Sell must at least be considered.

[pravnik]

1. The fact that it’s a violent crime is relevant, but not dispositive. The Court had indicated in dicta in the previous case of Riggins that a defendant might be medicated to be made competent to stand trial for a murder charge; here they indicated that it is possible for a non-violent crime as well, but not in this instance. If a defendant may be medicated to stand trial for a serious non-violent crime, they may be medicated for a serious violent one a fortiori. The Court also made clear that before the question of whether a defendant can be involuntarily medicated to make them competent to stand trial can be answered, the question of whether the person in custody can be involutarily medicated under the rule of Harper, i.e. whether they pose a danger to themselves or others, should be answered. Answering the second one in the affirmative avoids the somewhat stickier constitutional questions of the first one: “hey, we’re not medicating him so he can stand trial, we’re medicating him because he’s trying to bite us!”. The propriety of medicating a non-dangerous person for a non-violent crime is a more complex issue.

2. The standards probably aren’t any more vague than any other SCOTUS case. They basically tell the judge to look for the following:

(1) Is the crime serious enough to warrant it?
(2) How much will the medication help?
(3) Is medication necessary to acheive that level of help, or are there other means available?
(4) Is it medically appropriate? Harmful side effects?

The judge is told to evaluate these factors as a balancing test and justify his or her decision in those terms.

3. Scalia is pissed because this was an appeal from a pretrial order which he felt wasn’t appealable yet. Ordinarily you can only appeal a pretrial order and obtain a “collateral order” from the appellate court in a narrow area of circumstances where the harm caused by the trial courts order can’t be repaired if you wait until the trial is over or where there has been a final judgment in a determinative matter that will be “unreviewable” on appeal, e.g., once your trial is over you have no recourse if your bail was set too high prior to trial. The majority said you can’t wait; once he’s forced to take the medication, the damage is done. Scalia said now people will be able to immediately appeal orders pertaining to not being allowed to wear “Black Power” t-shirts in court or having their testimony compelled becasue the damage is done as soon as their rights are violated. Sometimes I think Scalia thinks other judges are morons.

[paperbackwriter]

I think I got all of that, thanks to both of you. I still don’t understand why the attempted murder charge got “lost” somwhere between the Magistrate and the appeals court. They were just considering the fraud charges as the basis for the action.

And I guess that I was right that Scalia really doesn’t care what happens to the people behind the cases.

I’ll stop there before this becomes GD material.

[Ponder_Stibbons]

Actually, I don’t have a question about the OP, so I guess this is a hijack (sorry). I just have a question about acronyms; I know IANAL, but what is IAALSDO? “I Am A Legal Secretary D’Oh” ???