Commonwealth v. Watson
Full Opinion (html_with_citations)
OPINION
Today we decide two appeals each presenting 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 he wishes to pursue relief under the Post Conviction Relief Act (PCRA).
On November 14, 1996, appellee filed a pro se PCRA petition. After several reassignments, the case was ultimately assigned to the Honorable David N. Savitt of the Court of Common Pleas of Philadelphia County. An amended petition was finally filed on October 3, 2001.
At a status conference held on May 20, 2004, the Commonwealth requested that the PCRA court issue an order compel
On October 18, 2004, the PCRA court held the first of two hearings on the issue of whether appelleeâs competency could be restored. At the first hearing, the defense presented testimony from Dr. Sadoff, one of its two mental health experts. On direct examination, Dr. Sadoff testified that it was his opinion âwithin reasonable medical certaintyâ that appellee, âbecause of his mental illness, which is paranoid schizophrenia and he is psychotic, does not really understand in a rational way the proceedings in which heâs involved or the consequences of those proceedings.â N.T., 10/18/04, at 22. As to whether appellee was currently a danger to himself or others while incarcerated on death row, Dr. Sadoff opined, based on his review of appelleeâs prison records, that appellee âhas not been violent.â Id. at 28.
I donât know, Your Honor. I know he has been tried on a number of different medications. I donât know how long heâs taken them. I donât know what dosages heâs had, but if he gets the right medication and the proper dosage and is monitored carefully over a period of time and shows improvement, then I would say yes, then it works.
Id. at 30. With respect to the side effects of the medications with which appellee had previously been treated, Dr. Sadoff testified as follows:
[F]or the medications that he took there were unsettling side-effects, thatâs because some of the medication was the old tranquilizers that are now in injectable form. The newer medications donât have that kind of tardive dyskinesia, but they all have some side-effects. But the newer medications have fewer of the serious side-effects than the old medications have.
Id. at 32. When asked whether the medications that appellee had taken had failed to restore his competency, Dr. Sadoff responded that he could not answer the question because he did not have the necessary data. Id. at 33. Finally, when asked what he would prescribe for appellee, Dr. Sadoff testified as follows:
[I]f heâs willing to take it, Iâd give him the oral Zyprexa. If heâs not willing to take it ... and I have to give him something that Iâm sure will stay there, Iâll give him an injectable form of either Haldol or Prolixin, but those two have the side-effects that are not so nice....
Id. at 34. Dr. Sadoff subsequently identified the ânot so niceâ side effects of Haldol and Prolixin as âthe shakiness that we call dyskinesia.â Id. at 38.
At the October 18th hearing, the PCRA court also heard testimony from Marie Watson, appelleeâs mother, whom the court had appointed as his next friend. During examination by appelleeâs counsel, Mrs. Watson testified as follows:
*493 Q. Now you have met with me with your daughter, Angela Stokes, in my office about a couple weeks ago; am I correct?
A. Yes, sir.
Q. And we discussed all the issues about Mr. Watsonâs case; am I right?
A. Yes, we did.
Q. We discussed that he had some good legal issues but no one knew where they would go; am I right?
A. Uh-huh.
Q. I discussed that there was a chance that the Court might be willing to impose life imprisonment if we gave up those other issues; do you remember that?
A. Yes, sir, you spoke on that.
Q. And you also had a chance to meet, at my request, with Ms. McCracken from the death penalty organization and Mr. McHugh from the death penalty organization; am I correct?
A. Yes, sir.
Q. You did that at my request and you met them on one or two occasions on this particular issue; am I right?
A. Yes, sir.
Q. And based on all those conversations, you understand itâs in the interest of your son to live and not to be put to death; am I correct?
A. Yes, sir.
N.T., 10/18/04, at 43-44 (emphasis added). At this point during Mrs. Watsonâs testimony, the PCRA court interjected, prompting the following additional testimony:
Q. Well, let me ask you this. Thatâs your opinion; is that right? You want him to live?
A. Itâs not totally my opinion. I think he deserves to live.
Q. Do you think he knows what heâs doing when he says he wants to die?
A. No, sir. No, sir. If that was so, I would have went [sic] home when he said go home.
Q. You donât want him to die, thatâs what you donât want. But the question is, if youâre his best [sic] friend, your obligation isnât necessarily to do what you want, itâs to do what he wants.
A. Yes, sir.
Q. Now you know him, heâs your son, youâve talked to him; is that correct?
A. Yes, sir.
Q. What does he want?
A. I would hope it would not be to die. I donât really think he wants to die. I think he has decided if he has to live like heâs been living, it would be better to be dead.
Q. Well, is that a reasonable â some people make that decision and that doesnât mean youâre incompetent, because the option then that youâve been asked is to give up any claims he has and he will do life imprisonment without parole; is that what you think he wants?
A. No, sir.
Q. You think he wants to be exonerated?
A. Well, I think heâs been here all the time, he did the suffering and I think he wants justice. I think he wants justice.
Id. at 46-47.
After briefly hearing testimony from appelleeâs sister, Angela Stokes, the PCRA court concluded the October 18th proceeding by hearing testimony from appellee himself. Although portions of it are incoherent, appelleeâs testimony does include a direct response to the courtâs pointed question, âYou want the death penalty?â:
*495 Yes, I do. People just got up there. Iâm concerned about my mother because my mother wouldnât be there normally. Normally she donât get involved. They saying they said something I be having a mental problem. I never had a mental problem at all in my life. The only reason I took medication was harassments in the prison. And when they came out there and saw me before, I told them that. The psychiatrist said something about me having a mental problem. Every time he came out there I spoke saying the letter that I wrote you donât say anything on it, and made it clear, the same way Iâm speaking now, which says nothing wrong with me. But what you just said that death only applies â like I said, Iâve been down a long time. It donât have anything to do with life sentence. Iâve been doing time. Jail is jail. It have to do with something thatâs death and then the person, the case, it [the victim] was my common law wife. And it just never set right to me in the beginning. All have to be judged now. I donât say anything about God to a psychiatrist. I could, I donât know why he came up to weak stuff, which is obvious.
And then the second in line â everybodyâwhich if you be a Judge, you see that and thatâs why youâre there to show that people show that. And thatâs all it is, but thatâs what it is and in this case clearly death penalty applies. Iâve been down on death row and thatâs the decision. I donât want to burden my family. Normally they donât get involved. I donât need a lawyer. The lawyer over here is a bad one. He is efficient to on the letters. It would not be hard to understand because it shows everything I said that he would do, he did. I donât want him on the case and he came on. Heâs not representing me; heâs doing what he want to do. A lawyer would have to represent the truth on what a person said. If I said Iâm guilty, how can he represent a lie. He said a lot about what Iâm saying. So thatâs it.
N.T., 10/18/04, at 57-59 (emphasis added).
On November 22, 2004, the PCRA court held a second evidentiary hearing at which Dr. OâBrien testified for the
After being questioned in some detail as to a sampling of the records, Dr. OâBrien testified more generally as follows:
Q. So ... when he is not under treatment or medication, he becomes incompetent ... ?
A. Yes, thatâs correct/4 -1
Q. But he can be treated?
A. Yes. And the treatment is effective for him as documented in the records.
Q. And when heâs treated, is it your opinion that he is competent?
A. Yes, it is my opinion heâs competent.
Id. at 24-25.
Before concluding direct examination, the prosecution asked for the courtâs permission to âgo through the factors that were discussed in Sell[ v. United States, 539 U.S. 166, 123 S.Ct. 2174, 156 L.Ed.2d 197 (2003)
*497 Q. Dr. OâBrien, what medication would you recommend to restore Mr. Watson to competence?
A. Antipsychotic medication. Heâs been on Zyprexa and Risperdal. These are good medications to treat his conditions and heâs responded to those in the past.
Q. And you may have answered this before, but bear with me, would these medications interfere with his ability to assist counsel in conducting a hearing?
A. No, they would not. In my opinion, and thatâs based upon my knowledge and familiarity with the medications as a treating doctor who prescribes them, but also my review of the records of Mr. Watsonâs actual response to the medications, and Iâve not observed in the records that he has exhibited side effects to the medications that I mentioned or really any of the other medications that Iâve seen used to treat him that would impair his ability to participate and assist in the proceedings.
Q. Okay. And are there any less intrusive means of treating or restoring Mr. Watson to competent [sic] other than medicating him?
A. No, in my opinion there is nothing. Heâs been basically under the supervision of clinical personnel for many years and itâs only during periods of time that heâs actually taking his medications that his symptoms are under control.
Q. Okay. And in your opinion is administering these drugs to restore the defendant to competence medically appropriate under the circumstances?
A. Well, treating his condition is medically appropriate with the medications that I mentioned or any antipsychotic medications because those are the medications that a physician would select to appropriately treat his condition.
Id. at 30-31.
Notwithstanding this testimony, at the conclusion of the hearing, the court inexplicably found that âtreatment and/or
Following this Courtâs order, the PCRA court held a status hearing on May 4, 2005. At the hearing, after reciting the recent procedural history of the case, the PCRA court noted the following:
... I received a copy of a letter that mother Marie Watson sent to the Honorable Governor Ed Rendell; and as a result of reading that letter, although I have great respect and feeling for the mother of the defendant here, it appears that thereâs a substantial likelihood that she may not be an appropriate person to be able to very dispassionately determine the defendantâs right [sic] as his next friend or guardian.
N.T., 5/4/05, at 4-5. Nevertheless, after a discussion off the record that led it to believe that the possibility remained that the case could âbe disposed of by some type of agreement,â id. at 13,
Finally, on September 11, 2005, the PCRA court issued a brief opinion explaining its reasons for concluding that it should deny the Commonwealthâs request that appellee be compelled to take psychiatric medication in order to enable him to pursue PCRA relief. The courtâs entire rationale as explained in the opinion is as follows:
The Commonwealth claims that this Courtâs ruling âessentially puts an end to this case by rendering it impossible to carry out the execution (or for all practical purposes even move forward with the current proceeding).â That contention is belied by the record. Prior to this appeal, the matter was scheduled to proceed with the PCRA hearing on May 2, 2005, with the defendant represented by the ânext friendâ (his mother) and counsel. This procedure was approved by the Pennsylvania Supreme Court in Commonwealth v. Haag, 570 Pa. 289, 809 A.2d 271 (2002). Moreover, at the hearing on the defendantâs competency, this Court determined, based on the testimony, that the defendant was not a danger to himself or others and therefore, could not be involuntarily medicated in an attempt to render him competent (see testimony of Dr. Robert Sadoff, 10/18/04 N.T. at 14-39). This was also based on the prison records submitted which disclosed that the defendant had been incarcerated for over 20 years in various institutions and had no history of violence to himself or others. Thus, while diagnosed as incompetent, this Court determined that, absent evidence the defendant is a danger to himself or others an order to involuntarily medicate him would be violative of the law. See Haag, supra, and Sell v. United States, 539 U.S. 166, 123 S.Ct. 2174, 156 L.Ed.2d 197 (2003).
PCRA Ct. Op. at 2.
Appealability
Before proceeding to the merits of the Commonwealthâs appeal, we first consider the contention of appelleeâs counsel
Under Rule 313(b), an order is considered collateral â and, therefore, appealable as of right â if: (1) the order is âseparable from and collateral to the main cause of actionâ; (2) âthe right -involved is too important to be denied reviewâ; and (3) âthe question presented is such that if review is postponed until final judgment in the case, the claim will be irreparably lost.â Pa.R.A.P. 313(b). With respect to the first requirement, both parties agree that the order at issue is separable from and collateral to the main cause of action. Indeed, the issue of whether appellee should be compelled to take psychiatric medication is completely distinct from, and has no bearing on, the questions of whether he wishes to pursue, and whether he is entitled to, collateral relief. We thus proceed to
Regarding the second requirement of Rule 313(b), the Commonwealth offers several reasons why the right implicated by these appeals is too important for immediate review to be denied. First, the Commonwealth argues, âthe issue of involuntary medical treatment âraises questions of clear constitutional importance.â â Commonwealthâs Brief at 2 (quoting Sell, 539 U.S. at 176, 123 S.Ct. 2174). Second, the Commonwealth contends, the order below also concerns âimportant public interests beyond those of the immediate litigants.â Id. In particular, the Commonwealth asserts that the PCRA courtâs ruling frustrates the societal interest in the finality of criminal proceedings and that the issue presented will likely recur in future capital cases, in which defendants often allege mental incompetence.
With respect to the third requirement, the Commonwealth argues that, â[b]y its very nature, the claim will be irreparably lost if the instant appeal is not allowed.â Id. at 4. The result of this Courtâs denying review, the Commonwealth contends, would be âthe very harm sought to be avoided, i.e., indefinitely delaying resolution of this case by requiring the Commonwealth to litigate PCRA proceedings against a purported next friend, which will not finally conclude [appellee]âs appeals.â Id.
In response, appelleeâs counsel attempts to distinguish the instant case from Sell. Regarding the second requirement, counsel asserts that these appeals do not implicate an important right because the PCRA court denied the Commonwealthâs request. Noting that the Sell court held that âan order requiring involuntary treatment satisfies the âimportanceâ requirement,â appelleeâs counsel argues that the second requirement of Rule 313(b) is not satisfied here because the Commonwealthâs appeal âdoes not seek to protect any right [ ] of clear constitutional importance.â Appelleeâs Brief at 37. As for the third requirement, appelleeâs counsel would distinguish the instant case from Sell based on the outcome in the lower court. In Sell, appelleeâs counsel notes, denying review
Taking the third requirement of Rule 313(b) before the second, we initially determine whether âthe question presented is such that if review is postponed until final judgment in the case, the claim will be irreparably lost.â Pa.R.A.P. 313(b). In the instant case, if we do not grant immediate review, the question of whether appellee can be compelled to take psychiatric medication to restore competence to decide whether he even wants to pursue collateral relief will never be definitively answered. As a result of the dispositive order of the PCRA court, appelleeâs competence is no longer relevant, and whether to pursue collateral relief becomes a matter for Marie Watson, appelleeâs mother and next friend, to decide. In other words, if review is denied here, the Commonwealthâs claim that compelled medication is permissible to ensure a single, comprehensive PCRA proceeding simply disappears forever; the third requirement of the collateral order doctrine is therefore easily satisfied.
Application of the second requirement of Rule 313(b) requires a more extensive analysis. We first note that, under Rule 313(b), âit is not sufficient that the issue be important to the particular parties. Rather it must involve rights deeply rooted in public policy going beyond the particular litigation at hand.â Geniviva v. Frisk, 555 Pa. 589, 725 A.2d 1209, 1213-14 (1999). Moreover, the âoverarching principleâ in determining the importance of an issue for purposes of Rule 313 is that âan issue is important if the interests that would potentially go unprotected without immediate appellate review of that issue are significant relative to the efficiency interests sought to be advanced by adherence to the final judgment rule.â Ben v.
In determining whether the finality interest invoked by the Commonwealth satisfies the importance requirement of the collateral order doctrine, we are guided by our discussion in Commonwealth v. Sam of whether that interest is sufficiently important to satisfy the important government interest prong of the Sell test for the involuntary administration of medication:
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. 1060, 103 L.Ed.2d 334 (1989) (plurality opinion) (âWithout finality, the criminal law is deprived of much of its deterrent effect.â). That societal interest in finality encompasses a concern for the victims of crime and their families. See Haag, 809 A.2d at 287 (Castille, J., concurring) (quoting Calderon, 523 U.S. at 556, 118 S.Ct. 1489) (â[I]t is only with real finality that the victims of crime can move forward knowing the moral judgment of the State will be carried out.â). This compelling interest in finality that is shared both by society and the state absolutely requires, to put it simply, that â[a]t some point litigation must come to an end,â Commonwealth v. Peterkin, 554 Pa. 547, 722 A.2d 638, 643 (1998).
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*504 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. Moms, 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 conviction[s].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 the latter category, âdelay is often an end in itself.â Haag, 809 A.2d at 286 (Castille, J., concurring) (quoting Commonwealth v. Michael, 562 Pa. 356, 755 A.2d 1274, 1284 (2000) (Castille, J. , concurring)); cf. Morris, 771 A.2d at 734 (recognizing that, because appeal was capital defendantâs second PCRA petition, the potential that he was âmerely using the process to delay the execution of his sentence [wa]s greaterâ). Particularly in capital cases, âwe cannot ignore that at some point in the proceedings societyâs interest in finality becomes overarching.â Morris, 771 A.2d at 739; cf. id. at 734 (noting that Commonwealthâs interest in finality is âmore compellingâ when litigating a second PCRA petition).
Sam, 952 A.2d at 576-77.
In the instant case, by seeking review of the PCRA courtâs denial of its request that appellee be compelled to take
Moreover, there is a liberty interest implicated in this case as well. A death row inmate enjoys the right to personally determine whether he wishes to institute a collateral attack upon a final judgment and sentence of death. To hold that a PCRA courtâs finding that a prisoner on death row cannot be medicated to determine whether he would agree with and approve of the course that his next friend would take substitutes the judgment of the friend for the self-determination of the individual. If, of course, medication were to prove incapable of restoring the defendantâs competence, the next friend procedure could be invoked. But, that is not an equivalent substitute for the defendantâs self-determination. It is obviously a matter of public importance that this Court ultimately
Merits of Commonwealthâs Appeal
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 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 âinvoluntarily [ ] administer antipsychotic drugs to a mentally ill defendant facing serious criminal charges in order to render that defendant competent to stand trial,â thus overriding his liberty interest. Sell, 539 U.S. at 179, 123 S.Ct. 2174. 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
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.
Id. at 181-82, 123 S.Ct. 2174. As this Court notes in our companion case:
The above caveat in Sell is significant, as the Court explicitly âemphasize[d]â that the purpose for which medication would be administered affects the evidentiary showing required. In Sell, the purpose of forced medication was to render the defendant competent to stand trial, an outcome the defendant (or his counsel) did not desire. In contrast, the purpose of forcibly medicating appellee in this case is to enable him to pursue PCRA relief if, once rendered competent, he so chooses. The PCRA serves an important sub*508 stantive, and failsafe, purpose exclusively for the benefit of convicted criminals â it exists to allow for vindication of persons who are actually innocent, or, if not innocent, at least have a colorable claim to a lesser sentence or conviction, or a claim to a new trial. An inmate who is entitled to relief should not be arbitrarily denied the prospect of collateral review. In short, compelled medication in a case like this would vindicate the inmateâs interests. If PCRA relief were not pursued, then that avenue would be waived. Therefore, the Sell caveat is relevant here â i.e., the Commonwealth should not have to meet the four strict Sell conditions because it is not seeking an end that is against appelleeâs interest.
Sam, 952 A.2d at 574-75 (footnotes omitted).
Nevertheless, the parties assume that Sellâs four-factor test applies for purposes of deciding the instant appeal. See Commonwealthâs Brief at 30-38 (arguing that â[e]ach of the [Sell ] requirements was established before the PCRA courtâ); Appelleeâs Brief at 31-35 (applying four Sell prongs to facts sub judice ).
In challenging the PCRA courtâs denial of its request that appellee be compelled to take psychiatric medication to render him competent to pursue PCRA relief if, once competent, he so chooses, the Commonwealth argues that the PCRA court erred as a matter of law in determining that âabsent evidence the defendant is a danger to himself or others an order to involuntarily medicate him would be violative of the law.â Commonwealthâs Brief at 28 (quoting PCRA Ct. Op. at 2). The Commonwealth contends that Sell, which the PCRA court cited for this proposition, âexpressly refutesâ it. Id. at 29 (noting that Haag, supra, which the PCRA court also cited, is
To support the proposition that it could not legally order that appellee be medicated absent evidence that he posed a danger to himself or others, the PCRA court cited two authorities: Haag and Sell. In citing Haag, the PCRA court apparently was adverting to the fact that the instant case was scheduled to proceed, with appellee represented by Mrs. Watson, whom the court had appointed to serve as appelleeâs next friend.
In Haag, this Court held that, âwhen represented by a next friend and counsel, a prisonerâs incompetence is not a bar to effective collateral review in a death penalty case.â Haag, 809 A.2d at 278. Haag, however, merely begs, rather than answers, the question sub judiee, for the only alternative to proceeding through a next friend perceived or discussed in Haag was âan indefinite suspension of PCRA proceedings,â which would prevent the resolution of issues âwhile evidence and memories are still fresh.â Id. at 280. Conversely, in the instant case, the Commonwealth has advanced a more comprehensive alternative to proceeding through a next friend, with the prospect of a later proceeding if the defendant returned to competence. Specifically, the Commonwealth seeks to promptly restore appelleeâs competence through the administration of antipsychotic drugs, thereby allowing him to make his own rational decision as to the more fundamental question of whether to pursue PCRA relief and, if so, to assist counsel. Haag does not prevent this course. Nor did Haag purport to lay down a legislative-type rule that would prevent consideration of alternative, and more promising, review paradigms. Therefore, because Haag is readily distinguishable, we turn to the PCRA courtâs reliance upon Sell.
As in Sam, the Commonwealth first argues, pursuant to Sell, that the societal interest in the finality of capital cases is sufficiently important to justify compelling appellee to take psychiatric medication in this instance. Noting that, under
In addition to societyâs finality interest, the Commonwealth asserts âthe obvious interest in allowing [appellee] to control the course of his own appeals.â Commonwealthâs Brief at 34. The Commonwealth contends that this autonomy interest, which it also invokes in Sam, is particularly strong here because appelleeâs next friend has indicated her willingness to follow actions that, by her own admission, she believes are contrary to appelleeâs own wishes.
Like counsel for Sam in our companion case, appelleeâs counsel responds by distinguishing the Commonwealthâs finality interest here from the federal governmentâs interest in bringing Sell to trial. Counsel for appellee emphasizes that, no matter what our holding is today, appellee will remain incarcerated on death row. Thus, appelleeâs counsel argues, âthe Commonwealthâs cries of âfinalityâ ring hollow â the only real blow to finality here is this interlocutory appeal, which unnecessarily delays these proceedings and wastes judicial resources.â Appelleeâs Brief at 33. Counsel for appellee does not address the autonomy interest asserted by the Commonwealth.
We have already determined that the finality interest that the Commonwealth invokes in seeking the involuntary administration of psychiatric medication to render appellee compe
More importantly, as the Commonwealth notes, appelleeâs counsel has already sought assurances from the PCRA court that, should appellee regain competence âat some future time,â counsel would be permitted âto file ... any additional claims that were subsequently identified.â [Appellee]âs Notice of Filing Supplemental Exhibits & Legal Authority at 3 (unnumbered), at Reproduced Record at 333a. Counsel presumably was relying on dicta to that effect in Haag, which speculated that, if Haag regained competence after his next friend failed to obtain PCRA relief, âHaag would have the opportunity to seek review of claims otherwise unavailable under the PCRA, but unraisable in his first petition due to his incompetence.â
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.
Sam, 952 A.2d at 579. Therefore, we hold that the Commonwealth satisfied 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 finality and appelleeâs concomitant interest in making his own rational determination as to whether to pursue PCRA relief. 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 asserts that its expert psychiatrist, Dr. OâBrien, addressed both of these requirements in his testimony. In particular, the Commonwealth cites Dr. OâBrienâs testimony that: (1) if medicated, appellee would be competent to represent his own interests; and (2) the newer antipsychotic drugs he recommended (Zyprexa and Risperdal) would not cause side effects impairing appelleeâs ability to assist PCRA counsel. The Commonwealth further notes that, when testifying for the defense, Dr. Sadoff did not identify any adverse side effects from these newer medications and agreed that they have fewer side effects than older medications. Thus, the Commonwealth argues that the PCRA court erred in finding that such medication âcould not and would notâ restore appelleeâs competence, emphasizing that the PCRA court cited no evidence to support this finding.
As the Commonwealth notes, Dr. OâBrien testified that it was his opinion that antipsychotic medication would render appellee competent to pursue PCRA relief. In reaching this conclusion, Dr. OâBrien relied upon the records from each of appelleeâs four involuntary commitments, which showed that appelleeâs symptoms abated once he resumed taking medication â namely, Zyprexa and Risperdal. Dr. OâBrien further opined that the re-administration of one or the other of these medications would not cause side effects that would interfere with appelleeâs ability to assist PCRA counsel. In rendering this opinion, Dr. OâBrien relied upon not only his knowledge of and familiarity with these medications as a treating physician but also his review of appelleeâs actual response to the medications in the recent past. The PCRA court did not state that it discredited this testimony or, if so, why.
Appelleeâs counselâs characterization of this question is not persuasive. Neither of the two defense experts forwarded the unequivocal conclusions that counsel presently advocates. In asserting that Dr. Cooke found that medication would not render appellee competent, appelleeâs counsel cites no record evidence. Counsel, instead, appears to be referring to the representation he makes in his âCounter-statement of the Caseâ in his brief to this Court that âDr. Cooke found that âbecause of the chronic nature of the illness, the medication would not change his status and he would continue to remain incompetentâ even if medicated.â Appelleeâs Brief at 10 (quoting N.T., 6/17/04, at 5). Dr. Cooke, however, did not testify
Appelleeâs counselâs characterization of Dr. Sadoffs testimony is equally questionable. More importantly, it is impossible to rectify the PCRA courtâs finding that medication âcould not and would notâ render appellee competent â a finding for which it cited no evidence â with Dr. Sadoffs actual testimony that, âif he gets the right medication and the proper dosage and is monitored carefully over a period of time and shows improvement, then I would say yes, then it works.â
In the psychiatric realm, of course, there is often little certainty. Defense counselâs claim respecting the âspeculationâ required is an ineluctable part of the equation. Here, however, when asked to predict the likely effect of medication, the expert evidence from the Commonwealth and the defense was consistent. That evidence showed that antipsychotic medication would be substantially likely to render appellee competent and substantially unlikely to have side effects that would interfere significantly with his ability to assist PCRA counsel should he choose to pursue PCRA relief.
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.
The Commonwealth notes that Dr. OâBrien testified that there were, in fact, no less intrusive means of restoring appelleeâs competence than the administration of antipsychotic medication. The Commonwealth further contends that Dr. Sadoff did not dispute Dr. OâBrienâs opinion. Counsel for appellee denies that the administration of antipsychotic drugs
We have already noted and explained why the fact that a next friend has been appointed does not eliminate societyâs finality concern. See supra at 557 (noting that appelleeâs counsel has already sought assurances from PCRA court that, should appellee regain competence in future, counsel would be permitted to litigate any additional claims that were subsequently identified); Haag, 809 A.2d at 280 n. 11 (opining, in dicta, that âHaag would have the opportunity to seek review of claims otherwise unavailable under the PCRA, but unraisable in his first petition due to his incompetenceâ). Moreover, as we noted in Sam:
[t]he âinterestâ here ... 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.
Sam, 952 A.2d at 579. Regarding this autonomy interest, the record does not support the notion that allowing the present litigation to proceed with Mrs. Watson serving as next friend would be adequate. According to her testimony, Mrs. Watsonâs conclusion that her pursuit of PCRA relief for appellee was in appelleeâs interest was based on her conversations with appelleeâs counsel and death penalty shadow counsel, none of whom appears to be receiving any cooperation or encouragement from appellee whatsoever. See N.T., 10/18/04, at 43-44 (responding affirmatively to the question, âAnd based on [the] conversations [with counsel], you understand itâs in the interest of your son to live and not to be put to death[?]â). For his part, appellee expressed to the PCRA court his ovm desire that his death sentence be executed.
Finally, guided by Sell, we ask 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, 539 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 last prong of the Sell test, the Commonwealth notes that Dr. OâBrien testified that it would indeed be medically appropriate to treat appellee with antipsychotic medication. The Commonwealth also cites prison records admitted by the PCRA court indicating that physicians there had repeatedly prescribed such medication for appellee. Dr. Sadoff, the Commonwealth notes, did not provide a contrary opinion.
This characterization of Dr. Sadoffs testimony again is inaccurate. Dr. Sadoff did not testify that appellee would have to be injected with medications with âlife-threateningâ side effects. Rather, Dr. Sadoff testified that he would prescribe Haldol or Prolixin (the injectable medications with more serious side effects) only if appellee refused to take Zyprexa (one of two oral medications with less serious side effects that appellee had voluntarily taken in the past). In any event, Dr. Sadoff never characterized the side effects of Haldol and Prolixin as âlife-threatening.â See N.T., 10/18/04, at 38 (identifying side effect of Haldol and Prolixin as âthe shakiness that we call dyskinesiaâ). More importantly, Dr. Sadoff did not testify that treating appellee with any of the above medications was medically inappropriate. Thus, Dr. OâBrienâs testimony in this regard (that treating appellee with antipsychotic medication was medically appropriate) not only remained unrebutted â it was consistent with that of Dr. Sadoff. The record sub judice therefore was more than adequate to support the Commonwealthâs assumed burden, under Sell, of showing that the administration of antipsychotic medication is medically appropriate in the case sub judice.
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.
Noting that Section 103 of the MHPA provides that the Act âestablishes rights and procedures for all involuntary treatment of mentally ill persons,â 50 P.S. § 7103, appelleeâs counsel contends that âunless involuntary treatment is allowed by the MHPA, it is forbidden entirely,â Appelleeâs Brief at 22. Citing Section 301(a) of the Act, counsel argues that treatment may be compelled for an inmate who has already been tried only if the inmate âposes a clear and present danger of harm to others or to himself.â Id. at 23.
In response, the Commonwealth notes that the text of Section 301 of the MHPA, which sets forth the standard for civil commitments, does not itself specify that dangerousness is the only circumstance in which medication may be compelled. Echoing its argument in Sam, the Commonwealth notes that this Court has declined to extend the provisions of the Act beyond their express terms, 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 further observes that nothing in the MHPA prohibits the involuntary administration of medication to render an inmate competent in the post-conviction context.
In rejecting Samâs counselâs reliance upon the MHPA in our companion case, we noted as follows:
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), ieâ 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:
*520 § 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). In determining that the MHPA did not apply to the proceeding, we noted in Jermyn that âSection 402 of the Act is plainly worded. It applies only during the trial, conviction and imposition of sentence.â Jermyn, 652 A.2d at 823; accord Haag, 809 A.2d at 277 (citing Jermyn for proposition that Section 402(a) âdoes not apply beyond sentencingâ). Accordingly, we held that the lower court correctly applied the Ford v. Wainwright standard to determine Jermynâs competence. Moreover, in light of our conclusion that the MHPA was inapplicable, we noted that it was unnecessary to consider Jermynâs claims that the lower court erred in failing to apply the hearing procedures outlined in the MHPA. Jermyn, 652 A.2d at 824 n. 2.
Instantly ... 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.
Sam, 952 A.2d at 583-85 (footnote omitted). Accordingly, and consistently with our decision in Sam, we hold that the MHPA does not provide alternate grounds to affirm the decision of the PCRA court.
For the foregoing reasons, we hold that the PCRA court erred in determining that appellee, or his counsel and next friend on his behalf, may refuse the administration of antipsychotic medication under the circumstances of this case. Ac
Reversed and remanded for proceedings consistent with this Opinion.
. 42 Pa.C.S. §§ 9541-9546.
. In the interim, the first and second appointed counsel withdrew, present counsel (Samuel C. Stretton, Esquire) was appointed, and a death warrant was issued but later stayed by the PCRA court.
. Although not necessary for our holding today, we note that, on cross-examination, Dr. Sadoff equivocated on this question. When asked by the prosecution whether appellee âis not a danger to himself or are you not able to say,â Dr. Sadoff responded: âWell, I haven't seen any evidence in the correctional medical file that shows that heâs tried to kill himself, harm himself or anybody else, either on or off medication, so I can't say that he is or is not. All I can say is we donât have evidence to show that he is.â N.T., 10/18/04, at 36.
. On cross-examination, Dr. OâBrien testified, consistently with Dr. Sadoff, that it was his opinion that appellee was incompetent due to â[s]chizophrenia, chronic paranoid type.â N.T., 11/22/04, at 33.
. In Sell, the U.S. Supreme Court held that
the Constitution permits the Government involuntarily to administer antipsychotic drugs to a mentally ill defendant facing serious criminal charges in order to render that defendant competent to stand trial, but only if the treatment is medically appropriate, is substantially unlikely to have side effects that may undermine the fairness of the
Sell, 539 U.S. at 179, 123 S.Ct. 2174.
. Section 702(b) of the Judicial Code provides as follows:
(b) Interlocutory appeals by permission. â When a court or other government unit, in making an interlocutory order in a matter in which its final order would be within the jurisdiction of an appellate court, shall be of the opinion that such order involves a controlling question of law as to which there is substantial ground for difference of opinion and that an immediate appeal from the order may materially advance the ultimate termination of the matter, it shall so state in such order. The appellate court may thereupon, in its discretion, permit an appeal to be taken from such interlocutory order.
42 Pa.C.S. § 702(b). '
. The court's statement immediately followed a discussion with counsel off the record, which makes it difficult to discern the nature of the
. As we note in Sam:
Sam, 952 A.2d at 576, n. 15. The point rings even truer here than it did in Sam, as this appellee has repeatedly expressed his desire to be executed and not to pursue collateral relief. See, e.g., N.T., 10/18/04, at 57-59.
. Accordingly, we need not address whether it would be appropriate for this Court to exercise plenary jurisdiction under 42 Pa.C.S. § 726.
. 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, â[u]nder Harper, forcing antipsychotic drugs on a convicted prisoner is impermissible absent a finding of overriding justification and a determination of medical appropriatenessâ) .
. Although he asserts that Sell "concerns only involuntary treatment in order to make an accused competent to stand trialâ (Appellee's Brief at 31), appelleeâs counsel defends the PCRA courtâs Sell analysis rather than challenging its application of the Sell standard.
. The Majority's speculation on this point was, in the view of this author, inaccurate and unwise. See Haag, 809 A.2d at 287-89 (Castille, J., concurring).
. Moreover, because the Commonwealth satisfied Sell, we need not squarely determine whether a more relaxed standard would satisfy due
. Act of July 9, 1976, P.L. 817, as amended, 50 P.S. §§ 7101-7503.
. As additional authority for his argument that the MHPA precludes compelled medication here, appellee's counsel relies upon the following sentence from our recitation of the procedural history in Haag, supra:
Following a hearing on January 4, 1999, the PCRA court dismissed the [Commonwealthâs] motion [that the Department of Corrections be ordered to provide treatment to Haag for paranoid schizophrenia] because the court found that the Attorney General had presented no evidence that Haag was a danger to himself or others as is required for involuntary treatment of all individuals under the Mental Health [Procedures] Act.
Haag, 809 A.2d at 276 (citing 50 P.S. § 7401 in a footnote). As the Commonwealth notes in response to appellee's counsel's reliance on the above quotation from Haag, this Court certainly did not hold â or even suggest â in that case that the MHPA requires a showing of dangerousness before an inmate can be compelled to take medication. Rather, in reciting the procedural history of that case, we merely noted, without passing upon, the PCRA courtâs determination that the Commonwealthâs failure to make such a showing was fatal to its motion. In any event, as we have already explained, Haag did not involve the