[Cite as State v. Jefferson, 2021-Ohio-2092.]
IN THE COURT OF APPEALS
FIRST APPELLATE DISTRICT OF OHIO
HAMILTON COUNTY, OHIO
STATE OF OHIO, : APPEAL NO. C-200135
TRIAL NO. B-1907157
Plaintiff-Appellee, :
: O P I N I O N.
VS.
:
LOUIS JEFFERSON, :
Defendant-Appellant. :
Criminal Appeal From: Hamilton County Court of Common Pleas
Judgment Appealed From Is: Affirmed
Date of Judgment Entry on Appeal: June 23, 2021
Joseph T. Deters, Hamilton County Prosecuting Attorney, and H. Keith Sauter,
Assistant Prosecuting Attorney, for Plaintiff-Appellee,
Raymond T. Faller, Hamilton County Public Defender, and Lora Peters, Assistant
Public Defender, for Defendant-Appellant.
OHIO FIRST DISTRICT COURT OF APPEALS
BERGERON, Judge.
{¶1} In the wake of an incompetency determination, the trial court ordered
that defendant-appellant Louis Jefferson be involuntarily medicated in order to
restore his competency. Mr. Jefferson now appeals that involuntary-medication
edict, challenging the court’s findings as against the manifest weight of the evidence.
After reviewing the record, however, we conclude that the court’s findings were
supported by at least some competent evidence and affirm its judgment.
I.
{¶2} Mr. Jefferson was indicted for murder, felonious assault, and
tampering with evidence. But this occurred against a documented history of mental
health issues for Mr. Jefferson, including schizophrenia, and the trial court deemed
him incompetent to stand trial. The court further determined that, with treatment, a
substantial likelihood existed that Mr. Jefferson could be restored to competency
within a year. He was accordingly committed to Summit Behavioral Health for that
purpose, but things didn’t go as planned because he refused to take any medication,
opting instead to “cleanse” his body through a regiment of diet and exercise.
{¶3} Mr. Jefferson’s holistic approach failed to make progress, prompting
Summit to petition the trial court for authority to involuntarily medicate him,
seeking authorization for 26 medications in total. The trial court soon convened a
hearing, and Mr. Jefferson’s psychiatrist, Dr. Vanessa Doyle, explained that she
hoped to use only one medication from that list: Invega, a drug that Mr. Jefferson
had taken before with positive results. She requested authorization for the other
medications only as contingencies in the event that Invega proved ineffective or
starting producing negative side effects. For example, Dr. Doyle sought
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OHIO FIRST DISTRICT COURT OF APPEALS
authorization for 11 or so additional antipsychotic drugs that could substitute for
Invega. The remaining, non-antipsychotic medications would be available to treat
issues such as mood-stabilization, agitation, insomnia, and depression—the goal
being to ensure that Mr. Jefferson was feeling well and not laboring under any
problematic side-effects. As the trial court put it, these medications represented Dr.
Doyle’s “toolbox” for restoring Mr. Jefferson to competency.
{¶4} Mr. Jefferson now appeals the trial court’s decision, featuring a single
assignment of error. He does not dispute Dr. Doyle’s credentials or any of her
conclusions. Nor does he point to contrary evidence in the record that might
undermine her testimony. Instead, Mr. Jefferson argues narrowly that some of the
trial court’s conclusions find no support in the record.
II.
{¶5} R.C. 2945.38(B)(1)(c) provides the procedural guidelines for
involuntary administration of medication to incompetent defendants. State v.
Ramey, 10th Dist. Franklin Nos. 19AP-642 and 19AP-643, 2019-Ohio-5087, ¶ 8.
However, this statute does not shed light on whether a court should order
involuntary medication. Id. at ¶ 9 (“R.C. 2945.38(B)(1)(c) does not set forth specific
standards for a trial court to apply in determining whether to order the involuntary
administration of medication to restore a criminal defendant’s competence to stand
trial.”); see State v. Brewer, 12th Dist. Clermont No. CA2008-04-040, 2008-Ohio-
6193, ¶ 9. Instead, Ohio courts follow four factors delineated in Sell v. United States,
539 U.S. 166, 123 S.Ct. 2174, 156 L.Ed.2d 197 (2003). See City of Cleveland v.
Tarver, 8th Dist. Cuyahoga No. 105522, 2017-Ohio-1165, ¶ 8 (“[T]he state of Ohio
has followed the standard set forth in Sell.”); see also State v. Upshaw, 166 Ohio
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OHIO FIRST DISTRICT COURT OF APPEALS
App.3d 95, 2006-Ohio-1819, 849 N.E.2d 91, ¶ 20–30 (2d Dist.); Ramey at ¶ 9. The
Sell factors require the trial court to make four findings to ensure constitutional
adequacy of the order: (1) “that important governmental interests are at stake”; (2)
“that forced medication will significantly further those concomitant state interests”;
(3) “that involuntary medication is necessary to further those interests”; and (4)
“that administration of the drugs is medically appropriate.” (Emphasis sic.) Sell at
paragraph two of the syllabus.
{¶6} While Mr. Jefferson concedes that the trial court made the specific
findings dictated by Sell, he attacks some of those findings as unsupported by the
evidence. Thus, we will reverse only if the trial court’s findings are against the
manifest weight of the evidence, i.e., not “supported by some competent, credible
evidence.” See Ramey at ¶ 11 (reviewing an evidentiary challenge to a Sell order
using a manifest-weight standard). Mr. Jefferson challenges the trial court’s findings
for only the second, third, and fourth Sell factors.
{¶7} The second Sell factor—whether the medications will significantly
further the state’s interest—actually poses a two-pronged inquiry: (1) whether the
“administration of the drugs is substantially likely to render the defendant
competent to stand trial”; and (2) whether the “administration of the drugs is
substantially unlikely to have side effects that will interfere significantly with the
defendant’s ability to assist counsel in conducting a trial defense, thereby rendering
the trial unfair.” Sell, 539 U.S. at 181, 123 S.Ct. 2174, 156 L.Ed.2d 197. Here, Mr.
Jefferson contests only the second prong of this inquiry, pointing out that Dr. Doyle
never specifically addressed whether the medications might interfere with his ability
to communicate with counsel. Although Dr. Doyle did not explicitly answer this
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OHIO FIRST DISTRICT COURT OF APPEALS
precise question, she conveyed that Mr. Jefferson had previously taken Invega, that
it worked well without yielding negative side effects, and that she believed Invega
would likely render Mr. Jefferson competent for trial. Based on her medical
judgment and his prior experience with Invega, Dr. Doyle was confident that Invega
would help restore Mr. Jefferson’s competency. Furthermore, Dr. Doyle explained
that, while she hoped not to use the remaining medications, their benefits would
outweigh any possible side effects. We also note that Mr. Jefferson points to no
contrary evidence in the record, and neither did his cross-examination of Dr. Doyle
bring anything to light that would cast doubt on her testimony. Thus, we conclude
that the trial court had at least some evidence supporting its second Sell finding.
{¶8} The third Sell factor asks whether the medications are necessary to
further the state’s interests. And in so concluding, “[t]he court must find that any
alternative, less intrusive treatments are unlikely to achieve substantially the same
results.” Sell at 181. Furthermore, before considering more intrusive methods of
administration (e.g., involuntary medication), the court must consider less intrusive
methods (e.g., a court order backed by contempt power). Id. Here, Mr. Jefferson
does not suggest that the trial court failed to consider less intrusive means, instead
contending that a less intrusive path existed. He stresses that counsel informed the
trial court that Mr. Jefferson would follow its orders. And because Mr. Jefferson
professed to recognize the authority of the court, he argues that a less intrusive
means was in fact available. But the court observed that if Mr. Jefferson would orally
agree to take his medication, “then there is no problem,” but that “up until this
particular date, he has not.” Indeed, if it were that simple, we presumably would not
be here. Mr. Jefferson’s attorney also asked the court to issue an order backed by
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OHIO FIRST DISTRICT COURT OF APPEALS
contempt power (a less intrusive means), but the court ultimately declined. Thus, we
conclude that the trial court satisfied the third Sell factor because it considered a less
intrusive means and had at least some basis for concluding that involuntary
medication was the only effective recourse in light of the totality of the record.
{¶9} The fourth and final Sell factor scrutinizes the medical appropriateness
of the administration of the drugs. More specifically, this inquiry focuses on whether
the medications are “in the patient’s best medical interest in light of his medical
condition.” Sell, 539 U.S. at 181, 123 S.Ct. 2174, 156 L.Ed.2d 197. Here, Mr.
Jefferson concedes that the evidence shows that Invega was in his best medical
interest, but he protests that no evidence demonstrated that the same holds true for
the other medications.
{¶10} In this regard, Mr. Jefferson relies upon Upshaw, 166 Ohio App.3d 95,
2006-Ohio-1819, 849 N.E.2d 91, at ¶ 31, where the Second District reversed an
involuntary-medication order because the trial court failed to make the necessary
Sell findings and because the evidence failed to support the trial court’s order.
Although the trial court in Upshaw authorized 33 medications in total, the record
contained no evidence about which medications would be used or their side effects.
Id. Applying Upshaw, Mr. Jefferson invites us to reverse because Dr. Doyle did not
walk through each of the non-Invega medications or explain their potential side
effects. Ultimately, we find Upshaw inapposite because Dr. Doyle testified about
which medications she planned to use and their possible side effects. Dr. Doyle
envisioned utilizing only Invega, to which Mr. Jefferson had previously responded
well. And she further explained that she requested approval to use the other
medications only in the event that Mr. Jefferson experienced unexpected side effects
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OHIO FIRST DISTRICT COURT OF APPEALS
or encountered other unforeseen problems with Invega. She also offered specific
reasons for potentially using the non-antipsychotic medications, including
addressing mood swings, insomnia, and agitation. And finally, Dr. Doyle testified
that the benefits of all the medications on her list would outweigh any possible side
effects, adding that none of them have any physiological or psychological addiction
potential. One of Mr. Jefferson’s chief concerns, based on her interactions with him,
was consuming a drug that would lead to addiction, and Dr. Doyle capably explained
why these drugs would not yield that effect. As a result, we conclude that the trial
court’s fourth Sell finding was also supported by the evidence.
* * *
{¶11} In light of the foregoing analysis, we overrule Mr. Jefferson’s sole
assignment of error and affirm the judgment of the trial court.
Judgment affirmed.
Myers, P. J., and Hendon, J., concur.
SYLVIA SIEVE HENDON, retired, from the First Appellate District, sitting by
assignment.
Please note:
The court has recorded its entry on the date of the release of this opinion
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State v. Jefferson
Combined Opinion