United States v. Almendarez

179 F.Supp.3d 498

United States of America

v.Jesse Almendarez, Defendant.

Case No. 13-130

United States District Court, W.D. Pennsylvania.

Signed April 13, 2016

Shardul S. Desai, U.S. Attorney's Office, Pittsburgh, PA, for United States of America.

OPINION and ORDER on INVOLUNTARY MEDICATION

Maurice B. Cohill, Jr., Senior United States District Court Judge

This matter comes before the Court for consideration of the request of the government by way of the United States Federal Medical Center in Butner, North Carolina for permission to involuntarily medicate the defendant to restore him to competency in order to stand trial. The Court conducted a hearing on March 3, 2016, pursuant to Sell v. United States, 539 U.S. 166, 123 S.Ct. 2174, 156 L.Ed.2d 197 (2003), to determine whether to permit involuntarily treatment of the Defendant, Jesse Almendarez, with psychotropic medications. For the reasons stated below we will deny the request.

I. Background

On May 7, 2013, a grand jury returned an indictment charging Jesse Almendarez with one count of threatening a Federal Officer in violation of 18 U.S.C. § 115(a)(1)(B), and one count of interstate threat in violation of 18 U.S.C. § 875(c).

On March 19, 2014, we held a status conference, initiated by motion of the government, to assess whether a competency evaluation was needed in this case. Prior to the status conference, the Court had received correspondence from Mr. Almendarez, who is represented by counsel, indicating the possibility of delusional thought.

In addition, the pleadings indicated that Mr. Almendarez has been diagnosed with schizoaffective disorder and schizophrenia, paranoid type, that he had been under psychiatric care from time to time, and that he does not always take his prescribed medications. Mr. Almendarez was present at the status conference, appeared to comprehend his circumstances, and responded appropriately to questions. In addition, defense counsel vigorously argued that her client was competent and represented to the court that a plea agreement between the parties had been reached. Thus we did not order a competency evaluation at that time.

We subsequently learned from defense counsel that Mr. Almendarez had decided to reject a plea agreement and on April 28, 2014, his counsel filed substantive pretrial motions, to which the government filed responses. One of Mr. Almendarez's motions raised the issue of whether he was competent to waive certain rights during various interviews conducted by law enforcement agents during the investigation of this case. In response, the government filed a motion for a competency hearing.

On May 28, 2014, we granted the government's motion and ordered a competency evaluation over the objection of defense counsel, in part, because it seemed evident that in an evidentiary hearing to address the issues raised in Mr. Almendarez's pretrial motions we would be making an assessment and judgment as to whether he was competent to understand and/or waive his constitutional, civil, and privacy rights. In addition, we had continued to receive numerous letters from Mr. Almendarez indicating delusional thought at odds with the reality of the present proceedings. Thus, we ordered that Mr. Almendarez undergo a competency evaluation.

Mr. Almendarez was evaluated locally by Robert Wettstein, M.D., who issued a Competency Report dated July 16, 2014. Dr. Wettstein diagnosed Mr. Almendarez with Schizoaffective disorder, bipolar type; alternatively, chronic undifferentiated schizophrenia ; a seizure disorder, and GERD. He described his mental condition as being “a severe mental disorder of psychotic proportions which is chronic in duration.” Wettstein Rep. 11. Dr. Wettstein concluded that Mr. Almendarez was able to understand the nature and consequences of the proceedings against him, despite his chronic psychosis, but that he is unable to assist properly in his defense due to his schizoaffective disorder. Dr. Wettstein opined that Mr. Almendarez “is in need of psychiatric treatment including psychotropic medication to improve his thinking, reduce his thought disorder, stabilize his mood, and improve his judgment.” Wettstein Rep. 12. He further stated, “It is of interest that his delusional thinking appears to be chronic and may or may not be mood dependent so that his delusions might be fixed in duration even if psychotropic medication is appropriately prescribed and taken.” His multiple psychiatric hospitalizations often occurred after he had discontinued his mood stabilizing, antipsychotic medications, so that it is likely that such medication is essential to his mood stability and cognition. Wettstein Rep. 12-13.

On November 13, 2014, we held a competency hearing and entered an Order finding by a preponderance of the evidence that the Defendant, Jesse Almendarez, was then presently suffering from a mental disease or defect rendering him mentally incompetent to the extent that he was unable to assist properly in his defense. Accordingly, we ordered that Mr. Almendarez be committed to the custody of the United States Attorney General to be hospitalized for treatment in a suitable facility to determine whether there was a substantial probability that in the foreseeable future he would attain the capacity to permit the trial to proceed. Mr. Almendarez is currently being treated at the Federal Medical Center in Butner, North Carolina.

While receiving treatment Mr. Almendarez's primary evaluator at the Medical Center, Robert Cochrane, M.D., issued two Status Reports to the Court, dated July 1, 2015 and August 20, 2015. In both reports Dr. Cochrane indicated that Mr. Almendarez was incompetent to proceed to trial and that he continued to refuse the medical staff's recommendation to be treated with antipsychotic medication.

On August 26, 2015, a comprehensive Forensic Evaluation was issued by Dr. Cochrane and the Medical Center's psychiatrist, Bryon Herbel, M.D. FMC Butner Forensic Eval, 8/26/15. Mr. Almendarez was diagnosed with Schizoaffective Disorder, Bipolar Type, Multiple Episodes, Currently in Acute Episode. FMC Butner Forensic Eval. 6. The doctors further explained that “Mr. Almendarez appears to have been suffering from this illness since approximately 1998 and his primary symptoms have included disorganized speech and thought processes, persecutory and grandiose delusions, irritable and unstable mood, and impaired judgment.” FMC Butner Forensic Eval. 6. Doctors Cochrane and Herbel concluded, as did Dr. Wettstein, that while Mr. Almendarez has a basic understanding of the nature and consequences of the proceedings against him, he is unable to assist his attorney and is therefore not competent to stand trial. FMC Butner Forensic Eval. 6. In addition, the doctors noted that he continues to refuse medication, and therefore they concluded that without antipsychotic medication “there is no reason to believe that Mr. Almendarez will become competent to stand trial in the foreseeable future.” FMC Butner Forensic Eval. 6-7.

These circumstances have therefore prompted the medical evaluators to request that the Court permit them to medicate Mr. Almendarez involuntarily. Accordingly, Doctors Cochrane and Herbel included a Proposed Treatment Plan and Analysis of the issues in light of the factors explained in the Supreme Court's Sell opinion (noting that the opinions and plan were based on medical criteria, not legal criteria). FMC Butner Forensic Eval. 7-24. Modifications to the proposed treatment plan were introduced into evidence at the March 3, 2016 hearing by Dr. Herbel to include an additional medication choice, which, because it is a preferred choice of Mr. Almendarez would be the first recommended oral medication. Ex. SH-2, Email dated 2/25/2016. The second modification concerns recommendations as to the order of use of long-acting injections of risperdone and haloperidol. Email, 2/25/2016, Ex. SH-2.

Mr. Almendarez was also independently examined by a psychiatrist, Moira Artigues, M.D., retained by the Defense. Dr. Artigues issued a Forensic Psychiatric Evaluation dated February 24, 2016, in which she diagnosed Mr. Almendarez with Schizoaffective Disorder, Bipolar Type. Dr. Artigues also concluded that although Mr. Almendarez is able to understand the nature of proceedings against him he is unable to assist his attorney in his defense and is therefore not competent to stand trial. Artigues Forensic Psych. Eval. 4. Dr. Artigues noted that Doctors Cochrane and Herbel made a compelling case for involuntary treatment, but she also offered her opinion that there are compelling reasons why involuntary treatment may not be a good option in this case. Artigues Forensic Psych. Eval. 6.

At the March 3, 2016 Sell hearing Mr. Almendarez and his counsel, Assistant Federal Public Defender Jay Finkelstein, appeared via videoconference from the Federal Medical Center in Butner. The attorney for the government, Assistant United States Attorney Shardul appeared in person in Pittsburgh, Pennsylvania. Testifying via videoconference from the same room in Butner as Mr. Almendarez and his counsel were Dr. Cochrane, Dr. Herbel, and Dr. Antigues, all of whom were testifying as experts. Finally, United States Marshal Jason Byham testified from Pittsburgh regarding the United States Marshal's health monitoring capabilities and protocols when transporting prisoners.

II. Legal Standards

The primary issue for the Court is whether the defendant should be administered psychiatric medications against his will pursuant to Sell v. United States, 539 U.S. 166, 123 S.Ct. 2174, 156 L.Ed.2d 197 (2003). By refusing the recommended medical treatment, Mr. Almendarez is asserting his constitutionally protected Fifth and Fourteenth Amendment liberty interest in remaining free from unwanted medical treatment. The United States Supreme Court has recognized that an individual has a constitutionally protected liberty interest in avoiding the unwanted administration of antipsychotic drugs that...