U.S. v. Charters

• Decision Date: 18 September 1987
• Docket Number: No. 86-5568,86-5568
• Citation: 829 F.2d 479
• Parties: UNITED STATES of America, Plaintiff-Appellee, v. Michael Francis CHARTERS, Jr., Defendant-Appellant.
• Court: U.S. Court of Appeals — Fourth Circuit

Page 479

829 F.2d 479

56 USLW 2219

UNITED STATES of America, Plaintiff-Appellee, v. Michael Francis CHARTERS, Jr., Defendant-Appellant.

No. 86-5568.

United States Court of Appeals Fourth Circuit.

Argued May 8, 1987.

Decided Sept. 18, 1987.

Thomas Rawles Jones, Jr. (William B. Moffitt, Lisa Bondareff Kemler, Moffitt & Jones, Alexandria, Va., on brief), for defendant-appellant.

Constance H. Frogale, Asst. U.S. Atty. (Henry E. Hudson, U.S. Atty., Alexandria, Va., Melissa Glassman, Third-Year Law Student, on brief), for plaintiff-appellee.

Before WINTER, Chief Judge, MURNAGHAN, Circuit Judge, and KAUFMAN, Senior United States District Judge for the District of Maryland, sitting by designation.

MURNAGHAN, Circuit Judge:

Michael Francis Charters appeals a district court order permitting medical personnel at the Federal Correctional Institution at Butner, North Carolina (Butner) to medicate him with antipsychotic drugs over his objection.

Charters was indicted in late 1983 for making threats against the President of the United States in violation of 18 U.S.C. Sec. 871. On February 1, 1984, the district court found Charters incompetent to stand trial and ordered him confined to Butner pursuant to what was then 18 U.S.C. Secs. 4241-4247. Thereafter, the district court reviewed Charters' commitment to Butner five times, ¹ each time finding Charters dangerous and incompetent to stand trial and returning him to Butner.

Upon the government's motion, in May 1986, the district court entered an order permitting medical personnel at Butner forcibly to medicate Charters with antipsychotic drugs but stayed the order pending Charters' expedited appeal to the Fourth Circuit. The district court decided to permit forcible medication after weighing Charters' interests in liberty and privacy against the interests of the government. The court identified three government interests: (1) protecting society and other inmates from a dangerous individual; (2) ensuring the defendant's competence to stand trial; and (3) providing proper care Based on the testimony of a single witness, Dr. Sally Johnson, a psychiatrist employed as director of Forensic Services and Clinical Research at Butner, the court concluded that the government's interests outweighed the individual's interests, and ordered the forcible medication. The principal basis for the court's ruling was its conclusion that the state's "duty" to treat the medical needs of pretrial detainees justified forcibly medicating Charters. ²

and treatment for its citizens. The court identified Charters' interests as liberty and privacy protected by the Due Process Clause of the Fifth Amendment and freedom of thought protected by the First Amendment.

In finding that Charters should be forcibly medicated, the district court also concluded that Charters was not competent to make decisions concerning his medical care. The court equated competence to stand trial (legal competence) with competence to make personal health care decisions (medical competence):

The inability to understand the nature and consequences of the proceedings The court based its conclusion that Charters was not competent to make decisions concerning his medical treatment on Dr. Johnson's testimony. Dr. Johnson took the position that Charters' medical incompetence was evidenced by his refusal to accept antipsychotic medication since refusing the medication was not, in Johnson's view, the decision most beneficial to Charters. The government later summarized Johnson's testimony as follows:

against him and to assist properly in his defense, the elements of incompetence to stand trial, equate with the reasoning, decision making, and comprehension inabilities prompting the defendant's refusal to accept medication. And the court's findings as to the former are applicable to the latter.

So, the drugs have been discussed with him. The positive effects, the risks. [H]e does have a primal level of understanding about the nature of the drugs and what it does to him. [H]is response, it is not an incompetent response from the perspective of making a rational, reasoned decision where he responds appropriately and not in non sequiturs, but is incompetent from somebody who is trying to do him good. And he needs to be helped....

DISCUSSION

I. Introduction

Before reaching the central question on appeal--under what, if any, conditions a patient in a federal treatment facility may be forcibly and unwillingly medicated with antipsychotic drugs--we first address a preliminary issue: Charters' federal custodians do not at present have legal authority to detain Charters because procedures mandated by federal statutes governing detention of the mentally ill in federal facilities have not been followed. Although Charters did not raise the legality of his detention in a petition for habeas corpus, the issue is presented by the underlying dispute: If the federal government has no authority even to detain a man, it surely cannot forcibly inject him with chemicals which may well be dangerous and mind altering short of an emergency requiring such intrusion. No such emergency presented itself in the case before us. We therefore remand and direct the district court to conduct an inquiry into the legality of Charters' detention.

We then turn to the question of forcible medication. We conclude that a mentally ill pretrial detainee has a constitutionally protected interest in deciding for himself whether to accept or forego medical treatment. Where the detainee is competent to consent to or refuse medical care, his constitutional interest in making such decisions outweighs the government's interest in medicating him against his will. Furthermore, a patient is entitled to be presumed competent until adjudicated incompetent.

Regarding a patient who is found incompetent to direct his own medical care, we conclude that incompetence does not extinguish a patient's constitutional rights and examine the alternatives available to allow treatment decisions to be made on that patient's behalf. We hold that the custodians of such a patient must apply for a court order permitting forcible medication. Upon such application, if it can be ascertained by the district court what treatment the patient would, if competent, select for himself then that "substituted judgment" is dispositive. Otherwise, the district court should direct treatment in accordance with the patient's best interests. Finally, because the present case does not present an emergency situation in which violence or the imminent deterioration of a patient will occur in the absence of forcible medication, we do not resolve whether such a situation might call for a different result.

II. Charters is Not Properly in Federal Custody

In continuing Charters' detention for more than three years, the district court attempted to comply with federal statutes governing the detention of mentally ill persons who are accused of federal crimes, 18 U.S.C. Secs. 4241-4247. Charters was originally committed to Butner under an earlier version of the current law. In 1984, Congress Charters did not directly raise the question of the legality of his detention in proceedings below, and we do not treat his claim as one for habeas corpus because that issue has not properly been presented. We do address the legality of Charters' detention as it relates to Charters' right to resist forcible medication at the hands of federal medical personnel. Before it can be determined that the government has authority to medicate Charters forcibly, it must be established that it has legitimate authority over his person at all. Because Charters is not properly detained under any federal law and no emergency otherwise justifies governmental intrusion, we cannot sanction forcible medication: to do so might well compound the denial of due process that Charters has already experienced.

significantly amended the procedures governing confinement of mentally ill persons. The district court apparently was unaware that, under the revised statutes, procedures once adequate are no longer sufficient.

Two statutory sections contained in the new law are relevant to Charters' confinement. The first, 18 U.S.C. Sec. 4241(d), provides for the temporary custody of a defendant judged incompetent to stand trial. The section permits federal custody and treatment of the individual for four months, a period of time, here long since expired, which Congress deemed adequate to determine the probability that the individual would regain competence in the foreseeable future. The four month limit under 18 U.S.C. Sec. 4241(d)(1) may be extended for an "additional reasonable period" of time if the court makes an explicit finding that there is a "substantial probability" that the defendant will attain the capacity to permit the trial to proceed within the additional time. 18 U.S.C. Sec. 4241(d)(2). ³

A second section, 18 U.S.C. Sec. 4246(a), provides for the custody of mentally ill individuals who no longer realistically can be considered to be awaiting trial because there is little possibility of their regaining competency. ⁴ However, federal custody is permitted under Sec. 4246(a) only after efforts have been made to obtain placement in a state institution for the individual and the efforts have not succeeded.

Charters' confinement is not in compliance with the provisions of Sec. 4241. Charters has been in a federal treatment facility since February 1984, more than three years, while Sec. 4241(d)(1) normally cuts off custody after four months. There has been no finding by the court pursuant to Sec. 4241(d)(2) that there is a substantial probability that Charters will attain a level of competency within an additional reasonable time so as to permit the trial to proceed. Indeed, the opposite finding has in effect been made. The district court found that Charters "shows no promise of improvement under the current treatment." Even were Charters medicated against...