Warren v. State, 297 Ga. 810

Background

Jesse James Warren indicted for a 2010 mass shooting (four murders, one paralysis); State seeks death penalty. Warren found incompetent to stand trial and confined to a state psychiatric hospital since May 2013.
State moved to involuntarily medicate Warren to restore competency; trial court held an evidentiary Sell hearing and granted the motion in a brief written order. Warren appealed.
The hearing featured contested expert testimony: State experts (psychiatrist Dr. Schief and psychologist Dr. Hughey) testified medication could substantially likely restore competency but gave no specific, agreed treatment plan; defense experts (treating psychiatrist Dr. Kane, psychologist Dr. Currence, and pharmacologist Dr. Morton) emphasized limited efficacy for long‑standing delusional disorder and substantial medical risks (age, diabetes, hypertension, prior adverse reactions).
The trial court’s order recited Sell language but did not specify which drugs, dose ranges, duration, or oversight; it also did not address whether the State had sought involuntary medication for dangerousness (Harper grounds) before pursuing Sell relief.
The Georgia Supreme Court reviewed the record, applied Sell, found multiple deficiencies (especially lack of an individualized, specific treatment plan and failure to consider less intrusive alternatives and Harper grounds), vacated the order, and remanded for further proceedings and updated evidence if the State re‑files the motion.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether Sell v. United States governs involuntary medication to restore competency	Warren argued Sell applies and requires (inter alia) specific findings tied to an individualized treatment plan; the order lacked required specificity	State argued Sell burden met and that detailed plan before an order is impractical because response requires trial-and-error	Court held Sell governs; first prong reviewed de novo, others for clear error; ordered Sell requirements strictly applied and reversed because order lacked specificity
Standard of review and burden of proof on Sell factors	Warren contended deferential review and burden should protect liberty interests	State contended trial court’s factual findings deserve deference	Court held: first Sell factor (governmental interest) is legal (de novo review); remaining factors are factual (clear-error); State bears burden by clear and convincing evidence
Sufficiency of findings re: whether medication will substantially further governmental interests and trial-related side effects	Warren argued the State failed to specify drugs/doses/duration, so predictions of efficacy and trial-related side effects were unsupported	State argued expert testimony showed substantial likelihood of restoration and side effects unlikely; detailed plan cannot be formulated before authorization	Court held findings insufficient: court must review a concrete, individualized treatment plan (drugs, dose limits, duration, monitoring) to assess efficacy and trial‑related side effects; blanket authorization improper
Necessity and consideration of less intrusive alternatives (including Harper remedies)	Warren argued court failed to consider less intrusive means (contempt orders, voluntary options) and did not show necessity; also court failed to ask why Harper grounds were not pursued	State argued forcible medication was necessary to avoid undue delay in prosecution and that clinicians need flexibility	Court held trial court failed to consider less intrusive measures and did not address whether Harper-type involuntary treatment for dangerousness was sought or why not; necessity finding inadequate without those considerations

Key Cases Cited

Sell v. United States, 539 U.S. 166 (establishes four‑part test for involuntary medication to restore competency)
Addington v. Texas, 441 U.S. 418 (clear and convincing evidence standard required in certain civil commitment contexts)
Washington v. Harper, 494 U.S. 210 (permissibility of involuntary medication for dangerousness/medical reasons)
United States v. Diaz, 630 F.3d 1314 (11th Cir.) (applied Sell; affirmed when government presented detailed individualized treatment plan)
United States v. Chavez, 734 F.3d 1247 (10th Cir.) (vacated where order granted unfettered discretion without specifying medications/doses)