U.S. v. Watson
| Decision Date | 11 January 1990 |
| Docket Number | Nos. 88-2578,89-1033,s. 88-2578 |
| Citation | 893 F.2d 970 |
| Parties | UNITED STATES of America, Appellee, v. Gale WATSON, Appellant. UNITED STATES of America, Appellee, v. Jackson HOLMES, Appellant. |
| Court | U.S. Court of Appeals — Eighth Circuit |
David Jones and Michael D. Hood, Springfield, Mo., for appellee.
Before JOHN R. GIBSON and BOWMAN, Circuit Judges, and HEANEY, Senior Circuit Judge.
Two federal prisoners, Jackson Rip Holmes and Gale Watson, 1 ask this Court to decide whether they have a constitutional right to refuse the administration of psychotropic medications. We hold that federal prisoners suffering from a mental disease or defect have a qualified right to refuse such treatment. We reverse the district court's order allowing the government to forcibly medicate Holmes and remand the case to the district court to determine whether Holmes can function adequately in the prison without medication. We affirm the district court's order with respect to Watson because such treatment has been shown to be necessary to control him within the prison setting.
Holmes is a thirty-seven-year old federal prisoner presently housed in the general population of the Mental Health Unit at the Medical Center for Federal Prisoners in Springfield, Missouri. On January 15, 1988, Holmes was convicted of threatening Secret Service protectee Jeb Bush, the son of George Bush, in violation of 18 U.S.C. Sec. 879(a)(2). He is presently serving a three-year prison sentence for this crime.
Holmes is a man of obvious high intelligence. He graduated fifth in his high school class and graduated with honors from the University of North Carolina at Chapel Hill with a double major in religion and psychology. He also graduated from the University of Florida's School of Law, but apparently failed the multiple choice ethics portion of the Florida bar examination.
Holmes has received both voluntary and involuntary psychiatric treatment over the last twenty years. He apparently first consulted a psychiatrist in 1970 or 1971. Dr. M.A. Conroy, Chief Psychologist at the Springfield Medical Center, reported that Holmes was committed to the Camarillo State Hospital in California in 1978, where he was diagnosed as paranoid schizophrenic. 2 In 1983, Holmes spent three or four months in a Miami hospital for a condition described as "schizophrenia, chronic undifferentiated type with paranoid features." Holmes then was admitted to the Institute of Living in Hartford, Connecticut for long-term psychiatric treatment. According to Dr. Conroy, this hospitalization became involuntary in 1984 when Holmes refused to take psychotropic medication. In 1985, Holmes moved into a halfway house but subsequently was discharged for "disruptive behavior" and failure to take psychotropic medications.
Holmes was admitted to the Medical Center on February 5, 1988 for observation; and on February 29, he agreed to be admitted to the Center's mental health unit. He refused, however, to take psychotropic drugs. On May 23, 1988, the United States filed a petition to determine the mental condition of Holmes pursuant to 18 U.S.C. Sec. 4245. 3 The government, through the psychological evaluation of Dr. Conroy, alleged that Holmes suffered from a mental disease for which he was in need of treatment with psychotropic medications.
The government bases its request to forcibly medicate Holmes on the report of Dr. Conroy and the supporting testimony of Jackson Holmes is currently suffering from an acute psychotic condition known as paranoid schizophrenia. His mental illness is clearly chronic and he has suffered from it for at least the past five years. There is evidence of a vast system of persecutory and grandiose delusions, which continue to expand to include the people around him, particularly authority figures. In stressful situations, Mr. Holmes' speech becomes pressured, his associations loose, and his attitude hostile. History indicates the potential for serious acting out behavior consistent with his delusional beliefs. History also indicates consistent non-compliance with the regimens of psychotropic medication. Although Mr. Holmes to date has been able to function adequately in our very structured environment, he is nearing parole eligibility. It would be a disservice to Mr. Holmes and the community to recommend release if his condition remains untreated. 4
Dr. Donald Butts, a staff psychiatrist at the Medical Center. Dr. Conroy reported that Holmes suffers from the grandiose and persecutory delusion that former President Reagan wants to poison him and to use him as a guinea pig to test the effects of psychotropic drugs. Dr. Conroy stated:
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In the opinion of his treating psychiatrist, that treatment would necessarily involve the administration of psychotropic medications. [Emphasis added]
Dr. Butts' testimony at the section 4245 hearing is consistent with Dr. Conroy's evaluation. He recommended the administration of a non-phenothiazine antipsychotic drug, 5 such as Haldol, Navane, or Moban, and an antidepressant such as Adapin, Sinequan, Elavil, or Tofranil. Dr. Butts testified that the anticipated effects of these medications would be decreased anxiety, a decreased investment in his delusional thought processes, an ability to interpret the behavior and presence of others as nonthreatening, and an increase in interpersonal contacts.
The diagnosis of paranoid schizophrenia and the need for antipsychotic drugs were called into doubt by the reports of Dr. Emasue Snow, a psychiatrist who evaluated Holmes at Holmes' expense, and Dr. Kenneth J. Burstin, a clinical psychologist who examined Holmes at the direction of the district court. Dr. Snow characterized Holmes' illness as a delusional disorder, 6 Mr. Holmes is an intelligent man whose symptoms of extreme anxiety are elaborated in his complex delusional system in an effort to rationalize his unrealistic anticipation of impending danger. He repeatedly denied that he had made any threats or acted in a disruptive manner, and he perceives his own hostile impulses as being directed against him from others. He feels depressed and powerless against such authority as the federal government, and in turn, he attempts to control his fear by relating himself to prominent figures in elective office, and by filing many lawsuits to redress his grievances. He shows evidence of a serious mental disorder characterized by persecutory delusion and grandiose repair. He does not have symptoms of thought broadcasting, hallucinations or other bizarre manifestations generally elicited in Schizophrenic Disorders.
rather than schizophrenia. Dr. Snow stated:
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It is unfortunate that Mr. Holmes' delusional preoccupation incorporates the fear of psychotropic drugs since he could probably benefit from a reduction of his constant anxiety by the administration of some of the major tranquilizers. However, if he were to be helped in this manner, it would require his cooperation, and at present that is unlikely to be forthcoming. It is my understanding that the issue of his commitment involuntarily which would allow him to receive drugs without his permission, is dependent upon the prediction of dangerousness. Mr. Holmes sounds threatening at times, but I could not find any indication that he has acted upon such threats, certainly not since his admission to the Medical Center, and therefore I do not think the administration of psychotropic medication against his will is necessary.
Dr. Burstin also reviewed Holmes' file and found that, while he had been characterized as a "disruptive individual" and "dangerous" in March 1987, Holmes had adjusted well to the structured environment at the Medical Center, was holding a job assignment and performing his work satisfactorily. Observations by staff for the three-month period preceding Dr. Burstin's evaluation indicated no acting out or significant disruptive behavior. At the section 4245 hearing, Dr. Burstin testified that the forced administration of antipsychotic drugs would not necessarily reduce Holmes' anxiety. He stated, "[I]n this particular case Mr. Holmes is going to without a doubt believe that he is being harmed by those medications and what I would expect to see is (a) greater anger at staff; (b) increased complaints of side effects due to medication; (c) increased agitation and anxiety."
The district court rejected the reports of Drs. Snow and Burstin, and held that the decision of the Medical Center to administer antipsychotic medications without Holmes' consent was not arbitrary or capricious.
Gale Watson is a forty-five year old man presently serving a twenty-year sentence for a 1980 conviction for armed robbery. According to the psychiatric report submitted to the district court by the Medical Center, Watson has a fifth grade education and a long history of psychiatric problems. At the age of thirteen, Watson was hospitalized for heroin addiction and childhood schizophrenia. Throughout his teenage years, he went from one institution to another. He was arrested twice for burglary and twice for armed robbery and has intermittently served time since 1974. It appears from the record that while Watson's court-appointed attorney attempted to convince him to plead guilty by reason of insanity at trial, Watson refused. He subsequently was adjudged competent to stand trial and was convicted.
While in prison, Watson has been charged with assault three times and has had several incident reports filed against him. In 1982, he had a serious altercation with some members of the Moorish Science Temple religious organization and suffered a stab wound. Since that time, Watson has In 1981, the Medical Center's psychiatric staff diagnosed Watson as suffering from a ...
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