Jurasek v. Utah State Hosp., 97-4082

• Decision Date: 14 October 1998
• Docket Number: No. 97-4082,97-4082
• Citation: 158 F.3d 506
• Parties: Jan E. JURASEK, Plaintiff-Appellant, v. UTAH STATE HOSPITAL; K.V. Greenwood, Adult II Psychiatrist; John Nilsen, individually and as psychiatrist, Utah State Hospital; Mark Payne, individually and as Administrative Superintendent, Utah State Hospital; Craig Hummel, individually and as Clinical Director, Utah State Hospital; Bruce A. Guernsey, individually and as psychiatrist, Utah State Hospital; and Dr. James Hardy, individually and as psychiatrist, Utah State Hospital, Defendants-Appellees. American Orthopsychiatric Association ("AOA"), Amicus Curiae.
• Court: U.S. Court of Appeals — Tenth Circuit

Page 506

158 F.3d 506

Jan E. JURASEK, Plaintiff-Appellant, v. UTAH STATE HOSPITAL; K.V. Greenwood, Adult II Psychiatrist John Nilsen, individually and as psychiatrist, Utah State Hospital; Mark Payne, individually and as Administrative Superintendent, Utah State Hospital; Craig Hummel individually and as Clinical Director, Utah State Hospital Bruce A. Guernsey, individually and as psychiatrist, Utah State Hospital; and Dr. James Hardy, individually and as psychiatrist, Utah State Hospital, Defendants-Appellees American Orthopsychiatric Association ("AOA"), Amicus Curiae.

No. 97-4082.

United States Court of Appeals, Tenth Circuit.

Oct. 14, 1998.

Linda V. Priebe, Brazelon Center for Mental Health Law, Washington, DC (Erin Bradley Yeh, Disability Law Center, Salt Lake City, UT, with her on the brief), for appellant.

Debra J. Moore, Assistant Utah Attorney General, Salt Lake City, UT, for appellees.

John Townsend Rich and Jodi L. Short, Shea & Gardner, Washington, DC, on the brief for amicus curiae.

Before BRISCOE, McWILLIAMS, and MURPHY, Circuit Judges.

BRISCOE, Circuit Judge.

Jan Jurasek appeals the district court's entry of summary judgment in favor of defendants in this action brought under 42 U.S.C. § 1983. Jurasek, who was civilly committed and hospitalized for mental illness, claimed defendants violated his rights under the Due Process Clause of the Fourteenth Amendment and his rights of free expression under the First Amendment by forcibly medicating him with psychotropic drugs. We exercise jurisdiction pursuant to 28 U.S.C. § 1291 and affirm.

I.

Jurasek is a paranoid schizophrenic who was civilly committed to the Utah State Hospital on April 12, 1991. At the commitment hearing, a Utah state court determined (1) Jurasek suffered from a mental illness, (2) Jurasek posed an immediate physical danger to himself and others because of his mental illness, (3) Jurasek lacked the ability to engage in rational decision-making regarding the acceptance of mental treatment, (4) there was no appropriate less-restrictive alternative to a court order of commitment, and (5) the Hospital could provide Jurasek with adequate and appropriate treatment. Jurasek was examined by an independent psychiatrist prior to the commitment hearing and was represented by counsel at the hearing. The original commitment was slated to last six months. At the conclusion of the six months, a Utah state court reviewed Jurasek's commitment and, after finding the five requirements for civil commitment continued to exist, entered an order extending his commitment for an indeterminate period. Jurasek remains confined at the Hospital pursuant to this commitment order.

Jurasek has been treated with psychotropic drugs from the time he was first admitted to the Hospital. He has continuously objected to the treatment and it has been administered against his will. Since September 1991, the Hospital has had a series of policies which apply to patients who are involuntarily medicated. Under the current policy, patients can be forcibly injected with psychotropic drugs if the Hospital's involuntary medication hearing committee determines "the patient is, or will be, gravely disabled and in need of medication treatment or continuing medication treatment," or "without the medication treatment or continuing medication treatment, the [patient] poses or will pose, a likelihood of serious harm to himself/herself, others, or their property." Appellees' Br., Addendum C at § 6.9. This policy applies to all patients, including patients with legal guardians.

The involuntary medication hearing committee consists of a psychiatrist, a psychologist, and the hospital program administrator. None of the committee members are to be involved in the patient's treatment at the time the decision is made to forcibly medicate the patient; however, committee members "are not disqualified from sitting on the committee if they have treated or diagnosed the patient in the past." Id. at § 5.2. It is undisputed that none of the committee members involved in the multiple decisions to forcibly medicate Jurasek were part of his treatment team at the time of the decisions.

In September 1991, Jurasek filed the instant lawsuit in federal district court seeking injunctive relief and damages on the theory that his subjection to forced medication violated his Fourteenth Amendment due process and First Amendment free expression rights under the Constitution. Defendants responded they had not violated Jurasek's constitutional rights and, even if they had, the doctrine of qualified immunity absolved them of liability. In April 1997, the district court denied Jurasek's request for injunctive relief and granted defendants' motion for summary judgment.

II.

This court reviews a grant of summary judgment de novo, applying the same legal standard used by the district court. Sundance Assocs., Inc. v. Reno, 139 F.3d 804, 807 (10th Cir.1998). Summary judgment is appropriate "if the pleadings, depositions, answers to interrogatories, and admissions on file, together with the affidavits, if any, show that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law." Fed.R.Civ.P. 56(c). "When applying this standard, we examine the factual record and reasonable inferences therefrom in the light most favorable to the party opposing summary judgment. If there is no genuine issue of material fact in dispute, then we next determine if the substantive law was correctly applied by the district court." Wolf v. Prudential Ins. Co., 50 F.3d 793, 796 (10th Cir.1995) (internal citation and quotations omitted).

III.

It is well established that an individual has a liberty interest in "avoiding the unwanted administration of antipsychotic drugs under the Due Process Clause of the Fourteenth Amendment." Washington v. Harper, 494 U.S. 210, 221-22, 110 S.Ct. 1028, 108 L.Ed.2d 178 (1990); see Walters v. Western State Hosp., 864 F.2d 695, 698 (10th Cir.1988). It is also well established that when an individual is confined in a state institution, individual liberties must be balanced against the interests of the institution in preventing the individual from harming himself or others residing or working in the institution. Harper, 494 U.S. at 222-23, 110 S.Ct. 1028; Bee v. Greaves, 744 F.2d 1387, 1394 (10th Cir.1984) (Bee I ). ¹ In Harper, the Supreme Court applied this balancing test and concluded "the Due Process Clause permits the State to treat a prison inmate who has a serious mental illness with antipsychotic drugs against his will[ ] if the inmate is dangerous to himself or others and the treatment is in the inmate's medical interest." 494 U.S. at 227, 110 S.Ct. 1028. The question presented in the instant case is different from that in Harper because Jurasek is not a prison inmate, but a civilly-committed patient who has been adjudicated incompetent. Further, Jurasek is medicated because he is "gravely disabled," while Harper was medicated because he was "dangerous to himself or others." Although the policy at issue in Harper also allowed the prison to medicate prisoners who were "gravely disabled," the Supreme Court did not pass on that part of the policy.

The parties agree Jurasek has a liberty interest in avoiding the unwanted administration of antipsychotic drugs. Presumably, they would also agree the state has a legitimate interest in the health and safety of its patients and employees. However, the parties disagree over how to balance Jurasek's due process rights with the Hospital's interests in health and safety. We conclude the standards established in Harper for involuntarily medicating prisoners strike the appropriate balance. Accordingly, the Due Process Clause allows a state hospital to forcibly medicate a mentally ill patient who has been found incompetent to make medical decisions if the patient is dangerous to himself or others and the treatment is in the patient's medical interests.

Our conclusion is based on the fact that treatment with psychotropic drugs is not punishment. If such treatment was considered punitive, involuntarily-committed mental patients would undoubtedly be entitled to greater due process rights before being forcibly treated. See Youngberg v. Romeo, 457 U.S. 307, 321-22, 102 S.Ct. 2452, 73 L.Ed.2d 28 (1982) ("Persons who have been involuntarily committed are entitled to more considerate treatment and conditions of confinement than criminals whose conditions of confinement are designed to punish."). The lack of punishment in the context of forced medication, however, removes any need to provide involuntarily-committed patients with greater due process protection than prisoners. Moreover, unlike prisoners, involuntarily-committed patients have been adjudicated incompetent in a prior formal proceeding, thereby minimizing the potential for any abuse.

Our reasoning is further supported by the Supreme Court's application of the principles enunciated in Harper to a pretrial detainee who had been found incompetent to stand trial, but had not been civilly committed. See Riggins v. Nevada, 504 U.S. 127, 135, 112 S.Ct. 1810, 118 L.Ed.2d 479 (1992). Like a mentally incompetent patient involuntarily committed at a mental health hospital, pretrial detainees have not been convicted of any crime. One could argue that because a pretrial detainee has not been convicted of a crime, he deserves greater due process protections than a prisoner. The Court, however, implicitly rejected this argument in Riggins by applying the Harper standards to an incompetent pretrial detainee. See also Morgan v. Rabun, 128 F.3d 694, 697 (8th Cir.1997), cert. denied, --- U.S. ----, 118 S.Ct. 1809, 140 L.Ed.2d 947 (1998) (applying Harper to forcibly medicate an insanity acquittee found incompetent and ordered committed to mental institution because "governmental interests in running a state mental hospital are similar in material aspects to...