State v. Holden
Decision Date | 02 December 2014 |
Docket Number | No. W11D–CR13–0151132–S.,W11D–CR13–0151132–S. |
Citation | 110 A.3d 1237 |
Court | Connecticut Superior Court |
Parties | STATE of Connecticut v. Carol HOLDEN. |
George Flores, for the defendant.
Matthew A. Crockett, senior assistant state's attorney, for the state.
On July 12, 2013, in the early morning hours, numerous fire departments responded to a residential address due to smoke coming from the eaves of the house. The fire personnel entered the home, suppressed the fire and found the defendant, Carol Holden, in a bedroom. The defendant was transported to the hospital. According to the probable cause affidavit, the defendant admitted that she lit the fire because she was sick of society and people, and she wanted to get back at her landlord for charging high rent and threatening to have her evicted. She said she put corn oil on the electric stove, turned on the stove and went to bed.
The defendant was arrested and charged with arson in the second degree, breach of the peace in the second degree and criminal damage of a landlord's property in the first degree. On August 2, 2013, the court (Riley, J. ) ordered that the defendant be evaluated for competency pursuant to General Statutes § 54–56d. Following a hearing held on August 30, 2013, the court (Swords, J. ) found the defendant was not competent to stand trial, but that there was a substantial probability that she could be restored to competence through an inpatient psychiatric hospitalization at the Whiting Forensic Division of Connecticut Valley Hospital (CVH) for a period of sixty days.
A second hearing to determine the defendant's competency was held on October 25, 2013. The court (Riley, J. ) found that the defendant had not yet been restored to competence to stand trial, but that there was a substantial probability that she could be restored to competence within the time allowed by law. The court ordered a further period of ninety days of inpatient treatment at CVH.
Another hearing was held on March 7, 2014, to address the treatment team's determination that the defendant would not attain competency within the remainder of the period covered by the placement order unless she was administered psychiatric medication for which she was unwilling or unable to provide consent. The court (Riley, J. ) ordered the appointment of Susan Devine, A.P.R.N., B.C., to serve as a health care guardian pursuant to § 54–56d (k)(3).
On October 10, 2014, this court (Seeley, J. ) held a hearing on the state's request that the defendant be forcibly medicated in an attempt to restore her to competency to stand trial. At the hearing, the court heard testimony from Mark S. Cotterell, M.D., a psychiatrist in the Restoration Services Unit at the Whiting Forensic Division of CVH, and from Ms. Devine, the court-appointed health care guardian.
Dr. Cotterell testified that the defendant suffers from paranoid schizophrenia and recommended that she take two medications, Haloperidol (also known as Haldol ) and Olanzapine (also known as Zyprexa ). Both medications are used to treat symptoms of psychosis and mood disorders.
These medications have notable potential side effects. The use of Haloperidol can result in dizziness, headaches, the development of persistent motor problems expressed by tics and tremors, an increase or decrease in blood pressure, constipation, sleepiness, cognitive impairment such as the slowing of thought processes and a sense of restlessness such that the person cannot sit still. Similarly, notable potential side effects as a result of using Olanzapine include dizziness, dry mouth, lowering of blood pressure, increased heart rate, weight gain, increased blood sugar levels, joint pain, constipation and an increased rate of sedation. Dr. Cotterell agreed that the use of these antipsychotic medications can be sedating, which would make it harder for someone to assist in their own defense. Likewise, this medication also can result in someone feeling jittery and restless, which could then impact their ability to concentrate and participate in their defense.
The defendant currently is supposed to take 7.5 mg of Haldol ; however, her willingness to take this antipsychotic medication has been inconsistent. The use of 7.5 mg of Haldol has not yet restored her to competence to stand trial. Therefore, Dr. Cotterell is proposing that the defendant be administered 2–30 mg of Haldol and/or 5–30 mg of Olanzapine daily by mouth. If the oral medication is refused, then it would be administered by injection in accordance with the Proposed Medication Regimen outlined in a Memorandum dated October 10, 2014. See Hearing Exhibit 1.
Dr. Cotterell initially testified that it is his opinion to a reasonable degree of medical certainty that "the use of medication either voluntary or involuntary would very likely lead to a restoration of competence." He also stated that medical records from an inpatient hospitalization in 2008 showed that when the defendant has been administered antipsychotic medication, her psychotic symptoms lessened at that time. Dr. Cotterell acknowledged that the medical records from 2008 do not indicate that as a result of the use of the antipsychotic medication at that time, the defendant was then determined to be legally competent; rather, the records only described her as less psychotic. Dr. Cotterell concluded that "using those medications at this time will likely result in her being ... restore[d] to competency." He also opined that forced medication "is a good strategy to have and it is worth a try." Finally, Dr. Cotterell agreed that he is unable to say with "any certainty" that if the defendant is given an increased dose of either Haldol and/or Olanzapine, she will be restored to competence.
Susan Devine, the court-appointed health care guardian, testified that based on her review of the records, numerous meetings with the defendant, and discussions with the treatment providers at CVH, it is in the defendant's actual best interest to receive psychiatric medications, involuntarily if necessary. Ms. Devine's recommendation is detailed in a thorough report dated October 6, 2014. See Hearing Exhibit 2. Ms. Devine testified that she considered the risks and benefits, the adverse side effects on the defendant and the prognosis for the defendant in reaching her opinion.
In her report, Ms. Devine noted the reported side effects for psychiatric medications, but concluded that "the defendant is in an acute hospital setting where she is monitored continuously by trained staff."1 See Hearing Exhibit 2, p. 8. Ms. Devine detailed the efforts made by the treatment team at CVH to restore the defendant to competency by less intrusive means (other than medication) such as intensive psychoeducation, individual psychotherapy, groups to address competency education, stress management, community reentry and recovery group.2 Id., at pp. 7–8. Ms. Devine also indicated "[t]he defendant's symptoms will likely respond to a therapeutic dose of antipsychotic medication." Id., at p. 8.
The United States Supreme Court has recognized that forcible injection of medication into the body of a non-consenting person "represents a substantial interference with that person's liberty." Washington v. Harper, 494 U.S. 210, 229, 110 S.Ct. 1028, 108 L.Ed.2d 178 (1990). The Supreme Court further recognized in Sell v. United States, 539 U.S. 166, 169, 123 S.Ct. 2174, 156 L.Ed.2d 197 (2003), that the constitution allows the government to forcibly medicate a mentally ill criminal defendant who is not a danger to himself or others in order to render that defendant competent to stand trial for serious offenses in limited circumstances. "[I]t has been observed that when the purpose or effect of forced drugging is to alter the will and the mind of the subject, it constitutes a deprivation of liberty in the most literal and fundamental sense." State v. Seekins, 299 Conn. 141, 154, 8 A.3d 491 (2010), citing Washington v. Harper, supra, at 237–38, 110 S.Ct. 1028 (Stevens, J., concurring in part and dissenting in part). The Sell court indicated the circumstances in which it would be appropriate to administer forced medication to render a defendant competent would be rare. Sell v. United States, supra, at 180, 123 S.Ct. 2174; see also State v. Seekins, supra, at 155, 8 A.3d 491; United States v. Chatmon, 718 F.3d 369, 374 (4th Cir.2013) ().
Thus, to override the defendant's liberty interest in avoiding the unwanted administration of antipsychotic drugs for the purpose of a restoring the defendant to competency to stand trial, under Sell, due process requires this court to determine four factors:
(1) Important government interests are at stake, which can be established when a defendant is accused of a serious crime and special circumstances do not undermine the government's interest in trying him for that crime;
(2) Involuntary medication will significantly further those concomitant state interests, i.e., involuntary medication is both (a) substantially likely to render the defendant competent to stand trial, and (b) substantially unlikely to have side effects that will interfere significantly with the defendant's ability to assist counsel in conducting a trial defense;
(3) Involuntary medication is necessary to further those interests, specifically, the court must find that any alternative, less intrusive treatments are unlikely to achieve substantially the same results; and
(4) Administration of the drugs is medically appropriate in that it would be in the defendant's best medical interest in light of his medical condition. Sell v. United States, supra, 539 U.S. at 180–81, 123 S.Ct. 2174;...
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