Barrus v. Montana First Judicial District Court

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Justia Opinion Summary

The Supreme Court upheld a district judge's order allowing the Montana State Hospital (MSH) to involuntarily medicate Petitioner if he refused to take prescribed antipsychotic medication, holding that the district court did not err in finding that important governmental interests were at stake in this case and that involuntary medication was likely to render Petitioner competent to stand trial and was in Petitioner's best interest.

Petitioner was charged with five felonies arising from an incident including the shooting death of a law enforcement officer. Petitioner was found mentally unfit to proceed to trial due to a mental disorder, and MSH proposed a treatment plan, including antipsychotic medication, to try to render Petitioner mentally fit to stand trial. Because Petitioner refused to take the medication the State requested the district court to take the medication or allow MSH to give him involuntary injections of the medication. The district court granted the State's motion. The Supreme Court affirmed, holding that the State met its burden of proving the relevant facts by clear and convincing evidence.

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01/22/2020 OP 19-0285 Case Number: OP 19-0285 IN THE SUPREME COURT OF THE STATE OF MONTANA 2020 MT 14 LLOYD MORTIER BARRUS, Petitioner, v. MONTANA FIRST JUDICIAL DISTRICT COURT, BROADWATER COUNTY, HON. KATHY SEELEY, Presiding Judge, Respondent. ORIGINAL PROCEEDING: Petition for Writ of Supervisory Control In and for the County of Broadwater, Cause No. CDC-2017-15 Honorable Kathy Seeley, Presiding Judge COUNSEL OF RECORD: For Petitioner: Gregory A. Jackson, Jackson Law Firm, P.C., Helena, Montana Craig Shannon, Attorney at Law, Missoula, Montana For Respondent: Timothy C. Fox, Montana Attorney General, Micheal S. Wellenstein, Daniel Guzynski, Mary E. Cochenour, Assistant Attorneys General, Helena, Montana Cory Swanson, Broadwater County Attorney, Townsend, Montana Decided: January 22, 2020 Filed: cir-641.—if __________________________________________ Clerk Justice James Jeremiah Shea delivered the Opinion and Order of the Court. ¶1 Petitioner Lloyd Mortier Barrus seeks a writ of supervisory control directing the First Judicial District Court, Broadwater County, to reverse its Findings of Fact, Conclusions of Law and Order on Involuntary Medications in its Cause No. CDC-2017-15. In that Order, the District Court ordered Barrus to comply with a treatment plan or to be involuntarily medicated with antipsychotic drugs in an attempt to render Barrus competent to stand trial for five felony charges which arose out of a confrontation with law enforcement that resulted in the shooting death of a Broadwater County deputy sheriff. The State of Montana opposes Barrus’s petition for writ. ¶2 We consider the following issues: 1. Is this matter appropriate for consideration upon a petition for writ of supervisory control? 2. Did the District Court err by determining that the State may involuntarily medicate Barrus, if necessary, to attempt to restore him to competency to participate in his own defense? FACTUAL AND PROCEDURAL BACKGROUND ¶3 Barrus is currently facing five felony charges arising from an incident in March 2017 that included a police pursuit and the shooting death of a law enforcement officer. Barrus’s adult son, Marshall Barrus, was shot and killed during the encounter. Barrus was evaluated at Montana State Hospital (MSH) in December 2017 and found mentally unfit to proceed to trial due to a mental disorder. Virginia Hill, staff psychiatrist at MSH, and Timothy Casey, staff psychologist, diagnosed Barrus with Delusional Disorder, 2 Persecutory Type; Mixed Personality Disorder with Antisocial and Narcissistic Features; Alcohol Use Disorder; Cannabis Use Disorder; Hypertension; and Low Vitamin D Level. ¶4 In 2000, Barrus had been involved in a similar incident with law enforcement in California with his adult son Jeffrey Barrus. In that instance, the Barruses led California law enforcement on a high-speed chase and exchanged gunfire. After his arrest, Barrus was found mentally unfit to proceed to trial. The Court ordered involuntary medication with antipsychotic drugs and Barrus was ultimately restored to competency and convicted of numerous offenses in 2002. After his conviction, he stopped taking his medication and symptoms of his delusional disorder returned in 2009. ¶5 Dr. Hill developed a treatment plan designed to render Barrus fit to proceed in the present case. Her treatment plan called for the use of antipsychotic medications, including the same medication that had rendered him fit to proceed in the California matter. Barrus refused to comply with the plan. ¶6 The State asked the District Court to order Barrus to comply, including taking medication as prescribed. It then moved for a hearing on the issue of administering involuntary medication.1 ¶7 On December 4, 2018, the District Court began a five-day evidentiary hearing on the State’s motion, in accordance with Sell v. United States, 539 U.S. 166, 123 S. Ct. 2174 (2003). During the hearing, the court heard testimony from three expert witnesses. The State called Dr. Hill and Dr. Alan Newman, who both testified in favor of Dr. Hill’s 1 Because Barrus is not an imminent danger to himself or others in his present confinement at MSH, the State has not sought to involuntarily medicate him pursuant to Washington v. Harper, 494 U.S. 210, 110 S. Ct. 1028 (1990). 3 treatment plan. Barrus called Dr. C. Robert Cloninger, who was opposed to allowing Barrus to be involuntarily medicated. Both Dr. Hill and Dr. Cloninger had evaluated Barrus; Barrus refused to allow Dr. Newman to evaluate him. ¶8 On May 1, 2019, the court issued its Findings of Fact, Conclusions of Law and Order on Involuntary Medications, in which it ordered Barrus to comply with his treatment plan or face involuntary medication if he failed to comply. Ultimately, the court found Drs. Hill and Newman better qualified and more persuasive than Dr. Cloninger. Among other qualifications, it found that Dr. Hill, who is board-certified in forensic and general psychiatry, is one of only two board-certified forensic psychiatrists in Montana. She has treated patients at MSH for 32 years, and she has testified in over 50 Sell hearings. The court found that Dr. Newman is also board-certified in forensic and general psychiatry, and although this was his first Sell hearing, he has “extensive experience in maximum security, inpatient forensic facilities and prisons.” ¶9 The court found Dr. Cloninger’s credentials and testimony less persuasive. It noted that he is not a board-certified forensic psychiatrist and, although he had testified at six Sell hearings, he had never practiced in a forensic mental health facility in a secure correctional environment. The court further observed that Dr. Cloninger frequently testified as an expert witness on behalf of tobacco companies on the issue of whether cigarette smoking is addictive. ¶10 Weighing the experts’ testimony regarding the necessity of antipsychotic medication as part of the treatment plan, the District Court relied upon Dr. Hill’s opinion, 4 and the scientific evidence she cited in support of her opinion, that antipsychotic medications are necessary to treat delusional disorder effectively. Specifically, it found Dr. Hill’s planned medication regimen was likely to succeed in making Barrus fit to proceed, while Dr. Cloninger’s proposal of utilizing therapy instead of medication was unlikely to be effective. The court found that involuntary medication to alleviate his delusional disorder was in Barrus’s best interest. ¶11 The District Court also made detailed findings regarding the specifics of Dr. Hill’s proposed treatment plan. It found her plan to be “extremely conservative,” starting Barrus at a lower oral dosage of the same antipsychotic medication that he had received in California and increasing the dosage very slowly, and resorting to the use of an injectable antipsychotic only if Barrus refused to take the oral medication. It found that the plan Dr. Hill proposed was designed to limit potential side effects, taking into account Barrus’s age and physical condition. It also found that Barrus had no significant medical concerns and that he did not experience notable side effects when he was previously treated with antipsychotic medication. The court individually weighed the evidence of each potential major side effect and found the risk to be low or very low. ¶12 Barrus petitioned this Court for a writ of supervisory control. Acknowledging that writs of supervisory control are limited to questions of law, he further moved the Court to suspend the applicable Rule of Appellate Procedure to allow the Court to consider his challenges to the District Court’s factual findings. The State responded in opposition to Barrus’s petition for writ and objected to his motion to suspend the Rule. 5 STANDARD OF REVIEW ¶13 The credibility of witnesses and the weight to be given to their testimony are to be determined by the trier of fact, and disputed questions of fact and credibility will not be disturbed on appeal. If the evidence conflicts, it is within the province of the trier of fact to determine which will prevail. State v. Ahmed, 278 Mont. 200, 212, 924 P.2d 679, 686 (1996). This Court will not reweigh the evidence or the credibility of witnesses. State v. Zimmerman, 2018 MT 94, ¶ 20, 391 Mont. 210, 417 P.3d 289 (citation omitted). ¶14 We review a district court’s evidentiary rulings for abuse of discretion. State v. Spencer, 2007 MT 245, ¶ 14, 339 Mont. 227, 169 P.3d 384. A district court abuses its discretion when it acts arbitrarily, without conscientious judgment, or exceeds the bounds of reason. State v. Franks, 2014 MT 273, ¶ 11, 376 Mont. 431, 335 P.3d 725. Further, we determine whether the court’s underlying findings of fact are clearly erroneous, which occurs if they are not supported by substantial credible evidence, the court has misapprehended the effect of the evidence, or if our review of the record leaves us with a definite and firm conviction that a mistake has been committed. Zimmerman, ¶ 13. ¶15 A court’s application of controlling legal principles to its factual findings is a mixed question of law and fact which this court reviews de novo. State v. Luke, 2014 MT 22, ¶ 10, 373 Mont. 398, 321 P.3d 70. 6 DISCUSSION ¶16 1. Is this matter appropriate for consideration upon a petition for writ of supervisory control? ¶17 As a threshold issue, we must determine whether this matter is appropriate for a writ of supervisory control. Supervisory control is an extraordinary remedy that may be invoked when the case involves purely legal questions and urgent or emergency factors make the normal appeal process inadequate. M. R. App. P. 14(3). The case must meet one or more of three additional criteria: (a) the other court is proceeding under a mistake of law and is causing a gross injustice; (b) constitutional issues of statewide importance are involved; or (c) the other court has granted or denied a motion for substitution of a judge in a criminal case. M. R. App. P. 14(3)(a)-(c). ¶18 The difficulty with utilizing a writ of supervisory control in the present case is that, as Barrus acknowledges, the matter does not involve purely legal questions. Rather, he argues this Court should suspend its rules and permit his petition for writ to go forward because the factual and legal bases of the trial court’s order are inextricable. Barrus points out that Sell requires specific factual and legal requirements to be met before involuntary medication may occur, and thus the Sell criteria are an imperfect fit for Montana’s writ of supervisory control. However, Barrus further argues that the Court should accept supervisory control because he has no adequate remedy of appeal. ¶19 The State responded and objected to Barrus’s request that this Court suspend the rules. The State acknowledges, however, that as Barrus asserted, the Sell factors require 7 factual findings. The State argues that this Court should thus not examine the District Court’s findings, but should only review its legal conclusions. ¶20 Our procedure for writ of supervisory control is unique to Montana, and we are loathe to suspend or refashion its criteria.2 Similarly, while Sell reviewed the lower court’s order under the collateral order doctrine, we have previously declined to adopt this doctrine3 and are not inclined to do so here. However, Barrus is not without remedy: M. R. App. P. 14(2) provides for original jurisdiction of other extraordinary writs, including a writ of injunction. Effectively, Barrus seeks to enjoin the District Court from enforcing its Order on Involuntary Medications. Therefore, we have determined to treat his petition as a petition for a writ of injunction. ¶21 Although a writ of injunction has rarely been sought in this Court, in Langford v. State, 287 Mont. 107, 951 P.2d 1357 (1997), Langford sought a writ pursuant to this Rule (then numbered Rule 17) and § 3-2-205(2), MCA, which provides in part, “No action to obtain an injunction may be commenced in the supreme court except in cases where the state is a party, the public is interested, or the rights of the public are involved.” In Langford, the petitioner sought to enjoin the State from executing him. Langford, 287 2 Larry Howell, “Purely the Creature of the Inventive Genius of the Court”: State ex rel. Whiteside and the Creation and Evolution of the Montana Supreme Court’s Unique and Controversial Writ of Supervisory Control, 69 Mont. L. Rev. 1, 4-5 (2008) (“By inventing this new writ, the Court in 1900 addressed what is still considered today one of the thorniest issues in appellate law: how to allow immediate review of crucial but discretionary interlocutory rulings that otherwise could not be appealed until after trial under the final judgment rule.”). 3 In re Litigation Relating to the Riot of September 22, 1991 at the Maximum Sec. Unit of the Mont. State Prison, 283 Mont. 277, 284, 939 P.2d 1013, 1018 (1997). 8 Mont. at 109, 951 P.2d at 1359. As a threshold issue, this Court considered whether it had jurisdiction to hear Langford’s petition. It explained: This Court has original jurisdiction to issue such writs as are provided by law, including writs of injunction. Art. VII, Sec. 2, Mont. Const.; § 3-2-202(1), MCA. In determining whether to exercise such original jurisdiction in any given case, however, we examine the substance of the petition in light of the statutory criteria relating to our issuance of a writ of injunction. Under those criteria, which are set forth in the disjunctive, an action for a writ of injunction may not be commenced in this Court unless the State is a party to the action, the issue is of public interest or the rights of the public are involved. Section 3-2-205(2), MCA. Furthermore, the supreme court is an appellate court but it is empowered by the constitution of Montana to hear and determine such original and remedial writs as may be necessary or proper to the complete exercise of its jurisdiction. The institution of such original proceedings in the supreme court is sometimes justified by circumstances of an emergency nature, as when a cause of action or a right has arisen under conditions making due consideration in the trial courts and due appeal to this court an inadequate remedy, or when supervision of a trial court other than by appeal is deemed necessary or proper. Rule 17(a), M.R.App.P.4 Langford, 287 Mont. at 111, 951 P.2d at 1360. The Court then proceeded to determine that the State was a party, that the public had an interest in establishing and maintaining the validity of state actions, and that Langford had no adequate remedy of appeal if this Court were to later determine his execution had been carried out in error. Langford, 287 Mont. at 111-12, 951 P.2d 1360. 4 The Rules of Appellate Procedure have since been significantly revised and renumbered. The current provisions analogous to then-Rule 17(a) are found in Rule 14. 9 ¶22 Similarly in this case, the State is a party, the public has an interest in establishing and maintaining the validity of the State’s actions, and Barrus would have no adequate remedy of appeal if this Court were to allow him to be involuntarily medicated prior to review of that decision. For these reasons, this matter is properly taken into consideration as a petition for writ of injunction. Since the procedure by which a party would petition this Court for any writ is found within Rule 14, the briefs the parties have filed are sufficient for this Court to determine the merits of Barrus’s petition.5 ¶23 2. Did the District Court err by determining that the State may involuntarily medicate Barrus, if necessary, to attempt to restore him to competency to participate in his own defense? ¶24 In its rulings now before this Court, the District Court applied the Sell factors to this case: (1) the court must find that important government interests are at stake; (2) the court must conclude that involuntary medication will significantly further those state interests and further must find that administration of the drugs is (A) substantially likely to render the defendant competent to stand trial, and (B) substantially unlikely to have side effects that will interfere significantly with the defendant’s ability to assist his counsel in conducting his defense; (3) the court must conclude that involuntary medication is necessary to further the state’s interests, and that any alternative, less intrusive treatments are unlikely to achieve the same results; and (4) the court must 5 M. R. App. P. 14(2) calls for original proceedings for remedial writs or orders to be “commenced and conducted in the manner prescribed by the applicable sections of the Montana Code Annotated for the conduct of such or analogous proceedings and by these rules.” When, as here, a petition seeks review of a district court order by a petition for extraordinary relief, we do not commence proceedings anew but review the district court’s decision based on the record it developed, consistent with appellate practice and procedure. The District Court conducted a thorough hearing on this matter, and we consider Barrus’s contentions under applicable standards of review. 10 conclude that administration of the drugs is medically appropriate, i.e. in the patient’s best medical interest in light of his medical condition. Sell, 539 U.S. at 180-81, 123 S. Ct. at 2185. The Sell factors do not represent a balancing test, but a set of independent requirements, each of which must be found to be true before the forcible administration of psychotropic drugs may be considered constitutionally permissible. United States v. Ruiz-Gaxiola, 623 F.3d 684, 691 (9th Cir. 2010). While Sell does not specify a burden of proof, because of the importance of the liberty interests implicated by a Sell order and the high risk of error, the Ninth Circuit has concluded that the government must prove the relevant facts by clear and convincing evidence. Ruiz-Gaxiola, 623 F.3d at 692. We agree that this burden of proof is correct. ¶25 Barrus contends the District Court erred in its application of each Sell factor. As to the first factor, he concedes important governmental interests are at stake, but points out that Sell further holds that special circumstances may lessen the importance of the governmental interests. Sell noted that a lengthy civil confinement could “diminish the risks that ordinarily attach to freeing without punishment one who has committed a serious crime.” Sell, 539 U.S. at 180, 123 S. Ct. at 2185. Barrus argues that the District Court erred in his case by concluding that a civil commitment would not satisfy Sell because it incorrectly found that a civil commitment is a temporary placement. Barrus alleges that at least one patient has been legally confined at MSH for over 40 years, and thus this demonstrates he could face commitment for the rest of his life. ¶26 The State responds that the District Court correctly recognized that Montana’s civil commitment laws do not provide for a lengthy civil confinement. It explains that if 11 a court finds Barrus is unlikely to be fit to proceed to trial within the reasonably foreseeable future, as required by § 46-14-221(3)(a), MCA, the State would then petition for an involuntary civil commitment. However, even if granted, the initial civil commitment lasts no more than three months, § 53-21-127(3), MCA, and if petitioned, a district court may either extend the commitment by six months or discharge the patient. Section 53-21-128(1)(d), MCA. After that, recommitment proceedings must occur at least annually. Section 53-21-128(3), MCA. As the District Court concluded in its Order on Involuntary Medications, these civil commitment laws do not provide for a “lengthy confinement . . . that may diminish the State’s interest in bringing a defendant to trial.” As noted above, it is not this Court’s job to reweigh the evidence. Zimmerman, ¶ 20. While Barrus argues that a civil commitment might not be temporary, and that he could face a life-long civil commitment, the District Court did not err in deciding that these possible outcomes were not likely enough to tip the balance against the governmental interest under the first factor. ¶27 In United States v. Gillenwater, 749 F.3d 1094, 1101 (9th Cir. 2014), the Ninth Circuit focused in part on the length of the defendant’s potential civil commitment versus the potential length of incarceration. In this instance, Barrus, if convicted, faces a potential life sentence, while under a civil commitment, he faces the possibility of release in as little as three months. The first Sell factor is typically examined as a legal conclusion and is thus reviewed de novo. Gillenwater, 749 F.3d at 1100. We see no error in the District Court’s interpretation of the relevant statutes. 12 ¶28 Barrus next argues the District Court erroneously determined Sell factor 2A—the court must conclude that involuntary medication is substantially likely to render the defendant competent to stand trial—in the State’s favor. While the first Sell factor is primarily a legal question, this and the remaining factors involve questions that are factual in nature and require the trial court to resolve disputed issues by weighing expert testimony and evaluating other medical evidence. Ruiz-Gaxiola, 623 F.3d at 693. ¶29 In Ruiz-Gaxiola, the Ninth Circuit observed, “There is a compelling need in cases such as this for the district court to make factual findings so that the defendant may be assured that the trial court has conducted the stringent review mandated in light of the substantial infringement on his liberty interests, and so that upon review the appellate court may determine whether the findings are supported by clear and convincing evidence.” Ruiz-Gaxiola, 623 F.3d at 696. In this instance, the District Court made extensive findings regarding the testimony of the parties’ respective expert witnesses. It also made detailed findings about the medications involuntarily administered to Barrus in California beginning in September 2000, and the subsequent improvement in Barrus’s mental health as documented in his medical records. It compared that history to the treatment plan Dr. Hill proposed, took into consideration the treatment recommendations found in authoritative medical publications, and weighed the credibility of the experts in reaching its decision that involuntary medication, as proposed by Dr. Hill, was substantially likely to render Barrus competent to stand trial. ¶30 Barrus argues that the District Court made several erroneous findings. First, he alleges the court failed to appreciate that when Barrus was involuntarily medicated in 13 California, no physical force was used to medicate him, but in this instance, “[Dr.] Hill will use physical force.” That misstates the record. Dr. Hill’s testimony was that Barrus had stated an intention to physically resist medication, but that Barrus frequently made belligerent statements and it was unclear whether he would actually physically resist. Dr. Hill testified that at MSH, Barrus had made verbal threats, but had never physically accosted anyone. Dr. Hill further testified as to the extensive protocols MSH employed to try to avoid physical restraint if at all possible, and she further noted that, even if physical restraint was necessary for the initial dosages, she anticipated that as the medication took effect, Barrus would quickly improve to the point that forcible injection would be unnecessary. ¶31 Barrus next alleges that the District Court erroneously concluded that all antipsychotic drugs are the same when it found that Barrus had previously responded favorably to antipsychotic medication. However, Dr. Hill testified that she intends to start with Risperdal, the same antipsychotic drug Barrus was administered in California, but at a lower initial dosage than Barrus had previously taken. Dr. Hill further testified that if Barrus refused to take Risperdal, she would administer Zyprexa since Risperdal is not available in an injectable format. Barrus incorrectly alleges there was no evidence concerning the differences between these drugs, such as side effects. The District Court made findings regarding the difference in side effects between these drugs. ¶32 Third, Barrus alleges the District Court ignored changes in Barrus’s mental health since his confinement in California, and that his “duration of untreated psychosis since 2000 strongly suggests he will not respond to antipsychotic medication.” 14 Barrus’s contention is at odds with the record: First, Dr. Hill testified that from review of the medical records, she concluded that Barrus was suffering from “remarkably similar” symptoms now as he was at the time of his arrest in California. Furthermore, Barrus was treated with antipsychotic medication from 2000 until 2002 and he did not exhibit symptoms of delusional disorder after he ceased taking the medication until 2009. Prior to September 2000, Barrus’s delusional disorder had gone untreated for decades, as he had first exhibited symptoms in his early 20s. Therefore, Barrus’s argument that the District Court erred in this regard is without merit. ¶33 Finally, Barrus argues that the studies Drs. Hill and Newman relied upon were flawed or inapplicable. Here, Barrus rehashes the evidence heard by the District Court and asks this Court to reweigh it. We decline to do so. Zimmerman, ¶ 13. ¶34 Barrus argues the District Court erroneously determined Sell factor 2B—the court must conclude that involuntary medication is substantially unlikely to have side effects that will interfere significantly with the defendant’s ability to assist his counsel in conducting his defense—in the State’s favor. First, he maintains that the District Court should have given weight to Dr. Cloninger’s opinion that forcible medication would worsen Barrus’s condition. However, the credibility of witnesses and the weight to be given to their testimony are to be determined by the trier of fact, and disputed questions of fact and credibility will not be disturbed on appeal. If the evidence conflicts, it is within the province of the trier of fact to determine which will prevail. Ahmed, 278 Mont. at 212, 924 P.2d at 686. The District Court found Drs. Hill and Newman more credible than Dr. Cloninger and we will not disturb that finding. 15 ¶35 Next, Barrus maintains that the District Court failed to consider the side effects of the proposed medication. However, the District Court made extensive findings regarding the potential side effects and their likelihood of occurrence, assessing the reported side effects for second-generation antipsychotic medication—which includes Risperdal and Zyprexa—and found that Barrus has a “generally low risk” of developing tardive dyskinesia, a “very low” risk of developing neuroleptic malignant syndrome, and a “very low risk” of sudden cardiac death. The court further found that the proposed treatment plan did not present a risk of causing sedation or sluggishness that would interfere with Barrus’s ability to participate in his defense. ¶36 Simply put, the parties spent five days at a hearing in the District Court presenting this evidence, which the District Court then carefully weighed in making its findings. Although Barrus would prefer a different result, he has offered no evidence that the District Court abused its discretion or made any clearly erroneous findings. ¶37 As to the third Sell factor—the court must conclude that involuntary medication is necessary to further the state’s interests, and that any alternative, less intrusive treatments are unlikely to achieve substantially the same results—Barrus argues that the District Court erred because it should have concluded that Barrus should be offered either cognitive behavioral therapy or acceptance commitment therapy instead of medication. Barrus asserts that one of the authoritative references Drs. Hill and Newman relied upon supports this approach. Conversely, the State points out that Barrus has already been offered therapy at MSH and it has not improved his condition. It notes that Dr. Hill testified that Barrus’s delusional disorder prevents him from benefitting from therapy 16 because he does not recognize his problems and thus cannot engage in a collaborative therapeutic approach to resolving them. ¶38 In any event, both parties presented ample evidence and argument to the District Court regarding this issue. Weighing the evidence, the District Court determined alternative, less invasive treatments are unlikely to achieve the same results. Barrus presents no evidence that the District Court abused its discretion in making this evidentiary ruling, nor are the court’s findings clearly erroneous as they are supported by substantial credible evidence. Zimmerman, ¶ 13. ¶39 As to the fourth Sell factor—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 medical condition—Barrus argues that the District Court erred in determining this factor was met because the State did not offer clear and convincing evidence of it. He alleges the court ignored “the risk of death posed by forced medication” in its order. Barrus argues that Dr. Hill testified she has “great concern due to Barrus[’s] medical condition and age” and that forced medication could cause Barrus to suffer a stroke or cause his heart to go into ventricular arrythmia. He further states, “The experts agreed that medicating Barrus over a two-year period would have significant side effects, given his age, health condition and duration of his delusions.” (Emphasis added.) Barrus misstates the record. While Dr. Hill testified in great detail about all of the possible negative outcomes which could occur in involuntarily medicating a patient, she further testified to the extensive protocols MSH puts in place to minimize the risks. Although she agreed it was possible that Barrus could suffer a stroke or experience cardiac issues, she stressed 17 that MSH would take extreme precautions to prevent such an occurrence. Moreover, Barrus’s assertion that the experts agreed about side effects is incorrect: no expert, even Barrus’s own witness Dr. Cloninger, testified that significant side effects are a certainty. ¶40 Finally, Barrus asserts, without evidentiary support, that he would lose any positive effect from the medication and revert to his delusional state once the medications were halted. First, Barrus could choose to remain on the medications, and thus continue to benefit from them. Second, when Barrus previously ceased taking antipsychotic medication in 2002, symptoms of his delusional disorder did not manifest until 2009, approximately seven years later. In analyzing the fourth Sell factor, courts must consider the long-term medical interests of the individual rather than the short-term institutional interests of the justice system. Ruiz-Gaxiola, 623 F.3d at 703. In its Order on Involuntary Medications, the District Court found that Barrus would receive the benefit of freedom from “the unhappy and fear-filled state he endures” as a result of his delusional disorder. It further pointed out that, at present, Barrus was refusing to accept medical treatment for other ailments, such as dental issues and hypertension, because of his delusional disorder, and that alleviation of that condition would make him receptive to obtaining beneficial medical treatment. The District Court did not abuse its discretion with these findings. Franks, ¶ 11. ¶41 We conclude the State met its burden of proving the relevant facts by clear and convincing evidence. Having reviewed the record and the District Court’s findings of fact and conclusions of law in this matter, we affirm the court’s rulings in its Findings of Fact, Conclusions of Law and Orders on Involuntary Medications. 18 CONCLUSION ¶42 Barrus’s Petition for a Writ of Supervisory Control, which this Court has considered as a Petition for a Writ of Injunction, is GRANTED. The District Court’s Findings of Fact, Conclusions of Law and Order on Involuntary Medications is AFFIRMED. ¶43 This Court’s stay of this cause is VACATED and this matter may proceed in the District Court. ¶44 The Clerk is directed to send a copy of this Order to all counsel of record in this matter and in First Judicial District Court Cause No. CDC-2017-15, and to the Honorable Kathy Seeley, presiding District Judge. DATED this 22nd day of January, 2020. /S/ JAMES JEREMIAH SHEA We Concur: /S/ MIKE McGRATH /S/ BETH BAKER /S/ LAURIE McKINNON /S/ INGRID GUSTAFSON /S/ DIRK M. SANDEFUR 19
Primary Holding
The Supreme Court upheld a district judge's order allowing the Montana State Hospital to involuntarily medicate Petitioner if he refused to take prescribed medication, holding that the district court did not err in finding that important governmental interests were at stake and that involuntary medication was likely to render Petitioner competent to stand trial.

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