Keyhea v. Rushen
| Decision Date | 06 March 1986 |
| Citation | 223 Cal.Rptr. 746,178 Cal.App.3d 526 |
| Court | California Court of Appeals Court of Appeals |
| Parties | Canal KEYHEA et al., Plaintiffs and Respondents, v. Ruth RUSHEN et al., Defendants and Appellants. A028586. |
Peter E. Sheehan, Clifford C. Sweet, Legal Aid Society of Alameda County, Oakland, Steven Zieff, Legal Aid Society of San Mateo County, Redwood City, for plaintiffs and respondents.
John K. Van de Kamp, Atty. Gen., Gloria F. De Hart, Ralph M. Johnson, Kenneth C. Young, Bruce M. Slavin, Deputy Attys. Gen., San Francisco, for defendants and appellants.
In this case we hold that state prisoners presently have a statutory right to refuse long-term treatment with psychotropic drugs absent a judicial determination that they are incompetent to do so.
Psychotropic (or antipsychotic) drugs 1 have become a primary tool of public mental health professionals for treating serious mental disorders, replacing such earlier measures as lobotomy, insulin shock, and electroshock. In many patients they minimize or eliminate psychotic symptoms. (Kemna, Current Status of Institutionalized Mental Health Patients' Right to Refuse Psychotropic Drugs (1985) 6 Journal of Legal Medicine 107, 109-110 (hereafter cited as Right to Refuse ); Gelman, Mental Hospital Drugs, Professionalism, and the Constitution (1984) 72 Georgetown L.J. 1725, 1726, 1741 (hereafter cited as Mental Health Drugs ).) They "also possess a remarkable potential for undermining individual will and self-direction, thereby producing a psychological state of unusual receptiveness to the directions of custodians." (Mental Health Drugs, supra, at p. 1751.)
The drugs also, however, have many serious side effects. Reversible side effects include akathesia (a distressing urge to move), akinesia (a reduced capacity for spontaneity), pseudo-Parkinsonism (causing retarded muscle movements, masked facial expression, body rigidity, tremor, and a shuffling gait), and various other complications such as muscle spasms, blurred vision, dry mouth, sexual disfunction, drug-induced mental disorders, and on rare occasions sudden death. A potentially permanent side effect of long-term exposure, for which there is no cure, is tardive diskenesia, a neurological disorder manifested by involuntary, rhythmic, and grotesque movements of the face, mouth, tongue, jaw, and extremities. (Right to Refuse, supra, at pp. 111-114; Mental Health Drugs, supra, at pp. 1742-1746.) 2
At the California Medical Facility at Vacaville (CMF) the decision to administer psychotropic drugs involuntarily on a long-term 3 basis is made by the chairman of an institutional review board upon referral by a prison psychiatrist. After an oral presentation by the referring psychiatrist, a review and discussion of the patient's file by the board members, and an interview of the prisoner, the board chairman--a psychiatrist--makes the decision whether to medicate. CMF's internal procedures state that a decision to medicate is reviewed by the board every 90 days. Prisoners are afforded no right to counsel at board hearings and no right to judicial review.
The present case originated in 1977 as a combination individual action by two taxpayers and class action by prisoner Canal Keyhea, arising from CMF's practice of forced psychiatric drugging and Keyhea's transfer from CMF to a state mental health facility. The transfer issue was not asserted by the taxpayers and was eliminated by Keyhea's subsequent dismissal from the action. 4
The action proceeded as a taxpayers' suit against various state officials (hereafter the State) on involuntary psychiatric medication of prisoners. The pleadings alleged that forced drugging without judicial sanction violates the federal and state Constitutions as well as Penal Code section 2600. Under section 2600 a prisoner may be deprived only of such rights "as is necessary in order to provide for the reasonable security of the institution in which he is confined and for the reasonable protection of the public." (See generally De Lancie v. Superior Court (1982) 31 Cal.3d 865, 870-871, 183 Cal.Rptr. 866, 647 P.2d 142 [].) In 1982 the trial court bifurcated the statutory and constitutional issues, deferring trial of the latter.
At the trial of the statutory issue the taxpayers presented evidence tending to show that attendance of prisoners at judicial hearings on their competency to refuse treatment would not threaten prison security or public safety within the meaning of Penal Code section 2600.
On July 9, 1984, the court rendered judgment declaring that the State had violated Penal Code section 2600 by subjecting prisoners to long-term involuntary medication without a judicial determination of competency, the assistance of counsel, and a right to personal appearance. The court enjoined the State from subjecting prisoners to long-term involuntary medication without adhering to certain of the procedural requirements contained in specified provisions of the Lanterman-Petris-Short Act (Welf. & Inst. Code, §§ 5000 et seq.) (hereafter LPS) and the Probate Code. 5 In a statement of decision the court reasoned that nonprisoners have a statutory right to a judicial determination of competency, and deprivation of this right to prisoners was not necessary to protect prison security.
The State contends preliminarily that the trial court erred by pursuing a prison security analysis under Penal Code section 2600, and that the court's focus should instead have been on the adequacy of existing protections for mentally disordered prisoners. Specifically, the State argues that (1) Penal Code section 2600 protects only constitutional rights and does not encompass any statutory right of nonprisoners to a court determination of competency, and (2) the applicable rule here--affording a fundamental right to give or withhold consent to a proposed psychiatric treatment--requires consideration of the adequacy of existing protection.
The State's proposed adequacy of protection analysis cannot apply, however, because Penal Code section 2600 does indeed protect statutory rights. Section 2600 appears in a statutory scheme entitled "Civil Rights." (Pen.Code, part 3, tit. 1, ch. 3, art. 1.) Section 2600 states the general rule that prisoners retain civil rights other than those rights that would jeopardize prison security or public safety. The other statute in the scheme, Penal Code section 2601, lists specific civil rights that are retained notwithstanding other laws. (In effect the Legislature has predetermined that there is no overriding security interest in infringing the rights listed in section 2601.) Among these enumerated "civil rights" is the statutory right to receive workers compensation benefits under Labor Code sections 3370 and 3371 and Penal Code section 5069. (Pen.Code, § 2601, subd. (i).) 6 This leaves no doubt that the civil rights protected by Penal Code sections 2600 and 2601 include statutory rights. (Cf. Black's Law Dict. (5th ed. 1979) p. 1189, col. 2 [describing "right" as "A power, privilege, or immunity guaranteed under a constitution, statutes or decisional laws ..."]; see generally De Lancie v. Superior Court, supra, 31 Cal.3d at p. 874, fn. 8, 183 Cal.Rptr. 866, 647 P.2d 142 [], emphasis in original.)
The State argues that section 2600 cannot encompass statutory rights because this would require application of innumerable statutory rights (none of which the State specifically identifies) such as those afforded by the Labor and Education Codes, without any tempering "cost/benefit" analysis. But section 2600, as a prison "bill of rights" (see In re Harrell (1970) 2 Cal.3d 675, 698, 87 Cal.Rptr. 504, 470 P.2d 640, cert. den. (1971) 401 U.S. 914, 91 S.Ct. 890, 27 L.Ed.2d 814), affords civil rights to prisoners absolutely (except where deprivation is necessary to prison security or public safety), without cost/benefit considerations, presumably because of the importance of civil rights in a free society. In any event, the State's nonspecific threat of workers' and students' rights flooding the prison system is meritless; few if any of these rights will have any logical application in a prison setting.
Because Penal Code section 2600 does encompass statutory rights, the "adequate protection" analysis proposed by the State is irrelevant here. The question is indeed whether nonprisoners have a right to a judicial determination of competency before they are administered involuntary long-term psychotropic medication, and, if so, whether denial of this right to prisoners is necessary to prison security or public safety.
The foundation of the trial court's conclusion that nonprisoners have a right to a judicial determination of competency to refuse psychotropic drugs is the court's finding that LPS conservatees have this right by statute. The State attacks this conclusion on two fronts, arguing that (1) the qualified right of LPS conservatees to refuse medical treatment does not extend to psychiatric treatment, and (2) a consent decree in a federal suit concerning involuntary psychotropic medication at Napa State Hospital alone governs the rights of LPS conservatees in this field and does not afford a right to a judicial determination of competency.
LPS scrupulously protects the rights of involuntarily detained mentally disordered persons. (See Welf. & Inst....
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