Involuntary medication of patients who are incompetent to stand trial: a descriptive
study of the New York experience with judicial review.
B. Ladds, A. Convit, J. Zito and J. Vitrai,
Bull. Amer. Acad. Psychiatry & the Law
21(4): 529-45, 1993.
The United States Supreme Court, in the recent case of Riggins v. Nevada, extended its examination
of the issue of involuntary treatment with antipsychotic medication to the mentally disabled facing
criminal trial. A criminal defendant who is "incompetent to stand trial" cannot be subjected to trial.
Many such persons are committed to hospitals to be treated and rendered "competent to stand trial,"
and some of these patients refuse medication. The involuntary administration of antipsychotic
medication to such patients raises important and unique medical and moral questions. This highly
controversial issue has been understudied. We report here on the first study of persons committed
to a state hospital in order to be rendered competent to stand trial who refuse antipsychotic
medication and for whom judicial review is requested to allow involuntary treatment, and in which
results are given specifically for these subjects. This is a retrospective study to determine the
characteristics of such cases and aspects of their outcome in the hospital. We reviewed all cases (N
= 68) of application for treatment over objection, filed since the inception in 1986 of the new laws
and regulations requiring judicial review through 1990, among patients in the two facilities that
receive over 95 percent of all indicted felony offenders in New York State who are incompetent to
stand trial. Tentative conclusions are formulated based on the findings that, according to clinical
reports, no patient gave only rational reasons for medication refusal, clinicians always indicated the
clinical appropriateness of the proposed treatment, judges apparently never found that someone who
is "incompetent to stand trial" is "competent" to refuse medication, 93 percent of patients treated
involuntarily had a good clinical response, and 87 percent of patients treated involuntarily were
restored to "competency to stand trial." [References: 60]