Involuntary patients' right to refuse medication: impact of the Riese decision on a
California inpatient unit.
R. L. Binder and D. E. McNiel,
Bull. Amer. Acad. Psychiatry & the Law
19(4): 351-7, 1991.
On June 22, 1989, the California Supreme Court allowed the Appellate Court decision in the right
to refuse treatment case, Riese v. St. Mary's Hospital to stand. The court ruled that absent a judicial
determination of incompetence, antipsychotic drugs cannot be administered to involuntarily
committed mental patients in non-emergency situations without their informed consent. Much
concern was expressed by the California Psychiatric Association and the California Alliance for the
Mentally Ill about the decision's negative impact on patient care. In this paper, the authors review
the decision, elucidate the anticipated concerns about the impact of the decision, and then describe
the decision's actual impact on an acute inpatient unit in California. The authors report that Riese
hearings were held on 7 percent of admissions to their locked inpatient facility. Only 1 percent of
the patients were found to be competent to refuse medications. The authors give clinical examples
of patients who were affected by the Riese decision and review the benefits and risks of this decision
from the perspective of actual clinical practice.