Morgan v. Rabun, 97-1041

• Decision Date: 18 December 1997
• Docket Number: No. 97-1041,97-1041
• Parties: Reginald MORGAN, Appellant, v. John RABUN; Lori Derosear, D.O.; John Twiehaus; Myra Ward, R.N.; Jerlean Williams, R.N.; Wardell Hardy, R.N.; Ron Scharer, R.N.; Rosemary Gardner, R.N.; Theodor Rankin, II, L.P.N.; Willie Thomas, R.N., Appellees.
• Court: U.S. Court of Appeals — Eighth Circuit

Page 694

128 F.3d 694

Reginald MORGAN, Appellant, v. John RABUN; Lori Derosear, D.O.; John Twiehaus; Myra Ward R.N.; Jerlean Williams, R.N.; Wardell Hardy, R.N.; Ron Scharer, R.N.; Rosemary Gardner, R.N.; Theodor Rankin, II L.P.N.; Willie Thomas, R.N., Appellees.

No. 97-1041.

United States Court of Appeals Eighth Circuit.

Submitted Sept. 12, 1997.

Decided Nov. 10, 1997.

Rehearing Denied Dec. 18, 1997.

Margaret Hart-Mahon, St. Louis, MO, argued, for appellant.

Hugh L. Marshall, Jefferson City, MO, argued (Jeremiah W. (Jay) Nixon, Atty. General, on the brief), for appellee.

Before BOWMAN, Circuit Judge, HENLEY, Senior Circuit Judge, ¹ and MORRIS SHEPPARD ARNOLD, Circuit Judge.

BOWMAN, Circuit Judge.

Reginald Morgan filed suit under 42 U.S.C. § 1983 (1994) claiming that Dr. John Rabun and his staff administered psychotropic drugs to Morgan against his will in violation of his rights under the Due Process Clause of the Fourteenth Amendment. Dr. Rabun was Morgan's treating physician at the St. Louis State Hospital, where Morgan had been committed. The District Court ² granted summary judgment in favor of the defendants. Morgan now appeals the judgment of the District Court. We affirm.

I.

In November 1992, Morgan was indicted for first degree assault, armed criminal action, and unlawful use of a weapon. Morgan had allegedly stabbed a man with a butcher knife. The state trial court found that based upon a psychiatric evaluation of Morgan, he "lack[ed] the mental fitness to proceed" with trial and ordered Morgan committed for evaluation to the custody of the Director of the Department of Mental Health. Appellant's App. at 737. Morgan was admitted to St. Louis State Hospital on February 22, 1993.

In March 1994, the court ordered that Morgan stand acquitted of the charges "on the ground of mental disease or defect excluding responsibility." Id. at 739. The court committed Morgan "for care and treatment" to the Director of the Department of Mental Health. Id. The court noted that Morgan "suffers from Schizophrenia Chronic Paranoid Type." Id. at 738.

Dr. Rabun was Morgan's treating physician at the State Hospital from February 22, 1993 until August 11, 1994. Upon Morgan's admission on February 22, Dr. Rabun performed a psychiatric examination and filled out an assessment report. In the report, Dr. Rabun wrote:

The patient was uncooperative in general and evidenced an aloof/suspicious demeanor .... The patient was markedly hostile on exam and even began the interview by stating "I am hostile." The patient made numerous threats during the interview ... [like] "you are nagging me like an animal, usually people get in trouble when they nag me like an animal." The patient stated that he had "homicidal ideas but I am not going to tell you about any of that." ... The patient ... had the evident hostile and threatening demeanor. ³

Id. at 699-700. Morgan also admitted to Dr. Rabun that he had previously been convicted of murder and served time in the state penitentiary. Id. at 697. Based upon "the nature of the charges against him and his hostility towards [Dr. Rabun] and overt threats," Dr. Rabun found Morgan "obviously dangerous to others" and authorized forced medication. Id. at 701. On February 22, he was given an injection of psychotropic medication.

The second occasion on which Morgan was forcibly administered psychotropic medication was July 21, 1993. Morgan had become agitated in the patient lounge and began knocking pool balls and swinging a pool cue. He tore the net off of a ping pong table and tried to tear the metal brackets. Morgan told the staff, "I'm losing my mind, I'm going crazy, I can't control myself." Id. at 570. Morgan admits making these statements. Morgan Aff. para. 6. Dr. Rabun ordered an injection and five-point leather restraints "so that both the patient and others would not be in danger." Rabun Aff. para. 14.

Except for the two forced injections, Morgan typically drank his oral medication without incident. On occasion Morgan would refuse or spit out the medication.

Morgan admits, however, that the medications were never forcibly administered when he refused to comply with his treatment. Morgan Dep. at 31-32.

II.

Morgan claims that Dr. Rabun administered these psychotropic medications in violation of the Due Process Clause of the Fourteenth Amendment. Specifically, Morgan argues that Dr. Rabun violated his substantive due process rights on the two occasions when Morgan was forcibly injected. Morgan also asserts that Dr. Rabun's decision to treat Morgan involuntarily with psychotropic medications on a daily basis violated his procedural due process rights. Because we agree that the undisputed facts establish that Morgan's due process rights were not violated, we affirm the District Court's grant of summary judgment.

We review a grant of summary judgment de novo. See Coplin v. Fairfield Pub. Access Television Comm., 111 F.3d 1395, 1401 (8th Cir.1997). Summary judgment is proper if, taking all the facts and reasonable inferences in the light most favorable to the non-moving party, "there is no genuine issue as to any material fact and ... the moving party is entitled to a judgment as a matter of law." Fed.R.Civ.P. 56(c).

We must determine whether Morgan's evidence is sufficient to allow a reasonable jury to find that Dr. Rabun violated Morgan's due process rights. The issue necessarily has "both substantive and procedural aspects." Washington v. Harper, 494 U.S. 210, 220, 110 S.Ct. 1028, 1035, 108 L.Ed.2d 178 (1990). The substantive issue involves defining the protected constitutional interest, as well as identifying the conditions under which competing interests may outweigh it. See Mills v. Rogers, 457 U.S. 291, 299, 102 S.Ct. 2442, 2448, 73 L.Ed.2d 16 (1982). The procedural issue concerns the minimum process required by the Constitution. See id.

A. Substantive Due Process

Under the Due Process Clause of the Fourteenth Amendment, there is no doubt that Morgan "possesses a significant liberty interest in avoiding the unwanted administration of antipsychotic drugs." Harper, 494 U.S. at 221-22, 110 S.Ct. at 1036-37. Psychotropic drugs alter the chemical balance in a patient's brain and can produce serious, even fatal, side effects. See id. at 229, 110 S.Ct. at 1040. Notwithstanding these facts, an individual's liberty interest in avoiding forcible administration of psychotropic drugs is not unconditional. We must balance this liberty interest against the relevant state interests to determine whether Morgan's constitutional rights were violated. See Youngberg v. Romeo, 457 U.S. 307, 320-21, 102 S.Ct. 2452, 2460-61, 73 L.Ed.2d 28 (1982).

Before we discuss the federal constitutional aspects of substantive due process, however, we must first determine to what extent, if any, Missouri's applicable state laws provide additional protections. ⁴ The Federal Due Process Clause defines only the minimum protections required. State law, however, may recognize more extensive liberty interests than the Federal Constitution. See Mills, 457 U.S. at 300, 102 S.Ct. at 2448. These state-created liberty interests are entitled to protection under the Fourteenth Amendment's Due Process Clause. See id. Regarding the two instances of forced injections, the relevant Missouri statutes read in pertinent part:

1. No patient, resident or client of a residential facility or day program operated, funded or licensed by the department [of mental health] shall be subject to physical or chemical restraint, isolation or seclusion unless it is determined by the head of the facility or the attending licensed physician to be necessary to protect the patient, resident, client or others.

Mo.Rev.Stat. § 630.175.1 (1986). Chemical restraint is defined as:

[M]edication administered with the primary intent of restraining a patient who presents a likelihood of serious physical injury to himself or others, and not prescribed to treat a person's medical condition. ⁵

Mo.Rev.Stat. § 630.005.1. (3) (Supp.1991). These Missouri statutes create no additional rights that extend beyond the Federal Constitution. The statute requires no more than the constitutional requirement discussed infra--a finding that the patient presents a danger to himself or others. Therefore, the Federal Due Process Clause sets the standard by which to determine whether Dr. Rabun violated Morgan's substantive rights.

The Supreme Court has held that "given the requirements of the prison environment, 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." Harper, 494 U.S. at 227, 110 S.Ct. at 1039. The governmental interests in running a state mental hospital are similar in material aspects to that of running a prison. Administrators have a vital interest in ensuring the safety of their staff, other patients, and of course in ensuring the patients' own safety. Thus, we apply the Harper standard to this case. If Dr. Rabun found Morgan to be a danger to himself or others, then Morgan's substantive due process rights were not violated.

Our role is not to determine conclusively that Morgan was indeed dangerous. Rather, we must simply make certain that Dr. Rabun exercised professional judgment in making the determination that Morgan was dangerous. See Youngberg, 457 U.S. at 321, 102 S.Ct. at 2460 (adopting the standard that "the Constitution only requires that the courts make certain that professional judgment in fact was exercised"). To a limited extent, this requires us to examine the bases upon which Dr. Rabun made such a determination. See Cochran v. Dysart, 965 F.2d 649, 650-51 (8th Cir.1992) (remanding case to district court for review of documents on which treating doctor relied in authorizing involuntary medication). We start from a presumption that the...