Court Says Inmates Can Be Forced to Take Drugs : Rights: Justices hold that prison officials have the final say on using mind-altering substances. The ruling does not apply to California institutions.

The Supreme Court, in an unusual drug case, ruled Tuesday that the government may force prison inmates to take mind-altering drugs against their will.

On a 6-3 vote, the court said that the Constitution does not give inmates a right to refuse to take the drugs. Rather, it is up to prison officials, not inmates or judges, to decide whether a potentially dangerous inmate needs to be medicated, the justices said.

The ruling culminates a decade-long fight over antipsychotic drugs that has pitted psychiatrists and institutional administrators against psychologists and advocates for mental health patients and prisoners.

Psychiatrists say that powerful mind-altering drugs help control mental illness, letting prison inmates lead a more normal life and allowing thousands of patients to be set free from institutions.

But mental health advocates point to the potentially severe side effects of the drugs--such as uncontrollable and disfiguring muscle twinges--and say that they have been overused to keep disturbed patients in a “chemical straitjacket.” In briefs to the court, they portray a situation akin to Ken Kesey’s “One Flew Over the Cuckoo’s Nest,” which, in the movie version, saw actor Jack Nicholson electrically zapped into a catatonic state.

In the early 1980s, state courts in Massachusetts and New York ruled that prisons and mental hospitals may not forcibly medicate a patient without getting permission from a judge.

In 1986, the California courts, relying on state law, adopted the same patients’ rights approach. A patient or inmate in a state institution may not be forced to take mind-altering drugs unless a judge concludes that he is dangerous or incompetent, the state courts said. Because a California inmate’s right to contest a forced medication is grounded in state law, not the U.S. Constitution, Tuesday’s ruling has no direct impact on state institutions, but it does apply to inmates of federal prisons in California.

But most other states did not go along with the inmates’ rights standard, saying that such decisions should be made by staff psychiatrists and institutional officials alone. The dangers of the drugs are exaggerated, psychiatrists contend, and the judicial hearings a waste of time.

On Tuesday, the high court came down squarely on the side of prison officials and psychiatrists.

“We hold that, given the requirements of the prison environment, the (Constitution) permits the state to treat a prison inmate who has a serious mental illness with antipsychotic drugs against his will, if the inmate is dangerous to himself or others and the treatment is in the inmate’s medical interest,” Justice Anthony M. Kennedy said for the court.

“Notwithstanding the risks that are involved, we conclude that an inmate’s interests are adequately protected, and perhaps better served, by allowing the decision to medicate to be made by medical professionals rather than a judge.”

The ruling overturns a decision of the Washington state Supreme Court, which had said that prison officials must convince a judge that it was necessary to preserve safety and order before they could forcibly medicate an inmate.

Kennedy’s opinion stresses that it is the duty of prison officials, not judges, to decide how best to control dangerous and disturbed inmates. Walter Harper, the inmate whose case was before the court, had assaulted fellow inmates or prison staff members on at least 20 occasions, he noted.

Tuesday’s decision (Washington vs. Harper, 88-599) follows a series of rulings in recent years in which the Rehnquist Court has made clear that inmates do not have the same constitutional rights as others.

In a sharp dissent, three liberal justices said that no person should be required by the state to undergo “forced drugging” without a chance to contest that decision in an independent hearing.

Under the Washington prison policy reinstated by the court Tuesday, inmates may request a hearing within the prison before administrators and staff doctors. But the dissenters--Justices John Paul Stevens, William J. Brennan Jr. and Thurgood Marshall--said this “mock trial before an institutionally biased tribunal (does not) constitute due process of law.”

Mental health advocates called the ruling disturbing.

“This is a fundamentally dishonest decision,” said Leonard Rubenstein, a lawyer for the Washington-based Mental Health Law Project, which represented the inmate in the case. The court’s opinion says that the prison committee will act according to the best interests of both the prison and the prisoner, but the two often conflict, Rubenstein said.

In briefs to the court, the Mental Health Law Project and the American Psychology Assn. said that as many as 40% of inmates and patients treated with antipsychotic drugs suffer lasting damage. One increasingly common condition, known as tardive dyskinesia , results in uncontrollable and disfiguring muscle twinges in the face, arms, trunk and legs.

In general, a competent person has a right to refuse any medical treatment. However, if a person is judged incompetent and confined to a mental institution, the patient’s right to reject treatment may be limited.

Kennedy’s opinion did not say whether patients in mental hospitals have a constitutional right to refuse to take such drugs, “but it doesn’t bode well for them either,” Rubenstein said.

The Bush Administration and the American Psychiatric Assn. sided with Washington prison officials, contending that officials and staff psychiatrists within the institution are best suited to decide who gets medicated and when.

California Deputy Atty. Gen. Bruce M. Slavin said that, despite California’s policy, a prison inmate rarely wins the right to reject treatment. Each year, about 150 inmates at the state prison for mentally ill prisoners at Vacaville refuse to take their medication and go to court. But, in almost all instances, judges rule in the state’s favor, Slavin said.