United States of America v. Lamar McDonald, also known as Mike, also known as Marty

United States Court of Appeals
For the Eighth Circuit
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No. 22-3482
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United States of America
Plaintiff - Appellee
v.
Lamar McDonald, also known as Mike, also known as Marty
Defendant – Appellant
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Appeal from United States District Court
for the Eastern District of Missouri - St. Louis
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Submitted: September 21, 2023
Filed: December 6, 2023
[Unpublished]
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Before SHEPHERD, KELLY, and STRAS, Circuit Judges.
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PER CURIAM.
A court1 order requires doctors at the Federal Medical Center in Springfield,
Missouri, to medicate Lamar McDonald against his will. The goal is to make him
1 The Honorable Audrey G. Fleissig, United States District Judge for the
Eastern District of Missouri, adopting the report and recommendation of the

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competent to stand trial on a single count of conspiring to distribute
methamphetamine,2 see 21 U.S.C. §§ 841(a)(1), (b)(1)(A)(viii), 846. He claims that
the government’s justification is too weak, given the health risks, but we affirm.
I.
It takes an “important” government interest to forcibly medicate someone.
Sell v. United States, 539 U.S. 166, 180 (2003); see also United States v. Mackey,
717 F.3d 569, 573 (8th Cir. 2013) (applying de novo review). One interest that is
important enough is prosecuting someone for a “serious crime.” Sell, 539 U.S. at
180. McDonald’s drug-trafficking charge qualifies, given the life sentence he faces.
See 21 U.S.C. § 841(b)(1)(A)(viii); see also Mackey, 717 F.3d at 573 (recognizing
that the maximum punishment for a crime “is the most relevant objective indication
of the seriousness with which society regards [it]”). Indeed, an offense carrying a
maximum sentence equal to the minimum here—120 months, see 21 U.S.C.
§ 841(b)(1)(A)(viii)—can justify the forced administration of antipsychotic drugs.
See Mackey, 717 F.3d at 573.
Honorable Shirley Padmore Mensah, United States Magistrate Judge for the Eastern
District of Missouri.
2 The government is also medicating McDonald to stop him from harming
himself, which it can do without a court order. See Washington v. Harper, 494 U.S.
210, 227, 233 (1990). The competency order remains in effect, however, and
requires the doctors to keep medicating him even if he is no longer dangerous, so
McDonald retains a “concrete interest” in having it overturned. Chafin v. Chafin,
568 U.S. 165, 172 (2013) (citation omitted) (describing when an appeal “is not
moot”); cf. Eason v. United States, 912 F.3d 1122, 1123 (8th Cir. 2019) (explaining
that a prisoner can challenge a sentence that increases the time he has to serve or
“otherwise prejudice[s] him in any way,” even if he is also serving a concurrent
sentence). As for the possibility that his current treatment might undermine the
justification for the order, McDonald has not made that argument, much less offered
evidence to support it, so we do not address it. See Stephenson v. Davenport Cmty.
Sch. Dist., 110 F.3d 1303, 1307 n.3 (8th Cir. 1997).

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There is also nothing “[s]pecial” about McDonald’s case that “lessen[s] the
importance of” bringing him to trial. Sell, 539 U.S. at 180. The non-violent nature
of his crime and the absence of direct victims are not barriers, see id. at 169
(contemplating involuntary medication “for serious, but nonviolent, crimes”);
Mackey, 717 F.3d at 574, nor is the speculative possibility of civil commitment, see
Sell, 539 U.S. at 180 (explaining that, at most, this possibility “affects, but does not
totally undermine, the strength of the need for prosecution”). And even the
conviction of McDonald’s co-conspirators does not lessen the government’s interest
in prosecuting him.
II.
Administering antipsychotic drugs to treat his schizophrenia is also
“medically appropriate.” Id. at 181 (asking whether the proposed treatment is “in
the patient’s best medical interest in light of his medical condition”). According to
the chief psychiatrist at the facility holding him, these drugs are the standard
treatment in these circumstances, and he “would [have] strongly recommend[ed]”
them for McDonald, even “outside of the medical-legal setting.”
It is true that McDonald’s medical history is extensive. He suffers from
multiple conditions, including diabetes, hypertension, and stage-3 kidney disease.
But there is no evidence that any of them, individually or together, would make the
use of antipsychotic medications unsafe. And his treatment plan accounts for any
risk by requiring medical personnel to start at low doses, carefully watch for side
effects, and make sure his single remaining kidney can clear the medication. Even
if the doctors could not provide a “100 percent assur[ance]” that McDonald would
face no complications, the district court did not clearly err in concluding the
treatment was “medically appropriate.” See Mackey, 717 F.3d at 576 (reviewing for
clear error); see also United States v. Coy, 991 F.3d 924, 931 (8th Cir. 2021)
(upholding a “flexib[le]” treatment plan that “allow[ed] the treatment team to

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properly respond to the effects of the medication, especially undesired side effects
that might arise”).
III.
We accordingly affirm the order requiring the administration of antipsychotic
drugs to McDonald.
KELLY, Circuit Judge, dissenting.
As the parties clarified at oral argument, FMC Springfield has been forcibly
medicating McDonald since March 2023 on the grounds that he is a danger to
himself. See Washington v. Harper, 494 U.S. 210, 227 (1990) (“[T]he Due Process
Clause permits the [government] to treat a prison inmate who has a serious mental
illness with antipsychotic drugs against his will, [and without a court order,] if the
inmate is dangerous to himself or others and the treatment is in the inmate’s medical
interest.”). The government represents that the treatment McDonald is receiving is
the same treatment it proposed at the February 2022 Sell hearing, and which the
district court ordered. See Sell v. United States, 539 U.S. 166 (2003). However,
McDonald’s involuntary medication on Harper grounds may moot the district
court’s Sell order to forcibly medicate McDonald for trial competency purposes. Id.
at 183 (recognizing that when antipsychotic medication is authorized on “alternative
grounds, the need to consider authorization on trial competence grounds will likely
disappear”). At last report, it appears that McDonald is increasingly cooperative and
mostly compliant with his treatment at FMC Springfield.
Either way, the Sell order was entered without the benefit of the information
gathered in the more recent, and “more ‘objective and manageable’” Harper
proceedings. Sell, 539 U.S. at 182 (quotation omitted). At the Sell hearing,
McDonald raised concerns about the health risks associated with the government’s
proposed treatment plan. The district court should have the opportunity to consider
the efficacy of, and McDonald’s response to, the treatment regimen imposed under

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Harper before it enters an order under Sell. See United States v. Osborn, 921 F.3d
975, 982 (10th Cir. 2019) (“Vacating Sell orders if and when intervening Harper
proceedings occur helps to keep Sell orders in their proper place as remedies of last
resort.”).
Moreover, a Sell order addresses a situation where a “defendant is presently
suffering from a mental disease or defect rendering him mentally incompetent” to
stand trial. 18 U.S.C. § 4241(d) (emphasis added); Sell, 539 U.S. at 186 (“Since [a
defendant]’s medical condition may have changed over time, the Government
should [pursue forced medication] on the basis of current circumstances.”). The
government has an important interest in prosecuting McDonald, but there is no legal
support for the idea that it should be permitted to keep an outdated Sell order at-the-
ready in the event that McDonald is no longer gravely disabled or a danger to
himself. Because McDonald is currently receiving treatment—including
antipsychotic medication—the district court’s November 2022 Sell order does not
reflect the current necessity or medical appropriateness of the government’s
proposed competency-restoration plan.
Given McDonald’s recent Harper proceedings, I would vacate the district
court’s Sell order. If the current treatment regimen imposed pursuant to these
proceedings has not rendered McDonald competent to stand trial, then the statute
authorizes the government to file a competency motion, and request a Sell order, “at
any time” prior to sentencing. See § 4241(a). Regardless, McDonald retains “a
‘significant’ constitutionally protected ‘liberty interest’ in ‘avoiding the unwanted
administration of antipsychotic drugs.’” Sell, 539 U.S. at 178 (quoting Harper, 494
U.S. at 221); Riggins v. Nevada, 504 U.S. 127, 135, 137–38 (1992). And court-
ordered competency-restoration treatment, while permissible, should be imposed
only in carefully limited circumstances. Sell, 539 U.S. at 169; see also United States
v. Watson, 793 F.3d 416, 419 (4th Cir. 2015) (emphasizing that forced medication
to render a defendant competent to stand trial “is the exception, not the rule”).
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