Filed: Patrick Fisher
Filed: Patrick Fisher
PUBLISH
OCT 14 1998
No. 97-4082
PATRICK FISHER
Clerk
Linda V. Priebe, Brazelon Center for Mental Health Law, of Washington, D.C.
(Erin Bradley Yeh, Disability Law Center, of Salt Lake City, Utah, with her on
the brief), for the appellant.
Debra J. Moore, Assistant Utah Attorney General, of Salt Lake City, Utah, for the
appellees.
John Townsend Rich and Jodi L. Short, Shea & Gardner, of Washington, D.C., on
the brief for amicus curiae.
Before BRISCOE, McWILLIAMS, and MURPHY, Circuit Judges.
BRISCOE, Circuit Judge.
Jan Jurasek appeals the district courts entry of summary judgment in favor
of defendants in this action brought under 42 U.S.C. 1983. Jurasek, who was
civilly committed and hospitalized for mental illness, claimed defendants violated
his rights under the Due Process Clause of the Fourteenth Amendment and his
rights of free expression under the First Amendment by forcibly medicating him
with psychotropic drugs. We exercise jurisdiction pursuant to 28 U.S.C. 1291
and affirm.
I.
Jurasek is a paranoid schizophrenic who was civilly committed to the Utah
State Hospital on April 12, 1991. At the commitment hearing, a Utah state court
determined (1) Jurasek suffered from a mental illness, (2) Jurasek posed an
immediate physical danger to himself and others because of his mental illness, (3)
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commitment and, after finding the five requirements for civil commitment
continued to exist, entered an order extending his commitment for an
indeterminate period. Jurasek remains confined at the Hospital pursuant to this
commitment order.
Jurasek has been treated with psychotropic drugs
admitted to the Hospital. He has continuously objected to the treatment and it has
been administered against his will. Since September 1991, the Hospital has had a
series of policies which apply to patients who are involuntarily medicated. Under
the current policy, patients can be forcibly injected with psychotropic drugs if the
Hospitals involuntary medication hearing committee determines the patient is,
or will be, gravely disabled and in need of medication treatment or continuing
medication treatment, or without the medication treatment or continuing
medication treatment, the [patient] poses or will pose, a likelihood of serious
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members involved in the multiple decisions to forcibly medicate Jurasek were part
of his treatment team at the time of the decisions.
In September 1991, Jurasek filed the instant lawsuit in federal district court
seeking injunctive relief and damages on the theory that his subjection to forced
medication violated his Fourteenth Amendment due process and First Amendment
free expression rights under the Constitution. Defendants responded they had not
violated Juraseks constitutional rights and, even if they had, the doctrine of
qualified immunity absolved them of liability. In April 1997, the district court
denied Juraseks request for injunctive relief and granted defendants motion for
summary judgment.
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II.
This court reviews a grant of summary judgment de novo, applying the
same legal standard used by the district court.
139 F.3d 804, 807 (10th Cir. 1998). Summary judgment is appropriate if the
pleadings, depositions, answers to interrogatories, and admissions on file,
together with the affidavits, if any, show that there is no genuine issue as to any
material fact and that the moving party is entitled to a judgment as a matter of
law. Fed. R. Civ. P. 56(c). When applying this standard, we examine the
factual record and reasonable inferences therefrom in the light most favorable to
the party opposing summary judgment. If there is no genuine issue of material
fact in dispute, then we next determine if the substantive law was correctly
applied by the district court.
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Harper , 494 U.S. at 222-23; Bee v. Greaves , 744 F.2d 1387, 1394
(10th Cir. 1984) ( Bee I ). 1 In Harper , the Supreme Court applied this balancing
test and concluded the Due Process Clause permits the State to treat a prison
inmate who has a serious mental illness with antipsychotic drugs against his will[]
if the inmate is dangerous to himself or others and the treatment is in the inmates
medical interest. 494 U.S. at 227. The question presented in the instant case is
different from that in
Harper
also allowed the prison to medicate prisoners who were gravely disabled, the
Supreme Court did not pass on that part of the policy.
The parties agree Jurasek has a liberty interest in avoiding the unwanted
administration of antipsychotic drugs. Presumably, they would also agree the
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state has a legitimate interest in the health and safety of its patients and
employees. However, the parties disagree
process rights with the Hospitals interests in health and safety. We conclude the
standards established in
appropriate balance. Accordingly, the Due Process Clause allows a state hospital
to forcibly medicate a mentally ill patient who has been found incompetent to
make medical decisions if the patient is dangerous to himself or others and the
treatment is in the patients medical interests.
Our conclusion is based on the fact that treatment with psychotropic drugs
is not punishment. If such treatment was considered
punitive, involuntarily-
321-22 (1982) (Persons who have been involuntarily committed are entitled to
more considerate treatment and conditions of confinement than criminals whose
conditions of confinement are designed to punish.).
provide
than
have
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See Riggins v.
Nevada , 504 U.S. 127, 135 (1992). Like a mentally incompetent patient
involuntarily committed at a mental health hospital, pretrial detainees have not
been convicted of any crime. One could argue that because
not been convicted of a crime, he deserves greater due process protections than a
prisoner. The Court, however, implicitly rejected
See also
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Grave disability
In Harper , the Department of Corrections mental health policy permitted
officials to forcibly treat prisoners with psychotropic drugs if the prison medical
committee determined (1) the patient suffered from a mental disorder, (2)
treatment was in the patients medical interests, and (3) the patient either posed a
likelihood of serious harm to himself, others, or their property, or suffered from
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a grave disability. 494 U.S. at 215. Harper was medicated under the
likelihood of serious harm prong of the policy. Thus, the Supreme Court did
not specifically determine whether a confined individual found to suffer only
from a grave disability may be forcibly medicated within the framework of the
Fourteenth Amendment.
Nevertheless, the Courts subsequent discussion of the
in Riggins sheds some light on this issue. In
Harper requirements
and a determination of
medical appropriateness. 504 U.S. at 135 (emphasis added). The Court held due
process requires the state to establish treatment with antipsychotic medication
was medically appropriate and, considering less intrusive alternatives,
for the sake of Riggins own safety or the safety of others
essential
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who is not receiving care essential for his or her health or safety, Policy 6.9.1,
is, by definition, in need of treatment for the sake of [his or her] own safety.
See Riggins , 504 U.S. at 135. We thus conclude the Courts discussion in
Riggins implicitly authorizes the forced medication of involuntarily-committed
individuals designated as gravely disabled under the definition at issue here.
The Hospitals actions are justified.
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current dangerousness.
See Davis v.
Hubbard , 506 F. Supp. 915, 935 (N.D. Ohio 1980). A commitment courts
determination is temporal. The court is required to determine whether an
individual poses an immediate danger of physical injury to others or himself.
Utah Code Ann. 62A-12-234(10)(b) (emphasis added). Thus, a hospital may not
rely on a commitment courts determination unless such an assessment was made
close in time to the hospitals decision to medicate.
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the hospital had provided the mentally ill prisoner with procedural due process by
employing procedures substantially similar to those used here. 494 U.S. at 228-
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See
See
V.
Jurasek further suggests
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thereafter, the Hospital revised its involuntary medication policy to permit the
committee to override Lords direction. Citing
Health , 497 U.S. 261 (1990), Jurasek argues a mentally ill person who is
involuntarily committed under the Utah Mental Health Code has a right to have a
legal guardian make medical decisions that are inconsistent with treatment
determined appropriate by the hospital.
In Cruzan , the Court held that before allowing a guardian to withdraw
hydration and nutrition from an incompetent person in such a way as to cause
death, Missouri could constitutionally require clear and convincing evidence of
the incompetent patients wishes.
that a
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Although the opinion is not clear as to whether Harper sought the substituted
judgment of a legal guardian or a judicial officer, the Court unambiguously
declared:
The alternative means proffered by respondent for accommodating
his interest in rejecting the forced administration of antipsychotic
drugs do not demonstrate the invalidity of the States policy.
Respondents main contention is that, as a precondition to
antipsychotic drug treatment, the State must find him incompetent,
and then obtain court approval of the treatment using a substituted
judgment standard. The suggested rule takes no account of the
legitimate governmental interest in treating him where medically
appropriate for the purpose of reducing the danger he poses.
A rule
that is in no way responsive to the States legitimate interests is not a
proper accommodation, and can be rejected out of hand
.
494 U.S. at 226 (emphasis added).
Moreover, Jurasek has no absolute right to the substituted judgment of a
guardian under Utah law. We acknowledge, of course, that a state may confer
more comprehensive due process protections upon its citizens than does the
federal government.
Where a State creates liberty interests broader than those protected
directly by the Federal Constitution, the procedures mandated to
protect the federal substantive interests . . . might fail to determine
the actual procedural rights and duties of persons within the State.
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304(2) (courts shall prefer a limited guardianship and may only grant a full
guardianship if no other alternative exists). If an order of appointment is not
limited, the state vests guardians with specific powers and duties subject to
The order appointing Lord as guardian for Jurasek is not in the record.
Lord testified she believed the guardianship order required her to act as a go
between for Jurasek in his dealings with the Hospital.
See Record VI at 6-7.
4
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require hospital
may
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Thus, w hen a defendant asserts a qualified immunity defense, the plaintiff may
proceed to trial only by demonstrating defendants actions violated a
constitutional or statutory right, and the constitutional or statutory right was
clearly established at the time of the controverted conduct.
Rodriguez , 51 F.3d 1531, 1534 (10
th
Albright v.
Cir. 1995).
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violation. County of Sacramento v. Lewis , 118 S. Ct. 1708, 1714 n.5 (1998).
Only if the plaintiff crosses this threshold do we examine whether the right
allegedly implicated was clearly established at the time of the events in question.
Id. Having concluded defendants did not contravene any of Juraseks
constitutional or statutory rights, we find defendants are entitled to qualified
immunity.
VII.
We AFFIRM the district courts order granting summary judgment in favor
of defendants.
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