Psychiatric News September 7, 2001
Volume 36 Number 17
© 2001 American Psychiatric Association
p. 2
Appeals Court Upholds Judge’s Order To Medicate Capitol Hill Shooter
Kate Mulligan
A recent federal ruling indicates an evolution in the attitudes of courts toward antipsychotic medication.
On July 27 a three-judge panel of the U.S. Court of Appeals for the D.C. Circuit upheld a ruling by District Judge Emmet G. Sullivan last March that Russell Weston can be forcibly medicated for his symptoms of paranoid schizophrenia.
Weston is charged with the 1998 murder of two police officers in the U.S. Capitol but was found incompetent to stand trial because the severity of his symptoms made him incapable of participating in his own defense.
Weston has been confined in the psychiatric unit at the Federal Correctional Institute in Butner, N.C., since soon after the shootings. For much of that time he has been kept in an isolation cell where he has continued to deteriorate mentally and physically, according to testimony during prior hearings.
Sullivan originally agreed with the government and ordered that Weston be forcibly medicated, in part to reduce the chances that he could be dangerous to others or to himself. Defense attorneys immediately appealed, and the appeals court put the order on hold, telling Sullivan to go into more depth on the complex issues involved in involuntarily medicating a mentally ill suspect. After more hearings, the judge again ruled in favor of forced medication, stating that failure to medicate Weston with antipsychotics amounts to "simply the warehousing of Weston in a psychotic state." The issue of medication is particularly controversial because the prosecutors have refused to rule out the option of requesting the death penalty if Weston is convicted.
Appeals Court Judge A. Raymond Randolph refuted several defense arguments in the most recent ruling. He stated that the government’s interest in administering antipsychotic drugs to make Weston competent for trial overrode his "liberty interests" and added, "The government’s interest in finding, convicting, and punishing criminals reaches its zenith when the crime is the murder of federal police officers in a place crowded with bystanders where a branch of government conducts its business."
Defense attorneys said that medication would not restore Weston’s competence to stand trial because he was not likely to respond to it and also claimed that the "medication’s mind-altering properties and likely side effects would prejudice his right to a fair trial. . . ."
The appeals court, however, found "a sufficient likelihood that antipsychotic medication will restore Weston’s competence" and would "improve Weston’s ability to relate his belief system to the jury."
APA President-elect Paul Appelbaum, M.D., a forensic psychiatrist, said, "The decision represents a triumph for common sense in an area of law not always ruled by that virtue. In addition to recognizing that society has an important interest in trying defendants who have committed major crimes, the court also portrayed antipsychotic medications in a more realistic light than has been seen in many cases. The judges recognized that proper treatment with antipsychotics is likely to improve Weston’s mental functioning, rather than to impair it, as his attorneys alleged."
Forensic psychiatrist Jack Schoenholtz, M.D., a clinical professor of psychiatry and behavioral sciences at New York Medical College, emphasized, "We should not medicate Weston to have him appear competent to stand trial. The job of a doctor here must not be to serve the interests of the state. However, since he is in the state’s custody, we have a duty to provide him whatever medical care he needs. Otherwise, we violate the Eighth Amendment’s prohibition on cruel and unusual punishment."
The contrast between the Weston case and an earlier landmark case concerning forcible medication shows considerable change in both judicial attitudes and the efficacy of antipsychotic medication.
In 1992, the U.S. Supreme Court reversed the death penalty conviction of David Riggins in the case Riggins v. Nevada, holding that the due process clause of the 14th Amendment offered defendants awaiting trial a qualified right to refuse treatment. Riggins had received an involuntary, daily dose of 800 milligrams of Mellaril during the trial.
The Supreme Court in that case was concerned about the side effects of antipsychotic medications. "While the therapeutic benefits of antipsychotic drugs are well documented, it is also true that the drugs can have serious, even fatal, side effects." Although the ruling held that the administration of Mellaril was "medically appropriate," the justices also noted that the medication may have impacted [Riggins’] "testimony’s content, his ability to follow the proceedings, or the substance of his communication with counsel."
In a separate concurring opinion, Justice Anthony Kennedy wrote, "The medical and pharmacological data in the amicus briefs and other sources indicate that involuntary medication with antipsychotic drugs poses a serious threat to a defendant’s right to a fair trial."
The Weston case might also be headed to the Supreme Court as well. The head of Weston’s defense team, A.J. Kramer, said he was almost certain to appeal the ruling, either to the full appeals court or the U.S. Supreme Court. Appelbaum said, "Although it’s likely that the decision will be appealed, the opinion from the D.C. Circuit provides a sound basis on which further appellate decisions can be grounded." 
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