Case Information
Before BOWMAN, Circuit Judge, HENLEY, Senior Circuit Judge, and MORRIS SHEPPARD ARNOLD, Circuit Judge.
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BOWMAN, Circuit Judge.
*2
Reginald Morgan filed suit under 42 U.S.C. § 1983 (1994) claiming that Dr. John Rabun and his staff administered psychotropic drugs to Morgan against his will in violation of his rights under the Due Process Clause of the Fourteenth Amendment. Dr. Rabun was Morgan's treating physician at the St. Louis State Hospital, where Morgan had been committed. The District Court granted summary judgment in favor of the defendants. Morgan now aрpeals the judgment of the District Court. We affirm.
I.
In November 1992, Morgan was indicted for first degree assault, armed criminal action, and unlawful use of a weapon. Morgan had allegedly stabbed a man with a butcher knife. The state trial court found that based upon a psychiatric evaluation of Morgan, he "lack[ed] the mental fitness to proceed" with trial and ordered Morgan committed for evaluation to the custody of the Director of the Department of Mental Health. Appellant's App. at 737. Morgan was admitted to St. Louis State Hospital on February 22, 1993.
In March 1994, the court ordered that Morgan stand acquitted of the charges "on the ground of mental disease or defect excluding responsibility." Id. at 739. The court committed Morgan "for care and treatment" to the Director of the Department of Mental Health. Id. The court noted that Morgan "suffers from Schizophrenia Chronic Paranoid Type." Id. at 738.
Dr. Rabun was Morgan's treating physician at the State Hospital from February 22, 1993 until August 11, 1994. Upon Morgan's admission on February 22, Dr. Rabun performed a psychiatric examination and filled out an assessment report. In the report, Dr. Rabun wrote:
*3 The patient was uncooperative in general and evidenced an aloof/suspicious demeanor. . . . The patient was markedly hostile on exam and even began the interview by stating "I am hostile." The patient made numerous threats during the interview . . . [like] "you are nagging me like an animal, usually people get in trouble when they nag me like an animal." The patient stated that he had "homicidal ideas but I am not going to tell you about any of that.” . . . The patient . . . had the evident hostile and threatening demeanor.
Id. at 699-700. Morgan also admitted to Dr. Rabun that he had previously been convicted of murder and served time in the state penitentiary. Id. at 697. Based upon "the nature of the charges against him and his hostility towards [Dr. Rabun] and overt threats," Dr. Rabun found Morgan "obviously dangerous to others" and authorized forced medication. Id. at 701. On February 22, he was given an injection of psychotropic medication.
The second occasion on which Morgan was forcibly administered psychotropic medication was July 21, 1993. Morgan had become agitated in the patient lounge and began knocking pool balls and swinging a pool cue. He tore the net off of a ping pong table and tried to tear the metal brackets. Morgan told the staff, "I'm losing my mind, I'm going crazy, I can't control myself." Id. at 570. Morgan admits making these statements. Morgan Aff. para. 6. Dr. Rabun ordered an injection and five-point leather restraints "so that both the patient and others would not be in danger." Rabun Aff. para. 14.
Except for the two forced injections, Morgan typically drank his oral medication without incident. On occasion Morgan would refuse or spit out the medication. *4 Morgan admits, however, that the medications were never forcibly administered when he refused to comply with his treatment. Morgan Dep. at 31-32.
II.
Morgan claims that Dr. Rabun administered these psychotropic medications in violation of the Due Process Clause of the Fourteenth Amendment. Specifically, Morgаn argues that Dr. Rabun violated his substantive due process rights on the two occasions when Morgan was forcibly injected. Morgan also asserts that Dr. Rabun's decision to treat Morgan involuntarily with psychotropic medications on a daily basis violated his procedural due process rights. Because we agree that the undisputed facts establish that Morgan's due process rights were not violated, we affirm the District Court's grant of summary judgment.
We review a grant of summary judgment de novo. See Coplin v. Fairfield Pub.
Access Television Comm.,
We must dеtermine whether Morgan’s evidence is sufficient to allow a reasonable
jury to find that Dr. Rabun violated Morgan's due process rights. The issue necessarily
has "both substantive and procedural aspects." Washington v. Harper,
A. Substantive Due Process
Under the Due Process Clause of the Fourteenth Amendment, there is no doubt
that Morgan "possesses a significant liberty interest in avoiding the unwanted
administration of antipsychotic drugs." Harper,
Before we discuss the federal constitutional aspects of substantive due рrocess,
however, we must first determine to what extent, if any, Missouri's applicable state laws
provide additional protections. The Federal Due Process Clause defines only the
minimum protections required. State law, however, may recognize more extensive
liberty interests than the Federal Constitution. See Mills,
1. No patient, resident or client of a residential facility or day program operated, funded or licensed by the department [of mental health] shall be subject to physical or chemical restraint, isоlation or seclusion unless it is determined by the head of the facility or the attending licensed physician to be necessary to protect the patient, resident, client or others.
*6 Mo. Rev. Stat. § 630.175.1 (1986). Chemical restraint is defined as:
[M]edication administered with the primary intent of restraining a patient who presents a likelihood of serious physical injury to himself or others, and not prescribеd to treat a person's medical condition.
Mo. Rev. Stat. § 630.005.1.(3) (Supp. 1991). These Missouri statutes create no additional rights that extend beyond the Federal Constitution. The statute requires no more than the constitutional requirement discussed infra--a finding that the patient presents a danger to himself or others. Therefore, the Federal Due Process Clause sets the standard by which to determine whether Dr. Rabun violated Morgan's substantive rights.
The Supreme Court has held that "given the requirements of the prison
environment, the Due Process Clause permits the State to treat a prison inmate who has
a serious mental illness with antipsychotic drugs against his will, if the inmate is
dangerous to himself or others and the treatment is in the inmate's medical interest."
Harper,
Our role is not to determine conclusively that Morgan was indeed dangerous.
Rather, we must simply make certain that Dr. Rabun exercised professional judgment
in making the determination that Morgan was dangerous. See Youngberg,
We find that on both instances when Morgan was forcibly injected, Dr. Rabun exercised his professional judgment in determining that Morgan was dangerous. The first time Morgan was injected was upon his admission to the hospital. Dr. Rabun determined that Morgan was dangerous based upon the nature of the crime that led to his commitment and his hostile demeanor. Morgan denies saying that he had homicidal ideas or that he made any threats when he was admitted. He claims this is a question of fact that should bе decided by a jury. But even if we accept Morgan's self-serving denials as true, there is still enough other evidence to satisfy us that Dr. Rabun exercised his professional judgment in concluding that Morgan was dangerous. Morgan had just been committed to the state hospital for stabbing a man based upon active psychotic beliefs. Prior to that, Morgan also had committed murder. In the admission interviеw, Dr. Rabun had detailed his observations of Morgan and recorded portions of their conversations. The assessment report clearly indicates Morgan was *8 unstable and potentially dangerous. In fact, Morgan admits telling Dr. Rabun in the interview that he was hostile. Finally, Morgan points out that he had been in city jail for six months prior to his hospital admission without medication and did not cause injury to himself or others. But the fact that Morgan was in such a volatile atmosphere for six months, unmedicated, and harboring active psychotic beliefs actually weighs in favor of Dr. Rabun's determination that he was potentially dangerous.
The second occasion on which Dr. Rabun authorized a forced injection was when
Morgan began swinging a pool cue, knocking pool balls, and teаring up a ping-pong
table in the patient lounge. Morgan told the staff he was going crazy and losing control.
In this situation, Dr. Rabun clearly exercised professional judgment in determining that
Morgan was a danger to himself and others. Even though Morgan claims it was his
medication that caused him to lose control, he is not qualified to make this determination.
See Kayser v. Caspari,
B. Procedural Due Process
Morgan claims his procedural due process rights were violated when Dr. Rabun decided to treat Morgan with antipsychotic drugs for almost eightеen months. Procedural due process involves ascertaining "whether the State's nonjudicial mechanisms used to determine the facts in a particular case are sufficient." Harper, 494 U.S. at 220. From February 22, 1993 through August 11, 1994, Dr. Rabun and his staff administered oral medications to Morgan. On most occasions, Morgan took the medications. Morgan contends, however, that on each day he took his medications orally, it was involuntary.
Like substantive due process, procedural due process is intertwined with state
law issues. See Mills,
Morgan is alleging a procedural due process violation only with respect tо the daily, oral doses of medication. The applicable Missouri statute reads:
Subject to other provisions of this chapter, the head of a mental health or mental retardation facility may authorize the medical and surgical treatment of a patient or resident under the following circumstances: (1) Upon consent of a patient or resident who is competent; (2) Upon consent of a parent or legal guardian of a patient or resident who is a minor or legally incapacitated;
(3) Pursuant to the provisions of chapter 431, RSMo; (4) Pursuant to an order of a court of competent jurisdiction.
Mo. Rev. Stat. § 630.183 (1986) (emphasis added). The procedures set forth in this statute create no additional constitutionally protected interests. In Hewitt v. Helms, 459 U.S. 460, 472 (1983), the Supreme Court held that state laws setting forth procedural restrictions take on constitutional significance only if those laws contain "explicitly mandatory language in connection with requiring specific substantive predicates."
The Supreme Court has rejected the Hewitt methodology when the source of the claimed liberty interest derives from a prison regulation. See Sandin v. Connor, 515 U.S. 472, 480-84 (1995). The Supreme Court held that instead of searching for mandatory language in a prison regulation, courts should examine whether the claimed violation "present[s] the type of atypical, significant deprivation in which a State might conceivably create a liberty interest." Id. at 486. Sandin, however, does not apply to *10 this case. In Sandin, the Court specifiсally limited its reasoning to prison regulations: [The search for negative implication from mandatory language] may be entirely sensible in the ordinary task of construing a statute defining rights and remedies available to the general public. It is a good deal less sensible in the case of a prison regulation primarily designed to guide correctional officials in the administration of a рrison.
Id. at 481-82. Here we are dealing with a state statute promulgated under a scheme
which delineates its goals solely "for the citizens of this state," i.e., the general public,
rather than a prison regulation. Mo. Rev. Stat. § 630.020.1 (1986). Moreover, the
Supreme Court reasoned that prison regulations should be analyzed differently than other
statutes because "such regulations [are] not designed to confer rights on inmates."
Sandin,
Because Sandin does not apply, we return to the Hewitt analysis. Section 630.183
does not use "mandatory" language in describing limits placed upon state оfficials'
conduct. See Dautremont v. Broadlawns Hosp.,
Therefore, we look only to the Due Proсess Clause in determining what minimum procedures are required. In determining what procedures are required under the Due Process Clause, we balance the private interest at stake, the risk of erroneous deprivation of such interest, and the governmental interests involved. See Mathews v. Eldridge, 424 U.S. 319, 335 (1976).
We need not perform the Mathews balancing test, however, because Morgan’s
evidence fails to create a fact issue as to whether he took these oral medications
voluntarily. Morgan claims his compliance was involuntary because he feared that his
refusal to cooperate would result in the forced administration of the medication. But
Morgan admits that he was never forced to take the medicine when he did refuse to
comply. Moreover, nothing in the record establishes that Dr. Rabun knew Morgan was
taking the medicine out of fear. Only if Morgan had made Dr. Rabun aware that his
consent was involuntary could Dr. Rabun have attempted to jump through any necessary
procedural hoops. See Doby v. Hickerson,
In fact, the record suggеsts the opposite. For instance, on April 12, 1993, when Dr. Rabun changed Morgan's daily medication from Haldol to Prolixin, he wrote "[Patient] requesting a [change] in medications. Wants to [discontinue] his Haldol and agrees to a trial of Prolixin; side effects explained to [patient] . . . ." Appellant's App. at 712. This suggests Morgan was taking both medications on a voluntary basis and shows that Dr. Rabun honored Morgаn's request to stop taking Haldol. Morgan cannot now simply rest on bare assertions. Otherwise, plaintiffs such as Morgan could avoid summary judgment merely by asserting they took their prescribed medication out of fear. There was no constitutional violation because the record shows that Morgan voluntarily took his medication.
In conclusion, we hold that Dr. Rabun did not violate Morgan's substantive due process rights, nor did he violate Morgan's procedural due process rights. Accordingly, we affirm the District Court's grant of summary judgment.
A true copy.
Attest:
CLERK, U. S. COURT OF APPEALS, EIGHTH CIRCUIT
Notes
[1] Judge Henley died on October 18, 1997. This opinion is consistent with his vote at the panel’s conference following oral argument of the case on September 12, 1997.
[2] The Honorable Jean C. Hamilton, Chief Judge, United States District Court for the Eastern District of Missouri.
[3] Although Morgаn admits he told Dr. Rabun he was hostile, Morgan denies saying "that [he] had homicidal ideas or that 'people who keep nagging me like animals could get hurt,' or any statements of similar import." Morgan Aff. para. 4.
[4] In their briefs, neither party discusses relevant Missouri state law and its
potential effect on the substantive due process question. We engage in the discussion
because "[f]or purpоses of determining actual rights and obligations . . . questions of
state law cannot be avoided." Mills v. Rogers,
[5] The District Court stated that section 630.175.1 and section 630.005.1(3) did not apply "[b]ecause [Morgan] received the involuntary injections of haldol and prolixin as part of a treatment regimen and not as a form of chemical restraint." Morgan v. Rabun, No. 4:94CV909, Mem. and Order at 8 (E.D. Mo. Nov. 26, 1996). However, upon еxamination of Dr. Rabun's actual prescription orders, it seems clear that the forced injections were used as a form of chemical restraint. See Appellant's App. at 705. Dr. Rabun ordered Haldol and Ativan intramuscular (by injection) or orally "prn-agitation," meaning as needed for agitation. Id. He added that the two medications could be given concurrently. See id. In addition, Dr. Rabun wrote a standing order for oral Haldol to be taken at bedtime everyday, see id., which he later changed to Prolixin. See id. at 712. Injections of Haldol and Ativan were to be given only if Morgan became agitated--these were not part of his daily treatment regimen. Rather, the "primary intent" of the injections was to restrain Morgan if he got out of hand. The standing orders for daily, oral Haldol and Prolixin, rather than the injections, were for treatment purposes.