Case Information
*1 Before TACH A, Chief Circuit Judge, PO RFILIO and A ND ER SO N , Circuit Judges.
After examining the briefs and appellate record, this panel has determined unanimously that oral argument would not materially assist in the determination of this appeal. See Fed. R. App. P. 34(a)(2); 10th Cir. R. 34.1(G). The case is therefore ordered submitted without oral argument.
*2 Defendant and appellant Benjamin Archuleta appeals an order determining that the involuntary administration of antipsychotic medication is necessary to render him competent to stand trial. W e affirm.
BACKGR OUN D
In September 1998, Archuleta was charged with threatening the life of a federal district court judge in Utah. He was sent to a facility in Springfield, M issouri, for a competency evaluation. After undergoing treatment, Archuleta was found competent to stand trial while on medication. Thereafter, the government and Archuleta entered into a stipulation that led to a finding of not guilty by reason of insanity. Archuleta was accordingly committed to a hospital.
Archuleta was subsequently released from the hospital w ith specific conditions of release, pursuant to 18 U.S.C. § 4246. After Archuleta violated the conditions of release, the district court imposed stricter conditions and released Archuleta to a halfway house. W hen Archuleta again violated his conditions of release, the court revoked his release and remanded him to the custody of the Bureau of Prisons for continued hospitalization at the Springfield facility.
In June 2004, the court again ordered Archuleta released on certain conditions. In February 2005, the court terminated supervision of Archuleta and considered the case closed. W ithin seven months of the termination of his supervised release, the United States M arshal Service and the Bureau of Alcohol, *3 Tobacco and Firearms (“BATF”) learned that Archuleta had attempted to purchase a firearm from a local pawn shop in Salt Lake City, Utah. In doing so, Archuleta had lied about his prior mental health commitment on a form used as a background check. Pursuant to 18 U.S.C. § 922(g)(4), Archuleta is a restricted
person who is not permitted to possess or attempt to possess a firearm.
The government charged him with providing false information in the acquisition of a firearm. W hen Archuleta made his initial appearance on the new firearms charge, the court ordered him to undergo a psychiatric evaluation to determine his competency to stand trial and his mental state at the time of the offense. The court-appointed forensic psychiatrist concluded that Archuleta was not competent to stand trial, but was unable to determine his mental state at the time of the offense.
A magistrate judge held a competency hearing in M arch 2006 and determined that Archuleta was not competent to stand trial and ordered that he be remanded to the custody of the Bureau of Prisons for restoration of competency. The magistrate judge also ordered an evaluation of Archuleta’s mental health status at the time of the offense and an assessment of whether Archuleta was a danger to himself or others. Later that same day, the district court ordered a specific psychiatric evaluation of whether Archuleta should be involuntarily medicated during the court-ordered competency restoration commitment.
Dr. Jeffrey W atabe conducted the evaluation on involuntary medication and
prepared a report. In preparing his report, Dr. W atabe relied upon a number of
items, including an interview with Archuleta, records and/or reports from the
Davis County jail, the BATF and the Springfield facility, a forensic evaluation
prepared by Jasmine A. Tehrani, Ph.D, a risk assessment review report prepared
by Eduardo Ulloa, M .D., a mental health evaluation prepared by Kathy Reimherr,
L.C.S.W ., and forensic reports prepared by Lea Ann Preston, Ph.D and Robert L.
Denney, Psy.D., A.B.P.P. Dr. W atabe evaluated the possibility of involuntary
medication under the four-part analysis of Sell v. United States,
That four-part analysis involves the follow ing inquiry: (1) “a court must
find that
important
governmental interests are at stake”; (2) “the court must
conclude that involuntary medication will
significantly further
. . . state interests
. . . [in that the] administration of the drugs is substantially likely to render the
defendant competent to stand trial . . . [and that] administration of the drugs is
substantially unlikely to have side effects that will interfere significantly with the
defendant’s ability to assist counsel in conducting a trial defense”; (3) “the court
must conclude that involuntary medication is
necessary
to further those interests
. . . [in that] any alternative, less intrusive treatments are unlikely to achieve
substantially the same results”; and (4) “the court must conclude that
administration of the drugs is
medically appropriate
,
i.e.
, in the patient’s best
*5
medical interest in light of his medical condition.” Sell,
Dr. W atabe diagnosed Archuleta as having “Schizophrenia, paranoid type.” Report at 11, R. Vol. III. The schizophrenia diagnosis was “based on M r. Archuleta’s difficulty with delusions and hallucinations that have caused him significant interpersonal, occupational, and legal difficulties” which have “persisted for a number of years and do not appear to be related to mood disorders, medical conditions, or drug abuse.” Id. The “paranoid type” qualifier was “based on the prominence of M r. Archuleta’s delusions and absence of significant disorganized or catatonic behaviors.” Id.
Applying the four Sell factors, D r. W atabe concluded that Archuleta should undergo involuntary medication to restore his competency to stand trial. On the first factor, whether important governmental interests are at stake, Dr. W atabe stated that he was unable to “address with reasonable medical certainty whether important governmental interests were at stake . . . because this topic lies outside the area of [his] expertise.” Id. at 11-12. The doctor did, however, state “with reasonable medical certainty” that Archuleta “does not meet the criteria for civil commitment to an institution for the mentally ill” because he “does not currently pose a substantial danger of physical injury to himself . . . or others.” Id. at 12. *6 W ith regard to the second factor, whether administration of drugs w ill restore Archuleta to competency to stand trial and whether such drugs are substantially likely to have side effects, Dr. W atabe concluded “with a reasonable medical certainty that administration of antipsychotic medication is substantially likely to render M r. Archuleta competent to stand trial.” Id. The basis for that conclusion was: (1) Archuleta’s past experience with antipsychotic medication reveals that he was previously restored to competency on two occasions, once in 1998 and again in 1999; (2) he has a “well-documented history of resolution of his psychotic symptoms as a result of treatment with antipsychotic medications” such as Prolixin in 1998 and Risperdal in 2003; and (3) there is “no indication of any cognitive deficit that would prevent restoration to competence once M r. Archuleta’s psychotic symptoms are treated.” Id. at 12-13.
Dr. W atabe also concluded “with reasonable medical certainty that treatment with antipsychotic medications is substantially unlikely to have side effects that will interfere significantly with M r. Archuleta’s ability to assist counsel in conducting a trial defense.” Id. at 13. This conclusion was based upon the fact that Archuleta has “no history of side effects from the antipsychotic medications (Prolixin, Risperdal) previously used to treat his psychosis,” the fact that his medical records document his willingness to take medications and that he has never required large doses of medication to adequately treat his psychosis and restore him to competency. Id.
*7 W ith respect to the third factor, whether adequate alternative treatments exist, Dr. W atabe opined “w ith reasonable medical certainty that involuntary medication is necessary to restore M r. Archuleta to competency” because (1) “[t]here are no alternative, less intrusive treatments likely to achieve substantially the same results as antipsychotic medications”; and (2) there is no less intrusive means for administering drugs given that Archuleta “insists he has no mental illness” and that “he will refuse all antipsychotic medications, even in the face of contempt of court.” Id. at 14.
Regarding the fourth factor, whether the administration of antipsychotic drugs is medically appropriate, Dr. W atabe opined “with reasonable medical certainty” that Archuleta should be treated with antipsychotic medications because it is the treatment of choice for schizophrenia and that “all other treatment interventions such as psychotherapy are minimally effective.” Id. He further concluded that, while such treatment might exacerbate Archuleta’s diabetes, that side effect could likely be medically controlled.
In June 2006, the court noted that the involuntary medication evaluation had been completed and scheduled a hearing on the question of whether to order such involuntary medication. The hearing took place in A ugust 2006. The court admitted as evidence a letter from Archuleta, Dr. W atabe’s report, and the forensic evaluation by Jasmine Tehrani. Additionally, Dr. W atabe testified at the hearing.
In addition to confirming his findings and conclusions contained in his report, Dr. Watabe testified about the four-part analysis required by Sell. He testified that he did not believe that the criteria for civil commitment applied to Archuleta because he was “relatively stable in terms of dangerousness” to himself or others. Tr. of Hr’g at 19-20, R. Vol. II. The doctor concluded, however, that, although he did not evaluate Archuleta’s long-term risk of violence, given Archuleta’s history of assaults, drug and alcohol abuse, paranoia regarding the government, threats to government officials, and his conduct in attempting to purchase a weapon, he believed Archuleta’s long-term risk of assaultive conduct was “moderate to high.” Id. at 21. Regarding the likelihood that antipsychotic medication would render Archuleta competent to stand trial, Dr. W atabe estimated that with medication Archuleta’s “psychotic symptoms would begin resolving within a few weeks, and probably within three to six months.” Id. at 23.
Dr. W atabe also testified about improvements in medications, such that the newer ones had fewer side effects. Further, he noted that Archuleta had taken various medications with no side effects and that, in fact, Archuleta had made “an explicit denial of side effects.” Id. at 25. As to alternative treatments, Dr. W atabe testified there were no other means to restore competency, and, as to the medical appropriateness of medication, the doctor stated that “antipsychotic medication is the standard of care for psychosis, and in M r. Archuleta’s case, schizophrenia, it is the only effective treatment for it.” Id. at 28.
*9
The district court thereafter made its findings of fact and conclusions of
law . It found “by a preponderance of the evidence that [Archuleta] is
incompetent to stand trial consistent with the reasons and analysis set forth in
Dr. Tehrani’s report.” O rder at 4, R. Vol. I. The court then turned to an analysis
of whether involuntary medication to restore Archuleta’s competency was
required. Follow ing our instructions in M orrison, the district court first
considered whether involuntary medication could be justified under the analysis
of W ashington v. Harper,
The court then considered whether involuntary medication was justified
under Sell. Applying the four Sell factors, the district court found “by clear and
convincing evidence” that involuntary medication should be ordered while
Archuleta was hospitalized for competency restoration. Id. W ith regard to the
first factor, the court concluded there were “important governmental interests . . .
in bringing [Archuleta] to trial,” id. at 5, and that “‘[t]he Government’s interest in
*10
bringing to trial an individual accused of a serious crime is important’ because
‘the Government seeks to protect through application of the criminal law the basic
human need for security.’” Id. (quoting Sell,
As part of this factor, the Court in Sell noted that courts “must consider the
facts of the individual case in evaluating the Government’s interest in
prosecution. Special circumstances may lessen the importance of that interest.”
Sell,
Turning to the second and third Sell factors, the district court concluded
that involuntary medication of Archuleta would result in the restoration of his competency without side effects that would interfere with his ability to assist trial counsel in his defense. The court also concluded that no other less intrusive means w ould achieve substantially the same results. Finally, applying the fourth Sell factor, the court concluded that administration of antipsychotic medication was medically appropriate and in the best interest of Archuleta.
Archuleta appeals, arguing the court erred in its determination that involuntary medication was warranted. He argues that the government’s interest in prosecuting him is lessened by the negative effects he will suffer because of long-term forced medication and because he has already served time comparable to what he would be sentenced to serve under the Guidelines.
D ISC USSIO N
Because the Supreme Court in Sell specified “neither a standard of proof
for the Sell factors nor a standard of appellate review, Bradley,
‘W hether the Government’s asserted interest is important is a legal question.’ . . . W e would expand the parameters of the legal question to include whether involuntary administration of antipsychotic drugs ‘is necessary significantly to further important governmental trial- related interests. In other words, ‘[h]as the Government, in light of the efficacy, the side effects, the possible alternatives, and the medical appropriateness of a particular course of antipsychotic treatment, shown a need for that treatment sufficiently important to overcome the individual’s protected interest in refusing it?’ . . . [T]he remaining Sell factors depend upon factual findings and ought to be proved by the government by clear and convincing evidence. . . . We review conclusions of law de novo and findings of fact for clear error.
Id. at 1113-14 (quoting United States v. Gomes,
W e have carefully reviewed the district court’s opinion, and we conclude
that its analysis of the four Sell factors is thorough and correct. Its legal
conclusion that the governmental interest in prosecuting Archuleta is strong and
undiminished by any special circumstance is correct. W hile Archuleta argues that
we should consider a potential Guideline sentence when comparing time already
spent in custody with Archuleta’s likely sentence, we agree with the district court
that the appropriate comparison is to the statutory maximum, ten years in this
*13
case. See Bradley,
C ON CLU SIO N
For the foregoing reasons, the district court’s order is A FFIRMED. ENTERED FOR THE COURT Stephen H. Anderson Circuit Judge
Notes
[*] This order and judgment is not binding precedent except under the doctrines of law of the case, res judicata, and collateral estoppel. It may be cited, however, for its persuasive value consistent with Fed. R. App. P. 32.1 and 10th Cir. R. 32.1.
[1] Even if the proper comparison was between the expected sentence under the Guidelines and time spent in custody, the district court noted that “a reasonable sentence would be in excess of predicted sentencing guidelines that may apply to the defendant.” O rder at 5, R. Vol. I.