P. v. Coleman
Filed 8/1/12 P. v. Coleman CA1/3
California
Rules of Court, rule 8.1115(a), prohibits courts and parties from citing or
relying on opinions not certified for publication or ordered published, except
as specified by rule 8.1115(b). This
opinion has not been certified for publication or ordered published for
purposes of rule 8.1115.
IN
THE COURT OF APPEAL OF THE STATE OF CALIFORNIA
FIRST
APPELLATE DISTRICT
DIVISION
THREE
THE PEOPLE,
Plaintiff and Respondent,
v.
MALCOLM
PAUL COLEMAN,
Defendant and Appellant.
A133226
(Napa County
Super. Ct.
No. CR144833)
Defendant
appeals from an order authorizing his involuntary medication for purposes of
restoring him to competency to stand
trial. He contends that insufficient evidence supports the order and that
the order is fatally nonspecific insofar as it fails to identify the specific
medications he may be given, as well as the dosage and duration of any
treatment. We shall affirm.
On
February 24, 2009, defendant was charged with
§§ 261, subd. (a)(2), 664), attempted
forcible oral copulation (§§ 288a, subd. (c), 664), and indecent exposure
(§ 314, subd. 1). The complaint also alleged defendant had served a prior
prison term (§ 667.5, subd. (b)). An information was subsequently filed charging
defendant with the crimes and enhancement alleged in the complaint and adding a
fourth count for making criminal threats (§ 422). The underlying conduct
occurred while defendant was a patient at Napa State Hospital; the victim was a
psychiatric technician
assistant at the hospital.
On
April 7, 2009, defendant was found incompetent to stand trial. In conjunction
with the new commitment to Napa State Hospital, the court authorized
involuntary administration of antipsychotic medication to restore him to
competency. On November 24, 2010, the court found defendant had been restored
to competence.
At
the request of defendant’s counsel, the court ordered that defendant continue
to be housed at the state hospital. As defense counsel explained, “[I]t appears
to me that Mr. Coleman’s competence is fragile, and very dependent upon the
regimen of medications he’s been receiving carefully by Napa State Hospital,
and . . . I believe if housed in the jail, that that medication is
not likely to be continued in the same fashion, and I am very concerned about
the competence of Mr. Coleman if he is to be housed in the jail.”
By
letter dated July 25, 2011, the hospital requested authorization to
involuntarily medicate defendant as a person competent to
treatment. The letter explains, “During his current hospitalization, Mr.
Coleman was medicated with Chlorpromazine (antipsychotic), Haloperidol
(antipsychotic) and Topiramate (mood stabilizer). The medications resulted in
significant stabilization of Mr. Coleman’s symptoms and restored him to
competent to stand trial. [¶] Mr. Coleman has begun to refuse all
psychotropic medications. . . . [¶] Since refusing psychotropic
medications, Mr. Coleman’s symptoms of mental illness have significantly
worsened. . . . Increasingly, he is becoming paranoid and distrustful
of his lawyer and the legal system. . . . In summary, the stability
that existed at the time Mr. Coleman was taking medications is quickly
deteriorating away.” The “Treatment Plan and Rationale” included in the July
letter states: “Psychotropic medications . . . are the mainstay of
treating psychotic mental illness. While previously treated with these
medications Mr. Coleman experienced resolution and/or control of many symptoms
of his mental illness. Furthermore, these medications stabilized Mr. Coleman’s
symptoms to a degree that his treatment team felt he was competent to stand
trial. This competency will be lost or put in question if the disease process
(i.e. schizophrenia) is left untreated (i.e. without medications).”
On
August 5, 2011, defense counsel again declared a doubt as to defendant’s
competency. On August 8, counsel reiterated his concerns regarding defendant’s
competency and the court suspended proceedings and appointed psychologist
Richard Geisler to evaluate defendant. In his report, Dr. Geisler concluded
that defendant was not competent. Dr. Geisler explained, “Unfortunately, the
symptoms of Mr. Coleman’s schizophrenia have become much more acute since the
examiner’s previous evaluation of him in November 2010. The exacerbation of his
symptoms is the likely result of his refusal to take the antipsychotic medications
that have been prescribed for him. He now has developed delusions that have
become an integral part of the way he perceives and thinks about his legal
defense. His unwavering insistence on using non-existent evidence to prove his
innocence has interfered with his comprehension of the proceedings against him
and with the conduct of a rational defense with his attorney. That is, he
appears so convinced of the irrefutability and unambiguousness of nonexistent
evidence that he is absolutely certain that he would be exonerated in a trial.
Accordingly, he will not entertain a [not guilty by reason of insanity] plea
because of his conviction that he will be exonerated as a direct result of
evidence that does not exist.” Earlier in the report, Dr. Geisler explains that
when he interviewed defendant he “was able to give a reasonable account of the
alleged offense itself, but he drifted into delusional material when talking
about the secret system of surveillance electronics installed on the hospital
unit where the instant offense occurred. These delusions about a (non-existent)
surveillance system appear to be interfering with his trial competency in a
major way.” (Fn. omitted.)
On
September 12, 2011, after the parties waived a jury trial and submitted the
question of competence on the report of Dr. Geisler, the court found defendant
incompetent to stand trial. After making that finding, the court considered the
issue of involuntary medication. Dr. Ripudanan Brar, defendant’s treating
psychiatrist at Napa State Hospital and the co-author of the July 2011 letter,
testified that defendant suffers from schizophrenia undifferentiated type. He
explained that for several months, defendant had been receiving Chlorpromazine
and Haloperidol, both of which are antipsychotics, and Topiramate, which is a
mood stabilizer. For the two months before the hearing, however, defendant had
refused to take his medication, causing him to decompensate quickly. He
explained, “Symptoms of his mental illness [have] returned or exaggerated in particular
delusions,” including “delusions regarding cameras and surveillance equipment
located in his previous unit.” The doctor opined that if defendant “were to
take psychotropic medications there’s a significant chance that his symptoms
will remit and he will once more become competent.” Dr. Brar testified about
the various side effects of the prescribed medications,
and explained that while defendant was on these medications previously, “he did
not appear to have any significant cognitive effects because of these
medications” nor did Dr. Brar observe defendant with “droopy eyes effect or
falling asleep” while taking the medication. Dr. Brar also testified that
“[f]or severe schizophrenia the standard of treatment is medications” and that
in his opinion, there was no less intrusive treatment. Dr. Brar believed that
the administration of antipsychotic medications was in defendant’s best
interest in light of his condition.
Following
the hearing, the court issued an order authorizing the Napa State Hospital “to
involuntarily administer antipsychotic medications to the defendant as
prescribed by his treating psychiatrist.” Defendant timely filed a notice of
appeal.
Discussion
“The
United States Supreme
Court has held that ‘an individual has a “significant” constitutionally
protected “liberty interest” in “avoiding the unwanted administration of
antipsychotic drugs.” [Citation.]’ [Citation.] To override that interest for
the purpose of restoring a criminal defendant to competency to stand trial, due
process requires the trial court to determine four factors: ‘First, a court
must find that important governmental interests are at stake.’ [Citation.]
‘Second, the court must conclude that involuntary medication will
state interests. It must find that administration of the drugs is substantially
likely to render the defendant competent to stand trial. At the same time, it
must find 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 . . . .
[Citation.]’ [Citation.] ‘Third, the court must conclude that involuntary medication
is necessary to further those interests. The court must find that any
alternative, less intrusive treatments are unlikely to achieve substantially
the same results. . . .’ [Citation.] ‘Fourth, . . .
the court must conclude that administration of the drugs is medically
appropriate, i.e., in the patient’s
best medical interest in light of his medical condition.’ ” (
Cal.App.4th 1040, 1049 (Christiana),
fn. omitted, quoting Sell v. United
States (2003) 539 U.S. 166, 178, 180-181 (Sell).)
Section
1370, which authorizes involuntary
treatment in California, “essentially tracks the Sell factors. (§ 1370, subd. (a)(2)(B)[(i)(III)]; [citation].)
Under section 1370, . . . the trial court may authorize ‘the
treatment facility to involuntarily administer antipsychotic medication to the
defendant when and as prescribed by the defendant’s treating psychiatrist,’ if
the court determines that ‘[t]he people have charged the defendant with a
serious crime against the person or property; involuntary administration of
antipsychotic medication is substantially likely to render the defendant
competent to stand trial; the medication is unlikely to have side effects that
interfere with the defendant’s ability to understand the nature of the criminal
proceedings or to assist counsel in the conduct of a defense in a reasonable
manner; less intrusive treatments are unlikely to have substantially the same
results; and antipsychotic medication is in the patient’s best medical interest
in light of his or her medical condition.’ (§ 1370, subds. (a)(2)(B)[(ii),
(a)(2)(B)(i)(III)].)” (Christiana,
1049-1050.) We review an order authorizing involuntary treatment under section
1370 for substantial evidence. (Christiana,
pp. 1049-1050.)
In
this case, defendant acknowledges that substantial evidence supports “some of
the elements necessary to justify an involuntary medication order on competency
grounds,” but contends the record lacks substantial evidence that the
involuntary administration of antipsychotic medication was substantially likely
to render him competent to stand trial or that administering antipsychotic
medications was medically appropriate in light of his medical condition.
1.
that the administration of antipsychotic medication is substantially likely to
render defendant competent to stand trial.
The
second Sell factor, as incorporated
in section 1370, subdivision (a)(2)(B)(i)(III), requires the court to find that
“involuntary administration of antipsychotic medication is substantially likely to render the defendant competent to stand
trial.” (Italics added.) Defendant argues, as he did in the trial court, that
Dr. Brar’s testimony that there is a “significant chance” that medication will
restore defendant to competency is not the equivalent of evidence that there is
a “substantial likelihood” that medication will restore defendant’s competency,
as required by both Sell and section
1370. Defendant also faults the prosecution for failing to establish a “nexus
between [defendant’s] competence and his medication.” He argues that “Dr.
Brar’s testimony should have been directed at the bases for Dr. Geisler’s
opinion (and the court’s determination) that [he] was not competent to stand
trial,” including “whether [defendant], with the benefit of antipsychotic
medication, would be able to recall the specific charges against him or
rationally weigh the pros and cons of an insanity defense or the significance
of his prior strike convictions on plea negotiations.”
Contrary
to defendant’s arguments, Dr. Brar’s testimony when considered in the context
of the full evidentiary record, amply supports the court’s finding that there
is a substantial likelihood that medication will restore defendant’s competence
to stand trial.
title="">[3]
The record establishes a sufficient nexus between the antipsychotic medications
and the specific barriers to competence identified by Dr. Geisler. As set forth
above, Dr. Geisler concluded that defendant’s delusional beliefs that
non-existent surveillance video would exonerate him of all criminal charges was
interfering with his competence to stand trial. The July letter requesting
authorization for involuntary medication explains that defendant’s paranoid
delusions have “significantly worsened” since he began refusing medication and
were increasingly interfering with his legal representation. In his live
testimony, Dr. Brar reiterated that since stopping his medication, defendant’s
paranoia and delusions, including those regarding the surveillance cameras, had
returned or been exaggerated. Dr. Brar’s July letter states that when defendant
was treated previously with antipsychotic medications he “experienced
resolution and/or control of many symptoms of his mental illness” and that the
medication stabilized his “symptoms to a degree that his treatment team felt he
was competent to stand trial.” The above evidence supports the conclusion that
the medications were intended to remedy or at least control the specific
symptoms (i.e., the delusions) that were interfering with defendant’s
competence.
The
record establishes further that there is a substantial likelihood that
defendant’s competence will be restored with medication. Defendant makes much
of Dr. Brar’s testimony that he believed there was only a “significant chance”
that medication would restore defendant’s competence. But as the trial court
noted, although “it might be helpful to ask him . . . if there was
substantial likelihood,” there was no meaningful difference between the terms
in this case. Indeed, the July letter, which Dr. Brar signed as defendant’s
treating psychiatrist/physician, states that it is the “medical opinion of the
treating physician that the administration of medication is substantially
likely to render the patient and/or maintain the patient as competent to stand
trial.” Perhaps the most persuasive evidence of the likelihood that medication
will restore defendant’s competence is defendant’s own medical history.
Medication successfully restored defendant’s competence previously and he moved
from competency to incompetency only after he stopped taking his medication.
Nothing in the record suggests that medication would not be similarly effective
again.
2.
that the administration of antipsychotic medication is medically appropriate in
this case.
The
fourth Sell factor as incorporated in
section 1370, subdivision (a)(2)(B)(i)(III), requires the court to find that
“antipsychotic medication is in the patient’s best medical interest in light of
his or her medical condition.” Evaluation of this factor requires the trial
court “ ‘to consider specific drugs, their unique side effects, and their
medical appropriateness. Specificity as to the medications to be administered
is critical.’ ” (Carter v. Superior
Court (2006) 141 Cal.App.4th 992, 1004; see also People v. O'Dell (2005) 126 Cal.App.4th 562, 572 [“This fourth
factor in Sell corresponds to the
fifth factor in section 1370, subdivision [(a)(2)(B)(i)(III)]. ‘The specific
kinds of drugs at issue may matter here as elsewhere. Different kinds of
antipsychotic drugs may produce different side effects and enjoy different
levels of success.’ ”], quoting Sell,
supra, 539 U.S. at p. 181.)
Federal courts have adopted similar requirements regarding the evidentiary
showing necessary to satisfy the fourth Sell
factor. (See United States v.
Rivera–Guerrero (9th Cir. 2005) 426 F.3d 1130, 1137, 1142 [the trial court
must develop a record that gives “ ‘attention to the type of drugs
proposed, their dosage, and the expected duration of a person’s
exposure’ ”]; United States v. Evans
(4th Cir. 2005) 404 F.3d 227, 241-242 [in seeking an involuntary medication
order the government must “set forth the particular medication and dose range
of its proposed treatment plan . . . [and] must also relate the
proposed treatment plan to the individual defendant’s particular medical
condition”].)
Here,
the psychologists and psychiatrists have consistently diagnosed defendant with
schizophrenia and uniformly agreed that medication would be medically
appropriate for treatment of his mental illness. The specific antipsychotic
drugs to be administered to defendant were identified in both the proposed
treatment plan included in the July letter and at the hearing. The proposed
medications are the same medications previously administered to defendant and
the prior dosage of those medications given defendant is contained in reports
submitted by the Napa State Hospital.
Dr. Brar detailed the known potential side effects of these medications and
testified that he had not observed defendant suffering from any severe side
effects while previously on the medications.
This
record stands in stark contrast to the record in the cases cited by defendant.
In Carter v. Superior Court, supra,
141 Cal.App.4th at page 997, one
defendant as suffering from schizophrenia and included in his report summary
findings of each of the Sell factors.
When pressed for further information, the doctor “answered ‘maybe’ to the
following questions: (1) whether it would be medically appropriate to treat
petitioner with medication, (2) whether medication would be effective, (3)
whether the medication would make petitioner competent to stand trial, and (4)
whether if left untreated petitioner would suffer serious harm to his physical
or mental health.” (Id. at
p. 998.) A second doctor was less certain in his diagnosis and concluded
that “ ‘[in]voluntary administration of medication to restore competency
would be reasonable if the diagnosis after psychological testing is one[]
[w]hich responds to medication.’ ” (Id.
at p. 997.) Neither doctor provided any evidence regarding the “actual medication
petitioner should be given.” (Id. at
p. 1003.)
In
Christiana, supra, 190 Cal.App.4th at
pages 1048, 1051, the psychiatrists found it “difficult” to identify
“defendant’s specific medical condition” and “testified only about
antipsychotic drugs as a class, without identifying what drugs would likely be
used to treat defendant.” The doctors “did not testify whether the generic
antipsychotic medication he described would be equally effective regardless of
what defendant was diagnosed with.” (Id.
at p. 1048.) The psychiatrists’ “testimonies about potential side effects were
similarly generic” (id. at p. 1051)
defendant, unlike defendant in the present case, “ ‘hasn’t been medicated
yet, and his symptoms have gone on for a long period of time[,] [s]o he may be
a little resistant to those medications initially’ ” (id. at p. 1048).
Finally,
in United States v. Evans,
noted that the involuntary medication report “generally discusses the benefits
of atypical antipsychotic medication over conventional antipsychotics, but it
never actually states the particular type of atypical antipsychotic medication
the [hospital]staff planned to administer to [defendant].” The report concludes
that medication “is ‘medically appropriate’ because ‘the standard treatment of
anyone with [defendant’s] condition of Schizophrenia would involve the
prescription of antipsychotic medication’ ” (id. at p. 241) but “never addressed why it concluded that
[defendant], an elderly man with diabetes, hypertension, and asthma who takes a
number of medications to treat these conditions, would not experience side
effects that would interfere with his ability to assist counsel” (
3.
deficient.
Section
1370, subdivision (a)(2)(B)(ii) directs the court to “issue an order
authorizing the treatment facility to involuntarily administer antipsychotic
medication to the defendant when and as
prescribed by the defendant’s treating psychiatrist.” (Italics added.)
Defendant does not dispute that the court’s order complies with this statute.
He argues, however, that Sell,
to include in its order “basic limitations as to the type of medication the
defendant’s treating physician may administer, the maximum dosage, and the
duration of the authorization.” Defendant relies on United States v. Hernandez–Vasquez (9th Cir. 2008) 513 F.3d 908,
916–917 in which the court held that an order authorizing involuntary medication
for the purpose of restoring a defendant to competence “must provide at least
some limitations on the medications that may be administered and the maximum
dosages and duration of treatment. At a minimum, to pass muster under
identify: (1) the specific medication or range of medications that the treating
physicians are permitted to use in their treatment of the defendant, (2) the
maximum dosages that may be administered, and (3) the duration of time that involuntary
treatment of the defendant may continue before the treating physicians are
required to report back to the court on the defendant’s mental condition and
progress.” The court acknowledged that “Sell
does not identify a requisite degree of specificity concerning the drugs to be
used for involuntary medication,” but reasoned that “Sell's discussion of specificity would have little meaning if a
district court were required to consider specific drugs at a
Bureau of Prisons unfettered discretion in its medication of a defendant. While
Sell appropriately does not direct
district courts to micromanage the decisions of medical professionals, reading
it as imposing no limits upon the discretion of the treating physicians would
render judicial inquiry about specific drugs academic. A broad grant of
discretion to medical professionals also risks distracting such professionals
from Sell’s narrow purpose of
restoring a defendant’s competency for trial.” (Id. at p. 916.) No California court has adopted these additional
requirements.
title="">[5]
Nor have the requirements of Hernandez-Vasquez
been strictly applied by other federal courts.
In
United States v. Green (6th Cir.
2008) 532 F.3d 538, 556, the court recognized that the parameters set forth in
pages 916-917 are intended “to ensure
the government meets its burden under the fourth Sell factor.” The court concluded, however, that requiring strict
adherence to the Hernandez-Vasquez
requirements “would elevate form over substance in determining the
appropriateness of the directive” (Green,
p. 554) and therefore it was “not inclined to find a lack of specific
directives fatal to the propriety of the Sell
order here” (Green, p. 557). The
court explained, “This is not a situation, such as that presented in
where the government failed to present sufficient evidence to meet its burden
. . . . Rather, it is a situation where the district court
simply chose not to incorporate all the evidence presented to it in its written
order. Therefore, we assume, as did the district court, that [defendant] will
be medicated in accordance with the proposed treatment plans of [his treating
psychiatrist] as described at the hearing below. . . .
[¶] . . . We require that the record is clear that physicians
exercise their medical judgment and make decisions in accordance with
prevailing medical standards, all while taking into account the particular
needs and decisions of the individual patient. As noted, the detailed record
before us shows a treatment plan with the specific medication or range of
medications to be administered by the Bureau of Prisons, and under what
circumstances each will be administered (e.g., voluntarily or forcibly), as
well as the expected dosages and the expected time frame for achieving
competence.” (Green, pp. 557-558.)
We
too conclude that strict adherence to the
Hernandez-Vasquez requirements is not necessary to ensure the protection of
the defendant’s rights. As in United
States v. Green, supra, 532 F.3d at pages 557-558, and as discussed above, substantial evidence supports the finding
that the course of treatment detailed throughout the record is medically
appropriate for defendant. The doses of medication previously administered to
defendant are specified with particularity in the record. Implicit in the
court’s order is that the authorization of involuntary medication is to be
consistent with defendant’s well-documented prior treatment plan. While it would
be preferable to expressly state this limitation in the order, we believe that
the record in this case leaves no room to doubt the scope of the order. The
order cannot reasonably be understood to grant the hospital carte blanche to
administer medication beyond what the record reveals to be defendant’s
treatment plan.
Finally,
while it may be necessary in federal court to specify in the court’s order “the
duration of time that involuntary treatment of the defendant may continue
before the treating physicians are required to report back to the court on the
defendant’s mental condition and progress,” such specificity is unnecessary in
California state courts because the statute requires periodic judicial review.
The reporting requirement is governed by section 1370, subdivision (b)(1),
which provides: “Within 90 days of a commitment made pursuant to subdivision
(a), the medical director of the state hospital or other treatment facility to
which the defendant is confined shall make a written report to the court
. . . concerning the defendant’s progress toward recovery of mental
competence. If the defendant has not recovered mental competence, but the
report discloses a substantial likelihood that the defendant will regain mental
competence in the foreseeable future, the defendant shall remain in the state
hospital or other treatment facility or on outpatient status. Thereafter, at
six-month intervals or until the defendant becomes mentally competent, where
the defendant is confined in a treatment facility, the medical director of the
hospital or person in charge of the facility shall report in writing to the
court . . . regarding the defendant’s progress toward recovery of
mental competence. . . . If the report indicates that there is no
substantial likelihood that the defendant will regain mental competence in the
foreseeable future, the committing court shall order the defendant to be
returned to the court for proceedings pursuant to paragraph (2) of subdivision
(c).” (See also § 1370, subd. (a)(2)(B)(vi) [“Any report made pursuant to
paragraph (1) of subdivision (b) shall include a description of any
antipsychotic medication administered to the defendant and its effects and side
effects, including effects on the defendant’s appearance or behavior that would
affect the defendant’s ability to understand the nature of the
in the conduct of a defense in a reasonable manner. During the time the
defendant is confined in a state hospital or other treatment facility or placed
on outpatient status, either the defendant or the people may request that the
court review any order made pursuant to this subdivision. The defendant, to the
same extent enjoyed by other patients in the state hospital or other treatment
facility, shall have the right to contact the patients’ rights advocate
regarding his or her rights under this section”].) These provisions undoubtedly
provide sufficient judicial oversight and protection against unending ineffective
involuntary medication.
Disposition
The
order is affirmed.
_________________________
Pollak,
J.
We concur:
_________________________
McGuiness, P. J.
_________________________
Siggins, J.
name="_ftn1" title="">[1]
All statutory references are to the Penal Code unless otherwise noted.
Dr. Brar testified that “Thorazine and Haldol can cause [a] variety of
different side effects ranging from sedation to drowsiness. They can, there is
cardiac effects which range from palpitations to sudden death. There are
possible, there are some studies that [find] Thorazine may cause cataracts in
Beagle dogs. They can also cause weight gain, metabolic syndrome,
hypercholestremia. They can cause constipation as well. There are some
prudentially failed side effect which is neurological malignant syndrome which
is potentially life threatening. Patient presents with fever, breakdown of
muscle tissue that can cause kidney failure.” Defendant apparently was
receiving generic versions of Thorazine and Haldol which presumably have the
same side effects.
