Commonwealth v. Sam
Full Opinion (html_with_citations)
OPINION
Today we decide two appeals that present the identical issue of whether an inmate who is presently incompetent may be compelled to take psychiatric medication in order to render him competent to determine whether to pursue relief under the Post Conviction Relief Act (PCRA).
On July 2, 1991, appellee Thavirak Sam was convicted of, inter alia, three counts of first-degree murder and received three consecutive death sentences for the killing of his moth
On January 16, 1997, Robert Brett Dunham, Esquire, of the Center for Legal Education, Advocacy and Defense Assistance (CLEADA) filed a PCRA petition, purportedly on behalf of appellee.
With the approval of the court, appellee was examined by psychologist William F. Russell, Ph.D., for the defense on May 10 and May 24, 2000, and by psychiatrist John S. OâBrien, II, M.D., for the Commonwealth on October 4, 2000. Although Dr. OâBrien diagnosed appellee with bipolar disorder and Dr. Russell determined the diagnosis to be paranoid schizophrenia, both mental health experts concluded that appellee was
On January 7, 2002, the Commonwealth filed a Motion to Compel Psychiatric Medication in which it relied on the conclusions of Drs. OâBrien and Russell. In particular, the Commonwealthâs motion quoted the following from the report of Dr. Russell: âMr. Sam will not disclose any personal, let alone pertinent information unless he perceives the person as being trustworthy and in line with his delusions. Without intervention[
It is my opinion that Mr. Samâs treatment records reflect good response to appropriate psychiatric treatment and utilization of medications in the past, and I would expect that the current manifestations of his psychiatric condition would likewise respond to necessary and appropriate psychiatric treatment. It is my opinion that Mr. Samâs prognosis for achievement of a remission of his current grandiose and paranoid symptoms, with appropriate psychiatric treatment, is excellent.
Id. (quoting Letter from Dr. OâBrien to Christopher Diviny, Esquire, Assistant District Attorney (Feb. 5, 2001), at 4-5). The defense timely filed a Memorandum of Law in Response to the Commonwealthâs motion on February 20, 2002.
The Commonwealth then presented the testimony of Dr. OâBrien. During direct examination, Dr. OâBrien stated a number of conclusions that he had reached after examining appellee and reviewing numerous materials in connection with his case, including prison medical records and reports of prior mental health evaluations. In particular, Dr. OâBrien testified that it was his âopinion, with a reasonable degree of medical certainly [sic], that Mr. Sam would respond to treatment, psychiatric treatment, for his current symptoms.â Id. at 17. Dr. OâBrien noted that his opinion in this regard was based both on his general expertise in forensic psychiatry as well as the fact that âMr. Sam himself[ ] has been treated in the past with antidepressant and antipsychotic medications with good responseâ â i.e., without symptoms of the type that he was currently presenting. Id. at 18.
Dr. OâBrien also testified extensively as to the general course of treatment with psychiatric medications and their potential for side effects. In particular, Dr. OâBrien testified as follows:
Q. How would someone like Mr. Sam be treated with these drugs you are describing?
A. Well, just in more general terms, physicians identify symptoms in the course of conducting examinations of patients. And then select medications that are known to have a beneficial effect on those particular symptoms.
We have a body of knowledge in medicine that basically educates us about the statistical likelihood of therapeutic*532 responses and also certain side effects. But there is really no way ... predicting in advance how a particular patient will respond to a particular medication of choice until that choice has been made, the medication prescribed, and at that point the physician observes the patientâs response to the medication in terms of itâs [sic] effect on the symptoms, and also observers [sic] the patient to determine whether or not side effects are present.
Id. at 20-21. Dr. OâBrien proceeded to explain the typical course of treatment of psychosis as follows:
[T]he way in which one would typically proceed is to choose one of the lower side effect profile newer medications first and try those, or try one of those. If he was [sic] not to respond, then there are a number of other ones within that category that one can try. But, if none of those work, you would move then to the medications that have a higher side effect profiles [sic]. In other words, a greater statistical likelihood of side effects.
Id. at 23.
With respect to the specific medications available to treat psychosis, Dr. OâBrien testified that âmost of the medications are very effective. The newer medications have very low side effect profiles. The older medications, such as the ones [appellee]âs been on in the past, have higher side effect profiles.â Id. at 23. Indeed, Dr. OâBrien testified that appellee âwas treated with a higher side effect profile antipsychotic medication, Thorazine, and didnât demonstrate serious side effectsâ and that â[m]edications that are available today have a far more benign side effect profile than Thorazine.â Id. at 25. When asked whether there were any less intrusive means of achieving appelleeâs competency, Dr. OâBrien responded that it was his opinion that there were not and that, in fact, appelleeâs symptoms would not improve if left untreated. Id. at 29-30;
Following the testimony of Dr. OâBrien, defense counsel called Dr. Russell, the psychologist who had examined appellee for the defense. Dr. Russell agreed with Dr. OâBrien that appelleeâs delusions are âthe predominant issues at the present time that interfere with his competency.â Id. at 72. Dr. Russell further agreed with Dr. OâBrien that whether the source of appelleeâs delusions was bipolar disorder (as Dr. OâBrien concluded) or paranoid schizophrenia (as Dr. Russell determined), the treatment protocol would be âvery similar.â Id. at 91. When the defense attempted to question Dr. Russell about the side effects of the medications used as such treatment, the court declined to qualify him to testify with respect thereto.
On October 20, 2005, the PCRA court ultimately issued an order denying the Commonwealthâs Motion to Compel Psychiatric Medication and denying Attorney Epsteinâs previous motion requesting that he be designated appelleeâs next friend.
The court began its discussion of the Commonwealthâs motion by noting that this Court had not yet adopted a standard of competence for purposes of authorizing and pursuing relief under the PCRA.
Having found a lack of dangerousness, the court proceeded to consider, as an alternate basis for compelling medication, the four-factor test set forth in Sell. In the words of the PCRA court, the Sell test required consideration of:
*535 whether or not: (1) an important governmental interest has been established; (2) the proposed treatment is substantially likely to render Defendant competent and is substantially unlikely to have side effects that may undermine the fairness of the proceedings; (3) alternative, less intrusive treatments are unlikely to achieve the same results and taking account of less intrusive alternatives, the treatment sought is necessary to further important governmental interests; and, (4) the administration of the drugs is âmedically appropriateâ and therefore in Defendantâs best interest in view of his medical condition.
PCRA Ct. Op. at 13 (quoting Sell, 539 U.S. at 179, 123 S.Ct. 2174).
With respect to the existence of an important governmental interest, the PCRA court first acknowledged that the Sell Court determined that âbringing an individual accused of a serious crime to trialâ qualified as such an interest. Id. at 14. Nevertheless, the court distinguished the instant case from Sell by noting that appellee already had been tried, convicted, and sentenced; that he was being held under maximum security on death row; and that, âaccording to testimony elicited throughout the hearing, [he] has not presented a threat to anyone while confined.â Id. at 15. The court then concluded that the Commonwealth had failed to satisfy the first factor of the Sell test. Although it noted that the Commonwealthâs failure to meet the first of the conjunctive requirements was fatal to its motion to compel psychiatric medication, the court proceeded to consider two of the three remaining factors for purposes of a âcomplete analysis.â Id. at 16.
Applying the second prong of the Sell test â ie., likelihood that medication would restore competence and likelihood of side effects â the court first considered the risk of side effects of the proposed treatment. In particular, the court found that âthe Commonwealth has failed to prove, and the record is devoid of any concrete details regarding the particular medication that would be administered, dosages, or how the proposed treatment (monitoring, in particular) could be accom
Without discussing the third factor of the Sell test, the court turned finally to the medical appropriateness of the proposed treatment. Other than repeating its view that appellee âhas been deemed not to be a danger to himself or others in his confined state,â PCRA Ct. Op. at 23, the courtâs application of the fourth Sell prong consisted simply of repeating its findings regarding the âuncertaintiesâ of the proposed treatment. âIn view of the foregoing assessment of the four Sell factors,â the court concluded that it was âprohibited from ordering forced medication solely to render Defendant competent to proceed with his [sic] Petition for Post Conviction Relief.â Id. at 25.
On November 16, 2005, the Commonwealth filed its notice of appeal of the PCRA courtâs order. This Court granted oral argument, which was initially heard on October
This Court reviews the PCRA courtâs findings of fact to determine whether they are supported by the record. Commonwealth v. Reaves, 592 Pa. 134, 923 A.2d 1119, 1124 (2007). We review the PCRA courtâs conclusions of law to determine whether they are free from error. Id. Our scope of review is limited to âthe findings of the PCRA court and the evidence on the record of the PCRA courtâs hearing, viewed in the light most favorable to the prevailing party.â Id.
Before proceeding to the partiesâ respective arguments, we first review the High Courtâs decision in Sell, which, the parties both argue, provides the framework for the resolution of the case sub judice. Sell recognized that âan individual has a âsignificantâ constitutionally protected âliberty interestâ in âavoiding the unwanted administration of antipsychotic drugs.â â Sell, 539 U.S. at 178, 123 S.Ct. 2174 (quoting Washington v. Harper, 494 U.S. 210, 221, 110 S.Ct. 1028, 108 L.Ed.2d 178 (1990)). As previously mentioned, the Sell Court established four conditions before the Government can involuntarily administer antipsychotic drugs to a mentally ill defendant facing serious criminal charges â thus overriding his liberty interest â in order to render that defendant competent to stand trial. Specifically, before issuing an order authorizing the involuntary administration of such drugs, a court must conclude that: (1) âimportant governmental interests are at stakeâ; and that administering the medication: (2) will âsignificantly further those concomitant state interestsâ; (3) âis necessary to further those interests,â taking account of less
In establishing the above four conditions, however, the Sell Court emphasized that they are not always applicable whenever the Government seeks to compel a defendant to take antipsychotic medication: '
We emphasize that the court applying these standards is seeking to determine whether involuntary administration of drugs is necessary significantly to further a particular governmental interest, namely, the interest in rendering the defendant competent to stand trial. A court need not consider whether to allow forced medication for that kind of purpose, if forced medication is warranted for a different purpose, such as the purposes set out in Harper related to the individualâs dangerousness, or purposes related to the individualâs own interests where refusal to take drugs puts his health gravely at risk.
Nevertheless, the parties assume that Sellâs four-factor test applies for purposes of deciding the instant appeal. See Commonwealthâs Brief at 26 (âThe [Sell ] Court set forth the standards under which medication may be required for purposes of restoring competency.â); Appelleeâs Brief at 15-16 (âHere, appellant and appellee are in basic agreement as to the governing constitutional test for involuntary or compelled medication.â) (quoting Sellâs four-factor test).
As for the PCRA courtâs rationale in concluding that the first Sell factor was not satisfied here, the Commonwealth disputes the relevance of appellee being held under maximum security on death row, arguing that Sell does not preclude the possibility of an important governmental interest arising after the conclusion of trial. Indeed, noting Sellâs acknowledgment that delay hampers the governmentâs ability to try a case, the Commonwealth argues that the same concern exists here âin light of the fact that [appelleejâs conviction occurred nearly 15 years ago and there is no indication when â or even if â his PCRA action will ever move forward.â Commonwealthâs Brief at 32.
In response, appelleeâs counsel
In addition to the societal finality interest, the Commonwealth asserts âthe obvious interest in allowing [appellee] to control the course of his own appeals.â Commonwealthâs Brief at 29. The Commonwealth contends that this autonomy interest is particularly strong here because appellee has repeatedly expressed, even to the PCRA court, his preference to be executed rather than to spend the rest of his life in prison. The Commonwealth further observes that appellee has, in fact, never sought to pursue collateral relief and that there is no indication that he wants an appointed attorney or an appointed next Mend to do so on his behalf.
In response, counsel for appellee acknowledges that a competent defendant has the right to waive his appeals. However, appelleeâs counsel disputes that the instant case implicates that right, let alone that the right qualifies as an important interest in the Sell equation.
There is absolutely no doubt that there is an enduring societal interest in the finality of criminal proceedings. Indeed, â[o]ne of the lawâs very objects is the finality of its judgments.â McCleskey v. Zant, 499 U.S. 467, 491, 111 S.Ct. 1454, 113 L.Ed.2d 517 (1991). âFinality is essential to both the retributive and the deterrent functions of criminal law for neither innocence nor just punishment can be vindicated until the final judgment is known.â Commonwealth v. Haag, 570 Pa. 289, 809 A.2d 271, 287 (2002) (Castille, J., concurring) (quoting Calderon v. Thompson, 523 U.S. 538, 555, 118 S.Ct. 1489, 140 L.Ed.2d 728 (1998)) (internal quotation marks omitted); see also Teague v. Lane, 489 U.S. 288, 309, 109 S.Ct.
In Pennsylvania, the societal interest in finality is not just a notion of criminal theory; rather, it is reflected in the very letter of our PCRA. Indeed, the primary intent of many of the Actâs 1995 amendments was to narrow the grounds for collateral relief and thereby establish a scheme by which collateral petitions may be processed promptly in order to achieve finality. Commonwealth v. Morris, 565 Pa. 1, 771 A.2d 721, 739 (2001); Peterkin, 722 A.2d at 642-43. The General Assemblyâs intent to achieve finality in PCRA proceedings is particularly evident in the Actâs provision for stays of execution. Morris, 771 A.2d at 749 (Castille, J., concurring); 42 Pa.C.S. § 9545(c)(1) (providing that PCRA is only source of authority for issuing stay); 42 Pa.C.S. § 9545(c)(2) (requiring âstrong showing of likelihood of success on the meritsâ before stay may be issued). This provision, perhaps more than any other contained in the PCRA, reflects the General Assemblyâs recognition that the reason why convicted defendants are permitted to seek collateral relief is ânot to provide convicted criminals with the means to escape well-deserved sanctions, but to provide a reasonable opportunity for those who have been wrongly convicted to demonstrate the injustice of their convictionfs].â Peterkin, 722 A.2d at 643. In reviewing collateral appeals, it is the role of this Court to distinguish between the wrongly or unfairly convicted and those who deserve their sanctions. In doing so, we are not blind to the fact that, in capital cases, for those who fall into
To argue, as appelleeâs counsel does, that finality has already been âensuredâ and that âthe resolution of his case has been completedâ is to ignore both the juryâs penalty verdictâ the judgment of society â and the very circumstances that led to the instant appeal. The juryâs lawful verdict here was death, a verdict that became final when appelleeâs convictions and sentence were affirmed on appeal. That judgment and sentence have not been executed, nor can they be executed so long as a PCRA petition, which appellee never authorized, sits in stasis in perpetuity â operating not as a collateral vehicle to secure relief from unlawful confinement, but as a roadblock to the execution of a lawful judgment. Moreover, at the hearing on the Commonwealthâs Motion to Compel, the Commonwealthâs psychiatric expert, Dr. OâBrien, testified that it was his opinion that appelleeâs symptoms would not improve if left untreated. The defense expert psychologist, Dr. Russell, did not offer any testimony inconsistent with Dr. OâBrienâs opinion in this regard, nor did the PCRA court draw a contrary conclusion. Thus, we must assume for purposes of the instant appeal that, if left untreated, appellee will never be able to determine for himself whether or not to pursue post-conviction relief.
The prospect that a next friend will ever be appointed to make that determination on appelleeâs behalf seems just as unlikely. As the PCRA court noted in denying the defense motion to appoint Attorney Epstein as next friend, it will be
In addition, it must be remembered that convicted defendants are not required to pursue PCRA relief and, if a defendant does not timely pursue a collateral attack under the PCRA, the right to do so expires. Nothing in the PCRA requires that the failure to avail oneself of a state court collateral attack be knowing and voluntary, or even that the failure be the result of a competent decision. Since appellee himself did not pursue â or authorize pursuit of â PCRA relief, and no timely and appropriate next friend did so, unless appellee can pursue PCRA relief through the guise of the present litigation, or finds a claim that qualifies for one of the narrow exceptions to the time bar, then appelleeâs ability to collaterally attack his convictions and death sentences in Pennsylvania courts should be deemed to have expired, and the question of medication to enable competency is moot. In short, if the case is final, as appelleeâs counsel says, it may be final in a way that is different than he assumes: appellee
The purpose of PCRA review, we reiterate, is not to afford convicted criminals a means to escape deserved sanctions and, in this case, the effect of the juryâs verdict. It exists exclusively to benefit criminal defendants, allowing them a second chance to undo a judgment, a chance not afforded to civil litigants and a chance that furthers our Commonwealthâs respect for life and individual liberty. It allows those who would proclaim their innocence, or that their trials violated constitutional norms, a second chance to prove the same and escape an undeserved fate.
The âinterestâ here, then, is not simply the strong societal interest in finality. Rather, the instant case clearly implicates the Sell caveat, see Sell, 539 U.S. at 181-82, 123 S.Ct. 2174 (recognizing possible existence of âdifferent purposesâ for compelled medication such as âpurposes related to the individualâs own interestsâ). Medicating appellee so that he can decide whether to pursue PCRA relief, and then assist in its pursuit if he desires collateral review, is in appelleeâs interest. This is so because the proper outcome of the proceeding below is not holding the unauthorized PCRA petition filed sua sponte by Attorney Dunham in stasis, and thereby indirectly enjoining the judgment and sentence of death. Rather, the proper result is, assuming a suitable next friend cannot be found, to dismiss a filing that was never authorized by appellee or pursued by a person with next-friend standing. See Florida v. Nixon, 543 U.S. 175, 187, 125 S.Ct. 551, 160 L.Ed.2d 565 (2004) (âA defendant ... has the ultimate author
The Commonwealth laudably does not advocate dismissal of appelleeâs PCRA petition as unauthorized, which would mean that appelleeâs right to PCRA review has expired. The above discussion is nonetheless relevant because it more precisely identifies the interests truly at stake. Sell noted that a case where ârefusal to take drugs puts [the defendantâs] health gravely at riskâ might require a different calculus. Sell, 539 U.S. at 182, 123 S.Ct. 2174. Here, indulging a refusal or disinclination to take medication will compromise appelleeâs ability to collaterally attack his judgment, as permitted under the PCRA. We believe that the societal interest in finality (including the interest of crime victims and their families), as well as appelleeâs interest in exercising his personal right to statutory collateral review â should he so choose â are âimportantâ within the meaning of Sell. Accordingly, we hold that the PCRA court erred in determining that the Commonwealth failed to satisfy the first prong of the Sell test.
Consistently with Sell, we next examine whether the involuntary administration of antipsychotic drugs will significantly further the Commonwealthâs interest in the finality of the juryâs judgment against appellee, and appelleeâs concomitant right to seek collateral review. This factor requires the Commonwealth to show that administration of such medication is: (1) substantially likely to render appellee competent; and (2) substantially unlikely to have side effects that will interfere significantly with his ability to assist counsel. Sell, 539 U.S. at 181, 123 S.Ct. 2174.
The Commonwealth also specifically challenges the PCRA courtâs application of the second Sell factor. As for the first requirement of this factor, the Commonwealth takes issue with the courtâs determination that the âconcrete detailsâ of appelleeâs treatment must be proposed before the Commonwealthâs motion can be granted. Again citing the unrebutted testimony of Dr. OâBrien, the Commonwealth notes that it would be premature to identify specific medications or dosages until appellee undergoes a physical examination to rule out a physical cause of his psychosis.- Moreover, the Commonwealth observes, determining the appropriate course of treatment generally entails a process of trial and error whereby the effectiveness and adverse side effects of several different medications and dosages are observed over time, if necessary. With respect to this process, the Commonwealth submits, Dr. OâBrien provided detailed information, unlike the expert in United States v. Evans, supra, upon which the PCRA court relied. Citing Dr. OâBrienâs report, the Commonwealth notes that Risperdal and Zyprexa were specified as possible options for appelleeâs treatment and that the Physiciansâ Desk Reference was cited as a source for correct dosages for specific medications. Finally, the Commonwealth invites us to reject the Evans courtâs determination that the particular medication and dose range must be specified, noting that other Circuits have not required such specificity. Commonwealthâs Brief at 36 (citing United States v. Bradley, 417 F.3d 1107 (10th Cir.2005), and United States v. Gomes, 387 F.3d 157 (2d Cir.2004), cert. denied, 543 U.S. 1128, 125 S.Ct. 1094, 160
In response, and noting Dr. OâBrienâs recommendation that appellee be regularly monitored while treated, appelleeâs counsel emphasizes the PCRA courtâs feeling that the medical monitoring of an inmate committed to death row is not viable. Appelleeâs counsel also invokes the PCRA courtâs finding of inadequate proof that medication would be substantially likely to render appellee competent. Counsel for appellee argues that these are factual determinations that are supported by evidence in the record and, therefore, they cannot be challenged on appeal. See Appelleeâs Brief at 27 (noting Dr. OâBrienâs testimony that âLt]here is really no way to predict how a person is [] going to respond from a therapeutic perspective to a medicationâ).
We do not find the Fourth Circuitâs decision in Evans to be persuasive on the issue of the specificity required with respect to the medication administered to render a psychotic inmate competent to assist counsel. While the requisite level of specificity is difficult to pinpoint in the abstract, we hold that the PCRA court erred in purporting to determine, as a matter of law, that the Commonwealth needed to provide âconcrete detailsâ of particular medications and dosages to satisfy the second Sell factor. The following unrebutted testimony from Dr. OâBrien is instructive:
We have a body of knowledge in medicine that basically educates us about the statistical likelihood of therapeutic responses and also certain side effects. But there is really no way ... predicting in advance how a particular patient will respond to a particular medication of choice until that choice has been made, the medication prescribed, and at that point the physician observes the patientâs response to the medication in terms of itâs [sic] effect on the symptoms, and also observers [sic] the patient to determine whether or not side effects are present.
We further hold that the PCRA court erred in finding that inadequate evidence supported the Commonwealthâs assertion that medication would be substantially likely to render appellee competent. Preliminary, it is important to note that the PCRA court did not deem Dr. OâBrienâs testimony in this regard to be incredible. As the Commonwealth notes, Dr. OâBrien testified to a reasonable degree of medical certainty that appellee would respond to treatment with antipsychotic medication. Indeed, Dr. OâBrien concluded that appelleeâs prognosis, after treatment with such medication, was âexcellent.â Dr. OâBrienâs opinion was not ephemeral, as it was based in part on his observation that appellee had been successfully treated in the past with such medications. Appelleeâs counselâs reliance on Dr. OâBrienâs testimony as to there being no way to know for certain how one will respond to any given medication is a red herring. When considered in its entirety, Dr. OâBrienâs testimony on this point made clear that the psychiatric community has been able to calculate the statistical likelihood of certain therapeutic responses as well as certain side effects of a variety of different antipsychotic medications. With respect to appellee, Dr. OâBrien could be more certain of the drugsâ likely effectiveness because of appelleeâs positive response and the absence of serious side effects while taking Thorazine, an older antipsychotic medication with a higher side effect profile. Dr. Russell, the defenseâs expert psychologist, who was not a medical doctor, did not contradict the above testimony from Dr. OâBrien, nor could he (at least with respect to the likelihood of side effects),
Consistently with Sell, we next consider whether the involuntary administration of antipsychotic drugs is necessary to achieve the dual interests we have identified. This factor requires the Commonwealth to show that âany alternative, less intrusive treatments are unlikely to achieve substantially the same results.â Sell, 539 U.S. at 181, 123 S.Ct. 2174.
In arguing that it satisfied the third Sell factor, the Commonwealth notes that Dr. OâBrien testified that, without treatment, appelleeâs psychotic symptoms would not abate and that the administration of antipsychotic medication was the least intrusive means of treating him. The Commonwealth further notes that the involuntary administration of such medication would only be necessary if appellee refused to take the drugs orally, consistent with the course of treatment that Dr. OâBrien would recommend. Finally, the Commonwealth observes, Dr. Russell, the defense expert, agreed that appelleeâs symptoms would not improve without intervention with medication.
Without referring to the expert testimony presented at appelleeâs competency hearing, appelleeâs counsel simply asserts that the Commonwealth cannot meet the third Sell factor because it failed to meet the second factor. That is, according to appelleeâs counsel, the Commonwealthâs supposed failure to prove that medication would be substantially likely to render appellee competent is fatal to its attempt to show that medication is necessary to achieve appelleeâs competence.
Our review of the record indicates that there is no dispute that treatment with antipsychotic medication is necessary to restore appelleeâs competence. To begin with, both the Commonwealth and appelleeâs counsel agree that appellee is presently incompetent to participate in PCRA proceedings. Moreover, Dr. Russell did not dispute Dr. OâBrienâs opinions that appelleeâs symptoms would not improve if left unmedicated
Finally, guided by Sell, we address the question of whether the administration of antipsychotic drugs is medically appropriate. Within the meaning of Sell, a treatment is medically appropriate if it is âin the patientâs best medical interest in light of his medical condition.â Sell, 589 U.S. at 181, 123 S.Ct. 2174. Naturally, when considering the medical appropriateness of a given treatment, a certain degree of âdeference [ ] is owed to medical professionals who have the full-time responsibility of caring for mentally ill inmates ... and who possess, as courts do not, the requisite knowledge and expertise to determine whether the drugs should be used in an individual case.â Washington v. Harper, 494 U.S. 210, 230 n. 12, 110 S.Ct. 1028, 108 L.Ed.2d 178 (1990).
With respect to this factor, the Commonwealth notes that Dr. OâBrienâs testimony that treating appellee with antipsychotic drugs was in his best medical interest was unopposed by Dr. Russell. The Commonwealth suggests that the PCRA court erroneously substituted its own âspeculationâ for Dr. OâBrienâs uncontradicted testimony. Commonwealthâs Brief at 40. The Commonwealth also challenges the PCRA courtâs reasoning in finding this factor unsatisfied as being inconsistent, as a matter of law, with the very holding of Sell.
Appelleeâs counsel counterargues that the PCRA court must have disbelieved Dr. OâBrien, and did so based on the lack of foundation in the record for his expert conclusion. Counsel for appellee posits that the PCRA court made a factual
As the Commonwealth notes, the Sell Court expressly stated that the four factors it set forth were to be applied in a particular circumstance: to determine whether an inmate should be medicated to achieve his competence to stand trial. Indeed, the Court specifically distinguished this particular purpose of administering medication from different purposes and explicitly mentioned âpurposes related to the individualâs dangerousnessâ as distinct. Sell, 539 U.S. at 182, 123 S.Ct. 2174. Consequently, we are puzzled by the PCRA courtâs mention, in its analysis under the fourth factor of Sell, that appellee supposedly had been found not to be a danger to himself or others. The PCRA courtâs conflation of the two inquiries is particularly troubling given Dr. OâBrienâs uncontradicted opinion that antipsychotic medication would be the most appropriate treatment for appellee. We therefore find that the PCRA court erred in concluding that treating appellee with antipsychotic medication would be medically inappropriate. In conclusion, because we find that all four factors of the Sell test have been satisfied, we hold that the PCRA court erred in determining that federal due process precludes the involuntary administration of medication in order to advance the PCRA process in the instant case.
Our conclusion that the compelled medication of appellee to determine whether he wishes to pursue PCRA relief and to assist appointed counsel does not offend the federal Due Process Clause does not end our inquiry. Appelleeâs counsel contends further that the decision of the PCRA court can be affirmed on either of two alternate grounds. First, counsel for appellee argues that the Pennsylvania Mental Health Procedures Act (âMHPAâ or âthe Actâ)
With respect to the MHPA, appelleeâs counsel argues that the Act prohibits compelled medication for the purpose of rendering an inmate competent to participate in post-sentence proceedings. Indeed, appelleeâs counsel notes, Section 801 of the Act allows the involuntary administration of medication âonly to respond to a âclear and present dangerâ as presented by the subject.â Appelleeâs Brief at 32; see also 50 P.S. § 7301(a) (authorizing involuntary treatment of person who âposes a clear and present danger of harm to others or to himselfâ as defined by 50 P.S. § 7301(b)). Moreover, appelleeâs counsel argues, even if the MHPA would otherwise permit the Commonwealth to forcibly medicate appellee to achieve his competence, the particular order that the Commonwealth here seeks would be improper because Section 109(c) of the Act forbids a court from requiring âthe adoption of any treatment technique, modality, or drug therapy.â 50 P.S. § 7109(c).
The Commonwealth responds that Section 301 of the MHPA is inapplicable to the instant case, a post-conviction collateral appeal, because that Act sets forth the standard for civil commitments. Citing In re Heidnik, 554 Pa. 177, 720 A.2d 1016 (1998) and Commonwealth v. Jermyn, 539 Pa. 371, 652 A.2d 821 (1995), the Commonwealth notes that this Court has declined to extend the provisions of the Act beyond their express terms. The Commonwealth further notes that nothing in the MHPA prohibits the involuntary administration of medication to render an inmate competent in the post-conviction context. In response to appelleeâs counselâs argument based on Section 109(c) of the Act, the Commonwealth argues
âThe Mental Health Procedures Act governs the provision of inpatient psychiatric treatment and involuntary outpatient treatment.â Zane v. Friends Hosp., 575 Pa. 236, 836 A.2d 25, 33 (2003). The purpose of the Act is âto assure the availability of adequate treatment to persons who are mentally ill, and to establish procedures to effectuate this purpose.â Id. (citing Section 102 of the Act, 50 P.S. § 7102).
We considered the applicability of the MHPA in the post-conviction context in Commonwealth v. Jermyn, which concerned a death row inmateâs competence to be executed. Jermyn claimed that the lower court erred in applying the competence standard set forth in Ford v. Wainwright, 477 U.S. 399, 106 S.Ct. 2595, 91 L.Ed.2d 335 (1986), ie., whether the inmate understands the reasons for the death penalty and its implications. Instead, Jermyn argued, the lower court should have relied upon Section 402 of the MHPA, which provides, in pertinent part, as follows:
§ 7402. Incompetence to proceed on criminal charges and lack of criminal responsibility as defense
(a) Definition of Incompetency. â Whenever a person who has been charged with a crime is found to be substantially unable to understand the nature or object of the proceedings against him or to participate and assist in his defense, he shall be deemed incompetent to be tried, convicted or sentenced so long as such incapacity continues.
50 P.S. § 7402 (amended 1996).
Instantly, the PCRA court followed Jermyn in concluding that the MHPA was inapplicable to the appeal sub judice. We agree that it makes little sense to apply a statute that provides the standard for incompetence âto proceed on criminal chargesâ to a case involving a convicted inmateâs competence to initiate and assist his counsel in pursuing post-conviction collateral relief, particularly when the statuteâs very purpose is to assure the availability of adequate treatment for persons, like appellee, who are mentally ill. Accordingly, we hold that the MHPA does not provide alternate grounds to affirm the decision of the PCRA court.
Appelleeâs counsel also argues that the PCRA courtâs denial of the Commonwealthâs Motion to Compel Medication should be affirmed because the involuntary administration of medication to render appellee competent to determine whether he wishes to pursue PCRA relief and, if so, to assist PCRA counsel is a per se violation of his constitutional right to privacy under Article I, Section 8 of the Pennsylvania Constitution. Appelleeâs counsel contends that Article I, Section 8 goes beyond Sell and guarantees appellee the absolute right to refuse medication âwhen offered for any purpose other than to address a clear and present danger to himself or others.â Appelleeâs Brief at 34.
As appelleeâs counsel notes, Edmunds directs advocates to brief and analyze the following four factors when litigating a claim that state constitutional doctrine should depart from the applicable federal standard: (1) the text of the provision of the Pennsylvania Constitution; (2) the history of the provision, including the caselaw of this Commonwealth; (3) relevant caselaw from other jurisdictions; and (4) policy considerations, âincluding unique issues of state and local concern, and applicability within modern Pennsylvania jurisprudence.â Edmunds, 586 A.2d at 895. With respect to the first factor, appelleeâs counsel merely quotes the text of Article I, Section 8. For its part, the Commonwealth notes that the provision makes no mention of medical treatment but, rather, concerns unreasonable searches and seizures.
We begin our Edmunds analysis with a comparison of the language of Article I, Section 8 to that of its federal counterpart, the Fourth Amendment. The Fourth Amendment of the U.S. Constitution provides as follows:
The right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures, shall not be violated, and no Warrants shall issue, but upon probable cause, supported by Oath or affirmation, and particularly describing the place to be searched, and the persons or things to be seized.
Similarly, Article I, Section 8 of the Pennsylvania Constitution provides as follows:
The people shall be secure in their persons, houses, papers and possessions from unreasonable searches and seizures, and no warrant to search any place or to seize any person or things shall issue without describing them as nearly as may be, nor without probable cause, supported by oath or affirmation subscribed to by the affiant.
Turning to the second Edmunds factor, appelleeâs counsel begins by extensively quoting our review in Edmunds of the origin of Article I, Section 8. Counsel for appellee then briefly discusses Commonwealth v. Polo, 563 Pa. 218, 759 A.2d 372 (2000), Commonwealth v. Gindlesperger, 560 Pa. 222, 743 A.2d 898 (1999), Commonwealth v. Matos, 543 Pa. 449, 672 A.2d 769 (1996), and Commonwealth v. Sell, 504 Pa. 46, 470 A.2d 457 (1983), four decisions in which this Court recognized broader protections under Article I, Section 8 than the U.S. Supreme Court had allowed under the Fourth Amendment. In response, the Commonwealth asserts that the authorities cited by appelleeâs counsel are inapposite. The Commonwealth also notes that âthis Court has confirmed that the right to abstain from treatment is not absolute and âmust be balanced against the interests of the state.â â Commonwealthâs Brief at 43 (quoting In re Fiori, 543 Pa. 592, 673 A.2d 905, 910 (1996)).
In citing decisions of this Court recognizing broader Article I, Section 8 protection than under the Fourth Amendment, appelleeâs counsel fails to explain how appelleeâs desire not to take medication to render him competent to determine whether to pursue PCRA relief implicates the heightened privacy interest recognized in the decisions appelleeâs counsel cites,
With respect to the third factor of Edmunds, appelleeâs counsel cites Louisiana v. Perry, 610 So.2d 746 (La.1992) (prohibiting medication of inmate against his will to render him competent to be executed), Singleton v. State, 313 S.C. 75, 437 S.E.2d 53 (1993) (holding forced medication solely to facilitate execution would violate state constitutional right of privacy), and Riese v. St. Maryâs Hospital and Medical Cen
We do not find the decisions cited by appelleeâs counsel persuasive for present purposes. To begin with, all three cases preceded Sell and therefore did not provide the opportunity to consider whether to adopt the framework set forth by the High Court in that case. Moreover, all three cases are readily distinguishable from the instant matter. Riese presented the question of whether psychiatric patients â not prisoners â who had been involuntarily committed to a mental health facility had the âstatutory rights to exercise informed consent to the use of antipsychotic drugs in non-emergency situations absent a judicial determination of their incapacity to make treatment decisions.â Riese, 271 Cal.Rptr. at 201 (emphasis added). Although it answered the question in the affirmative, the Riese court explicitly avoided deciding the case on constitutional grounds. Id.
In Singleton and Perry, the other two decisions upon which appelleeâs counsel primarily relies, both courts determined that, in seeking the involuntary administration of antipsychotic drugs upon a prisoner, the Stateâs only justification was to render the prisoner competent to be executed. See Singleton, 437 S.E.2d at 61 (holding that privacy right under South Carolina constitution would be violated by âforced medication solely to facilitate executionâ); Perry, 610 So.2d at 752 (forbidding, under Louisiana constitution, âforcible medication of a prisoner merely to improve his mental comprehension as a means of rendering him competent for executionâ). Indeed, the Perry courtâs repeated advertence to the lack of any other state interest underscores the limited nature of the holding of that case. See Perry, 610 So.2d at 754 (finding that âstateâs involuntary use of drugs on [prisoner] must be vindicated if at all as a procedure that legitimately forms part of his capital punishmentâ); id. at 750, 755, 757, 761 (repeatedly referring to
It is also worth noting that in both Perry and Singleton the prisonersâ privacy rights were found violated under constitutional provisions that, unlike Article I, Section 8, explicitly protect against unreasonable âinvasions of privacy.â See Singleton, 437 S.E.2d at 61 (quoting S.C. Const, art. I, § 10); Perry, 610 So.2d at 755 (quoting La. Const, art. I, § 5). More persuasive for present purposes is In re Caulk, 125 N.H. 226, 480 A.2d 93 (1984), in which the Supreme Court of New Hampshire upheld a trial courtâs order to force-feed a prisoner conducting a hunger strike. The prisoner argued that the order violated his privacy right under Pt. I, Article 19 of the New Hampshire Constitution, which, like Article I, Section 8 of the Pennsylvania Constitution, does not exphcitly enshrine the right to be free from invasions of privacy. Noting that he was attempting to âfrustrate the criminal justice system,â the court rejected the prisonerâs claim. Caulk, 480 A.2d at 96-97.
Counsel for appellee concludes his Edmunds analysis by suggesting that the resolution of appelleeâs case is unnecessary given his continued detention, a policy consideration that is âconfirm[ed]â by the MHPA. Appelleeâs Brief at 41. The Commonwealth counterargues that recognizing a state constitutional right to refuse medication absent clear and present danger would allow capital murderers to delay the final resolution of their claims.
For the reasons discussed above in determining that the societal interest in finality and appelleeâs interest in vindicating any proper challenge he has to his conviction and sentence are sufficiently important to justify compelling appellee to take psychiatric medication, see supra at 576-80, we find the policy argument asserted by appelleeâs counsel to be unavailing. Appelleeâs counselâs reliance on the MHPA renders his argument no more persuasive in this context. For the reasons discussed above in rejecting his argument that the Act prohibits compelled medication for the purpose of rendering an inmate competent to participate in post-sentence proceedings, see supra at 576-79, we find the Act to be inapplicable to the instant case. â
For the foregoing reasons, we hold that the PCRA court erred in determining that appellee may refuse the administration of antipsychotic medication under the circumstances of this case. Accordingly, we reverse that part of the order of the PCRA court which denied the Commonwealthâs Motion to Compel Psychiatric Medication. We direct the PCRA court to order that appellee be administered, involuntarily if necessary, antipsychotic medication to render him competent. If such medication renders appellee competent, the PCRA court is hereby directed to ascertain the following: first, whether appellee, in fact, wishes to proceed with the PCRA petition that Attorney Dunham filed without his authorization; and, if the answer to the first question is in the affirmative, then, second, whether appellee can assist counsel in pursuing PCRA
Reversed and remanded for proceedings consistent with this Opinion.
. 42 Pa.C.S. §§ 9541-9546.
. The date of the filing by Attorney Dunham was not random. In light of the 1995 amendments to the PCRA, which added a one-year time restriction, see 42 Pa.C.S. § 9545(b), January 16, 1997 was the last day a PCRA petitioner whose conviction had become final prior to the amendments, such as appellee, could file a first PCRA petition as of right. See Commonwealth v. Fenati, 561 Pa. 106, 748 A.2d 205 (2000).
. It appears that Attorney Dunham is no longer involved in the litigation he initiated.
. Dr. Russell subsequently testified that by "intervention,â he meant "some sort of treatment," including treatment with medication. Notes of Testimony, 4/4/03, at 93.
. The defense subsequently filed two additional motions in this matter. First, on May 30, 2002, the defense filed a Memorandum of Law Seeking Denial of Hearing on Forced Medication, to which the Commonwealth filed an answer on June 27th. The PCRA court ultimately denied the defense motion on January 16, 2003. Second, on January 20, 2004, the defense filed a motion for appointment of Attorney Epstein as appellee's next friend, to which the Commonwealth filed an answer on May 26th. In the opinion it issued on October 20, 2005, see infra, the, PCRA court denied the defenseâs next friend motion without prejudice.
. At this point during the direct examination of Dr. O'Brien, the court posed its own question as to how a medication would be administered if refused. After noting that in his experience a "significantly larger number of patients [ ] verbally refuse medication than actually fight it off,â Dr. OâBrien testified with respect to appellee as follows:
N.T., 4/4/03, at 31.
. In its accompanying opinion, the court explained that the next friend motion was denied without prejudice to the ability of the defense to
. Subsequent to the PCRA courtâs decision, this Court defined competence for purposes of pursuing post-conviction relief as the ability to âunderstand[ ] the process and goals of PCRA proceedings and ... to assist in that process to the extent required given the specific legal and factual issues which remain to be litigated.â Commonwealth v. Zook, 585 Pa. 11, 887 A.2d 1218, 1224-25 (2005). Application of that standard to the instant case is unnecessary, as the Commonwealth stipulated before the PCRA court that appellee is presently incompetent for purposes of pursuing relief under the PCRA.
. In fact, Dr. OâBrien testified that it was his opinion that appellee was, at present, potentially dangerous to himself or others. N.T., 4/4/03, at 38. Dr. O'Brien based his opinion on prison medical records that indicated that appellee had refused routine physical evaluations, thereby precluding prison doctors from determining whether a medical condition was causing his delusions and from preventing the spread of communicable diseases.
. The defendant-appellee in Watson argues that the Commonwealth is not entitled to immediate review of the order of the PCRA court. As we explain in our opinion in Watson, the PCRA courtâs order, although interlocutory, is immediately appealable as a collateral order pursuant to Pa.R.A.P. 313. See Watson, 952 A.2d at 550-54. Counsel for appellee does not challenge the Commonwealthâs right to immediate review of the PCRA court order in the instant case. See Appellee's Brief at 11 ("Appellee does not dispute the jurisdiction of this Court to review the ORDER barring forced medication.â). In any event, the collateral order doctrine applies here for the same reasons as in Watson.
. The Sell Court derived its four-part test from the Court's decisions in Harper, supra (holding that danger to self or others is permissible basis for compelled administration of antipsychotic drugs to treat serious mental illness) and Riggins v. Nevada, 504 U.S. 127, 135, 112 S.Ct. 1810, 118 L.Ed.2d 479 (1992) (noting that, "[u]nder Harper, forcing antipsychotic drugs on a convicted prisoner is impermissible absent a finding of overriding justification and a determination of medical appropriatenessâ). Importantly, Sell did not break new ground in recognizing the possible existence of governmental interests other than inmate safety that are strong enough to outweigh a prisonerâs constitutionally protected liberty interest in avoiding unwanted medication. In Harper, the Court did not hold that danger to self or others was the only permissible basis for involuntarily medicating mentally ill inmates. Rather, what is required under Harper is "a finding of overriding justificationâ-or an "essential state policy.â Riggins, 504 U.S. at 135, 138, 112 S.Ct. 1810. Thus, in Riggins, the Court determined that antipsychotic medication might be permissible even though compelled medication was sought not to ensure inmate safety but to render Riggins competent to stand trial. See id. at 131, 138, 112 S.Ct. 1810 (remanding for further proceedings where trial court denied inmate's motion to terminate medication in one-page order that gave no indication of courtâs rationale); id. at 136, 112 S.Ct. 1810 (noting State's view was that "continued administration of Mellaril was required to ensure that the defendant could be tried").
. For example, where the purpose of compelled medication is to render an inmate competent to stand trial, Sell directs consideration of such matters as whether, once medicated, the inmate will be able to communicate with counsel, react to trial developments, and express emotions. See Sell, 539 U.S. at 185, 123 S.Ct. 2174. Such considerations are ânot necessarily relevant when dangerousness is primarily at issue,â id., nor are they of as much force where the Commonwealth seeks to restore appellee's competence merely to determine whether he wishes to pursue PCRA relief, requiring a significantly lesser intrusion upon appelleeâs liberty interest than the Government's request in Sell, which would require ongoing medication through trial.
. In his Dissenting Opinion, Mr. Justice Baer states that the Sell Court "held that the government failed to demonstrate a basis for involuntary medication sufficient to override Sellâs liberty interest based on the record in Sell." Dissenting Op. at 568, 952 A.2d at 592. Although the High Court in Sell did ultimately vacate the Eighth Circuitâs judgment approving of Sell's involuntary medication, the reason was not because the Court found the Governmentâs basis for involuntarily medicating Sell to be insufficient. Rather, the High Court remanded the matter in order to develop the record relative to the four factors it set forth as the test to be applied by the trial court in the first instance. As for the Governmentâs interest in restoring Sellâs competence to stand trial, the Court specifically directed that the Government could continue to pursue its request for forced medication on those grounds. See Sell, 539 U.S. at 186, 123 S.Ct. 2174. Therefore, the Dissenting Opinion relies on a mistaken premise in concluding that the Commonwealthâs finality interest (and appellee's PCRA interests) "simply cannot be sufficient to trump the important liberty interest in avoiding forced medication, considering that the governmental interest in bringing Sell
. Citing, e.g., Commonwealth v. Haag, 570 Pa. 289, 809 A.2d 271, 278 (2002) (requiring third party, in order to be able to proceed as next friend, to provide explanation for real party's failure to appear), the Commonwealth briefly argues that we need not reach the propriety of the order that it seeks under Sell because appellee has failed to carry his burden of showing that he cannot be made competent with psychiatric medication. Although the Commonwealth correctly notes that the burden normally falls on the party invoking his incompetence, whether appellee is incompetent is not disputed in the instant case. Appellee is not asserting a defense to a crime but, rather, merely the right not to be medicated without his consent. Therefore, we reject the Commonwealth's suggestion that appellee must be forcibly medicated unless and until he shows that he cannot be made competent without medication. See Sell, 539 U.S. at 183, 123 S.Ct. 2174 (identifying as ultimate constitutional question, "Has the Government, in light of the efficacy, the side effects, the possible alternatives, and the medical appropriateness of a particular course of antipsychotic drug treatment, shown a need for that treatment sufficiently important to overcome the individualâs protected interest in refusing it?â) (emphasis added); see also Riggins, 504 U.S. at 135, 112 S.Ct. 1810 (reviewing trial court's denial of defendant's motion to discontinue antipsychotic medication during trial) (noting that due process would have been satisfied "if the prosecution had demonstrated ... that treatment with antipsychotic medication was medically appropriate and, considering less intrusive alternatives, essential for the sake of Rigginsâ own safety or the safety of othersâ) (emphasis added).
. Although it is counsel who advocate, we generally attribute arguments to the parties whom they represent. Doing so would be, at best, misleading in this case, however, as it is not only the argument that he articulates but also the position he advances in opposing the Commonwealth's motion that are counselâs alone, as all parties agree that appellee remains incompetent to decide whether to pursue post-conviction relief, just as, according to Attorney Dunham, he was when a PCRA petition was filed on his behalf without his authorization. See PCRA Petition, filed Jan. 16, 1997, at 3.
. As the Commonwealth notes, the PCRA court failed to analyze the Commonwealth's showing under the third factor of Sell.
. Act of July 9, 1976, P.L. 817, as amended, 50 P.S. §§ 7101-7503.
. Preliminarily, we reiterate that, even if appellee's counsel were correct on these alternative theories, affirmance would not necessarily follow â i.e., it does not necessarily mean that the PCRA petition that Attorney Dunham took it upon himself to file without appellee's authorization would sit in perpetual stasis. Rather, as we shall discuss in framing the mandate, if medication cannot be compelled, the alternatives are that the PCRA petition must be dismissed, or a next friend must be appointed â if one is available â to pursue PCRA relief.
. The 1996 amendments to Section 402 of the MHPA did not alter the definition of incompetence.
. In arguing that granting the Commonwealth's motion would be unconstitutional, counsel for appellee also invokes Article I, Section 1 of the Pennsylvania Constitution. Rather than develop a distinct argument in this regard, however, appellee's counsel merely asserts, in a footnote, that âthe right of privacy inherent in this Constitutional provision has been carefully protected by the Pennsylvania courts.â Appelleeâs Brief at 35 n. 12 (citing this Courtâs plurality opinion in In the Matter of T.R., 557 Pa. 99, 731 A.2d 1276 (1999)). The single
. It bears mention that, in addition to lacking any source in the text of Article I, Section 8, the âclear and present dangerâ precondition to forced medication that appelleeâs counsel desires is not consistent with the holdings of decisions from other jurisdictions that have been decided on state constitutional grounds. See, e.g., Large v. Superior Court, 148 Ariz. 229, 714 P.2d 399 (1986) (allowing involuntary administration of "dangerousâ drugs to treat mentally ill prisoners "in non-emergency situationsâ under certain circumstances); People v. Hardesty, 139 Mich.App. 124, 362 N.W.2d 787, 794 (1985), appeal denied (Mich. 1986) (order denying appeal unpublished) (upholding constitutionality of state statute under which prisoner was involuntarily administered antipsychotic drugs).