State v. Garcia, 15128

• Decision Date: 09 May 1995
• Docket Number: No. 15128,15128
• Court: Connecticut Supreme Court
• Parties: , 6 NDLR P 414 STATE of Connecticut v. Jose GARCIA.

Page 947

658 A.2d 947

233 Conn. 44, 6 NDLR P 414

STATE of Connecticut v. Jose GARCIA.

No. 15128.

Supreme Court of Connecticut.

Argued Jan. 10, 1995.

Decided May 9, 1995.

Monte P. Radler, Asst. Public Defender, for appellant (defendant).

Judith M. Rossi, Asst. State's Atty., with whom, on the brief, were Eugene Callahan, State's Atty., and David I. Cohen, Senior Asst. State's Atty., for appellee (State).

Thomas A. Behrendt, filed a brief for the Connecticut Legal Rights Project, Inc., as amicus curiae.

Before PETERS, C.J., and BORDEN, BERDON, KATZ and PALMER, JJ.

BORDEN, Associate Justice.

The principal issue in this appeal is whether a criminal defendant who has been found incompetent to stand trial pursuant to General Statutes § 54-56d ¹ may be involuntarily medicated with antipsychotic drugs in order to render him competent to stand trial, and if so, under what circumstances. The defendant, Jose Garcia, appeals from an order of the trial court permitting the Whiting Forensic Institute (Whiting) to treat him with antipsychotic medication in order to attempt to restore him to competency to stand trial. The defendant claims that the trial court's order violated his rights under the federal and state constitutions because the trial court did not properly balance his liberty interest in being free from unwanted medication against the state's interest in determining his guilt or innocence. We conclude that, under certain circumstances, a defendant in a criminal case may be medicated against his will in order to restore him to competency, and we remand the case for consideration pursuant to the standards articulated hereinafter as to whether compelled medication is appropriate in this case.

This case comes before us with the following factual and procedural background. On January 30, 1993, the defendant was arrested and charged with the crimes of murder pursuant to General Statutes § 53a-54a, ² felony murder pursuant to General Statutes § 53a-54c, ³ and robbery in the first degree pursuant to General Statutes §§ 53a-133 ⁴ and 53a-134(a)(2). ⁵ The charges were brought in connection with the stabbing death of Mario Lopez on January 30, 1993. On August 27, 1993, the defendant filed a "Notice of Intention to Introduce Expert Testimony Relating to Mental Disease or Defect or Other Condition Relating to Mental State." The trial court, Dean, J., ordered a competency evaluation pursuant to § 54-56d, ⁶ and subsequently, on September 23, 1993, found the defendant incompetent to stand trial. The defendant was committed to the custody of the commissioner of mental health for a period of three months for inpatient treatment in order to restore competency.

On January 11, 1994, the trial court, Nigro, J., held a hearing at which it heard the testimony of Timothy G. Schumacher, a clinical psychologist on the staff of the Whiting diagnostic unit, where the defendant was confined for treatment. Schumacher testified, in accordance with the clinical team's evaluation, ⁷ that the defendant needed treatment with antipsychotic medication in order to restore his competency. Although, in the team's opinion, the defendant needed to take the medication on a regular basis, he had taken it only intermittently, which had yielded no positive therapeutic effect. Schumacher testified that, although the defendant understood the nature of the proceedings against him, he lacked the capacity to assist in his own defense. Schumacher further indicated that there was a substantial probability that the defendant could be restored to competency if he were medicated, but that there was no "guarantee" that the medication would be successful. The team's evaluation concluded by requesting that "the court consider legally directing the involuntary use of psychiatric medication as a measure to restore [the defendant] to competency."

The defendant objected to being medicated, arguing that there was no statutory authority for the court to make such an order and, in the alternative, that such an order could be entered only with appropriate deference to the defendant's constitutional rights. At the conclusion of the hearing, the trial court, Nigro, J., found that: (1) the defendant was not competent to stand trial because he was unable to assist his counsel in his defense; (2) there was a reasonable probability that he could be restored to competency with antipsychotic medication; and (3) because the defendant had refused such treatment, it might be necessary forcibly ⁸ to medicate him. Accordingly, the court entered an order allowing Whiting to medicate the defendant involuntarily (medication order), but stayed the order to give the defendant the opportunity to present argument that such an order was contrary to law.

On January 18, 1994, the defendant sought to vacate the medication order and moved for a full evidentiary hearing on the issue of forced medication, claiming that the court, in reaching its decision, had failed adequately to consider the substantive and procedural due process issues pertaining to the forced medication of the defendant. The defendant also moved for the appointment of a guardian to protect his medical interests.

At a hearing on January 20, 1994, the court stayed the medication order pending further argument on the defendant's due process concerns. The court did not decide the motion for appointment of a guardian, but indicated that it would entertain a motion for Attorney William Wynne of the Connecticut Legal Rights Project, Inc., to appear as amicus curiae in the defendant's competency proceedings. At the next hearing before the court, on April 28, 1994, the defendant moved that the court appoint the Connecticut Legal Rights Project, Inc., as special public defender, pursuant to General Statutes § 51-293, ⁹ to represent him on the issue of forced medication. The court determined that the statute did not give it authority to make such an appointment, but stated that it would allow the Connecticut Legal Rights Project, Inc., to file an appearance as amicus curiae on the issue of forced medication.

The defendant produced evidence at the April 28, 1994 hearing in connection with his motion to vacate the medication order. The defendant presented Kenneth Selig, a forensic psychiatrist experienced in both the administration of antipsychotic medications and the evaluation of competency. Selig testified that he was familiar with the defendant's case, having examined both the defendant and his records, and that in his professional opinion, the defendant was in a psychotic state, was convinced that he was not mentally ill and believed that antipsychotic medication is poison. Selig also indicated that the defendant's condition was consistent with either organic brain damage, perhaps related to the defendant's history of alcohol abuse, or a psychiatric disorder such as schizophrenia or some other paranoid disorder. He further testified that while antipsychotic medication could be useful in the treatment of these psychiatric disorders, its only value in the treatment of organic brain damage is to control agitation or aggressive behavior, in which case it would not restore the defendant to competency.

According to Selig, in cases where the patient is given antipsychotic medication of the proper type at the proper dosage for the proper length of time, the success rate could be broken down as follows: approximately one third of the patients considerably improve; approximately one third stay the same; and approximately one third become worse. Selig also indicated that there is the potential for a multitude of side effects associated with antipsychotic medications including blurry vision, dry mouth, urinary retention, severe motion problems, confusion and reduction of blood pressure. Additionally, Selig indicated that the long term use of antipsychotic medication created a risk of tardive dyskinesia, a repetitive involuntary motion disorder, and that a potentially fatal consequence, namely, neuroleptic malignant syndrome, occurs in less than 1 percent of cases.

Furthermore, according to Selig, although most people who receive forced medication are appreciative when they are helped by the treatment, there is a significant percentage of other patients who resent the intrusiveness, the side effects and the humiliation of forced medication. On cross-examination, Selig indicated that treatment with antipsychotic medication would be "the best bet" for a paranoid disorder, the only "real" possibility of restoring the defendant to competence, as long as the illness was not organic in nature, and that the only way to know whether medication would be successful was to try it. Selig also expressed concern that the procedure of forcibly medicating the defendant could exacerbate his paranoia in derogation of any positive effect the medication might otherwise have. The court then continued the hearing in order to allow the state to present a rebuttal witness.

At the next hearing, on August 10, 1994, the state presented the testimony of Earl Biassey, the treating psychiatrist on the defendant's treatment team at Whiting. Biassey indicated that, due to the defendant's refusal to cooperate, although the treatment team had been unable to perform the necessary testing and gather sufficient information to rule out any organic cause of the defendant's psychosis, several ascertainable factors pointed away from organic etiology. These included the defendant's lack of a memory deficit, lack of attention problems and lack of concentration problems. In contradiction of Selig, Biassey testified that even if the cause of the defendant's psychosis was organic, the defendant could benefit from treatment with antipsychotic medication because it could lessen his sense of confusion. Biassey stated that "[t]he simplest and least troublesome treatment would be the use of ... an antipsychotic medication." Biassey disagreed with Selig's estimate that...