The opinion of the court was delivered by: Honorable Barry Ted MoskowitzUnited States District Judge
ORDER RE INVOLUNTARY MEDICATION ORDER
On January 19, 2011, the Court held an evidentiary hearing pursuant to Sell v. United States, 539 U.S. 166 (2003), to determine whether the government would be permitted to forcibly medicate Defendant for the purpose of rendering him competent to stand trial. For the reasons that follow, the Court DENIES the government's request for entry of an order to involuntarily medicate Defendant.
Defendant is charged with violating 18 U.S.C. § 115(a)(1)(B) for threatening to kill a United States Judge and 18 U.S.C. § 876(c) for mailing a threatening communication to a United States Judge. On May 12, 2010, the Court held a competency hearing and found Defendant incompetent to stand trial. [Dock. #34.] The Court then temporarily committed Defendant to a Bureau of Prisons medical facility to determine whether he could be restored to mental competency such that proceedings could go forward. [Dock. #43]
On August 11, 2010, Dr. Patrick Gariety of the United States Medical Center for Federal Prisoners in Springfield, Missouri ("Springfield") issued a report concluding that Defendant did not meet the criteria for involuntary medication under Washington v. Harper, 494 U.S. 210 (1990), because he was not a danger to himself or others in the institutional context. (Def. Exh. [hereinafter "Exh."] A)
On September 8, 2010, Dr. Robert G. Sarrazin of Springfield issued a psychiatric report diagnosing Defendant with chronic paranoid schizophrenia for Axis I of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision ("DSM-IV TR"). (Exh. C at 8) This report conflicts with several prior Bureau of Prisons evaluations where Defendant had been diagnosed with a specific type of delusional disorder. In 2004, Defendant was diagnosed with methamphetamine induced psychotic disorder with delusions; in 2007, he was diagnosed with delusional disorder persecutory type; and most recently, in May of 2010, Defendant was again diagnosed with delusional disorder, persecutory type. (Id. at 2; Exh. E at 5)*fn1
Dr. Sarrazin states that the diagnosis of chronic paranoid schizophrenia is based on Defendant having "a history of greater than six months of delusions, hallucinations, and disorganized speech." (Exh. C at 3-4) Dr. Sarrazin does not discuss at length the basis for changing Defendant's diagnosis, stating only, "Delusional disorder is a psychotic disorder like chronic paranoid schizophrenia. At this time, it appears that the diagnosis of paranoid schizophrenia better fits Mr. Barajas-Bandt's current presentation and past history." (Exh. C at 4) Dr. Sarrazin's report then provides a proposed treatment plan for Defendant's illness that consists primarily of second generation antipsychotic medicine, but also includes haloperidol ("Haldol"), a first generation antipsychotic. (See id. at 13-15; Exh. G at 1-2)
In a September 21, 2010 report, Defendant's expert, Dr. Mark A. Kalish, questioned Dr. Sarrazin's diagnosis of schizophrenia because there was no evidence that Defendant suffered from hallucinations or any other Criterion A symptom of schizophrenia other than delusions. (Exh. F at 3) Nevertheless, he opined that the proposed treatment plan "is reasonable, appropriate, and consistent with currently accepted practice guidelines." (Id. at 2) Dr. Kalish explained that although antipsychotic medications are less effective in treating a delusional disorder than they are in treating chronic schizophrenia, "[t]hat is not to say that they do not provide some benefit in reducing the intensity of the delusions or helping the individual disidentify from their delusional beliefs." (Id. at 3)
"The government is allowed to medicate a defendant involuntarily for the purpose of rendering him competent to stand trial only in rare circumstances." United States v. Ruiz-Gaxiola, 623 F.3d 684, 687, 688 (9th Cir. 2010). Orders authorizing forcible medication for this purpose are disfavored. Id.
Under Sell v. United States, 539 U.S. 166, 180-81 (2003), the government may forcibly administer drugs to a mentally ill defendant in order to render him competent for trial only when the following factors are met:
1. "[A] court must find that important governmental interests are at stake."
2. "[T]he court must conclude that involuntary medication will significantly further those concomitant state interests. It must find that administration of the drugs is substantially likely to render the defendant competent to stand trial. At the same time, it must find that administration of the drugs is substantially unlikely to have side effects that will interfere significantly with the defendant's ability to assist counsel in conducting a trial defense, thereby rendering the trial unfair."
3. "[T]he court must conclude that involuntary medication is necessary to further those interests. The court must find that any alternative, less intrusive treatments are ...