United States v. Frank Chatmon , 718 F.3d 369 ( 2013 )

PUBLISHED
UNITED STATES COURT OF APPEALS
FOR THE FOURTH CIRCUIT
No. 12-4725
UNITED STATES OF AMERICA,
Plaintiff - Appellee,
v.
FRANK CHATMON,
Defendant - Appellant.
Appeal from the United States District Court for the Eastern
District of Virginia, at Alexandria. Claude M. Hilton, Senior
District Judge. (1:10-cr-00477-CMH-7)
Argued: May 15, 2013 Decided: June 10, 2013
Before WILKINSON, MOTZ, and SHEDD, Circuit Judges.
Vacated and remanded by published opinion. Judge Wilkinson
wrote the opinion, in which Judge Motz and Judge Shedd joined.
ARGUED: Charles Burnham, BURNHAM & GOROKHOV PLLC, Washington,
D.C., for Appellant. Lisa Owings, OFFICE OF THE UNITED STATES
ATTORNEY, Alexandria, Virginia, for Appellee. ON BRIEF: Eugene
V. Gorokhov, Ziran Zhang, BURNHAM & GOROKHOV PLLC, Washington,
D.C., for Appellant. Neil H. MacBride, United States Attorney,
Sean P. Tonolli, Assistant United States Attorney, Scott B.
Nussbum, Special Assistant United States Attorney, OFFICE OF THE
UNITED STATES ATTORNEY, Alexandria, Virginia, for Appellee.
WILKINSON, Circuit Judge:
After his indictment for conspiracy to distribute crack
cocaine and heroin, appellant Frank Chatmon was diagnosed with
paranoid schizophrenia and deemed incompetent to stand trial.
The government then filed a motion seeking permission to
forcibly medicate Chatmon in order to restore him to competency,
which the district court granted.
In doing so, the district court purported to apply the
standard mandated in Sell v. United States, 539 U.S. 166, 181
(2003). That standard permits involuntary medication for trial
competency purposes if, inter alia, “less intrusive treatments
are unlikely to achieve substantially the same results.” Id.The district court found this criterion satisfied, summarily
stating that “involuntary drugging [is] necessary because there
is no less intrusive means shown to be available.” In reaching
that conclusion, however, the court did not mention or analyze
any of the less intrusive alternatives suggested by the Supreme
Court in Sell or by Chatmon himself. Because careful findings
concerning the availability of less intrusive means are
necessary to vindicate the Supreme Court’s admonition that
forcible medication motions should be carefully scrutinized due
to their impact on personal liberty, see id. at 180-81, we
vacate the district court’s order and remand for further
proceedings.
2
I.
A.
In December 2010, Chatmon was arrested and charged with
conspiracy to distribute 280 grams or more of crack cocaine and
100 grams or more of heroin, in violation of 21 U.S.C.
§§ 841(a)(1) and 846. Before he could be tried on these
charges, Chatmon’s attorney expressed concern about his
psychological condition, declaring to the district court that
Chatmon’s “mental state has deteriorated to the point where I
feel he doesn’t understand what’s going on anymore.” Chatmon’s
attorney thus filed a motion seeking a formal competency
evaluation under 18 U.S.C. § 4241(a).
The district court granted the motion and ordered that
Chatmon be evaluated at the Butner Federal Medical Center in
North Carolina. Pursuant to that order, Chatmon was transferred
to Butner from his jail cell in Alexandria, Virginia for
evaluation by a staff psychologist in May and June 2011. The
psychologist’s report diagnosed Chatmon with “Schizophrenia,
Paranoid Type” and described several of his symptoms, including
the fact that he heard voices in his head and his beliefs that a
satellite was attached to his brain and that his thoughts were
being manipulated via remote control. The report concluded with
the opinion that Chatmon suffers from a mental disease that
3
renders him “unable to understand the nature and consequences of
the proceedings against him or assist counsel in his defense.”
Based on these unchallenged findings, the district court
deemed Chatmon incompetent to stand trial and ordered that he be
returned to Butner for hospitalization and treatment to
determine whether he might be restored to competency such that
the criminal proceedings could go forward. See 18 U.S.C. §
4241(d). Chatmon was accordingly transferred back to Butner for
a competency restoration evaluation in September 2011.
Upon his return to Butner, Chatmon was placed in the
facility’s Restrictive Movement Unit (“RMU”), a unit in which
individuals are held in solitary confinement in cells for all
but one hour of the day. Chatmon was housed in the RMU during
the entire period in which his competency restoration evaluation
was performed. That evaluation was conducted by three Butner
employees: Samantha DiMisa, a psychology intern who was
Chatmon’s primary evaluator; Dr. Angela Weaver, a staff
psychologist who supervised DiMisa; and Dr. Robert Lucking, a
staff psychiatrist who interviewed Chatmon once to discuss
antipsychotic medication. Together, the three produced a report
on December 9, 2011. The report confirmed Chatmon’s initial
diagnosis of paranoid schizophrenia and identified symptoms such
as paranoid ideation, auditory hallucinations, delusional
beliefs, hostility, and tangential conversation. The report
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also observed that Chatmon “denied having a mental illness and
would not consent to treatment with psychotropic medication.”
Finally, the report expressed the evaluators’ shared opinion
that although Chatmon remained incompetent for trial, there is a
“substantial probability that Mr. Chatmon’s competency can be
restored with a period of treatment with haloperidol decanoate,”
a type of antipsychotic medication.
On December 20, 2011 (eleven days after Chatmon’s
competency restoration report had been completed but before it
had been submitted to the parties or the district court),
Chatmon was transferred from the RMU to an open population unit
within Butner where he was able to move freely in and out of his
cell and interact with other inmates. Chatmon had previously
made multiple requests to be transferred into such a unit, but
each had been rejected. According to DiMisa, the reasons for
allowing the transfer were that Chatmon had begun to show
“greater engagement” with Butner staff members and that he had
completed paperwork that he had previously refused to sign.
Chatmon demonstrated notable improvement in his behavior
while in the open unit. DiMisa testified that when she met with
him two weeks after his transfer, on January 5, 2012, Chatmon
was more responsive to her redirection during conversation,
visited the library and exercised regularly, had a good
relationship with his roommate, and expressed the desire to take
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a GED class and work in the kitchen. In DiMisa’s opinion,
Chatmon had “adjusted well when transferred to the open
population.” DiMisa also noted, however, that “just because
someone becomes better able to manage their behavior does not
necessarily indicate that [they are] competent” to stand trial.
Still, notwithstanding Chatmon’s progress, Butner staff did not
conduct any additional evaluation of his competency and instead
submitted the December 9, 2011 report to the parties and the
district court on January 10, 2012.
B.
Based on the findings in the December report, the
government filed a motion for permission to forcibly medicate
Chatmon in February 2012. The district court held a hearing on
the motion on August 29.
During the hearing, the district court began its analysis
by identifying the four-part standard provided by Sell v. United
States, 539 U.S. 166 (2003), for determining whether the
government may involuntarily medicate a defendant in order to
restore him to competency for trial. 1 As relevant to the two
1
The government has made no contention that Chatmon is
dangerous to others, which would remove this case from the Sell
framework discussed herein. See 539 U.S. at 181-82 (discussing
Washington v. Harper, 494 U.S. 210, 225-26 (1990), which
recognized the government’s important interest in medicating
prisoners who pose a danger to themselves or to others).
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elements at issue in this appeal, the court found first that the
government had shown an important interest in medicating Chatmon
because he had been charged with “one of the most serious
offenses that can be committed,” a drug offense punishable by a
term of up to life in prison. See id. at 180. Second, the
court stated that “involuntary drugging would be necessary
because there is no less intrusive means shown to be available.”
See id. at 181. In reaching that conclusion, however, the
district court did not address a particular alternative required
by Sell: “a court order to the defendant backed by the contempt
power.” Id. Nor did the court discuss two less intrusive
treatments proposed by Chatmon: group therapy and permitting
Chatmon to remain in an open unit rather than solitary
confinement. 2 The court nonetheless issued an order permitting
the government to medicate Chatmon against his will, which
Chatmon now appeals.
II.
The question of when the government may involuntarily
administer psychotropic drugs to a defendant for the purpose of
2
According to Chatmon’s counsel, after Chatmon’s competency
restoration evaluation was completed (and after he had made
progress while being housed in Butner’s open unit), Chatmon was
returned to jail in Alexandria and placed in solitary
confinement, where his mental health again deteriorated.
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rendering him competent to stand trial entails a difficult
balance between the defendant’s interest in refusing mind-
altering medication and society’s interest in bringing the
accused to trial. The Supreme Court recognized the weighty
concerns on both sides of this balance in Sell, noting that
while individual defendants possess a “‘significant’
constitutionally protected ‘liberty interest’ in ‘avoiding the
unwanted administration of antipsychotic drugs,’” so too does
the government possess an “important” interest in “protect[ing]
through application of the criminal law the basic human need for
security.” 539 U.S. at 178, 180 (quoting Washington v. Harper,
494 U.S. 210, 221 (1990)).
Our own cases have conveyed the same point. In United
States v. White, for example, we characterized recourse to
forced medication as a “drastic resort” that, if allowed to
become “routine,” could threaten an elementary “imperative of
individual liberty.” 620 F.3d 401, 422 (4th Cir. 2010). We
also acknowledged, however, that “when an individual is alleged
to have committed a serious crime,” the individual may in some
cases “forfeit[] her liberty interest . . . to the extent
necessary for the government to bring her to trial.” Id. at 409.
The crux of the matter, then, is how to reconcile these
competing individual and societal interests so as to know which
cases warrant the serious intervention of forced medication and
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which do not. Courts are guided in this process by the four-
part test announced in Sell, which we have described as follows:
First, the government must show that “important
governmental interests are at stake” and that special
circumstances do not sufficiently mitigate those
interests. Sell, 539 U.S. at 180. Second, involuntary
medication must significantly further the government's
interests by making it “substantially likely to render
the defendant competent to stand trial” and
“substantially unlikely to have side effects that will
interfere significantly with the defendant’s ability
to assist counsel” at trial. Id. at 181. Third, the
involuntary medication must be necessary to further
the government’s interests, and less intrusive means
must be unlikely to achieve substantially the same
results. Id. And last, the court must conclude that
the administration of drugs is medically appropriate
and in the patient’s best medical interests in light
of her medical condition. Id.White, 620 F.3d at 410. The government must establish each
element of this test by clear and convincing evidence. United
States v. Bush, 585 F.3d 806, 814 (4th Cir. 2009).
In applying the Sell test, we note that circuit courts have
upheld involuntary medication orders on prior occasions. See,
e.g., United States v. Green, 532 F.3d 538 (6th Cir. 2008);
United States v. Bradley, 417 F.3d 1107 (10th Cir. 2005). But
we have never departed from the recognition that such orders are
a tool that must not be casually deployed, for forced medication
is a serious intrusion upon the integrity of the individual and
the effects of such medication upon body and mind are often
difficult to foresee. See White, 620 F.3d at 422 (Keenan, J.,
concurring). While involuntary medication orders may sometimes
9
be necessary, they carry an unsavory pedigree. See Harper, 494
U.S. at 229-30 (describing how forced administration of
antipsychotic medication can have “serious, even fatal side
effects,” such as cardiac dysfunction and tardive dyskinesia, a
neurological disorder in 10% to 25% of patients characterized by
“uncontrollable movements of various muscles”). With this
understanding of the legal framework, we turn now to the
application of the Sell test to Chatmon’s case.
III.
A.
Chatmon argues first that the district court incorrectly
deemed his drug trafficking charge a “serious” crime, a ruling
that (if correct) gives rise to an important government
interest. See Sell, 539 U.S. at 180 (“The Government’s interest
in bringing to trial an individual accused of a serious crime is
important.”). Unfortunately for Chatmon, the central
consideration when determining whether a particular crime is
serious enough to satisfy this factor is the “maximum penalty
authorized by statute.” United States v. Evans, 404 F.3d 227,
237 (4th Cir. 2005). For example, we held in White that certain
offenses were “serious” because they exposed a defendant to a
maximum prison term of “over ten years.” 620 F.3d at 410-11.
That Chatmon has been accused of a serious crime is thus clear
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because the offense with which he is charged carries the highest
possible maximum prison term: life imprisonment. 21 U.S.C.
§ 841(b)(1)(A). The seriousness of Chatmon’s charged offense is
also reinforced by the fact that § 841(b)(1)(A) imposes a
mandatory minimum of ten years, which rises to twenty years if
the defendant has a prior felony drug conviction, as the
government contends is true of Chatmon.
Chatmon responds that the maximum statutory prison term for
his drug trafficking charge is of no consequence because Sell
commands that in order to constitute a “serious crime,” the
offense must be against “persons” or “property.” Appellant’s
Br. 22. But that is not the law. Indeed, we expressly rejected
this argument in Evans, where we held that Sell’s mention of
serious crimes “against the person or . . . against property”
does not “impose[] the additional requirement that the crime
also be against either [a] person or property in order to be a
‘serious’ one.” 404 F.3d at 237 n.6. Other circuits agree.
See, e.g., United States v. Green, 532 F.3d 538, 550 (6th Cir.
2008). Instead, as we explained in Evans, the Sell Court
mentioned crimes against persons and property for the
unexceptional purpose of highlighting that those were the type
of charges that Sell himself faced. 404 F.3d at 237 n.6.
Finally, Chatmon points to no special circumstance that
would mitigate the government’s interest in bringing him to
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trial. Sell, 539 U.S. at 180. Chatmon’s case, for example, is
unlike White because the defendant in that case faced a likely
prison sentence of approximately 42-51 months if convicted --
and would have already served more than that amount by the time
of trial. 620 F.3d at 418. Here, by contrast, Chatmon faces a
potential mandatory minimum of twenty years if convicted, and
has been confined to date for but a fraction of that time --
roughly two and a half years. Furthermore, as the government
notes, this is likely not a case where its interest in
prosecuting Chatmon could be assuaged through a civil commitment
order because Chatmon has not been found to pose the risk of
injury to others necessary to warrant such commitment under 18
U.S.C. § 4246(d). We therefore reject Chatmon’s contention that
the government has no important interest at stake in his case.
B.
We turn now to Chatmon’s challenge relating to the third
Sell factor, the existence of means for restoring a defendant to
competency less intrusive than involuntary medication. 539 U.S.
at 181. Appellate courts have reviewed a district court’s
findings on this factor for clear error. See, e.g., United
States v. Fazio, 599 F.3d 835, 839-40 (8th Cir. 2010). As
relevant here, a district court commits clear error if it takes
“an erroneous view of the controlling legal standard” or makes
factual findings “without properly taking into account
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substantial evidence to the contrary.” Miller v. Mercy Hosp.,
Inc., 720 F.2d 356, 361 (4th Cir. 1983).
To start, the district court misapprehended the legal
standard. In Sell, the Supreme Court explained that the
overarching inquiry with respect to the third factor is whether
“involuntary medication is necessary” because “alternative, less
intrusive treatments are unlikely to achieve substantially the
same results.” 539 U.S. at 181. But Sell also contained a
specific command that must be met before a district court may
answer this inquiry in the affirmative: the court “must consider
less intrusive means for administering the drugs, e.g., a court
order to the defendant backed by the contempt power.” Id.; see
also, e.g., United States v. Bradley, 417 F.3d 1107, 1115-16
(10th Cir. 2005) (finding third Sell factor satisfied where
court entered order requiring defendant to take medication on
threat of civil contempt). Of course, this is not tantamount to
a requirement that a defendant must be first held in contempt in
each and every case. This option would, however, allow the
defendant to decline at least for a period of time forcible
medication, albeit at the cost of confinement or some other
civil sanction.
The district court failed to heed this legal requirement.
The court’s discussion of less intrusive means at Chatmon’s
hearing was limited to the summary conclusion that “involuntary
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drugging would be necessary because there is no less intrusive
means shown to be available.” The district court entered a
written order confirming this ruling a week later, but it was
just as brief, declaring simply that “involuntary medication of
the defendant is necessary to further the government’s interests
and any alternative, less intrusive treatments are unlikely to
achieve substantially the same result.” At no point did the
court acknowledge Sell’s requirement that it “must consider”
less intrusive means for administering Chatmon medication such
as a court order backed by contempt sanctions. We think such
consideration requires that the court explain upon remand why
less intrusive means would prove ineffectual.
The court also needs to account for evidence of other less
intrusive means presented by Chatmon. During the oral hearing
before the district court, Chatmon’s counsel discussed two
alternative means for restoring Chatmon to competency: group
therapy and allowing Chatmon to reside in an open population
unit rather than solitary confinement. In proposing those
alternatives, counsel repeatedly referenced supportive evidence
in the record, referring in particular to Ms. DiMisa’s
deposition testimony regarding Chatmon’s improvements upon being
admitted into Butner’s open unit. The district court
nevertheless found no less intrusive means to be available
without recognizing this contrary evidence or explaining why it
14
might be insufficient. Of course, a district court need not
credit a defendant’s evidence or accept his arguments, but its
findings should offer some reason why it did not. Here, during
oral argument, the government candidly conceded that the
district court offered no reasons why Chatmon’s alternatives
might be unavailing and essentially provided “no rationale” in
support of its ruling. See United States v. Francis, 686 F.3d
265, 273 (4th Cir. 2012) (“A court commits clear error when it
makes findings ‘without properly taking into account substantial
evidence to the contrary.’” (quoting Miller, 720 F.2d at 361)).
It is the context of this case that makes supported
findings significant. The need for such findings serves
typically not as a broad red light upon a judicial disposition
but as a blinking yellow. In a matter as sensitive as an
involuntary medication order, which trenches upon the elemental
individual liberty interest in refusing the invasive
administration of mind-altering medication, the need to slow
down and consider less intrusive alternatives is important. Put
simply, such consideration is necessary to provide this court
with assurance that forcible medication orders, while sometimes
warranted, will not become a device routinely or casually
employed.
Because the district court erred in its analysis of the
third Sell factor, we vacate the involuntary medication order
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and remand for further findings. We remand because the district
court remains far better situated than we are to evaluate in the
first instance the conflicting evidence concerning the
availability and effectiveness of less intrusive means for
restoring Chatmon to competency.
Upon remand, we note that the district court should
consider, as Sell suggests, the less intrusive option of
ordering Chatmon to take his prescribed medication with the
backing of civil contempt sanctions. The district court should
also consider and evaluate less restrictive means that Chatmon
plausibly suggests for restoring him to competency.
For the foregoing reasons, we vacate and remand for further
proceedings consistent with this decision.
VACATED AND REMANDED
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