[00:00:11] Speaker 00: Good morning, Your Honor's counsel, and may it please the court. [00:00:14] Speaker 00: My name is Michael Gomez on behalf of Matthew Taylor Coleman, and I'd like to reserve five minutes for a rebuttal. [00:00:22] Speaker 00: The district court here took the extraordinary step of ordering Mr. Coleman to be involuntarily medicated. [00:00:29] Speaker 00: Given the significance of this constitutional intrusion, the liberty interests at stake, and the high risk of error in this context, courts have set up simple yet crucial safeguards to ensure a defendant's due process rights are not sacrificed. [00:00:45] Speaker 00: Courts are required to make explicit specific factual findings and resolve disputes between disagreeing experts. [00:00:52] Speaker 00: The district court here did not do any of that. [00:00:54] Speaker 00: Instead, it issued the most cursory cell order I have encountered and certainly more succinct than any case cited in our or the government's briefs. [00:01:03] Speaker 00: Any one of those three errors is enough to vacate the cell order in this case. [00:01:08] Speaker 00: And I'd like to take those or address those three individual errors one by one. [00:01:14] Speaker 00: So as CEL stated, the Supreme Court stated in CEL, the second prong of the CEL, or the second factor of the four factor test requires the district court to make two independent factual findings. [00:01:30] Speaker 00: So one. [00:01:31] Speaker 00: that the proposed medication is substantially likely to restore the defendant's competency, and two, that the medication is substantially unlikely to cause side effects that would interfere with his rights to a fair trial and his rights to his assistance of counsel. [00:01:46] Speaker 04: Now, the side effects issue isn't in this. [00:01:50] Speaker 04: You argued it some in your briefs, but you said unequivocally in the district court that you weren't arguing it. [00:01:56] Speaker 04: Is that right? [00:01:57] Speaker 00: No, there was not an unequivocal, there was no waiver of this issue in the district court and there was no unequivocal giving up of any argument in this context. [00:02:07] Speaker 04: Not the side effects question? [00:02:09] Speaker 00: Not the side effects question, Your Honor. [00:02:12] Speaker 00: What Your Honor may be referring to was [00:02:15] Speaker 00: Defense counsel's comments that the prior administration of Haldal given to Mr. Coleman in an emergency situation did not cause him physical side effects. [00:02:28] Speaker 00: But it did not cause him physical side effects, but it did not indicate at all that he would be restored to competency. [00:02:34] Speaker 00: To the extent that this particular factor, the second prong of the second cell factor, was not given a full-throated argument by defense counsel, [00:02:45] Speaker 00: It does not relieve the court from its obligation to make that factual finding. [00:02:49] Speaker 00: That was set forth in Cell and in this court's prior decision in United States versus Ruiz-Gaciola. [00:02:57] Speaker 00: But turning to the first prong of the Cell's second factor, the court had to find that the medication was substantially likely to restore Mr. Coleman's competency. [00:03:10] Speaker 00: There is no specific factual finding in the record on that. [00:03:13] Speaker 00: At most, the court gave a list of the generic categories of information considered in finding that this medication was more likely to restore him to competency. [00:03:24] Speaker 00: But the cell ruling lacks the level of detail, the particularized findings, particularized to Mr. Coleman's specific condition that this court and the Constitution require to justify a cell order. [00:03:40] Speaker 02: So we presume that [00:03:41] Speaker 02: district court understands what the law is yes right and the court sort of so I mean the court did not expressly describe in any detail what the what the standard is under cell but it said it was considering the cell factors and it said that it thought that this factor was met so I mean [00:04:00] Speaker 02: Guess the question is we don't treat the district court like an administrative agency where we say that you know it has to say certain magic words I mean shouldn't we presume that you know given its reference to the standard its Determination that the standard was met that the sort of subsidiary factual findings are the findings that it was making and [00:04:27] Speaker 00: In other contexts, perhaps that may be the case, but in this context, it's not. [00:04:31] Speaker 00: As this court stated in Ruiz Garciola, there is a compelling need for such findings in this context so that the defendant may be assured that the district court has conducted the stringent review mandated in light of the substantial infringement on his liberty interests. [00:04:45] Speaker 00: And so that upon review, the appellate court may determine whether the findings are supported by clear and convincing evidence. [00:04:51] Speaker 00: So this court's review of those findings and of the cell ruling is hindered because the record was not made at all in the district court's ruling. [00:05:01] Speaker 00: And if we look into the record itself, [00:05:05] Speaker 00: The court's finding that this medication, which again is only more likely to restore his competency, is not borne out by the record. [00:05:13] Speaker 00: It's clearly erroneous. [00:05:15] Speaker 00: So first, I'd like to mention that no BOP doctor, none of the government's three BOP doctors said at all [00:05:23] Speaker 00: that this medication is substantially likely to restore Mr. Coleman's competency. [00:05:27] Speaker 00: At most, Dr. Grady wrote in his treatment plan that the effects of Haldol would be, quote, a decrease in his symptoms of mental illness and an increase in functioning. [00:05:39] Speaker 00: That's the most that can be said. [00:05:42] Speaker 00: We go to the next level, the generalized evidence that the government relies on. [00:05:46] Speaker 00: That did not appear in Dr. Grady's treatment plan and the report he wrote. [00:05:49] Speaker 00: That appeared in Appendix A to his treatment plan, which is a generic appendix that is attached to basically every cell proposal. [00:05:58] Speaker 00: And in that, once we delve a little deeper and look at those generalized statistics, we have studies show that 81% and 79% [00:06:08] Speaker 00: effective rate of competency restoration in the studies that were put forth in that appendix. [00:06:15] Speaker 00: So the government, I understand the intuitive force of the government's argument that, okay, we have this medication that's been approved by the FDA to treat psychotic disorders and delusional disorders for decades, so it's been effective for other people. [00:06:31] Speaker 00: Mr. Coleman has some of that, so it'll be effective for him. [00:06:35] Speaker 04: Was the study that [00:06:37] Speaker 04: The studies that Grady relied on, were they involuntary administrations of medication? [00:06:46] Speaker 00: I believe they were involuntary medications. [00:06:49] Speaker 04: They were or some of them were. [00:06:50] Speaker 00: Yes. [00:06:51] Speaker 00: I'm not exactly sure. [00:06:52] Speaker 00: The problem with those is that there's no real level of detail as to what particular psychotic disorders the defendants had. [00:07:00] Speaker 00: And it even covered many different types of antipsychotic medications, not just Haldol. [00:07:05] Speaker 00: But the point being that because it may have had an effective rate, [00:07:11] Speaker 00: an effective competency restoration rate of 81% and 79%. [00:07:14] Speaker 00: But there's still about 20% of defendants who were not restored to competency. [00:07:21] Speaker 00: The government doesn't address it. [00:07:22] Speaker 03: What is the standard for competency here? [00:07:25] Speaker 00: The standard for competency? [00:07:27] Speaker 00: Yeah. [00:07:27] Speaker 00: I would say the standard for competency is the ability of the defendant to be able to meaningfully participate in his defense, to understand the proceedings, understand the charges against him, and be able to make rational decisions for himself to protect his fair trial rights. [00:07:45] Speaker 03: I mean, in US versus Hernandez, we said it [00:07:49] Speaker 03: Competency restoration seeks only some minimal understanding of the proceedings and nothing more. [00:07:55] Speaker 03: I mean, I'm not certain. [00:07:59] Speaker 03: I mean, we make a distinction between restore functioning and competency to stand trial. [00:08:08] Speaker 03: This sounds like a very low standard for competency. [00:08:12] Speaker 00: It may be a low standard. [00:08:14] Speaker 00: I will say that in the cell context, the point is the protection of the defendant's due process rights and his rights to a fair trial. [00:08:22] Speaker 00: So if the defendant cannot participate in his trial in any meaningful way, if he cannot make those crucial decisions that are attended in every fair trial right, such as the decision whether to testify. [00:08:39] Speaker 04: I'd like to also point out. [00:08:43] Speaker 04: More than being a narrow or a higher or lower standard than restoration to functioning in general, it's a specific standard. [00:08:53] Speaker 04: It's a cognitive standard. [00:08:56] Speaker 04: So it could be that you could function. [00:09:00] Speaker 04: Well, he did function in the sense that he took care of himself and so on. [00:09:06] Speaker 04: He wasn't nonfunctional. [00:09:07] Speaker 04: He wasn't violent, but he wasn't [00:09:12] Speaker 04: coherent and so you might restore him to competency could be harder than or different than restoring him to other function Correct your honor and and I'd like to point out the the reason Mr. Coleman was found incompetent and it was his delusions so [00:09:32] Speaker 00: The delusions will affect and do affect his ability to perceive the proceedings, his ability to understand. [00:09:39] Speaker 00: There are indications in the record that he believed his children would be resurrected. [00:09:44] Speaker 00: So he still believes that there are these things that could happen. [00:09:48] Speaker 00: And then when a certain date passes and they aren't resurrected, he becomes extremely emotional. [00:09:54] Speaker 00: He formerly had a great relationship with a defense attorney because he believed that she was also a believer. [00:10:01] Speaker 00: in what he said, but then that relationship was ruined when he thought that she was collaborating with the government. [00:10:09] Speaker 00: So these delusions are the reasons that he was deemed incompetent, the reasons that the attorney-client relationship has broken. [00:10:18] Speaker 00: And Justice Kennedy wrote in his concurrence in Reagan versus Nevada, [00:10:23] Speaker 00: all the different ways that antipsychotic medication can affect an individual's fair trial rights. [00:10:29] Speaker 00: And all of those would be affected in this case. [00:10:33] Speaker 00: I'd like to go back to the effectiveness of the generalized evidence, because the government. [00:10:39] Speaker 02: On that point, what about, I mean, the defense expert, Dr. Morris, said that if Mr. Coleman were his patient, he would encourage him to try this. [00:10:50] Speaker 02: So I'm having trouble reconciling that claim from Dr. Morris with the idea that there's no substantial likelihood that this would be effective. [00:10:58] Speaker 00: Yes, Your Honor. [00:10:59] Speaker 00: Dr. Morris identified several factors or several facets of Mr. Coleman's particular condition that made it less likely that he would be restored to competency. [00:11:08] Speaker 00: So what Dr. Morris said, if he were his patient, he would try antipsychotic medication. [00:11:13] Speaker 00: He would try Haldol. [00:11:14] Speaker 00: That's for a patient who is voluntarily coming to him, believes something is wrong, and needs help. [00:11:21] Speaker 00: And as Dr. Morris said, studies have shown that when an individual is voluntarily seeking help, the Haldol and antipsychotic medication is more likely to work for that person. [00:11:32] Speaker 00: However, Dr. Morris said in this case, one, Mr. Coleman is not voluntarily seeking treatment. [00:11:38] Speaker 00: He's delusional and doesn't think there's anything wrong. [00:11:42] Speaker 00: Two, the duration of his undiagnosed psychosis makes it less likely that he would respond positively to Haldall. [00:11:50] Speaker 03: That's the factor that I'm wondering if the court weighed heavily enough, because it doesn't seem to weigh into the analysis. [00:11:58] Speaker 03: And what specifically do we have in the record about [00:12:02] Speaker 03: the impact of the lengthy duration on the ability to be restored to competency. [00:12:09] Speaker 00: Well, Dr. Morris wrote about it in his report and cited studies that showing that the lengthy duration of undiagnosed psychosis and also the severity and intensity of delusions is what makes it less likely for those delusions to be lessened or even just eliminated by a medication. [00:12:30] Speaker 04: There were several serious studies that he [00:12:33] Speaker 04: No, we're in the record, as I understand it. [00:12:35] Speaker 00: Yes, there were. [00:12:36] Speaker 00: And these talk about clinical outcomes, which was another point of contention, whether it's clinical outcome or competency restoration. [00:12:45] Speaker 00: But the clinical outcomes, they go hand in hand. [00:12:47] Speaker 00: It's not two things that could be parsed out. [00:12:49] Speaker 00: The clinical outcomes in those studies show that when you do have a longer duration of undiagnosed psychosis, when you do have severe and intense delusions, when you do have a patient who is involuntary, whose delusions are involuntary and is not voluntarily seeking treatment, all of those show that the delusions will not wane. [00:13:10] Speaker 00: They will not be lessened. [00:13:12] Speaker 00: Here, the delusions are the source of the incompetency. [00:13:15] Speaker 04: What did the district court say about Dr. Morris's opinions? [00:13:22] Speaker 04: Did you make any findings about it at all? [00:13:24] Speaker 00: No, Your Honor. [00:13:25] Speaker 00: And that is a different error that the court made, is that there were these two competing experts. [00:13:30] Speaker 00: There were disagreements between them as to the likelihood of restoration. [00:13:35] Speaker 00: On the one hand, generalized evidence. [00:13:37] Speaker 00: And on the other hand, specific factors about Mr. Coleman's condition. [00:13:41] Speaker 00: And Dr. Morris put those. [00:13:44] Speaker 00: That report was attached to the government's opposition and the government in reply did not address the report other than to say he didn't meet with them with Mr. Coleman but did not attach a supplemental report by Dr. Grady. [00:13:58] Speaker 00: Dr. Grady didn't meet with him either though. [00:14:01] Speaker 04: He tried but he wasn't able to. [00:14:03] Speaker 00: Correct, Your Honor. [00:14:05] Speaker 04: Neither of them met with him. [00:14:06] Speaker 00: Right. [00:14:06] Speaker 00: No one met with Mr. Coleman. [00:14:10] Speaker 00: And Dr. Grady did not rebut Mr. Coleman's report at all. [00:14:13] Speaker 00: The government didn't report it. [00:14:14] Speaker 00: So the district court had an obligation to resolve those disagreements. [00:14:18] Speaker 00: The district court never discredited Dr. Morris, never said, I find him not credible. [00:14:23] Speaker 00: I find his opinion unreliable. [00:14:26] Speaker 00: It was just that the district court [00:14:29] Speaker 02: Engaged in a colloquy with defense counsel about dr. Morris's opinion and then just sided with the government with no explanation So I mean if the district court had added a sentence that said you know having considered both dr. Gaddy and dr. Morris I find dr. Gaddy's opinion to be better reasoned and more persuasive I mean you would still say that that was clear error I take it but but would that would that satisfy your objection to the adequacy of the explanation [00:14:55] Speaker 00: No, your honor. [00:14:57] Speaker 02: I would say it's not only clear error, but a procedural error in failing to resolve those differences, but I guess in my in my Hypothetical like we have a We have a statement that having considered them both. [00:15:10] Speaker 02: I think I think the one is more persuasive than the other [00:15:13] Speaker 00: That's not enough there has to be But what more does there have to be yes your honor, and I'd like to point to the government's Own case that decided and if that believe it was United States versus deer in the 10th circuit where the defendant Complained there were two competing experts the 10th circuit chose one expert and in a written order explained why the government's expert was more credible the defendant [00:15:40] Speaker 00: argued that there should have been a more, or should have addressed the defense expert's conclusions as well. [00:15:46] Speaker 00: And the 10th Circuit said, no, it didn't need to because there was sufficient explanation for the government expert's opinion that we could infer the reasons the court did not agree with the defense expert. [00:16:00] Speaker 00: Here, we don't have any reasons whatsoever. [00:16:02] Speaker 00: Well, here we do. [00:16:02] Speaker 04: As you pointed out, from Dr. Grady, we don't actually have a finding as to competence. [00:16:07] Speaker 00: Correct, Your Honor. [00:16:08] Speaker 00: We don't have a finding as to competency. [00:16:11] Speaker 00: We just have a finding as to treatment and a decrease in symptoms and an increase in functioning without any further explanation. [00:16:19] Speaker 00: And the court certainly did not supplement that one sentence with any explanation as to why that should be credited over Dr. Morris's specific. [00:16:29] Speaker 04: And the district judge's ultimate conclusion was that it's more likely than not that this will help move him to competency. [00:16:37] Speaker 04: So she didn't find that it was more likely than not or clear and convincing evidence or wherever all those pieces fit together, which to make him competent. [00:16:49] Speaker 04: Correct, Your Honor. [00:16:50] Speaker 00: She did not make that finding at all. [00:16:53] Speaker 00: I see that I'm running out of time. [00:16:54] Speaker 00: So if the court has no further questions, I'll resume the reading. [00:16:57] Speaker 04: Let me just say one thing. [00:16:58] Speaker 04: I mean, you did say in the district court that is [00:17:04] Speaker 04: a different cell factor with regard to these terrible side effects. [00:17:08] Speaker 04: It's a different cell factor, and we're not arguing that cell factor. [00:17:12] Speaker 00: Yes, Your Honor, that was in reference to the fourth cell factor, whether medication is medically appropriate that looks to harm, whether the medication would harm or cause physical side effects. [00:17:23] Speaker 00: So counsel was not referring to the second prong. [00:17:26] Speaker 04: It's not so obvious that that wasn't true. [00:17:28] Speaker 00: Yeah, but there's the two, I guess, to clarify. [00:17:32] Speaker 04: So are you arguing that, because there isn't any actual evidence from Dr. Morris about [00:17:38] Speaker 04: the kind of side effects that Justice Kennedy was talking about or any other for that matter. [00:17:44] Speaker 00: Not specifically. [00:17:46] Speaker 00: The majority of the arguments here were on the first prong, so I'll admit that. [00:17:52] Speaker 00: But the second prong, the side effects were before the court. [00:17:56] Speaker 00: It takes up about maybe three to five pages in Appendix A, the different side effects that could occur with the administration of Haldal. [00:18:05] Speaker 00: So that's all within the record. [00:18:07] Speaker 00: And again, the court is obligated to make that finding. [00:18:09] Speaker 00: And that's a clearly established law, so to the extent the court does review this for plain error, we do believe that it does constitute plain error. [00:18:20] Speaker 00: And with that, I'll reserve the remainder of my time for rebuttal. [00:18:23] Speaker 00: Thank you. [00:18:38] Speaker 01: Morning. [00:18:39] Speaker 01: May it please the court. [00:18:40] Speaker 01: Zach Howell on behalf of the United States. [00:18:42] Speaker 01: Four doctors in this case agreed that antipsychotic medication was medically appropriate and would help Coleman. [00:18:49] Speaker 01: Would help him do what? [00:18:52] Speaker 04: I mean, Dr. Crady did not make a finding that it would help him become competent, did he? [00:18:57] Speaker 01: Yes, he said it was a necessity for the restoration of his competence. [00:19:00] Speaker 01: He says that at page 1507. [00:19:03] Speaker 01: And then at page 1518 through 1520 of the record, he says that haloperidol is an excellent treatment that will reduce his mental illness and that will increase his functioning. [00:19:13] Speaker 01: He also says that his condition requires treatment. [00:19:16] Speaker 01: And then he attached documents to his report showing the overwhelming success of medications at treating conditions just like [00:19:24] Speaker 01: the one that Coleman suffers from. [00:19:28] Speaker 01: And one of your questions was, do those studies actually deal with involuntary medication? [00:19:33] Speaker 01: The answer is yes. [00:19:35] Speaker 01: I just looked at them. [00:19:36] Speaker 04: I'm not sure they do. [00:19:37] Speaker 04: I mean, not specifically. [00:19:39] Speaker 01: I'll give you the title of the main article that was cited. [00:19:42] Speaker 01: It is involuntary medication treatment is a clear and convincing success. [00:19:47] Speaker 01: So I think it says very plainly that they're focusing on involuntary medication under cell and analyzing the effects of that medication. [00:19:56] Speaker 01: And across the board, it was demonstrated to be overwhelmingly effective at conditions like the one that Coleman suffers from. [00:20:04] Speaker 01: He was diagnosed with being on the unspecified schizophrenia spectrum. [00:20:11] Speaker 01: The studies show about an 86% rate of restoration for schizophrenia. [00:20:18] Speaker 01: And then he also was in kind of this uncategorized or this sort of catch-all category [00:20:22] Speaker 01: On the catch-all category, the Cochrane article says that psychosis not otherwise specified had about a 93% success rate of restoration. [00:20:31] Speaker 01: So again, I think both the specific findings of Dr. Grady and the studies he's citing show an overwhelming success rate. [00:20:39] Speaker 01: I think it would be hard to read that as anything other than a conclusion that this medication is substantially likely to restore him to confidence. [00:20:47] Speaker 03: A standard the district court kept reciting was more likely than not. [00:20:52] Speaker 03: And that is not the case law. [00:20:54] Speaker 03: So how do you reconcile that? [00:20:57] Speaker 01: Sure. [00:20:58] Speaker 01: So let me break it out because I think it's important to separate the burden of proof from the confidence interval. [00:21:04] Speaker 01: I absolutely agree. [00:21:05] Speaker 01: The burden of proof is clear and convincing evidence. [00:21:07] Speaker 01: That's what the government has to show all four cell factors. [00:21:10] Speaker 03: Clear and convincing that it is substantially likely that he would be restored to competence to stand trial. [00:21:16] Speaker 01: right and so substantial likelihood that would be the confidence interval now on the burden of proof the court is applying clear and convincing evidence it says at page thirty five the standard here is clear and convincing evidence yeah but she said a lot of things like at one point in the record she says I'm at a loss I don't know what to do you know he also said that the two [00:21:35] Speaker 04: things merged together that she didn't see a difference between them. [00:21:38] Speaker 03: And I'm happy to address the at a loss comment but just so that I can close the loop on... I mean she did say a lot of different things during the course of this thing and when she made her final findings she didn't recite substantial likelihood or clear and convincing although I agree that at the beginning she seemed to allude to that but I don't know this these findings are less than satisfactory to know that [00:22:02] Speaker 03: She was really making those findings that are required. [00:22:06] Speaker 01: I agree with you that on the confidence interval, the substantial likelihood, she is defining that as more likely than not. [00:22:14] Speaker 01: So I do think it's clear what she's doing. [00:22:15] Speaker 01: She's saying it's clear and convincing evidence that it is more likely than not to restore competency. [00:22:21] Speaker 01: The only question is, was she correct that it's a more likely than not standard? [00:22:25] Speaker 01: Now, I think that's on plain error review. [00:22:28] Speaker 01: There was never an objection to the more likely than not standard. [00:22:30] Speaker 01: In fact, when the court alluded to a more likely than not standard at page 27 and 28 of the record, Coleman's counsel says, I agree with everything the court said. [00:22:40] Speaker 01: So assuming there's no waiver, we are at most on plain error review. [00:22:45] Speaker 01: And there's a split in the courts on what's the sample. [00:22:47] Speaker 04: She said the standard here is clear and convincing evidence that this is going to be more likely. [00:22:52] Speaker 04: Again, that's such a blundered thing. [00:22:54] Speaker 04: So she didn't seem, she seemed to think that it was sort of saying the same thing twice, which I thought reading the standard maybe is true, but it's confusing. [00:23:08] Speaker 04: But she was not separating them out. [00:23:10] Speaker 04: But more than that, where did she actually find that it was more likely than not that he would, that there was clear and convincing evidence that he, that it was more likely than not that he would restore him to confidence? [00:23:23] Speaker 01: At page 40 and 41 of the record. [00:23:25] Speaker 04: At page 40, she says, they have proved it is more likely than not that this would help move him to competency. [00:23:33] Speaker 01: That's correct. [00:23:34] Speaker 04: I think it's... Well, it says help move him, but it doesn't say when make him competent. [00:23:39] Speaker 01: I think it's hard to read that as anything other than a finding that it's going to more likely than not make him competent. [00:23:45] Speaker 03: I think what the problem is, is that Dr. Grady, [00:23:52] Speaker 03: is saying that this is a necessity. [00:23:54] Speaker 03: He's not saying necessarily that this particular drug will restore his competence to stand trial. [00:24:02] Speaker 03: But what he is saying is that it's necessary to administer this or something like this because of his delusional mental illness [00:24:13] Speaker 03: that we don't know if it will, this is how I'm reading it, we don't know for sure if it will restore him to competency, but he needs to have this treatment first before we can even get to a point where we know he can be restored to competency. [00:24:31] Speaker 01: Your Honor, I don't read it that way. [00:24:32] Speaker 01: Right before Dr. Grady says that this is a necessity to restore him to competency, he says a court order is necessary via cell. [00:24:40] Speaker 01: So he's referencing cell itself and then saying, this is a necessity to restore him to competency. [00:24:45] Speaker 03: He's not a lawyer. [00:24:46] Speaker 03: He's a doctor. [00:24:47] Speaker 01: And I think that's probably why he's not. [00:24:49] Speaker 04: It's a necessity of medication. [00:24:51] Speaker 04: What he said is the necessity of medication for Mr. Coleman's restoration of competency. [00:24:58] Speaker 04: There is a confusion throughout this between [00:25:01] Speaker 04: whether he will do better with the medication than without it, or whether he will actually be restored to competency with it. [00:25:17] Speaker 04: And it seems to me that he was talking about the first and not the second. [00:25:21] Speaker 04: He was saying, well, if he's going to be restored to competency, he needs medication. [00:25:25] Speaker 04: But he wasn't saying that he was going to be restored to competency if he had medication. [00:25:29] Speaker 01: Your honor, I don't agree with that reading of the report. [00:25:32] Speaker 04: The necessity of medication for Mr. Coleman's restoration of competency. [00:25:37] Speaker 04: That's what he said. [00:25:38] Speaker 01: Yes. [00:25:38] Speaker 01: And then he says at page 15, 19 and 20 that he requires medication, that this is an excellent medication, that it's going to reduce his mental illness, that it's going to increase his functioning. [00:25:48] Speaker 01: And then he says he's attaching appendices. [00:25:50] Speaker 01: And he attaches those appendices showing the overwhelming success rate of these medications. [00:25:55] Speaker 01: As I said, the title of the article he's relying on is that involuntary medication is a clear and convincing success. [00:26:03] Speaker 01: It's hard to read. [00:26:04] Speaker 04: I mean, the real problem is that in almost every other instance, the district judge has written, you know, a substantial and considered opinion that we can work with. [00:26:13] Speaker 04: And here we have a lot of stray remarks as part of the problem. [00:26:17] Speaker 04: in terms of what the district court made of all this. [00:26:20] Speaker 04: I mean, because that's really the question. [00:26:24] Speaker 04: And we really don't know. [00:26:26] Speaker 01: I agree that's the question, Your Honor. [00:26:27] Speaker 01: I think the statement from the court that the evidence, analysis, records, case law, scientific data all prove that the involuntary medication will significantly advance the interest in the case is a pretty clear finding on the second cell factor. [00:26:41] Speaker 01: Not really. [00:26:42] Speaker 04: It's not very clear at all. [00:26:45] Speaker 04: It's a significantly advanced [00:26:47] Speaker 04: doesn't say he's going to be restored to competence. [00:26:50] Speaker 01: Your Honor, the second cell factor, the definition of what the Court has just said, includes both of those subparts, one of which is that it is significantly likely to restore me competence. [00:27:02] Speaker 01: As Judge Miller said, the Court is presumed to know the law, and so when it outright says, here is my finding, quoting verbatim cell factor two, [00:27:10] Speaker 01: It's assumed that that includes both subparts of cell factor two. [00:27:15] Speaker 01: But again, the court also does have that specific finding at page 40 where it says, this is more likely than not to help restore him to competency. [00:27:23] Speaker 04: No, she didn't say that. [00:27:25] Speaker 04: She said it's more likely than not to help both of them toward competency. [00:27:29] Speaker 01: Again, I think we're maybe looking for magic words. [00:27:32] Speaker 01: It's hard for me to read that as anything other than the court saying that will restore him to competency more likely than not. [00:27:37] Speaker 01: The only question is, is more likely than not the right standard. [00:27:40] Speaker 02: And can I ask, what do you make of our decision in Ruiz-Garriola which seems to suggest that the normal mode of analysis where we sort of assume that the district court made the necessary subsidiary findings given its legal conclusion maybe isn't appropriate here and that there is a sort of heightened requirement that the district court expressly articulate the findings that support the determination? [00:28:08] Speaker 01: Your honor, I don't read it as applying any sort of heightened finding requirements. [00:28:13] Speaker 01: It's certainly true that it is important that the court make findings that allow this court to determine that the district court has in fact [00:28:20] Speaker 01: made a reasoned finding on the various cell factors. [00:28:23] Speaker 01: The problem in Ruiz-Gaxiola is that those findings weren't present, and to the extent that they were, they were entirely undermined by the record. [00:28:32] Speaker 01: There, you did not have doctors who were in agreement on a medication and whether it would be helpful or not, nor did you have an expert who was citing studies that actually supported the use of the medication or anything like that. [00:28:46] Speaker 01: The court said that the government's expert [00:28:48] Speaker 01: was less experienced, hadn't cited any studies, hadn't provided the proper rationale, whereas the defense expert was far more experienced, was citing far better studies, and so on. [00:29:01] Speaker 01: Here, you don't have that. [00:29:02] Speaker 02: I think everyone... Well, but I mean, here we have conflicting expert testimony, and we can infer which one the district court must have preferred, but we don't really know why. [00:29:15] Speaker 01: I think you do know why, Your Honor. [00:29:17] Speaker 01: And let me try and sort of broaden the scope here, because this Court has always looked to the record as a whole. [00:29:24] Speaker 01: It doesn't just look at sort of the one page where the Court says, I hereby find. [00:29:29] Speaker 01: Throughout the course of the proceeding, the Court is actively engaged. [00:29:32] Speaker 01: And I think it's very easy to see why the Court is rejecting Dr. Morris's report and accepting the government's. [00:29:38] Speaker 01: So if you look at page 25 and 26, the Court describes Dr. Morris's report. [00:29:44] Speaker 01: And then there's an active discussion at page 29 through 36 of the record where the court is engaging with Dr. Morris's report. [00:29:52] Speaker 01: And it is drawing this distinction 29 through 36, and I'll walk through it, but the court is engaging with this notion that there is a difference between competency and prognosis or making Coleman entirely better. [00:30:08] Speaker 01: When you have defense counsel citing Dr. Morris's report and saying, we're talking about making him better, the court interjects at page 32 of the record and says, is there a difference the court should consider in making him better and restoring competency? [00:30:21] Speaker 01: And then it hits on that point throughout the rest of that transition. [00:30:24] Speaker 04: And the answer is yes. [00:30:24] Speaker 04: He should be making the decision. [00:30:26] Speaker 01: That's absolutely right. [00:30:27] Speaker 01: And the government picks up on that point. [00:30:28] Speaker 01: It says the point is substantially likely to make him competent for trial. [00:30:31] Speaker 01: It's not to make him better. [00:30:33] Speaker 01: And I think that's the disconnect in Dr. Morris's report. [00:30:36] Speaker 01: That's at page 33 of the report. [00:30:37] Speaker 04: Well, it's actually not. [00:30:38] Speaker 04: He had some of his cited. [00:30:40] Speaker 04: Articles were specifically about competency. [00:30:43] Speaker 01: And to the extent they were, they actually undermined his position, Your Honor. [00:30:46] Speaker 01: The government quoted from those articles at page 34 and 37 of the record, and what that article showed, the gay article, was that it's difficult for examiners, and I'm quoting, to parse out symptoms related to competency restoration due to the high base rate, i.e. [00:31:00] Speaker 01: 75 to 95 percent, of successful restorability. [00:31:03] Speaker 01: Dr. Morris makes the exact same point in his report at page 1524. [00:31:08] Speaker 01: So the reason that there wasn't a rebuttal report is because Dr. Grady has already basically pre-budded the studies that Dr. Morris is relying on. [00:31:17] Speaker 01: He's making the point that you can't rely on duration of untreated psychosis because the rate of restoration is so high that duration of untreated psychosis doesn't actually show anything about the ability to restore competency. [00:31:30] Speaker 01: But to go back to the board. [00:31:32] Speaker 01: I didn't say it doesn't show it. [00:31:33] Speaker 04: It just can't be shown statistically because the numbers are small. [00:31:36] Speaker 04: That's what I interested him to be saying. [00:31:38] Speaker 04: But the district judge said that, I mean, her discussion of Dr. Morrison's report was actually quite short. [00:31:48] Speaker 04: Most of the pages that you're talking about was Ms. [00:31:50] Speaker 04: O'Cotter talking. [00:31:54] Speaker 04: She what page was it again that you were talking about? [00:31:58] Speaker 01: So I was on 33 and 34. [00:31:59] Speaker 01: If you go to 35 and 36, that's where the court actually picks up on the government's points. [00:32:04] Speaker 01: So directly after the government is making these arguments about how Dr. Morris's report isn't focused on competency, the court then says, [00:32:13] Speaker 01: It's a problem for the court that these medical records and reports that people are referring to aren't really focused on that, that being competency, as opposed to how do you cure someone. [00:32:23] Speaker 01: So I think that's a pretty clear reference to Dr. Morris's report, which isn't focused on competency. [00:32:28] Speaker 01: Then the court says, referring to the government's doctors, I have one set of doctors who are seeing him, working with him, talking to him, who have seen this medication has worked for him in the past. [00:32:38] Speaker 01: They're opining, yes, if we medicate him, it is more likely we can get him, based on statistical numbers, to be able to communicate with his counsel and work on his defense. [00:32:47] Speaker 01: In other words, to be competent. [00:32:49] Speaker 03: Defense counsel is saying that's not... I think you're putting words in the judge's mouth. [00:32:54] Speaker 03: I mean that's another problem when she relies on it's helped in the past. [00:32:58] Speaker 03: He took it one time in the past. [00:33:01] Speaker 03: So how can she rely on such a generalized statement that it's worked in the past? [00:33:07] Speaker 03: One time and what it worked to do was to sedate him. [00:33:10] Speaker 03: It did not work to restore his competency. [00:33:14] Speaker 01: I don't think that's correct, Your Honor. [00:33:15] Speaker 01: So I think defense counsel... It also wasn't only one drug. [00:33:18] Speaker 03: It was several different drugs you took at that time. [00:33:20] Speaker 03: Like there were four different drugs in combination. [00:33:22] Speaker 01: And only one was the antipsychotic. [00:33:24] Speaker 01: That was the haloperidol. [00:33:26] Speaker 01: On the sedation issue, defense counsel conceded below at page 37 and 38 of the record that it was the Benadryl. [00:33:32] Speaker 01: That's the datatome. [00:33:33] Speaker 01: So that's not a harmful side effect that's going to, that the haloperidol is going to cause. [00:33:38] Speaker 01: Dr. Morris doesn't even focus on that. [00:33:40] Speaker 01: But then on the question of what the prior treatment with haloperidol actually did, I think you can look at the doctor's and the nurse's descriptions as well as Coleman's own description of how that medication affected him. [00:33:55] Speaker 01: The doctors and nurses, page 1400, 1472-74 and 1476 of the record, they describe him as alert, oriented, alert and cooperative, much improved. [00:34:07] Speaker 01: And then Coleman himself at page 1502 in a call to his wife says that he was pretty sick, but that he was doing better now and doing good now. [00:34:14] Speaker 01: So certainly as at least one factor in why this treatment would be beneficial, I think the court is absolutely right to hit on that. [00:34:22] Speaker 01: But again, that's not the only factor the court noted. [00:34:25] Speaker 01: It's talking about the fact that the doctors, they saw him, they worked with him, they talked to him, they're looking at statistical numbers. [00:34:31] Speaker 01: It's after all of those sentences that the court says defense counsel is saying that's not good enough. [00:34:36] Speaker 01: I'm kind of at a loss here. [00:34:38] Speaker 01: There's really no other way to read that given what the court has just said than that it's at a loss at why those thorough efforts and those statistical numbers wouldn't be good enough. [00:34:49] Speaker 04: But they therefore would be good enough for anyone. [00:34:53] Speaker 04: I mean, the real problem here is whether there is some individualization that's required, which is what [00:35:00] Speaker 04: the case law seems to say. [00:35:03] Speaker 04: And she kept saying, well, this is a matter of statistics. [00:35:06] Speaker 04: And you're saying it's a matter of statistics. [00:35:10] Speaker 04: So those same studies could be attached to any competency finding or any finding about restoration or competency. [00:35:19] Speaker 04: And that would be the end of the story. [00:35:21] Speaker 01: Not necessarily, Your Honor. [00:35:22] Speaker 01: I think you could have situations where you might have that rare variety of delusional disorder, you know, the grandiose type or the persecution type that is especially resistant to treatment. [00:35:32] Speaker 01: Or you could have a defendant who has taken medication in the past and it has actually caused problems or hasn't worked. [00:35:38] Speaker 01: You can have situations where it's not going to work. [00:35:41] Speaker 01: This just wasn't that. [00:35:42] Speaker 01: And again, I do think it's important to focus on the points of agreement here. [00:35:46] Speaker 04: Or the studies, and I don't know the answer to this, the studies that Dr. Grady [00:35:50] Speaker 04: pointed to specifically about schizophrenia? [00:35:53] Speaker 01: Yes, it breaks some of them out at page 1524. [00:35:56] Speaker 01: So again, schizophrenia, the success rate was 76 percent. [00:36:00] Speaker 01: And then for the catch-all unspecified psychotic disorders, it was about 93 percent. [00:36:06] Speaker 01: And then for schizophrenia with a mood disorder, so schizoaffective disorder, it was about 82 percent. [00:36:13] Speaker 01: So all of the disorders that would be close to what Coleman has, again, showed an overwhelming success rate. [00:36:22] Speaker 01: And I should note, haloperidol was the most commonly used medication in that study. [00:36:28] Speaker 01: And the government pointed that out. [00:36:29] Speaker 01: It's at page 1275. [00:36:30] Speaker 01: That's the government's briefing below. [00:36:31] Speaker 01: It points out that haloperidol was the most commonly used medication. [00:36:36] Speaker 01: So both the condition and the medication, I think, were specifically tailored. [00:36:40] Speaker 01: And then you add to that the fact that Coleman has used this in the past and that dr. Grady considered all of that. [00:36:46] Speaker 04: What about I mean the main issue that Your opponent saying wasn't taken into account is his is the question of the length of his psychosis how long it been going on [00:37:00] Speaker 01: Right, Your Honor. [00:37:01] Speaker 01: So I think it was taken into account. [00:37:03] Speaker 04: Where? [00:37:04] Speaker 01: In fact, at page 30, defense counsel in the court below even says that they did account for his duration of untreated psychosis. [00:37:13] Speaker 01: They just don't agree with the conclusions that were drawn about it. [00:37:17] Speaker 01: But again, I don't think it was clear error for the courts not to credit Dr. Morris's untreated duration. [00:37:24] Speaker 01: I'm sorry. [00:37:24] Speaker 04: The defense counsel said it, but Dr. Grady's [00:37:28] Speaker 04: analysis took no account of it, and the judge took no account of it. [00:37:31] Speaker 01: I don't think that's correct, Your Honor. [00:37:32] Speaker 01: So at page 1519 and 1518 of the record, Dr. Morris has a very nuanced analysis of the duration of untreated psychosis. [00:37:40] Speaker 04: Dr. Morris or Dr. Grady? [00:37:41] Speaker 01: Excuse me, Dr. Grady. [00:37:43] Speaker 01: He says that he believes that the psychosis is long-standing, but that he believed the baseline was not mental psychosis until about 2023, and that prior to that he was having these [00:37:58] Speaker 01: severe episodes. [00:38:00] Speaker 01: based on all of the material he's reviewed. [00:38:03] Speaker 01: So he actually does account for it. [00:38:04] Speaker 01: He has a pretty nuanced analysis of it, and yet he still says Haloperidol is an excellent treatment. [00:38:09] Speaker 04: But he doesn't factor it into his. [00:38:11] Speaker 04: Well, first of all, what page did you say it was on? [00:38:13] Speaker 01: I believe it's 1518 and 1519 directed. [00:38:16] Speaker 01: There's a big bullet point 1, 2, 3, where he sort of walks through some of the past incidents and draws these conclusions about the baseline flipping from being normal functioning with [00:38:28] Speaker 01: mental lapses and then the baseline being the mental psychosis a couple years back. [00:38:35] Speaker 01: So again, he does talk all about the long duration of the condition. [00:38:41] Speaker 01: It's not something that he overlooked. [00:38:44] Speaker 01: But the problem is that that doesn't relate to competency restoration. [00:38:50] Speaker 04: And in fact... Well, but Morris says it does. [00:38:52] Speaker 04: That's the dispute that the district judge did not acknowledge and did not resolve. [00:38:58] Speaker 01: I think the discussion I've just quoted, page 29 through 36, where the court specifically addresses the difference between competency and a cure, and is it all in response to a discussion of Dr. Morris's report, and then says it's crediting the government's doctors who have met with him, and et cetera, it seems pretty clear the court is rejecting Dr. Morris's report, other than saying... But she never... His main point was that you have to change [00:39:27] Speaker 04: his history into account. [00:39:29] Speaker 04: Although Dr. Grady said what he really said in that part where you were talking about is we really don't know his history because he won't talk to us, pretty much is what he said. [00:39:40] Speaker 04: But Dr. Morris had found some more by reading some of his journals and he thought a clearer idea of his history. [00:39:48] Speaker 04: And none of that is in the district court's recognition about [00:39:55] Speaker 04: which expert to credit. [00:40:00] Speaker 01: So, Your Honor, I think the pages I've quoted are reasonably read that way, but what I can say is even if you... But where? [00:40:07] Speaker 04: I'm sorry, Your Honor. [00:40:09] Speaker 04: Show me where that's the case. [00:40:10] Speaker 04: I just don't see it. [00:40:13] Speaker 04: Does she say anywhere that Dr. Morris says that we should be taking into account his long history and... [00:40:19] Speaker 04: Dr. Grady, for some reason I don't think that's true. [00:40:25] Speaker 04: No, nowhere. [00:40:27] Speaker 01: I think the two best places I can point you to are at page 35 and 36 where the court says it's a problem for the court that you have one set of doctors relying on studies about how to cure someone. [00:40:40] Speaker 01: And then says, I have another set of doctors who are meeting with him, looking at statistical data, talking to him, taking account of his past treatment. [00:40:47] Speaker 01: I'm at a loss for what defense counsel says that's not good enough. [00:40:51] Speaker 01: I'm at a loss. [00:40:52] Speaker 01: And then, of course, at page 40, when the court expressly finds that the government proved through the statistics, through the case law, through the various different factors that it listed off, [00:41:03] Speaker 01: that the second factor was met, I think that's more than enough to encompass that finding. [00:41:07] Speaker 04: And even if it wasn't as explicit as... But she says all of this is going to be statistical, which is really saying we're not going to look at the specifics of the person. [00:41:20] Speaker 01: I don't think that's right. [00:41:21] Speaker 01: I mean, I think what she's saying is it's statistical the, you know, chance of success. [00:41:25] Speaker 01: You're ultimately going to have to look at statistics related to the medication success rate, which I think is absolutely true. [00:41:32] Speaker 01: I think it's important to cite all of those studies that Dr. Moore cited. [00:41:36] Speaker 01: But I don't think it, you know, when she's saying they've met with them, they've looked at his past use of medication, [00:41:42] Speaker 01: They've talked to him. [00:41:44] Speaker 01: The court is clearly placing weight on the fact that these doctors actually did all of this robust analysis of him specifically. [00:41:52] Speaker 01: But not with regard to his past history of psychosis. [00:41:56] Speaker 01: I believe so, Your Honor. [00:41:58] Speaker 04: And not with any recognition that that matters. [00:42:01] Speaker 01: I see. [00:42:03] Speaker 01: Again, I think the rejection of Dr. Morris's report, which she views as focusing on curing him rather than competency, would encompass that. [00:42:11] Speaker 01: And if you want a case for support, I do think the Deer case from the Tenth Circuit is a good one. [00:42:15] Speaker 01: There the specific argument [00:42:18] Speaker 01: was that the court failed to address duration of untreated psychosis. [00:42:22] Speaker 01: And the 10th Circuit said, that is true. [00:42:24] Speaker 01: But the court did say it was crediting an expert based on their experience and having met with the defendant. [00:42:30] Speaker 01: And that was enough to infer that they were rejecting this notion of duration of untreated psychosis. [00:42:35] Speaker 01: If I could just make one last point, I know I'm a little over time here, but if you really wanted to credit this duration of untreated psychosis analysis, I think you would have to conclude that there could never be a silver. [00:42:47] Speaker 01: Because the duration of untreated psychosis that is defined as excessive is a year or more, and in some cases four weeks or more. [00:42:54] Speaker 01: But as this case shows and as every case you can look at that we've cited shows, it takes longer than a year just to get to the point of being able to issue a cell order. [00:43:05] Speaker 04: But our question here is whether there could be a cell order with an adequate analysis. [00:43:13] Speaker 04: The question is whether the district court really looked at all the pieces before she came to her conclusion. [00:43:20] Speaker 01: And I think the answer is yes. [00:43:23] Speaker 01: The district court cites all of the cell factors. [00:43:26] Speaker 01: It quotes them, page 25 and 26 of the record. [00:43:28] Speaker 01: It then discusses Dr. Morris's report specifically. [00:43:31] Speaker 01: It describes his report specifically. [00:43:34] Speaker 04: And then you have that... All she says about it is negative because she says he said that he would recommend it if it was his patient and then it would be more likely than other things to restore him, both of which are not pertinent to the question. [00:43:50] Speaker 04: And that's basically what you said about Dr. Morris. [00:43:54] Speaker 01: Again, I don't agree that's the sum total of what the court said. [00:43:57] Speaker 01: What else was she saying? [00:43:58] Speaker 01: The fact that the court makes the point that it's focused on not on competency, but on how to cure someone. [00:44:06] Speaker 01: That's the court recognizing the point the government has just made about the, quote, disconnect between Dr. Morris's report. [00:44:13] Speaker 03: And why do you say over your time, and this is getting very repetitive, [00:44:19] Speaker 03: I think we can interpret what she's saying based on the record ourselves. [00:44:23] Speaker 03: So if you want to sum up, I'd appreciate that. [00:44:27] Speaker 01: Absolutely, Your Honor. [00:44:28] Speaker 01: I would simply say that I think the court here should find that the district court made adequate findings and that it did not act illogically or implausibly in crediting the government's medical experts over the defendants. [00:44:43] Speaker 01: Thank you, Counsel. [00:44:54] Speaker 00: I'd like to begin by addressing the government's point about Dr. Grady stating that antipsychotic medication was a necessity for competency restoration. [00:45:02] Speaker 03: Okay, but then will you discuss the 10th Circuit case also that council refers to? [00:45:07] Speaker 00: Sure, I'll start with dear. [00:45:10] Speaker 00: Deer actually is helpful to this court and our position because what Deer says is that the need for a high level of detail and particularized findings is plainly contemplated by SELT. [00:45:25] Speaker 00: So there is a need for a high level of detail and particularized findings, which is not the case here. [00:45:31] Speaker 00: The reason the 10th Circuit found that the court could infer [00:45:35] Speaker 00: the district court's reasons for rejecting one expert's conclusions over another is because the detailed written order showed the difference between the two experts and why the court found in favor of one as opposed to another. [00:45:51] Speaker 00: As your honors have seen and in the questions, the government has been unable to point to anywhere in the record where the district court stated clearly its reasons [00:46:01] Speaker 00: for accepting Dr. Grady's opinion over Dr. Morris's. [00:46:06] Speaker 00: Here we have effectiveness rates, but for Haldal, [00:46:11] Speaker 00: However, there's about 20% of defendants who were not restored to competency in those same statistics. [00:46:16] Speaker 00: The government believes or assumes that Mr. Coleman would fall into the effective 70% or 80%. [00:46:23] Speaker 00: But Dr. Morris identified at least three factors that would place Mr. Coleman in the 20% who would not be restored to competency. [00:46:32] Speaker 00: That's the length of duration of undiagnosed psychosis, the intensity of his delusions, and the involuntariness of his need for treatment. [00:46:41] Speaker 00: And I'd like to point out the government even admitted this at the cell hearing on page 2ER34. [00:46:48] Speaker 00: It said, and when you look at certain characteristics that he has, yeah, he fits into some of them that suggest maybe he is not as receptive to it. [00:46:56] Speaker 00: But he also fits some that suggest he probably is receptive to it. [00:47:00] Speaker 00: So we have even the government admitting there are particular facets of Mr. Coleman's condition that render him more unlikely to respond to Haldall and restoring his competency. [00:47:10] Speaker 00: So the government, not below and not here, has been able to point to anything in the record in its own briefing or in Dr. Grady's report or any other BOP report. [00:47:20] Speaker 00: addressing those characteristics that placed Mr. Coleman in the unrestored camp. [00:47:25] Speaker 00: Piecing together random comments in a cell hearing is not what cell Ruiz, Gaciola, Williams, or the Constitution had in mind when justifying an order to involuntarily medicate someone against their will. [00:47:43] Speaker 00: And if the court has no further questions, we ask that this court vacate the order or alternatively [00:47:48] Speaker 00: remand for further findings on an open record. [00:47:51] Speaker 03: All right. [00:47:52] Speaker 03: Thank you, counsel, both sides for an excellent argument. [00:47:56] Speaker 03: United States versus Coleman will be submitted.