STATE OF MAINE SUPERIOR COURT
KENNEBEC, SS. - ACTION
Docket No. 
STATE OF MAINE
v. - DECISION AND ORDER
LEROY SMITH 

Defendant

Before the Court is the State?s motion for court authorized treannent
pursuant to 15 MRS. 106(3). In May of 2014, the Defendant was charged by
indictment with one count of intentional or knowing or depraved indifference
murder in Violation of 17-A M.R.S. (B). In January of 2015, the
Court found the Defendant not competent to be arraigned or to otherwise
participate in any pretrial criminal proceeding. The Defendant was ordered
committed to the custody of the Commissioner of Health and Human Services for
an appropriate program for observation, care, and treatment pursuant to 15 MRS.
Pursuant to statute, a thirty day competency examination was
conducted and a report made to the Court in March of 2015 advising that the
Defendant remained ?oridly delusional with no signi?cant change. Defendant has
refused medication to treat his illness and other interventions by

Riverview staff have been unsuccessful at restoring competency.

However, it was noted that the Defendant willingly took 
medication in connection with the issues relating to sleep and that while taking
such medication, the treatment team noted a lack of evident The team
noted that the medication appeared to lead to better organization of his thoughts.
However, Defendant re?ised to continue with the medication and terminated the
treatment. He continues to refuse other suggested medications.

A hearing was held December 2, 2015 on the State?s motion. Testifying
were Dr. Peter Donnelly, a forensic and Miriam Davidson, a
nurse practitioner. Dr. Donnelly conducted an evaluation of the
Defendant and diagnosed a delusional disorder. He indicated that the Defendant
understands the process and has the intellect to participate, but his delusional
thinking interferes with his ability to cooperate. He noted that the medication,
Seroquel, seemed to address his delusional The doctor further noted
that a person may have delusions and still be. competent.

Ms. Davidson, the nurse practitioner, described the protocol of
Riverview of treatment by use of a clinic review panel to determine when a person
may be involuntarily medicated. There is no similar process available on the
forensic side unless the individual is dangerous and requires emergency medication
for the safety of him/herself and others. She further described that people vary as

to responses to medication and that somewhere between six weeks and three to six

months is necessary to determine what the appropriate medication is and the
therapeutic dose. She described the side effects from, typical medications and
atypical medications, wherein the patient is reviewed daily for obvious side effects
and those that would appear only from blood testing. She described sedative
qualities as the most common side effect of both typical and atypical medication.
The treatment team would be aware if such sedation interferes with the
Defendant?s thought processes.

Ms. Davidson described the administration of Seroquel and that it had a
positive effect as to Defendant?s delusion, but that the Defendant stopped taking
the medication because he did not believe it helped his insomnia. She noted there
were no side effects.

Ms. Davidson described the procedure to be utilized if approved by the
Court. The medication would be explained to the Defendant and an offer made for
him to. voluntarily take the mediation orally. In the event of refusal, he would be
advised of the authority for the administration by hypodermic syringe. She
suggested an order authorizing the forced medication for a six month period,
recognizing that the appropriate medication could be determined much earlier. She
asked for the authority to administer typical and atypical medications depending
upon the result and that the Defendant?s medical condition would be constantly

monitored. She indicated the monitoring by the treatment team would include

 

 

Defendant?s interactions and conversations with staff. She allowed that the
Defendant might still have delusions, but should have the capability of controlling
and dealing with those delusions while displaying appropriate thought.

Under the provisions of 15 MRS. 106(2), the Commissioner was advised
through its forensic staff that the Defendant is not consenting to treatment and
unlikely to be restored to competency without the administration of 
medication over his objection. The Commissioner must assert that there is no basis
for involuntarily medicating the Defendant other than to restore the Defendant?s
competency. Pursuant to 15 MRS. 106(3), the Court must find by clear and
convincing evidence that important State interests are at stake in restoring the
Defendant?s competency, the involuntary medication will signi?cantly further
important State interest, the medication proposed is substantially likely to render
the Defendant competent and it is substantially unlikely to produce side effects that
would signi?cantly interfere with the Defendant?s ability .to assistdefense counsel
in conducting the counsel?s defense. Further, the involuntary medication is
necessary to further important State interest, and that any alternate less intrusive
treatments are unlikely to achieve substantially the same results. Finally, the Court
must. find that the administration of the proposed medication is medically
appropriate, and it is in the Defendant?s best medical interest in light of the

Defendant?s medical condition.

 

 

it is -?without debate that the responsibility and accountability for taking the
life of another under our criminal justice system is a significant and important State
interest. Therefore, the restoration of Defendant to competency ?irthers the
important State interest of establishing the accountability for the underlying
homicide through the criminal trial process.
I Based upon medical, and testimony, the Court is
satisfied that the protocol suggested by the treatment team at the Riverview
Forensic Unit is likely to render the Defendant competent to proceed and is
unlikely to provide side effects that would signi?cantly interfere with the
Defendant?s ability to assist defense counsel in conducting the Defendant?s
defense. The Court is satis?ed that the experience of the treatment team and
Defendant?s previous refusal to accept any medication, particularly 
medication, removes the finding that less intrusive methods are likely to achieve
the desired result. The Court further finds that the proposed treatment protocol is
medically appropriate While subject to timely monitoring of Defendant?s medical
condition.

Accordingly, it is the conclusion of the court that the involuntary

administration of medication to the Defendant, having been found

 

 

necessary and appropriate, is to be authorized over the Defendant?s objection in
order to attempt to restore the Defendant to competency. 1

Based on the aforementioned fmdings of fact by the Court, the Court Orders
the following:

The State?s motion to au?aorize involuntary treatment of the defendant is

GRANTED subject to the following:

a medication as deemed appropriate by Defendant?s treating
and medical team at Riverview Center.
Medication may be switched to other medications within this class to
maximize bene?cial response and minimize side effects. Dosage to be
adjusted to obtain best clinical response. Appropriate laboratory work to
allow monitoring of medication and potential side effects.

a The team may administer anti-cholinergic medication as deemed
appropriate by Defendant?s treating and medical team at
Riverview Center to address potential side effects.

a Medications may be given orally. They may be administered
intramuscularly only if the Defendant has refused administration orally,
and as deemed appropriate by Defendant?s treating and
medical team at Riverview Center. -

a The practitioner is to provide progress notes as such pertain to
Mr. Smith?s treatment at Riverview to the Court. Such notes are to be
provided minimally on a weekly basis, but if more frequent notes are
created, such will also be provided to the Court, the attorney for the State,
and the Defendant?s attorneys. Said notes shall detail the type of
medication that is being administered to the Defendant, the method of
administration, the dosage, and any effect on the Defendant.

 

1 The Defendant cites Self v. United States, 539 US. 166, in which the Supreme Court of the United States
declined to support the involuntary medication of a defendant in the absence of a determination of dangerousness on
the part of Mr. Self. The Court distinguishes this case from the present circumstances because of a signi?cant
difference in interest of the State wherein Mr. Self was charged with fraud and Mr. Smith is charged murder.

 

a Forensic Monitoring shall be conducted by State Forensic Services in
thirty day. increments. State Forensic Services shall inform the Court of
such monitoring in a letter summarizing the treatment. This monitoring
is to be in addition to reports mandated by Title 15 MRS. 

A status conference will be held at the ?rst available date in April of
2016 to review the status of Defendant?s treannent. Either party may
petition the court for earlier review as deemed necessary. 

This order shall remain in effect for six months ?om this date unless vacated
by court order following appropriate motion and hearing.

The clerk is directed to incorporate this Order into the docket by reference

pursuant to MR. Civ. P. 79(a).

DATED: ref?- ?6

   

.

Superior Court Justice