The opinion of the court was delivered by: John D. Bates United States District Judge
The government has moved for the involuntary medication of defendant Simon Dillon, who suffers from mental illness, to render him competent to stand trial. Pursuant to Sell v. United States, 539 U.S. 166, 180 (2003), the Court must consider whether involuntary medication is medically appropriate and necessary to significantly further an important government interest. Upon consideration of the pleadings, the record, and the arguments and evidence presented at the April 17 and 26, 2013 Sell hearing, the Court determines that the government has demonstrated by clear and convincing evidence*fn1 that the Sell standards have been met and that involuntary medication is appropriate and necessary. The government's motion to involuntarily medicate defendant is therefore granted.
On or about December 10, 2011, defendant allegedly threatened the President of the United States with bodily harm by sending an email to a United States Secret Service ("USSS") agent stating that, if the President refuses to meet with him, he "will get the worse Christmas present ever," "will suffer for 30 days," and "will wish for death, but death will not come to him." Indict. at 1-2 [ECF No. 3]. Defendant was indicted for violating 18 U.S.C. § 871. A warrant was issued with the return of the indictment, and the USSS arrested defendant on that warrant on January 17, 2012. Gov't's Mem. Supp. Invol. Medication at 2 [ECF No. 32].
On January 20, 2012, the Court ordered defendant committed to the custody of the Attorney General for a competency evaluation. Defendant was evaluated at the Metropolitan Correctional Center, and William J. Ryan, Ph.D and Elissa R. Miller, Ph.D authored the competency report diagnosing him with Schizophrenia, Paranoid Type. See Competency Report at 15 (March 14, 2012). Drs. Ryan and Miller found that although defendant has a mental illness that compromises his insight and his recognition that he is mentally ill, he nonetheless has a rational and factual understanding of the proceedings against him and is capable of assisting counsel with his defense. Id. at 14. However, the conclusion that defendant was competent to stand trial was made "with less than the usual degree of psychological certainty" because defendant was "unable to rationally consider an Insanity Defense to which he may be entitled." Id. at 14-15.
The Court subsequently found defendant competent to stand trial. However, both defendant and the government later orally moved for further psychiatric evaluation. The Court granted the motions and ordered defendant committed to the custody of the Attorney General for further evaluation at Butner Federal Medical Center ("Butner"). Once at Butner, defendant was diagnosed with Delusional Disorder, Grandiose Type in a forensic report authored by Heather H. Ross, Ph.D. See Forensic Report at 16 (Aug. 24, 2012). Dr. Ross found that, although defendant is able to understand the nature and consequences of the proceedings against him, he suffers from a severe mental disease or defect that prevents him from assisting properly in his defense.
Id. at 19. Dr. Ross concluded that defendant was not competent to proceed, and recommended that he be committed for mental health treatment. Id.
A competency hearing was subsequently held, and the Court found
defendant incompetent and ordered him committed to the custody of the
Attorney General for a Competency Restoration Study. Jill R. Grant,
Psy. D. and Jill C. Volin, M.D. authored the Study and diagnosed
defendant with Schizoaffective Disorder, Bipolar Type.*fn2
See Gov't's Ex. 2, Competency Restoration Study at 19 (Feb.
14, 2013) (hereinafter "Competency Restoration Study"). The Study
concluded that defendant is incompetent to stand trial as he "is
unable to understand the significance of his charges or the criminal
process in a rational manner due to his psychotic illness," and "would
be unable to assist in his defense due to his ingrained delusional
beliefs." Id. at 21. Drs. Grant and Volin also found that defendant's
prior medical record indicates that defendant responded favorably to
psychotropic medication in the past, and that there was a substantial
probability that he could be restored to competency with the
administration of antipsychotics. Id. at 20, 31. As a result, Drs.
Grant and Volin requested a judicial order for the involuntary
treatment of defendant with antipsychotic medication to restore him to
competency. Id. at 21.
On February 20, 2013, the government orally moved to have defendant involuntarily medicated. Defendant opposed the motion, and a Sell hearing was held on April 17 and 26, 2013. At the hearing, the government provided testimony from forensic psychologist Dr. Jill Grant and psychiatrist Dr. Jill Volin via videoconference from Butner. Drs. Grant and Volin had previously evaluated defendant for the February 14, 2013 Competency Restoration Study.
Dr. Grant, whom the court qualified as an expert witness in the area of clinical forensic psychology, testified that, in her opinion and to a medical degree of certainty, defendant suffers from Schizoaffective Disorder, Bipolar Type. 4/17/13 Hr'g Tr. at 10:15-17, 17:2-3. In particular, Dr. Grant testified that defendant has bizarre delusions, hallucinations, and mood problems that vary from mania to depression. Id. at 17:8-14, 21:11-16, 24:16-19. She further testified that defendant lacks insight into his illness and that his psychotic disorder "directly interferes with his ability to help prepare his defense and understand what is going on in the courtroom." Id. at 15:5-8, 23:10-11.
Dr. Volin, whom the court qualified as an expert witness in the area
of forensic psychiatry, also testified that, in her opinion and to a
medical degree of certainty, defendant suffers from Schizoaffective
Disorder, Bipolar Type. Id. at 65:17-19, 66:25-67:1. Dr. Volin
testified that defendant lacks insight into his mental illness, and
that treatment of defendant's mental illness with antipsychotics is
medically appropriate and substantially likely to restore him to
competence. Id. at 68:15-18, 73:6-11, 76:5-6. She also testified that
defendant's lack of negative symptoms of psychosis*fn3
and his previous positive response to antipsychotic
medicine*fn4 are important factors that support the
likelihood that antipsychotics can restore his competency. Id. at
82:1- 83:2. Dr. Volin noted that defendant previously experienced
hallucinations and sadness after taking an antipsychotic,*fn5
and stated that these effects were symptoms of defendant's
mental illness, not side effects of the medication. Id. at 86:23-88:2.
Dr. Volin further testified that antipsychotic medication is substantially
unlikely to result in side effects that will interfere significantly
with defendant's ability to assist his counsel in his defense. Id. at
88:3-11. In particular, Dr. Volin stated that most of the likely side
effects would have no effect on cognition and could be monitored and
treated with other medication if necessary, and that such treatment
would not be expected to have an adverse effect on defendant's
competency. Id. at 88:19-20, 89:2-3, 91:2-16.
Also at the Sell hearing, defendant testified concerning his competency*fn6 and his past experience with antipsychotic medication. In particular, defendant testified that he believes antipsychotic medication caused him to suffer severe depression and numbness in his extremities. Id. at 129:6-14, 130:1-7. He also stated that he is not delusional and that he does not need any treatment. Id. at 134:13-21. However, defendant then testified that he was "the King of Gia," was reincarnated as "Simon Peter" about 2,000 years ago, and that he would prove he was the "Star of Seven" at trial. Id. at 135:2-16.
Although an individual has a constitutionally protected interest in avoiding involuntary medication, that interest can be overcome by an "essential" or "overriding" state interest in some circumstances. Sell, 539 U.S. at 179-80. In particular, a court may order the administration of medication to ...