United States Court of Appeals
Fifth Circuit
REVISED DECEMBER 14, 2005 FILED
November 21, 2005
IN THE UNITED STATES COURT OF APPEALS
FOR THE FIFTH CIRCUIT Charles R. Fulbruge III
Clerk
No. 04-31137
UNITED STATES
Plaintiff - Appellee
versus
DEDRICK REGINALD WHITE
Defendant - Appellant
Appeal from the United States District Court
for the Middle District of Louisiana
Before HIGGINBOTHAM, WIENER & DENNIS, Circuit Judges.
WIENER, Circuit Judge:
Defendant-Appellant Dedrick Reginald White appeals an order of
the district court that he be involuntarily medicated. Concluding
that this case is not ripe for appellate review because the
Plaintiff-Appellee the United States failed to exhaust the
administrative procedures required, we vacate and remand.
I. FACTS & PROCEEDINGS
White was indicted on charges of (1) assaulting a postal
carrier, and in so doing placing the postal carrier in jeopardy by
the use of a semi-automatic rifle, (2) using, carrying, and
brandishing that rifle during the assault, and (3) being a felon in
possession of a firearm.1 If convicted, White faces a mandatory
minimum sentence of 15 years imprisonment. At his initial
appearance, White stipulated to detention in East Baton Rouge
Parish Prison (“EBRPP”).
White then filed a motion for a mental examination to
determine his competency to stand trial. The district court
ordered Dr. John Bolter of Baton Rouge to conduct a psychiatric and
psychological examination, but White refused to participate in the
examination. White was then transferred to the Federal Medical
Center in Fort Worth, Texas, for an examination. The staff at the
Medical Center was unable to render an opinion as to White’s
competency because White again refused to participate in the
examination. Finally, White was transferred to the Federal Medical
Center in Butner, North Carolina, where the staff evaluated him and
concluded that he is incompetent to stand trial. Accordingly, on
August 19, 2002, the district court found White incompetent to
stand trial and committed him to the custody of the Attorney
General for hospitalization and treatment according to the
provisions of 18 U.S.C. § 4241.
The government subsequently had White transferred back to
EBRPP and sought an order of the court to have White medicated
involuntary. Two grounds were advanced: (1) White is dangerous to
himself and others, and (2) medication is necessary and appropriate
1
See 18 U.S.C. §§ 2114, 924(c)(1)(A)(ii), and 922(g)(1).
2
to render him competent to stand trial. The district court held
that involuntary medication was warranted on both grounds.
II. ANALYSIS
A. Jurisdiction
Involuntary medication orders such as the one at issue here
conclusively decide the disputed question and resolve an important
issue.2 We therefore have jurisdiction under the collateral order
doctrine over White’s appeal of the district court’s order
authorizing prison authorities to administer antipsychotic
medication to him on an involuntary basis.3
B. Standard of Review
We review the district court’s findings of fact for clear
error and conclusions of law de novo.4
C. Applicable Law
Under 18 U.S.C. § 4241, if a district court finds a criminal
defendant incompetent to stand trial, the court must commit the
defendant to the custody of the Attorney General.5 Then, the
Attorney General must hospitalize the defendant in “a suitable
facility” for a time (1) sufficient to determine whether the
2
Sell v.U.S., 539 U.S. 166, 176-77 (2003).
3
Id.
4
U.S. v. City of Jackson, Miss., 359 F.3d 727, 731 (5th Cir.
2004).
5
18 U.S.C. § 4241(d).
3
defendant will regain competence within a reasonable time, and, if
so, (2) for an additional period until the defendant’s “mental
condition is so improved that trial may proceed,” so long as “the
court finds that there is a substantial probability” that the
defendant will regain competence.6
Although inmates have a significant liberty interest in
avoiding the administration of unwanted medication, prison
officials may administer such medication under limited
circumstances to, inter alia, render the inmate non-dangerous or
competent to stand trial.7 “Title 18 U.S.C. § 4241... and federal
court decisions require that certain procedures be followed” before
the medication is involuntarily administered to a person in the
custody of the Attorney General.8 28 C.F.R. § 549.43 outlines the
“administrative due process procedures” that “must be provided to
the inmate” and “must be followed after a person is committed for
hospitalization and prior to administering involuntary treatment,
including medication.”9
Specifically, when an inmate refuses medication, he is
entitled to an administrative hearing at the facility to determine
6
Id. at § 4241(d)(1)-(2).
7
Washington v. Harper, 494 U.S. 210, 222, 227 (1990)
(dangerousness); Sell, 539 U.S. at 179-80 (competence).
8
28 C.F.R. § 549.43.
9
Id.
4
whether he may be medicated against his will.10 The facility staff
must inform the inmate of “the date, time, place, and purpose of
the hearing, including the reasons for the medication proposal,”
and “a psychiatrist who is not currently involved in the diagnosis
or treatment of the inmate” must conduct the hearing.11 In
addition, the inmate’s treating psychiatrist or clinician “must be
present at the hearing and must present clinical data and
background information relative to the need for medication.”12 The
inmate has the right, inter alia, “to appear at the hearing, to
present evidence, to have a staff representative, [and] to request
witnesses.”13 At the conclusion of the hearing, the conducting
psychiatrist must determine whether “medication is necessary in
order to attempt to make the inmate competent to stand trial or is
necessary because the inmate is dangerous to [him]self or others”
and “prepare a written report regarding the decision.”14 The
facility must provide a copy of the report to the inmate, and the
inmate may appeal the decision to the facility administrator.15
“The administrator shall ensure that the inmate received all
10
Id. at § 549.43(a).
11
Id. at § 549.43(a)(1) and (3).
12
Id. at § 549.43(a)(4).
13
Id. at § 549.43(a)(2).
14
Id. at § 549.43(a)(5).
15
Id. at § 549.43(a)(6).
5
necessary procedural protections and that the justification for
involuntary treatment or medication is appropriate.”16
Although § 4241 does not expressly mandate exhaustion of
administrative procedures, “the jurisprudential doctrine of
exhaustion [still] controls.”17 This “long settled rule of judicial
administration” serves several important purposes.18 For example,
it permits the agency to develop the factual background of the case
and apply its expertise, and, at the same time, it conserves scarce
judicial resources.19 Furthermore, it prevents general disregard
for agency procedures that could ultimately weaken the agency’s
effectiveness.20 Consequently, a court should excuse the failure
to exhaust administrative procedures only “in extraordinary
circumstances.”21 Extraordinary circumstances typically arise when
the administrative process would be inadequate or futile, the
claimant challenges the legality of the administrative process
itself, or the claimant has advanced a constitutional challenge
that would remain after the completion of the administrative
16
Id.
17
Taylor v. U.S. Treasury Dept., 127 F.3d 470, 475 (5th Cir.
1997).
18
Myers v. Bethlehem Shipbuilding Corp., 303 U.S. 41, 50-51
(1938).
19
Taylor, 127 F.3d at 476-77.
20
Id.
21
Id. at 477.
6
process.22
D. Merits
In this case, the government made an end run around the
regulatory scheme laid out in § 549.43 and sought an order directly
from the district court authorizing involuntary medication, first
on the basis of dangerousness, and, in the alternative, on the
basis of competence to stand trial. The government advances no
extraordinary circumstances to excuse its failure to exhaust the
administrative procedure in § 549.43. In fact, the government
advances no reason at all to justify its failure to follow the
prescribed procedure. Moreover, in disregarding the administrative
procedure required by § 549.43, the government ignores the
unequivocal, mandatory language of the regulation that is
specifically tailored to protect the inmate’s due process rights.
In light of the existing administrative procedure and the
government’s failure to provide any explanation whatsoever for
bypassing that process, it was error for the district court to make
the initial determination to medicate White involuntarily.23 We
therefore remand the action to the district court with instructions
22
Id.
23
See U.S. v. Morgan, 193 F.3d 252, 263 (4th Cir. 1999)
(observing that Ҥ 549.43 requires that a determination of
whether to forcibly medicate an inmate be made in the context of
an administrative hearing”).
7
to order a due process hearing in accordance with § 549.43.24
The government insists that even if we cannot review the
district court’s order to medicate White involuntarily on grounds
of dangerousness, we may nevertheless review that court’s order to
medicate White to restore his competency to stand trial. The
government’s position is grounded in the Supreme Court’s
observation in Sell that deciding to administer forced medication
to restore competence involves “quintessentially legal questions of
trial fairness and competence.”25 The government therefore contends
that, in making this statement, the Supreme Court overturned the
regulatory scheme laid out in § 549.43 as to the issue of
involuntary medication to render a defendant competent for trial.
We disagree. The Sell Court was addressing an inmate’s substantive
right to be free from unwanted medication —— not the procedural
protections of that right. We seriously doubt that the Court would
thus eviscerate an entire regulatory scheme designed to protect an
inmate’s due process rights by implication.
Ultimately, however, we need not address the government’s
contention here, given the Supreme Court’s admonition in Sell to
24
See U.S. v. Kourey, 276 F.Supp.2d 580, 581 (S.D.W.Va.
2003) (noting that “[t]he decision whether or not [to medicate
the defendant] is best left to the medical professionals at the
Butner Federal Medical Center acting in accordance with
established administrative due process procedures” and that
judicial review “has only been deemed appropriate after
exhaustion of the administrative procedure”).
25
539 U.S. at 182.
8
consider whether involuntary medication is appropriate on grounds
of dangerousness before considering whether doing so would be
appropriate to restore an inmate’s competence to stand trial.26 The
Court reasoned that medicating an inmate to alleviate dangerousness
will, in most cases, obviate the need to do so to restore his
competency, noting that the dangerousness inquiry is more
“‘objective and manageable’” than the competency inquiry.27
Importantly, observed the Sell Court, “medical experts may find it
easier to provide an informed opinion about whether, given the risk
of side effects, particular drugs are medically appropriate to
control a patient’s potentially dangerous behavior... than to try
to balance the harms and benefits related to the more
quintessentially legal questions of trial fairness and
competence.”28 Furthermore, “courts typically address involuntary
medical treatment as a civil matter” and justify it on
dangerousness grounds.29
Even if the government’s position has merit, it is of no
moment in this proceeding. Nothing in Sell casts doubt on §
26
Id. at 183; U.S. v. Morrison, 415 F.3d 1180, 1185 (10th
Cir. 2005) (remanding action to district court to consider
involuntary medication to render the inmate non-dangerous before
considering it to render the inmate non-dangerous).
27
Sell, 539 U.S. at 182, 183 (quoting Riggins v. Nevada, 504
U.S. 127, 140 (1992) (Kennedy, J., concurring)).
28
Id. at 182.
29
Id. at 182 (citing, inter alia, various state statutory
schemes and 28 C.F.R. § 549.43).
9
549.43's applicability to the dangerousness inquiry. In fact, when
it reviewed a state’s involuntary medication administrative
procedure that is substantially similar to § 549.43, the Court
observed that “an inmate’s interests are adequately protected, and
perhaps better served, by allowing the decision to medicate to be
made by medical professionals rather than a judge.”30
III. CONCLUSION
As the government bypassed the administrative procedure
required under the instant circumstances, the district court’s
order is not ripe for review. Accordingly, we vacate the district
court’s order authorizing the involuntary medication of the
defendant and remand the case for further proceedings consistent
with this opinion, beginning with exhaustion of administrative
procedures.
VACATED and REMANDED for further consistent proceedings.
30
Washington v. Harper, 494 U.S. 210, 231 (1990).
10