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A federal appeals court has established a standard for medicating criminal defendants against their wishes so they will be competent to stand trial. The first impression ruling by the 2nd U.S. Circuit Court of Appeals rejected arguments that the Bill of Rights for Mental Health Patients (42 U.S.C. � 9501 and �� 10841, et seq.) prohibits involuntary medication of criminal defendants who are not considered to be dangerous. But the ruling also dismissed criteria established by a federal trial court in Connecticut, saying that court’s ruling was too broad and did not adequately address the defendant’s liberty interest, limits on the government’s interest in prosecuting and the need for monitoring the defendant’s condition. Writing for the unanimous court in United States v. Gomes, 01-1143, Chief Judge John M. Walker Jr. said the panel was holding that “heightened, but not strict scrutiny is the appropriate standard” for determining when medicating a defendant should be allowed. The court then laid out the factors to be considered in the analysis. The government must show, and the trial court must explicitly find: that the proposed treatment is medically appropriate; that it is necessary to restore the defendant to trial competence; that the defendant can be fairly tried while under the medication; and that trying the defendant will serve an essential government interest. Walker said the U.S. Supreme Court has “yet to articulate a standard for determining when a non-dangerous criminal defendant may be medicated to render him competent to stand trial.” But, he said, the high court has “framed the issue in general terms,” saying resolution requires defining the protected constitutional interest at stake and determining whether it is outweighed by competing state interests. The case before the court centers on Aaron Gomes, who is charged with felony possession of a firearm and possession of narcotics. He has at least three other convictions for violent felonies and faces a mandatory minimum sentence of 15 years in prison. Gomes has on numerous occasions refused to participate in a psychiatric evaluation. He was examined while in custody at a federal prison in Springfield, Mo., where a doctor found that Gomes suffered from an undefined psychotic disorder that caused him to be delusional and believe that the charges against him were part of a vast conspiracy. Doctors later concluded that Gomes was in need of anti-psychotic medication. Gomes repeatedly refused the treatment and was eventually brought before U.S. District Judge Christopher F. Droney in Connecticut for a hearing on whether he should be involuntarily medicated. Gomes argued that involuntary medication was warranted only when a defendant posed a danger to himself or others, but Droney disagreed, concluding that the government’s interest in enforcing criminal laws constituted an “essential, overriding justification for involuntary medicat[ion].” Droney laid out 13 factors for courts to consider in such cases, including the competing interests of the defendant and the government, whether there was sound medical basis for the treatment, and whether the treatment would have harmful effects. BROAD BRUSH Last week, the 2nd Circuit took issue with the reasoning behind Droney’s ruling, saying the court had “swept with too broad a brush” in construing the government’s interest in prosecuting crimes. “While the government has a strong interest in prosecuting all crime,” Chief Judge Walker wrote, “some prosecutions are simply so minor that, in the absence of some unusual compelling reason, they ordinarily will not outweigh a defendant’s interests in avoiding involuntary medication.” The court declined to list minor offenses, but said it had in mind first-time theft or unlawful possession of a small amount of drugs. But those crimes should be considered case by case, the court said, for exceptions in “appropriate circumstances.” COURT WAS REMISS Walker also said the lower court was remiss in failing to address Gomes’ liberty interest. Given the invasiveness of the procedure and the “severity of possible side effects of antipsychotic medication,” the chief judge wrote, “it follows that the non-consenting criminal defendant’s liberty interest to be free from this sort of bodily intrusion under the Due Process Clause of the 14th Amendment is a substantial one.” The judge added that there were other interests at stake, including the fact that with some drugs, a defendant’s in-court demeanor may be affected “as well as his willingness and ability to assist in his defense,” which implicates a defendant’s right to a fair trial. Walker ordered the lower court to update the testimony from Gomes’ doctors and continue to monitor Gomes’ condition. As far as a possible insanity defense, the judge wrote that Gomes would not be precluded from offering such a defense because of the involuntary medication. “The need for medication to render [Gomes] competent continues to yield an argument of some force that but for the medication, his illness would amount to insanity and that he suffered from the same illness when the crime was committed.” Jeremiah Donovan of Old Saybrook, Conn., represented Gomes. Thomas V. Dailey, an Assistant U.S. Attorney in New Haven, Conn., prosecuted the case.

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