People v. LameedPeople v. Lameed
Ozro William Childs, under appointment by the Court of Appeal for Defendant and Appellant.
Kamala D. Harris, Attorney General, Gerald A. Engler, Chief Assistant Attorney General, Jeffrey M. Laurence, Assistant Attorney General, Catherine A. Rivlin and Bruce M. Slavin, Deputy Attorneys General, for Plaintiff and Respondent.
MÁRQUEZ, J.—Defendant Nurudeen Abiodun Lameed was charged with domestic violence (
Defendant challenges the trial court‘s order authorizing the involuntary administration of antipsychotic medication. He argues the order does not meet the constitutional requirements set forth in Sell v. United States (2003) 539 U.S. 166 (Sell) or the statutory requirements of
FACTS
Defendant was born and raised in Nigeria. He obtained a Bachelor of Science degree in computer science from the University of Ibadan in Nigeria in 1998. From 2006 until 2013, he lived in Montreal, Canada, and attended McGill University, where he received a Master‘s Degree and a Ph.D. in computer science. In November 2013, defendant got a job as a software engineer and moved to Santa Clara, California. By 2014, defendant had been married for 12 years and had three children. Defendant moved to California without his wife and children.
Prior Psychotic Episode
On March 17, 2014, defendant called 911 ” ‘after having numerous paranoid delusions that [had] been going on for some time.’ ” His delusions1
Defendant ended up in the emergency room of El Camino Hospital, where he was diagnosed with “psychosis NOS” (not otherwise specified) and admitted for a 72-hour hold under
At the time of his hospital admission, defendant was “unwilling to take antipsychotic medications,” which medications Dr. Gardner opined would be ” ‘quite helpful to relieve him of the stress of his numerous delusions.’ ” During his three-day hospital stay, defendant continued to refuse medications. He eventually agreed to try a medication called risperidone. He ” ‘reluctantly signed the consent form’ ” to take that medication, but never actually took it.
At the end of the 72-hour hold, the doctors concluded that defendant was no longer a danger to himself or others, or gravely disabled, and could no longer be held involuntarily. But Dr. Gardner nonetheless believed defendant required further treatment and reported that defendant had left the hospital “against medical advice.”
Defendant later stated that after his March 2014 hospitalization, he spoke with his family and “was able to get uplifted.” He arranged for his wife and children to move to Santa Clara at the end of March 2014. His wife later reported that they moved due to concerns about defendant‘s well-being.
Events That Resulted in Criminal Charges
On May 12, 2014, at approximately 8:40 a.m., defendant started arguing with his wife. He locked himself and his wife in the master bedroom suite
When police officers arrived, they had to force the bathroom door open. When the officers entered the bathroom, defendant looked at them and continued assaulting his wife. Defendant resisted the officers, so they used a Taser to accomplish the arrest.
Defendant‘s wife told the officers defendant had been ” ‘acting extremely strange lately,’ ” with significant changes in behavior for two weеks prior to the assault. The night before the assault, defendant was up all night, pacing, saying he wanted to die, and “crying profusely.” Defendant‘s wife reported that defendant was stressed at work and had been having financial problems for about a year. She stated that defendant had ” ’ “never laid a hand on her” in the past.’ ”
Defendant‘s wife complained of pain in her head, back, groin, and chest and was transported to a hospital for treatment. The couple‘s three children (ages nine, seven, and five) were taken into protective custody and dependency proceedings were filed as a result of the incident. In July 2014, the dependency proceedings were dismissed and defendant‘s wife and children returned to Canada.
Psychiatric Treatment in Jail
When defendant arrived at the jail, he was placed on a 72-hour hold (
When he was first incarcerated, the medical staff put defendant on antipsychotic medications—Ativan (two milligrams every six hours) and Zyprexa (10 milligrams per day). In July 2014, defendant was “complaining of Zyprexa.” The nature of the complaint is not described in the record. But after he complained, the dosage was increased to 15 milligrams per day and
PROCEDURAL HISTORY
In May 2014, the prosecution filed a complaint charging defendant with six felony counts: (1) assault with intent to commit a felony (
On October 27, 2014, the court declared a doubt as to defendant‘s mental competence, suspended the criminal proceedings, and certified the case to the general jurisdiction of the court to determine defendant‘s competence to stand trial.
On November 5, 2014, thе court appointed neuropsychologist Brent Hughey, Ph.D., to evaluate whether (1) defendant was mentally incompetent; (2) it was medically appropriate to treat him with antipsychotic medication; (3) defendant had the capacity to make decisions about such medications (
Court-ordered Evaluation by Dr. Hughey
Dr. Hughey interviewed defendant on November 10, 2014. He also reviewed the police report, the disposition report from the dependency proceeding, and defendant‘s medical records from El Camino Hospital and the jail. Defendant initially denied any prior mental health history, but when prompted, he acknowledged the 72-hour hold at El Camino Hospital “for ‘being depressed’ and ‘paranoid.’ ” He acknowledged that Dr. Gardner had wanted him to take medication, but stated, ” ‘in fact I do not need any medication.’ ” Defendant told Dr. Hughey he had refused medications (presumably while in jail), but also stated that he was on Zyprexa for ” ‘schizophrenia ... my confusion, to think straight ....’ ”
During the interview, defendant was adequately groomed and dressed in jail attire. He spoke in a “very soft, quiet voice in a frequently mumbling and stilted manner.” He had “considerable difficulty expressing himself with
Dr. Hughey concluded defendant was “quite clearly mentally ill but [was] making unsuccessful attempts to present himself in a more favorable manner.” He opined that defendant‘s refusal to take medications and his decision to leave the hospital against medical advice after the 72-hour hold in March 2014 “points to an untreated psychotic disorder.” He added that the auditory hallucinations, paranoid delusions, and claims of being controlled by others suggest a schizophrenic disorder. He noted that defendant continued to exhibit “significant symptoms despite his extended time in custody with psychotropic medication management.”
Dr. Hughey diagnosed “Psychosis NOS vs. Schizophrenia, Paranoid Type.” He opined that defendant‘s prognosis was guarded for both clinical and capacity issues and that defendant was mentally incompetent to stand trial. Although defendant demonstrated adequate understanding of the criminal proceedings, “his ability to assist counsel in a rational manner [was] markedly impaired.” Dr. Hughey concluded that it was medically appropriate to treat defendant with antipsychotic medications since he continued to exhibit a psychotic disorder. He added that use of antianxiety medications such as Ativan may help reduce some of defendant‘s anxiety, which is an important factor in his decompensation. He stated that defendant “will continue to require conservatorship for medications as he does not perceive any mental illness or need to utilize psychotropic medication.”
Dr. Hughey also opined that defendant did not have the capacity to make decisions about antipsychotic medication. He reasoned that defendant was “in frank denial over his obvious mental illness,” showed poor reasoning in general, had little understanding of his mental illness, and did “not believe that any medications are necessary and those that have been provided may be for sleep only.”
Finally, Dr. Hughey opined that defendant did not present a danger of inflicting harm on others. Dr. Hughey noted that although defendant had acted violently toward his wife, resisted the police officers, and exhibited unusual behavior upon his admission to the jail, he had not otherwise made active efforts to harm others or himself. Dr. Hughey recommended that defendant continue taking antipsychotic medication, opined that it is probable defendant would attempt to limit his use of medication, and suggested random blood testing tо monitor defendant‘s medication levels.
After receiving Dr. Hughey‘s report, the court appointed psychiatrist John Greene, M.D., to evaluate defendant. The court asked Dr. Greene to address the same four questions it had asked Dr. Hughey. Dr. Greene evaluated defendant on December 5, 2014, and filed his report with the court on February 27, 2015. Dr. Greene relied in part on Dr. Hughey‘s report.
Defendant told Dr. Greene he had never suffered from a psychiatric illness, delusions, or hallucinations. He also told Dr. Greene he was depressed after he was arrested, but was not depressed at the time of the evaluation. He said he had been taking Zyprexa and it helped him to sleep. Dr. Greene stated that during the evaluation, defendant “expressed substantial impairment in insight to his symptoms of mental illness.” Defendant said the repоrts of psychotic symptoms before and during the 72-hour hold at El Camino Hospital and at the time he assaulted his wife were not true, and that he did not suffer from a mental illness. But defendant was not able to provide an alternative explanation for the events described in the police report. He stated that although he had been given antipsychotic medication, he did not need to take it and does not suffer from psychotic thinking. Dr. Greene diagnosed “Psychotic Disorder Not Otherwise Specified.”
Dr. Greene reported that defendant was mentally incompetent to stand trial because he was unable to assist his attorney in conducting a defense in a rational manner due to his psychotic disorder. He also concluded it was “medically appropriate to treat defendant with antipsychotiс medication, given his current diagnosis and need for treatment,” and that defendant did not have the capacity to make decisions about such medications. Dr. Greene based his conclusion on defendant‘s “presentation of not understanding that he suffers from mental illness, and that medication has minimized his symptoms and improved his overall functioning.” Dr. Greene also opined that defendant did not present a danger of inflicting physical harm on others within the meaning of
Hearing on Involuntary Administration of Antipsychotic Medication
On March 11, 2015, the court conducted a hearing on defendant‘s competency to stand trial and found that defendant was incompetent. The court then (1) referred the case to South Bay Conditional Release Program (South Bay CONREP) for a recommendation on the appropriate trеatment setting for defendant (
Dr. Greene was the only witness at the hearing. Dr. Greene testified that his diagnosis was “psychotic disorder not otherwise specified,” which is recognized by the Diagnostic and Statistical Manual of Mental Disorders as a diagnosis. It is used when the evaluator does not have evidence to confirm a more specific psychotic diagnosis like schizophrenia or bipolar disorder. (See also American Psychiatric Assn., Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev., 2000) p. 298.) Dr. Greene initially testified it was not clear what illness defendant was suffering from—whether it was a brief psychotic disorder, or schizophrenia, or bipolar disorder. Dr. Greene later ruled out a brief psychotic disorder since defendant had two psychotic episodes more than 60 days apart.
Dr. Greene testified that psychotic disorder NOS can be treated with antipsychotic medications—that is how he usually treats patients with delusions—and that it is medically appropriate to treat defendant with such medications. There are several antipsychotic medication available and any one of them would be beneficial to defendant in reducing his delusions. Zyprexa, the antipsychotic defendant was taking in jail, is used for patients who suffer from delusions or bipolar disorder, or both. The usual dosage is five to 20 milligrams per day. Defendant was taking 15 milligrams per day while in jail.
Dr. Greene believes defendant‘s offenses were due to his psychotic disorder, which was untreated before he went to jail. Dr. Greene opined that if defendant is not treated with antipsychotic medication, he will become delusional again and exhibit further violent behavior related to his delusions. He based his opinion on the victim‘s report that defendant was not acting like himself for a day or two before his crimes and the fact that defendant‘s offenses involved violent conduct.
Dr. Greene testified that if defendant is not treated with antipsychotic medication, there is a risk he will decompensate and become gravely
Regarding side effects, Dr. Greene asked defendant whether he was having any problems on Zyprexa. Defendant said Zyprexa helped him fall asleep. Dr. Greene did not know whether defendant thought this was a beneficiаl effect since it is very difficult to sleep in jail. Dr. Greene also asked defendant whether the Zyprexa affected his diabetes. Defendant did not report any problems. Dr. Greene disagreed with the assertion that all antipsychotic medications affect diabetes and stated that a treating physician would monitor the effects of the medication with lab work. Dr. Greene did not ask defendant about any other specific side effects defendant may have been experiencing.
Trial Court‘s Order on Capacity to Make Decisions Regarding Medication
On April 20, 2015, the court found “by clear and convincing evidence that defendant does not have the capacity to consent to antipsychotic medications, [his] mental disorder requires medical treatment with antipsychotic medication, and, if [his] mental disorder is not treated with antipsychotic medication, it is probable that serious harm to the physical or mental health of the patient will result.” The court also found “that sufficient evidence has been presented that the defendant is presently suffering adverse effects to his physical or mental health.” Specifically, the court found “that [defendant‘s] inability to recognize his mental illness, his lack of insight into his actions and denial of past events are evidence of the adverse effects of his current illness.” The court ordered that “defendant may be involuntarily medicated while in placement” pursuant to
One week later, on April 27, 2015, the court filed its order committing defendant to the State Department of State Hospitals. The court ordered that defendant “may be involuntarily administered antipsychotic medication by the Department of State Hospitals in the dosage and frequency deemed necessary by the treatment staff.” The court stated that its order shall expire
When the court issued its order of commitment, defendant made a motion to stay the order pending appeal, which the trial court denied. The court reasoned that defendant will receive better treatment at the state hospital than at the local jail and that it is in defendant‘s best interest and the court‘s interest to have his capacity restored forthwith.
DISCUSSION
I. Legal Principles Governing Involuntary Administration of Antipsychotic Drugs
Since both parties rely on Sell, we begin with a brief discussion of the constitutional standards in Sell, which apply when the court orders involuntary medication with antipsychotic medication to render the defendant competent to stand trial. (Sell, supra, 539 U.S. at pp. 181–182.) We will then review the statutory requirements for involuntary administration of antipsychotic medication under
A. Constitutional Requirements Under Sell v. United States
The United States Supreme Court has recognized that “an individual has a ‘significant’ constitutionally protected ‘liberty interest’ in ‘avoiding the unwanted administration of antipsychotic drugs.’ [Citation.]” (Sell, supra, 539 U.S. at p. 178, quoting Washington v. Harper (1990) 494 U.S. 210, 221.)
In Sell, the court held that the “Constitution permits the Government involuntarily to administer antipsychotic drugs to a mentally ill defendant facing serious criminal charges in order to render that defendant competent to stand trial” if the court finds that four factors support such an order. (Sell, at pp. 179–181.)
“First, a court must find that important governmental interests are at stake.” (Sell, supra, 539 U.S. at p. 180, original italics.) The state‘s interеst in bringing a person accused of a serious crime to trial is important, but the court must evaluate each case individually to determine whether there are facts that may lessen that importance. In addition to its interest in timely prosecution, the state “has a concomitant, constitutionally essential interest in
Although constitutionally permitted, orders for involuntary medication with antipsychotic drugs are disfavored and should be issued only upon a compelling showing. (Carter v. Superior Court (2006) 141 Cal.App.4th 992, 1000, citing U.S. v. Rivera-Guerrero (9th Cir. 2005) 426 F.3d 1130, 1137–1138.)
The Sell factors apply only when the purpose of involuntary medication is to render the defendant competent to stand trial. As the United States Supreme Court explained in Sell, the trial court need not consider the Sell factors “if forced medication is warranted for a different purpose,” such as “the individual‘s dangerousness, or purposes related to the individual‘s own interests where refusal to take drugs puts his health gravely at risk. [Citation.] There are often strong reasons for a court to determine whether forced administration of drugs can be justified оn these alternative grounds before turning to the trial competence question.” (Sell, supra, 539 U.S. at p. 182.) The focus of the inquiry with respect to a request to administer antipsychotic medication for “trial competence purposes” is “upon such questions as: Why is it medically appropriate forcibly to administer antipsychotic drugs to an individual who (1) is not dangerous and (2) is competent to make up his own mind about treatment?” (Id. at p. 183, original italics.)
B. Requirements Under Section 1370
Under
The California Legislature amended
Under the first prong (
The third prong of
“If the court finds any of the conditions described in [the three prongs of subdivision (a)(2)(B)(i)] to be true, the court shall issue an order authorizing involuntary administration of antipsychotic medication to the defendant when and as prescribed by the defendant‘s treating psychiatrist at any facility housing the defendant for purpоses of this chapter.”4 (
II. Standard of Review
We review the trial court‘s order authorizing the involuntary administration of antipsychotic medication to defendant for substantial evidence. (O‘Dell, supra, 126 Cal.App.4th at p. 570.)
A. The Sell factors and the third prong of section 1370, subdivision (a)(2)(B)(i)(III) do not apply in this case.
Defendant contends there is insufficient evidence to support the trial court‘s order permitting involuntary administration of antipsychotic medication under the standards set forth in Sell and the third prong of
Defendant‘s reliance on Christiana and O‘Dell is misplaced. Both of those cases recognize that the Sell factors and the third prong of
In this case, the court found that defendant lackеd capacity to make decisions regarding antipsychotic medication under the first prong of
B. Substantial evidence supports the court‘s order.
We turn next to the question whether there was substantiаl evidence to support the court‘s order under the first prong. To order involuntary administration of antipsychotic medication under the first prong, a trial court must find the following three facts true: “The defendant lacks capacity to make decisions regarding antipsychotic medication, the defendant‘s mental disorder requires medical treatment with antipsychotic medication, and, if the defendant‘s mental disorder is not treated with antipsychotic medication, it is probable that serious harm to the physical or mental health of the patient will result.” (
First, there was substantial evidence that “defendant lack[ed] capacity to make decisions regarding antipsychotic medication.” (
In November 2014, defendant acknowledged that Dr. Gardner had wanted him to tаke antipsychotic medication, but he told Dr. Hughey: “in fact I do not need any medication.” Dr. Hughey opined that defendant had an “untreated psychotic disorder,” and that he did not have the capacity to make decisions about antipsychotic medication. Dr. Hughey reasoned that defendant was “in frank denial over his obvious mental illness,” showed poor reasoning in general, had little understanding of his mental illness, and did “not believe that any medications are necessary and those that have been provided may be for sleep only.” Although Dr. Hughey recommended defendant continue taking antipsychotic medication, he opined that it is
When defendant saw Dr. Greene in Decеmber 2014, he “expressed substantial impairment in insight to his symptoms of mental illness.” Defendant said the reports of psychotic symptoms in March 2014 and at the time he assaulted his wife were not true, and he did not suffer from a mental illness. He also told Dr. Greene that although he had been given antipsychotic medication, he did not need to take it and does not suffer from psychotic thinking. Dr. Greene concluded that defendant did not have the capacity to make decisions about antipsychotic medication based on defendant‘s “presentation of not understanding that he suffers from mental illness, and that medication has minimized his symptoms and improved his overall functioning.”
Second, substantial evidence supported the trial court‘s finding that “defendant‘s mental disorder requires medical treatment with antipsychotic medication.” (
Third, there was substantial evidence that if “defendant‘s mental disorder is not treated with antipsychotic medication, it is probable that serious harm to the physical or mental health of the patient will result.” (
As the trial court found, there was ample evidence that defendant was “presently suffering adverse effects to his physical or mental health.” Defendant‘s psychotic disorder was not treated before he went to jail. After being incarcerated, defendant was housed in a psychiatric or special unit of the jail, and he was taking antipsychotic medicаtion. He initially required a 72-hour hold and suicide watch in jail because he was gravely disabled and a danger to himself. That hold was later extended by 14 days and then converted to a temporary conservatorship. Dr. Hughey opined that defendant “will continue to require conservatorship for medications as he does not perceive any mental illness or need to utilize psychotropic medication.” He observed that defendant had considerable difficulty expressing himself, his speech and thought patterns were markedly disorganized, and he continued to exhibit “significant symptoms despite his extended time in custody with psychotropic medication management.” Both experts agreed that defendant was sufficiently mentally disabled that his ability to assist counsel in a rational manner was markedly impaired. And, as we have noted, Dr. Greene testified that if defendant is not treated with antipsychotic medication, he will have a recurrence of his delusions and symptoms (including suicidal ideation), may exhibit further violent behavior related to his delusions, and there is a risk he will decompensate and become gravely disabled. For these reasons, we conclude there was substantial evidence to support the trial court‘s order under the first prong of
Defendant argues that the “time to consider issuing an order for involuntary medication is when or if, in [the] custodial setting [of the state hospital], appellant actually refuses to take his medication.” This argument ignores the express language of
The order for involuntary administration of antipsychotic medication in the state hospital is affirmed.
Rushing, P. J., and Grover, J., concurred.
Appellant‘s petition for review by the Supreme Court was denied August 10, 2016, S235172.