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United States v. Gamarra

United States District Court, District of Columbia

October 12, 2018




         Before the Court is [31] the government's objection to Magistrate Judge Deborah A. Robinson's Report and Recommendation on the government's motion to involuntarily medicate defendant Jean-Paul Gamarra to restore him to competency. The Report and Recommendation denied the government's motion, holding that “treatment” is a statutory prerequisite for involuntary medication and that the government failed to meet that requirement. For the reasons that follow, this Court will set aside the Report and Recommendation.


         Gamarra was arrested outside the White House on March 28, 2017, after approaching United States Secret Service Officers with a package that he claimed contained a detonator for a nuclear device. United States v. Gamarra, 308 F.Supp.3d 230, 231 (D.D.C. 2018). Upon inspection, the package was found to “contain[] a Bluetooth keyboard, along with a note stating: ‘Warning this device is a threat on Senatar and President Life [sic].'” Id. (citation omitted). The government arrested and charged Gamarra with threatening the President in violation of 18 U.S.C. § 871 and threatening and conveying false information concerning the use of an explosive device in violation of 18 U.S.C. § 844(e). Id. at 232.

         On April 3, 2017, Gamarra underwent a preliminary competency screening and was found incompetent. Gov't's Mot. to Medicate Involuntarily Def. to Restore Competency (“Gov't's Mot.”) [ECF No. 22] at 3. A grand jury indicted Gamarra on April 4, 2017, on both charges, and the government requested that Gamarra be committed to the custody of the Attorney General for a thirty-day psychological examination to determine whether he was presently suffering from a mental disease or defect that rendered him incompetent. Id.

         This further screening followed at the Bureau of Prisons' Medical Correction Center, New York, New York (“MCC New York”). Id. A “Competency to Stand Trial Evaluation, ” dated June 14, 2017, and prepared by Forensic Psychologist Samantha E. DiMisa, Ph.D., at MCC New York (“Competency Evaluation”) concluded that Gamarra currently suffered from a mental disease and advised that Gamarra “does not possess a rational understanding of the proceedings against him” and did not have “capacity to adequately assist legal counsel in his defense or make decisions regarding his legal strategy.” Competency Evaluation at 18.

         After such a finding, a court may order that the defendant undergo further evaluation pursuant to 18 U.S.C. § 4241(d). That section provides that “[t]he Attorney General shall hospitalize the defendant for treatment in a suitable facility” for up to four months to determine whether competency can be restored and for a reasonable period afterwards until his “mental condition is so improved that trial may proceed” or until pending charges are “disposed of according to law.” 18 U.S.C. § 4241(d) (emphasis added). Having reviewed the competency evaluation, Magistrate Judge Robinson granted the government's motion to commit Gamarra, and he was transferred to Federal Medical Center Butner (“FMC Butner”) for further evaluation. Gamarra, 308 F.Supp.3d at 232.

         Gamarra arrived at FMC Butner in September 2017, underwent a physical examination, and participated in a series of interviews with Forensic Psychologist Evan S. Du Bois, Psy.D., and Psychology Intern Kelsey L. Laxton, who completed a forensic evaluation dated February 5, 2018. See Gov't's Ex. 2 (“Forensic Evaluation”) at 1-2.[1] Staff Psychiatrists Bryon Herbel, M.D., and Logan Graddy, M.D., consulted on Gamarra's treatment. Id. at 2. Laxton and Du Bois administered several standardized tests to Gamarra as part of their evaluation, including the Personality Assessment Inventory (“PAI”), Evaluation of Competency to Stand Trial, Revised (“ECST-R”), and the Revised Competency Assessment Instrument (“RCAI”). Id. at 2. Gamarra also voluntarily participated in two meetings of a competency restoration group. Id. at 8.

         Clinical Pharmacologist Laura Enman documented Gamarra's condition in a series of clinical encounter notes between October 2017 and March 2018. See Gov't's Ex. 12 (“Clinical Encounter Notes”). In October, Enman prescribed Gamarra quetiapine, an antipsychotic medication, and staff monitored his progress over several weeks. See Oct. 26, 2017, Clinical Encounter Note. Gamarra initially seemed willing to take medication, noting that it “helped him sleep” and reduced the effect of “the electrical waves” that Gamarra believed were affecting his mind. Id. Enman adjusted Gamarra's dosage several times at his request to encourage him to take the medication voluntarily as prescribed. See id. (reducing dosage from 400 to 300 mg due to reported hypersomnia); Mar. 12, 2018, Clinical Encounter Note (increasing dosage from 300 to 400 mg at Gamarra's request); Mar. 20, 2018, Clinical Encounter Note (reducing dosage from 400 to 300 mg at Gamarra's request). However, overall Gamarra exhibited poor compliance with his medication regimen, even though FMC Butner staff repeatedly encouraged him to take his medication as prescribed, and they (and Gamarra himself) noted improvement when he did so. See e.g., Forensic Evaluation at 6, 14.

         Gamarra's poor compliance ultimately “necessitated a lengthier examination period by Butner staff.” Gamarra, 308 F.Supp.3d at 233. In all, Gamarra spent more than six months committed to FMC Butner while staff prepared forensic reports. Id. Du Bois and Laxton ultimately concluded that Gamarra remained “[in]competent to proceed to trial” but that “his competency is likely to be restored with adherence to a medication regimen.” Forensic Evaluation at 14. Graddy similarly concluded that administration of antipsychotic medication was medically appropriate, that other interventions were unlikely to be beneficial without medication, and that the benefits of medication would outweigh the risks. Gov't Ex. 11 (“Forensic Addendum and Treatment Plan”) at 1, 3.

         During a March 8, 2018 hearing, the government requested a hearing to determine whether Gamarra could be involuntarily medicated to restore his competency pursuant to Sell v. United States, 539 U.S. 166 (2003). See Min. Entry of Mar. 8, 2018.[2] In Sell, the Supreme Court outlined four factors that the government must prove by clear and convincing evidence before a defendant may be involuntarily medicated to restore his competency to stand trial. Id. at 180-81; see United States v. Dillon, 738 F.3d 284, 291-92 (D.C. Cir. 2013). At the Sell hearing, which took place on April 13, 18, and 20, 2018, Evan Du Bois, Kelly Laxton, and Logan Graddy testified for the government.[3] On April 30, 2018, the government formally moved to involuntarily medicate Gamarra, arguing that it had met its burden of proof as to each of the four factors outlined in Sell. See Gov't's Mot. at 4-17. Gamarra opposed the motion, arguing that the government had failed to prove each of the Sell factors by clear and convincing evidence. See Def.'s Opp'n to Gov't's Mot. to Forcibly Medicate Def. [ECF No. 25] at 6-18.

         On August 24, 2018, Magistrate Judge Robinson filed a Report and Recommendation recommending that the government's motion to involuntarily medicate be denied due to its failure to provide “treatment” under 18 U.S.C. § 4241(d). R. & R. [ECF No. 29] at 8-9. She reasoned “that ‘treatment' during a 120-day hospitalization” as described in section 4241(d) “is a necessary predicate to a governmental request for authorization to involuntarily administer antipsychotic medication . . . to restore . . . competency.” Id. at 5. The magistrate judge noted that “no court” had ever applied such a standard. Id. However, she concluded that the Supreme Court's admonition in Sell that forced medication should be a “rare” occurrence required holding “that the government, as a factual prerequisite to a Sell motion, must demonstrate that the ‘treatment' mandated by the statute has been undertaken, albeit without the intended result.” Id. at 6. The magistrate judge explained that she “undertook a comprehensive review of the record herein in search of evidence that Defendant was afforded ‘treatment' during his 120-day hospitalization” and found none.[4] Id. at 6-9. In particular, she highlighted that Gamarra's treatment did not include “art therapy, music therapy, or individual therapy” including “talk therapy.” See id. at 6-7 (citation omitted). Because the magistrate judge found that the government had failed to provide the requisite “treatment, ” she denied the government's motion and “omitted any discussion of the four Sell factors.”[5] Id. at 9 n.8.


         A district court reviews de novo a magistrate judge's report and recommendation and “may accept, reject, or modify, in whole or in part, the findings or recommendations made by the magistrate judge” or “recommit the matter to ...

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