United States v. Coy

991 F.3d 924

UNITED STATES of America, Plaintiff-Appellee,

v.Matthew H. COY, Defendant-Appellant.

No. 20-1156

United States Court of Appeals, Eighth Circuit.

Submitted: January 12, 2021

Filed: March 17, 2021

Rebecca L. Kurz, Asst. Fed. Public Defender, Kansas City, MO, argued (Laine Cardarella, Fed. Public Defender, on the brief), for defendant-appellant.

David Wagner, Asst. U.S. Atty., Kansas City, MO, argued (Timothy A. Garrison, U.S. Atty., on the brief), for plaintiff-appellee.

Before COLLOTON, WOLLMAN, and SHEPHERD, Circuit Judges.

SHEPHERD, Circuit Judge.

Matthew H. Coy, who suffers from amphetamine-induced psychotic disorder, with onset during intoxication, was charged with unlawful possession of a firearm by a convicted felon. The district court¹ found Coy incompetent to stand trial, and after Coy declined medication, the government moved to begin involuntary treatment under Sell v. United States, 539 U.S. 166, 123 S.Ct. 2174, 156 L.Ed.2d 197 (2003). The district court granted the government's motion, and Coy now appeals. Having "jurisdiction over interlocutory appeals of orders for involuntary medication under the collateral order doctrine," United States v. Nicklas, 623 F.3d 1175, 1177 (8th Cir. 2010), we affirm.

I.

After being charged by criminal complaint, Coy was indicted on two counts of unlawful possession of a firearm by a convicted felon, in violation of 18 U.S.C. §§ 922(g)(1) and 924(e)(1). Coy and his mother had an altercation, which resulted in a gunshot wound to Coy's leg. Coy was treated at a medical center and was described as: having "an altered mental status"; "exhibiting delirium"; and "screaming random statements." R. Doc. 36, at 5. While Coy was being treated, police found two firearms in his residence. Coy claims that his mother shot him as part of a large conspiracy aimed against him; his mother claims that Coy had taken methamphetamine, attacked her, and shot himself in his delirium.

Coy filed a motion for determination of competency. After a psychological evaluation, Dr. Jeremiah Dwyer, a forensic psychologist, noted that while Coy's exam was largely unremarkable, Coy would be unable to assist in his trial due to his delusions regarding his mother, law enforcement, and medical personnel. The magistrate judge recommended that an order of incompetency be entered and that Coy be committed to the custody of the Attorney General for treatment at a federal medical center (FMC Butner) for four months, a recommendation which the district court adopted in full.

After the first ordered period at FMC Butner ended, Dr. Robert Cochrane, the primary psychologist, filed a report with the district court stating that Coy's delusions had persisted, and the district court extended the treatment another four months. Shortly thereafter, Dr. Cochrane notified the district court that Coy had declined further medication, and the government requested authority to begin involuntary treatment under Sell. The magistrate judge recommended that the district court enter a finding that there were important government interests at stake, the first element under Sell, based on the seriousness of Coy's crime. The district court adopted the recommendation in full and ordered the staff of FMC Butner to prepare an "Addendum and Treatment Plan" to address the other Sell elements.

The magistrate judge subsequently held an evidentiary hearing on the three remaining Sell elements. Dr. Logan Graddy, the chief psychiatrist at FMC Butner, submitted the requested "Addendum and Treatment Plan" (the Treatment Plan). In the Treatment Plan, Dr. Graddy determined that Coy suffered from amphetamine-induced psychotic disorder, with onset during intoxication, and that the disorder's impact on Coy's life was "moderate to severe." R. Doc. 71, at 2. The Treatment Plan contained Dr. Graddy's findings:

3. My opinions related to these matters:

* * *

b. In regards to [element] 2:

i. I have no opinion as to whether involuntary medication will significantly further government/state interests.

ii. In my opinion, with reasonable medical certainty, involuntary medications are substantially likely to render Mr. Coy competent to stand trial.

iii. In my opinion, with reasonable medical certainty, involuntary medication is substantially unlikely to have side effects that will interfere significantly with the defendant's ability to assist counsel in conducting a trial defense.

c. In regards to [element] 3:

i. I have no opinion as to whether involuntary medication is necessary to further government/state interests.

ii. In my opinion, alternative, less intrusive treatments are unlikely to achieve substantially the same results as involuntary medication.

iii. I have no opinion as to whether less intrusive means (court order backed by contempt order) will achieve substantially the same results as involuntary medication.

d. In regards to [element] 4: It is my opinion that administering antipsychotic medication to Mr. Coy is medically appropriate. It is in his best medical interest in light of his medical condition.

R. Doc. 71, at 5-6 (footnote omitted). The Treatment Plan further noted that Coy had voluntarily taken antipsychotic medication while at FMC Butner but that he "ha[d] been reluctant to take the medications at sufficient doses or for a sufficient period of time to treat his disorder." R. Doc. 71, at 3. Coy's reluctance stemmed from his belief that "the treatment team was trying to poison him or part of the conspiracy against him." R. Doc. 71, at 4.

Dr. Graddy also submitted an appendix of studies to the Treatment Plan, the purpose of which was "to provide the [district c]ourt [with] helpful scientific information to be used in weighing the potential risks and benefits of a trial of treatment." R. Doc. 71-1, at 1. The appendix largely referenced schizophrenia, but it also included data on other psychotic disorders, such as delusional disorder. The appendix summarized the data, stating: "[T]he effectiveness of antipsychotic medication in treating schizophrenia and related psychotic disorders has been repeatedly demonstrated in published professional literature for nearly 50 years, and is considered an essential element in the treatment of these conditions." R. Doc. 71-1, at 3. The appendix further discussed the myriad side effects associated with antipsychotic medications and outlined the proposed monitoring procedures FMC Butner would take and the responses the clinic would implement should such side effects manifest.

At the evidentiary hearing, Dr. Graddy testified on behalf of the government and adopted the Treatment Plan as his direct testimony. He testified that he was board certified in general psychiatry and addiction medication and was a distinguished fellow in the American Psychiatric Association. Dr. Graddy testified that in compiling the Treatment Plan he had relied on his correspondence with Coy's nurse practitioner, a clinical pharmacist, and Dr. Cochrane (the primary psychologist), in addition to his own observations of Coy, which totaled about two hours. Dr. Graddy testified that he had experience treating individuals with conditions similar to Coy's. While he was unable to recall these patients’ specific outcomes, Dr. Graddy noted that he had treated amphetamine-induced psychotic disorder similar to schizophrenia. On cross-examination, Dr. Graddy acknowledged that Coy had claimed that he had experienced side effects from the voluntarily-accepted antipsychotic medication, but Dr. Graddy was unable to state whether Coy actually experienced those side effects.

To rebut Dr. Graddy, Coy called Dr. Roger Sommi, a psychiatric pharmacist who serves as a professor of psychiatry and pharmacy, to testify. Dr. Sommi testified that in his academic role he conducted research and made drug therapy recommendations to psychiatrists. While Dr. Sommi testified that he had worked with "hundreds" of patients that had a condition similar to Coy's, see R. Doc. 81, at 26, he admitted that he had not met with Coy personally and was merely basing his opinions on Coy's medical records. Based on Dr. Graddy's diagnosis, Dr. Sommi opined that there was a "low probability" that antipsychotic medication would alleviate Coy's delusions given their persisting nature. R. Doc. 81, at 28. Dr. Sommi acknowledged that if Coy was willing, he would likely take the same approach as Dr. Graddy. On cross-examination, Dr. Sommi admitted that there was a possibility that the Treatment Plan could render Coy competent. He also testified that, in a clinical setting, the opinion of a psychiatrist or nurse practitioner would prevail over his as a psychiatric pharmacist if a disagreement as to a patient's treatment arose.

The magistrate judge subsequently issued a report and recommendation, recommending Coy's involuntary medication. The magistrate judge relied on Dr. Graddy's testimony, which was based on his personal interactions with Coy, in finding that involuntary medication was substantially likely to restore Coy to competency and that any resulting side effects could be managed with medication. The magistrate judge noted that while Dr. Sommi was less optimistic about the viability of the Treatment Plan, portions of Dr. Sommi's testimony were supportive of Dr. Graddy's proposed plan. The magistrate judge referenced the appendix of studies with approval. The magistrate judge also found that the Treatment Plan included sufficient flexibility to adequately accommodate any side effects such that the Treatment Plan was medically appropriate for Coy. The district court adopted the report and recommendation in full and ordered the commencement of Coy's involuntary medication. Coy appeals.

II.

"In Sell v. United States, the United States Supreme Court considered longstanding precedent regarding a defendant's constitutional right to refuse medical treatment." United States v. Curtis, 749 F.3d 732, 735 (8th Cir. 2014) (citing Sell, 539 U.S. at 177-80, 123 S.Ct. 2174 ). "[T]he Supreme Court concluded...