Forcing Competency With|Big Drug Doses a No-Go

     PASADENA, Calif. (CN) – A schizophrenic man who called in false terrorist threats to Los Angeles International Airport should not be forcibly medicated with a high dosage of antipsychotics so that he can stand trial, the Ninth Circuit ruled Wednesday.
     Nna Alpha Onuoha made the threats in September 2013, shortly after resigning from his job at the airport as a TSA screener. According to the Circuit’s opinion, he called airport authorities with instructions to evacuate the airport because he was going to “deliver a message” to the United States and the world.
     Authorities did not evacuate the airport, but they did evacuate TSA headquarters.
     When Onuoha was apprehended by law enforcement later that day, he told police that he did not intend to make a bomb threat, stating that “killing was not on my mind.”
     Onuoha was indicted on three counts of false information and hoaxes and three counts of making telephonic threats.
     Medical personnel from the Bureau of Prisons then evaluated Onuoha to see if he was competent to stand trial. The evaluation revealed that Onuoha believed that he had received personal revelations from God and indicated that he was not competent to stand trial.
     A psychiatrist from the bureau subsequently diagnosed Onuoha with schizophrenia and recommended a course of long-acting Haldol, an antipsychotic medication, in order to restore his competency.
     Relying on Sell v. United States, the government then filed a motion for an order to involuntarily medicate Onuoha, and a federal judge granted the motion.
     But the Circuit’s three-judge panel vacated the court’s order in Wednesday’s 21-page opinion, finding that involuntary medication was not justified under the fourth Sell factor which requires that such medication be administered only if it is “in the patient’s best medical interest in light of his medical condition.”
     Writing for the panel, Circuit Judge Ronald Gould said that the psychiatrist’s recommended antipsychotic dosage for Onuoha “skips the starting dose and goes straight to the maximum dose of 300 milligrams per month,” which he said is three to six times the Bureau of Prisons’ starting recommendation.
     Although the psychiatrist suggested that the higher dose would allow Onuoha to reach a therapeutic blood level faster, Gould said “restoring competency quickly is not a controlling concern under the fourth Sell factor — only best medical interests are considered.”
     He added that the federal judge “appears to have miscalculated the amount of long-acting Haldol that Onuoha would receive in the first month,” incorrectly stating that Onuoha would be administered 150 milligrams of the drug on a monthly basis when he would in fact receive 300 milligrams in the first month, followed by 150 milligrams in subsequent months.
     “Because the district court miscalculated the dosage and failed to take into account the Bureau of Prisons’ dosage recommendations, it clearly erred in concluding that the proposed treatment was in Onuoha’s best medical interest,” Gould said.
     He said that the Circuit “agree[s] with Onuoha that ‘best medical interests are best medical interests, whether that individual is in custody or in the community.'”
     The Circuit remanded the case to the district court for further proceedings.
     The parties’ attorneys did not immediately respond to emails requesting comment on Wednesday morning.

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