from the United States District Court for the District of
Utah (D.C. No. 2:15-CR-00107-WPJ-1)
Cleary, Assistant Federal Public Defender (Rene L.
Valladares, Federal Public Defender, and Cristen C. Thayer,
Assistant Federal Public Defender, with her on the briefs),
Office of the Federal Public Defender, Las Vegas, Nevada, for
C. Hargrove, Assistant United States Attorney (Bart M. Davis,
United States Attorney, with her on the brief), United States
Attorney's Office, District of Idaho, Boise, Idaho, for
HOLMES, BALDOCK, and CARSON, Circuit Judges.
CARSON, CIRCUIT JUDGE.
Sell v. United States, 539 U.S. 166, 169, 180-81
(2003), the Supreme Court outlined a demanding four-part test
that, if satisfied, allows the government to forcibly
medicate a mentally ill but nonviolent criminal defendant
"to render that defendant competent to stand
trial." That test is as follows:
First, a court must find that important governmental
interests are at stake. . . .
. . . .
Second, the court must conclude that involuntary medication
will significantly further those concomitant state
interests. . . .
Third, the court must conclude that involuntary medication is
necessary to further those interests. . . .
Fourth, . . . the court must conclude that administration of
the drugs is medically appropriate, i.e.,
in the patient's best medical interest in light of his
Sell, 539 U.S. at 180-81 (emphases in original).
Supreme Court cautioned that lower courts "need not
consider whether to allow forced medication for that kind of
purpose, if forced medication is warranted for a
different purpose." Id. at 181-82
(emphasis in original). Specifically, courts
"ordinarily" must first consider whether forced
medication is in the defendant's medical interest because
it safeguards him from himself or others, a circumstance
which the Supreme Court previously addressed in
Washington v. Harper, 494 U.S. 210, 227 (1990).
Sell, 539 U.S. at 183. The Supreme Court reasoned
that the Harper standard is "usually more
'objective and manageable' than the inquiry into
whether medication is permissible to render a defendant
competent," so addressing it first can potentially
eliminate-or, at the very least, better inform-a
Sell inquiry. Id. at 182- 83 (quoting
Riggins v. Nevada, 504 U.S. 127, 140 (1992)
(Kennedy, J., concurring)).
what happens when changed circumstances necessitate that a
defendant be forcibly medicated under Harper
after the district court has already authorized
forced medication under Sell? Does the Sell
order stand, or should the court vacate the Sell
order and start again on a clean slate? For the reasons we
describe in more detail below, we hold that courts generally
should vacate the Sell order and begin anew armed
with the findings of the intervening Harper
Joan Osborn is one of the many individuals worldwide who must
wake up each day and battle a severe and debilitating mental
illness. A sixty-one-year-old woman, she has been diagnosed
at different times with schizophrenia, possible depression,
and possible post-traumatic stress disorder. She has thus
spent a large portion of her life-on and off since 1982-in
hospitals and mental health facilities for treatment. Most of
her stays were not voluntary. ...