ACSBlog: The Blog of the American Constitution Society

by Mick Collins, Editor at Large

On June 21, 2006, Utah District Court Judge Judith Atherton granted a Utah State motion compelling Wanda Barzee to take antipsychotic medication. Judge Atherton is the Mental Health Court Judge for the Third Judicial District of Utah. Currently, the Utah Supreme Court has taken this order to compel involuntary medication under advisement. The Utah Supreme Court has given no indication as to when they will rule.

Previously held incompetent to endure criminal trial, Wanda Barzee stands accused of the aggravated kidnapping and aggravated sexual assault of Elizabeth Smart. Barzee refused medication and other forms of treatment at Utah State Hospital.

While the U.S. Supreme Court’s holding in United States v. Sell establishes a four part test for determining whether or not the government may force criminal defendant’s to take medication, Barzee’s defense conceded in a court filing that whether or not the administration of drugs is likely to render Barzee competent was, “Without question … the most important factor in … the present case.

A key government witness, Dr. Kreg Jeppson, an employee of the Utah State Hospital, rendered a diagnosis of delusional disorder. Later Dr. Jeppson changed his diagnosis to Psychotic Disorder not otherwise specified. He testified that he was not an expert witness but that medication would be substantially likely to restore Barzee, quantifying this likelihood at 75%. Dr. Jeppson relied on personal observation of Barzee as well as an overall success rate of around 80%, at State Hospital, in restoring patients with psychotic disorder to competency. 

Dr. Xavier Amador, an adjunct Professor at Columbia University and New York University agreed with the original diagnosis of delusional disorder. Dr. Amador spent 15 hours with Barzee and reviewed materials regarding Barzee, collected by an investigator.  Dr. Amador placed the likelihood of restoration of competency at 20% because

“Considering the delusional disorder and the particular nature of the delusions from which she suffers, he does not believe that there is a substantial likelihood that the administration of antipsychotic medication would restore Ms. Barzee to competency.”

Further, He thought that the long duration of Barzee’s illness (13 years) made it very unlikely that Barzee would restore through medication.

Currently, data on the psychopharmacological treatment of delusional disorder rely on case reports or small collection studies. There are no published controlled studies. Testifying in a similar case, Dr. Robert L. Goldstein stated the literature concerning Delusional Disorder skews toward success because 

“There aren't many articles where someone says I treated six patients with this illness and none of them got better. Those kind of papers are generally not published. So there's a kind of skewing of the literature towards only writing about things where you have a favorable outcome.”

In ruling, Judge Atherton said,

Dr. Jeppson has had the advantage of seeing and interacting with Defendant on almost a weekly basis since March 2004.

The ruling continued,

“As Dr. Amador testified, it may be true as a general matter that there is a low likelihood that patients diagnosed with Delusional Disorder whose psychosis has not been treated for many years can be restored to competency.”

Concluding,

“Dr. Jeppson’s clinical experience, his success rate in restoring patients to competency who exhibit symptoms similar to Defendant’s, his interaction with defendant over two years, and the fact that he is the actual physician who will continue to treat Defendant  trump any statistical data concerning the general rates of successful restoration to competency of patients with Defendant’s symptoms. “

According to Deseret News reporter Pat Reavy, Barzee’s attorney Scott Williams said, referring to Dr. Amador,

“The quality and quantity of time spent by those doctors with Barzee made them more of an expert than Barzee's own attending physician at the State Hospital, Dr. Kreg Jeppson. Williams said Jeppson was the ‘worst possible’ person in terms of someone providing a diagnosis for Barzee because she believed that Jeppson was ‘possessed by Satan’ simply because he worked for the state and refused to cooperate in his evaluations.”

Mr. Reavy also noted that Dr. Jeppson died of cancer the day Judge Atherton’s ruling was released.