United States v. Dennis Grigsby, 2013 U.S. App. LEXIS 7286

Grigsby, an Ohio pretrial detainee with paranoid schizophrenia, challenged a district court order allowing involuntary medication to restore competency for bank robbery prosecutions.
Competency evaluations diagnosed Grigsby with paranoid schizophrenia; reports conflicted on his ability to understand wrongfulness but found he could not assist counsel.
Because Grigsby was not gravely disabled or dangerous, the doctors sought a Sell v. United States order to forcibly medicate to render him competent.
Experts predicted four to twelve months of involuntary antipsychotic treatment; side effects and future impact on trial could impair his ability to assist defense counsel.
The district court granted the medication order but stayed it; this appeal followed under the collateral order doctrine.
The majority reversed, concluding the government’s interest in prosecution was sufficiently tempered by potential lengthy civil commitment under 18 U.S.C. § 4246 and the possibility of insanity defense, and remanded for § 4246 proceedings.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Sell special circumstances lessen prosecution interest	Grigsby argues special circumstances lessen government interest.	Grigsby contends the government’s interest is tempered by potential civil commitment and fairness concerns.	Yes; special circumstances lessen prosecution interest and require reversal
Whether potential §4246 civil commitment is a valid special circumstance	Grigsby asserts §4246 risk of lengthy confinement reduces government interest.	Grigsby contends §4246 outcome is speculative and not established.	Yes; potential §4246 civil commitment supports mitigation of government interest
Whether length of pretrial confinement and possible sentencing align with Sell factors	Grigsby claims confinement duration and possible future sentence mitigate prosecution interest.	Grigsby argues speculative link between confinement length and sentence; not decisive.	Yes; potential confinement length and sentencing considerations weigh against forced medication
Whether the record shows medication would be medically appropriate and not interfere with fair trial	Grigsby asserts side effects could irreparably impair trial participation and counsel assistance.	Grigsby’s doctors testified medication would restore competency and side effects could be managed.	No; record lacks clear evidence that side effects would be substantially unlikely or that medication is necessary

Sell v. United States, 539 U.S. 166 (U.S. (2003)) (four-part test balancing government interest and individual rights to compel medication)
Washington v. Harper, 494 U.S. 210 (U.S. (1990)) (forced medication of convicted mentally ill inmates; medical interest and danger standard)
Riggins v. Nevada, 504 U.S. 127 (U.S. (1992)) (due process protections for mentally ill defendant; trial rights considerations)
United States v. Green, 532 F.3d 538 (6th Cir. 2008) (Sell factors and standard of review in competency-for-trial contexts)
Gutierrez, 704 F.3d 442 (5th Cir. 2013) (civil commitment considerations and government’s interest in prosecution under §4246)