Supreme Court decision on mental competency to affect Nevada little

Cy Ryan and Erica D. Johnson

Tuesday, July 1, 2003 | 9:21 a.m.

CARSON CITY -- Some local authorities predict a U.S. Supreme Court ruling limiting state's ability to force medication on mentally ill defendants to make them competent to stand trial will have little impact in Nevada.

In a split 6-3 decision, the ruling states that the government can administer anti-psychotic drugs to defendants only if prosecutors prove important governmental interests are at stake.

According to the ruling, which affects only defendants charged in serious but non-violent crimes, the court should try to use alternative, less intrusive means to help defendants become mentally competent to stand trial.

District Attorney David Roger said the ruling will likely have little effect on local cases because the state "rarely" forces medication on defendants.

"The thrust of this ruling is that the court has take real long look at the defendant's mental state before it orders forced medication to obtain competency," he said.

Roger said he believes the court's ruling was appropriate.

"I believe an accused's liberty and interest are important and we should make sure it is absolutely necessary to force medication before doing so," he said.

But other local officials fear the ruling will result in cases being held in limbo indefinitely, unable to go to trial until a defendant submits to medication.

The case before the U.S. Supreme Court involved a dentist Dr. Charles T. Sell, who was found incompetent to stand trial on Medicaid fraud and mail fraud.

He has refused medication, which has kept him in a federal prison medical center in Missouri for four years without trial.

Carlos Brandenburg, administrator for the state Division of Mental Health and Developmental Disabilities, said drugs are the only way some mentally ill defendants can reach competency.

Brandenburg, who ran Lakes Crossing, a state health care facility in Sparks, before becoming division administrator, said 90 percent of people transferred from the courts are "severely mentally ill."

Most of those defendants don't want to be medicated because they believe they are stable, he said.

"Ninety percent of the time the only way to get them to stand trial is through medication," he said.

In Nevada those defendants who are charged with a crime and suffer from mental illness are sent by district judges to the facility until they are deemed sane enough to help their defense lawyer and to stand trial.

The state follows other guidelines for criminal defendants who don't want to take drugs, Senior Deputy Attorney General Ed Irvin said.

If an inmate refuses to take medication after he or she is advised about the drug and its consequences, a panel of professionals reviews the case and meets with the inmate, he said.

If the inmate continues to refuse medication, the case goes to the medical director of the facility. If the medical director decides the inmate should take the drug, the defendant still has a right to go to court, where a judge determines whether involuntary medication should be used, Irvin said.

"Nevada has more due process than most states," he said.

Even before the Supreme Court issued its decision, Irvin said, the Legislature passed Senate Bill 179, which sets guidelines for courts to determine if a criminal suspect should be forced to take drugs.

Local defense attorney JoNell Thomas said the "series of hoops" are necessary because too few rules could prove dangerous for mentally ill defendants.

"You could have a situation where (defendants) are so drugged up that they cannot help in their defense," she said. "The state has an interest in taking the case to trial, but it also must be a fair trial. That's what this opinion addresses. "

Thomas said she doesn't expect the decision to affect many cases in Nevada because few defendants are found incompetent.

"There are not that many of these cases out there," she said. "I think it is a pretty rare thing."

In the high court's decision, Justice Stephen Breyer said the forced administration of antipsychotic drugs should be rare.

The ruling states that drugs should be involuntary administered only "if the treatment is medically appropriate" and if the defendant is "substantially unlikely to have side effects that may undermine the fairness of the trial."

The decision to force medication must also be necessary "significantly to further important governmental trial-related interests."

If the incompetent criminal defendant cannot be brought to trial, Brandenburg said, it is then up to the district judge to possibly dismiss the criminal charges, either with or without prejudice.

Charges dropped without prejudice can be reinstated if competency is achieved.

If the charges are dismissed, defendants are transferred to a civil wing in the mental health institution, where they can be forced to take medication if they are a threat to themselves or the public, Brandenburg said.