323 Conn. 115
Conn.2016Background
- Defendant Lishan Wang, charged with murder and related offenses (2010), was found incompetent to stand trial twice; after the second finding (2015) the court considered forcible medication to restore competency.
- Psychiatrist Mark S. Cotterell and psychiatric advanced practice nurse Gail Sicilia evaluated Wang at Whiting Forensic Division and recommended antipsychotics (Olanzapine, Ziprasidone); Wang refused medication claiming no disorder.
- Cotterell testified based on clinical experience and literature that these medications have a mid-50% to 70% likelihood of restoring competency; Sicilia opined medications were in Wang’s best medical interest and no less intrusive effective alternatives existed.
- Trial court applied the Sell v. United States framework, found by clear and convincing evidence that forcible medication was (1) substantially likely to restore competency, (2) substantially unlikely to produce side effects that would render trial unfair, (3) necessary because less intrusive alternatives were unlikely to succeed, and (4) medically appropriate/in Wang’s best interest, and ordered forcible medication.
- Connecticut Supreme Court affirmed, defining “substantially likely” under Sell to mean “more likely than not” (greater than 50% probability) and reviewing factual findings for clear error.
Issues
| Issue | Plaintiff's Argument (State) | Defendant's Argument (Wang) | Held |
|---|---|---|---|
| Whether forcible medication is “substantially likely” to restore competency under Sell | Cotterell’s testimony and literature show a >50% (mid-50s–70%) chance; that meets Sell’s standard | A 55–70% success rate is not a "substantial likelihood"; expert testimony was too generalized for Wang’s specific condition | Court: “substantially likely” means >50%; Cotterell’s evidence met the clear-and-convincing standard; holding for State |
| Whether medication is substantially unlikely to have side effects that would impair a fair trial | Evidence shows limited/monitorable sedation risk; staff monitoring reduces trial-impact risk | Side effects (e.g., sedation, other risks) could impair trial fairness or be permanent | Court: Findings supported by clear-and-convincing evidence; short-term sedation unlikely to force denial of medication |
| Whether less intrusive alternatives could achieve same results | Current nonpharmacological care at Whiting had failed to restore competency; psychotherapy/education previously used had been ineffective this admission | Past restoration via therapy suggests nonpharmacologic options might work again | Court: Testimony supported conclusion alternatives unlikely to achieve substantially same result |
| Whether forced medication is medically appropriate / in patient’s best interest | Sicilia testified medication would reduce delusions and improve functioning; benefits for health and for restoring competency | Forcing meds to get to trial then stopping may entrench delusions or harm long-term trust; risks not adequately proven harmless | Court: Sicilia’s testimony sufficed; no evidence rebutting that medication was in Wang’s best medical interest |
Key Cases Cited
- Sell v. United States, 539 U.S. 166 (2003) (establishes four-part test permitting involuntary antipsychotic medication to restore trial competency)
- Riggins v. Nevada, 504 U.S. 127 (1992) (recognizes constitutionally protected liberty interest against involuntary antipsychotic drugging)
- Washington v. Harper, 494 U.S. 210 (1990) (framework for due process limitations on involuntary medication of inmates)
- State v. Seekins, 299 Conn. 141 (2010) (discusses Sell factors and Connecticut application)
- State v. Garcia, 233 Conn. 44 (1995) (Connecticut precedent on forcible medication; clear-and-convincing proof requirement)