United States v. Fieste

84 F.4th 713

UNITED STATES of America, Plaintiff-Appellee, v. Darlene FIESTE, Defendant-Appellant.

No. 23-1739

United States Court of Appeals, Seventh Circuit

Argued September 7, 2023

Decided October 19, 2023

Appeal from the United States District Court for the Central District of Illinois. No. 22-cr-10001 — James E. Shadid, Judge

Jeffrey Kienstra, Attorney, Office of the United States Attorney, Peoria, IL, for Plaintiff-Appellee.

Thomas Drysdale, Attorney, Office of the Federal Public Defender, Urbana, IL, for Defendant-Appellant.

Before Brennan, St. Eve, and Jackson-Akiwumi, Circuit Judges.

St. Eve, Circuit Judge.

Defendant Darlene Fieste faces charges for threatening to assault and murder two federal judges, three former United States presidents, and the current President. She is currently incompetent to stand trial—Fieste struggles with a mental illness that causes her to experience delusions. Now in custody, Fieste has refused the antipsychotic medication that experts believe will restore her competence. The government therefore has moved for permission to involuntarily medicate her to render her competent to stand trial. The district court granted the motion, but the order is stayed pending this appeal. For the following reasons, we affirm in part, vacate in part, and remand.

I. Background

Darlene Fieste suffers from a mental illness that leads her to hold the delusional belief that various high-ranking federal officials have sexually abused and raped her. She has struggled with her illness for more than thirty years.

Over the course of several days in December 2021, Fieste sent a series of graphic emails and voicemails threatening to kill federal judges and presidents, all of whom she believed had sexually abused her. The messages began with a voicemail on December 22, 2021, in which Fieste stated:

Judge [A] is f***in dead. I am going to f***in kill him. Tell all the judges in your federal building in St. Louis, that Judge [A], I'm gonna kill Judge [A]. I am f***ing going to kill him.

Fieste left another voicemail several days later, this time targeting a former president. She stated: "[President B] is a sick f***. I'm gonna put a bullet right in his f***in head."

Other emails and voicemails arrived in the days that followed. Each was violent and targeted the life of a federal official:

• "I WILL SHOOT . . . JUDGE [A]."

• "I WILL SHOOT . . . JUDGE [C]."

• "I WILL SHOOT . . . [PRESIDENT D]."

• "I WILL SHOOT . . . [PRESIDENT E]."

• "I WILL SHOOT . . . JOE BIDEN."

A grand jury returned a seven-count indictment charging Fieste with threatening to assault and murder two federal judges, 18 U.S.C. § 115(a)(1)(B), threatening to kill three former presidents, 18 U.S.C. § 879, and threatening to kill the current president, 18 U.S.C. § 871(a). Fieste was arrested on January 20, 2022, and has remained in custody ever since.

Fieste's conduct at her initial appearance prompted the magistrate judge to order a competency evaluation. See 18 U.S.C. § 4241(b). Fieste was then transferred to the Federal Medical Center ("FMC") in Carswell, Texas, where several months of psychiatric evaluation ensued.

FMC psychologists submitted their report to the district court on June 7, 2022, concluding that Fieste was not competent to stand trial. They diagnosed Fieste with a "delusional disorder" marked by paranoia and persecutory delusions, which led her to believe numerous individuals had raped her.

FMC examiners noted Fieste's deep fixation with the subject of her delusions. During the evaluation period, Fieste reported a series of sexual assaults perpetrated by prominent national political figures, judges, police officers, and hospital staff. She also harbored paranoid ideas about government officials and federal law enforcement agencies, including the belief that government officials had retaliated against her for complaining about a federal judge.

Fieste's delusions, her evaluators concluded, rendered her incapable of assisting in her own defense. Even though Fieste demonstrated an understanding of court proceedings, her delusions interfered with her rational grasp of the accusations against her and her ability to communicate with her attorney. FMC psychologists predicted that Fieste's prognosis was "poor" absent medication and treatment. They added, however, that proper treatment was substantially likely to improve her condition.

After receiving the report, both parties stipulated to its findings and the magistrate judge found Fieste incompetent to proceed. The magistrate judge then committed Fieste to the custody of the Attorney General to determine whether there was a substantial probability that she could attain competency in the foreseeable future. See 18 U.S.C. § 4241(d)(1).

Over the next four months, Bureau of Prisons psychologist Matthew Opesso performed a competency evaluation for purposes of section 4241(d)(1). In his report to the court, Dr. Opesso observed that Fieste's delusions occupied her thoughts, led to altercations with medical staff and other inmates, and were the subject of almost daily emails she sent to FMC Carswell staff. Dr. Opesso diagnosed Fieste with "bipolar I disorder, current episode manic, with mood congruent psychotic features." He concluded, just as the first evaluation had, that Fieste was incompetent to stand trial because her delusions heavily impaired her abilities to participate in her defense and communicate with her attorneys. Dr. Opesso opined that Fieste's chances of attaining competency to stand trial were poor without medical treatment.

Dr. Opesso also commented on the outcome of psychiatric treatment that Fieste voluntarily underwent during and after the evaluation period. During the evaluation period, Fieste agreed to take several antidepressants and "low-dose antipsychotic medication." Dr. Opesso found these treatments ineffective in addressing her mood instability and delusions. After the evaluation period concluded, Fieste started taking an injectable antipsychotic, Prolixin. Dr. Opesso observed that Fieste's time taking the Prolixin coincided with some improvement in her condition. He predicted that adhering to the medication would give her a substantial probability of attaining competency.

Not long after Dr. Opesso issued his report, Fieste began to refuse medication. The government then moved to forcibly medicate her to restore her to competency to stand trial under Sell v. United States, 539 U.S. 166, 123 S.Ct. 2174, 156 L.Ed.2d 197 (2003). Before the Sell hearing, the Bureau of Prisons conducted a separate hearing to determine if involuntary medication was appropriate under Washington v. Harper, 494 U.S. 210, 110 S.Ct. 1028, 108 L.Ed.2d 178 (1990), which authorizes involuntary medication if a defendant poses a danger to herself or others while in custody. The Bureau of Prisons concluded that Fieste had not behaved dangerously while in custody, and so involuntary medication was unjustified on that basis.

The court held a Sell hearing on March 20, 2023, which primarily revolved around the testimony of three expert witnesses. The government presented two experts: Dr. Opesso, and Dr. Ramya Seeni, Fieste's psychiatrist within the Bureau of Prisons. Fieste, in turn, called a retained psychiatrist, Dr. Michael Byrne, who had met with her for two hours to assess her before the hearing.

At the hearing, the experts disagreed on the appropriate diagnosis for Fieste. Dr. Opesso reiterated his earlier finding that Fieste suffered from bipolar I disorder, current episode manic, with mood-congruent psychotic features. Dr. Seeni agreed. Dr. Byrne, in contrast, diagnosed Fieste with schizoaffective disorder, bipolar type.

Notwithstanding that disagreement, the experts coalesced around an appropriate course of treatment. Each concluded that a long-term injectable antipsychotic medication would be most effective in restoring Fieste to competency. Specifically, Dr. Seeni endorsed Prolixin, the antipsychotic that previously yielded significant improvement in Fieste. Dr. Seeni added that another anti-psychotic, Seroquel, might be an appropriate alternative, but that it would require a higher dosage than Fieste had agreed to take. Dr. Byrne agreed that Prolixin was "one of several appropriate medications." No expert, however, discussed a specific dosage of Prolixin besides acknowledging that identifying an effective dosage was a "trial-and-error process."

The experts further agreed that the medications they recommended carried potential side effects that could require additional medication to control. Those side effects included constipation, dry mouth, tremors, stiffness, shakes, anxiety, GI distress, weight gain, restlessness, short- and long-term involuntary muscle movements, cardiac effects, and even death. To address them, Dr. Seeni recommended Ativan, an antianxiety medication Fieste had previously taken to abate the "body-locking symptoms" she was experiencing. Dr. Byrne cautioned that Ativan had potentially addictive effects, but agreed that it would address certain side effects in limited circumstances.

The experts opined that the likelihood Fieste could attain competency for trial depended on her diagnosis. Dr. Opesso testified that "the literature" suggested if Fieste had bipolar disorder, there was an "almost 100 percent" chance she would regain competency; if Fieste suffered from delusional disorder, chances dropped to 73 to 87 percent; if she had schizoaffective disorder, chances ranged from 76 to 81 percent; and if she had schizophrenia, chances were "about 76 percent." Dr. Seeni testified that bipolar disorder carried a "good" prognosis, but the chances of success dropped to between 32 and 72 percent if Fieste had schizoaffective disorder. Although Dr. Byrne declined to provide exact estimates, he indicated that the prognosis was "much poorer" if Fieste suffered from schizoaffective disorder than if she suffered from bipolar disorder. Despite the experts' varied estimates, all agreed that...