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http://www.nytimes.com/2002/12/26/national/26DENT.html

Man Fights to Resist Efforts to Medicate Him for Trial

By JO THOMAS

r. Charles T. Sell, a St. Louis dentist, once spat in the face of a federal magistrate who was deciding whether to revoke his bail on charges of Medicaid fraud. That helped to land him behind bars, and five years later, facing more charges and after a diagnosis of mental illness, Dr. Sell is still locked up awaiting trial.

His situation has posed a question that the Supreme Court has agreed to answer: Can the government forcibly medicate a person charged with a nonviolent crime to make him mentally competent to stand trial?

Psychiatrists say Dr. Sell, who is 53, suffers from a "delusional disorder of the persecutory type." The government wants to give him antipsychotic medicine so it can prosecute him. Dr. Sell and his lawyers contend that medicating him by force would violate his fundamental right to bodily integrity.

Judges in the Federal District Court and the United States Court of Appeals for the Eighth Circuit, in St. Louis, have agreed with the government, though the appellate court split 5 to 4. On Nov. 4, the Supreme Court decided to accept the case.

The appeals court noted that Dr. Sell was also charged in a separate indictment, handed down nine months after the first, with conspiring to murder an F.B.I. agent and a witness in his fraud case, but said, "We base our reasoning solely on the seriousness of the fraud charges."

"It is possible," the judges wrote, "that Sell's threats after his first indictment were a manifestation of his delusional disorder and we decline to make a determination about whether those charges suffice to involuntarily medicate him."

The case of Dr. Sell first came to national attention in early 2001 when John Ashcroft, formerly a senator from Missouri, was seeking confirmation as attorney general and there were reports that as senator, he had once met briefly with Thomas S. Bugel, a friend of Dr. Sell, who was asking the Missouri Congressional delegation to look into accusations Dr. Sell had been abused in prison.

Both Dr. Sell and Mr. Bugel were members of the Council of Conservative Citizens, a far-right group whose leaders have expressed extreme racial views.

Mr. Bugel contended that Dr. Sell was brutally shackled on a concrete slab for nearly two days in 1999 and deliberately scalded by guards a few months later. Prison authorities have denied any abuse but refused requests from Dr. Sell's family to release surveillance videos that might have recorded these events.

Dr. Sell and his wife, Mary, were arrested in May 1997 on charges of submitting false claims, including false documents and X-rays, to Medicaid and private insurers for dental services he did not provide. Dr. Sell would later say that his crime was filling teeth for poor people instead of extracting them.

Shortly after his arrest, federal prosecutors asked for a psychiatric examination of Dr. Sell, who was found competent to stand trial. He was indicted in July 1997 on 56 counts of mail fraud, 6 counts of Medicaid fraud and a count of money laundering.

Prosecutors asked to revoke Dr. Sell's bond in January 1998, saying that he had tried to intimidate a witness. At the first hearing before a federal magistrate, Dr. Sell screamed at the magistrate, using racial epithets. When she tried to continue the hearing, he shouted and spat in her face.

A psychiatrist who was treating Dr. Sell reported that the dentist was staying up night after night, expecting the F.B.I. to "come busting through the door," and that his mental condition was deteriorating. The psychiatrist recommended antipsychotic medications, and Dr. Sell was ordered detained.

The second indictment, for conspiring to murder and the attempted murder of a witness in the fraud case and an F.B.I. agent, came in April 1998.

By the following February, his lawyers said, Dr. Sell's behavior was becoming increasingly erratic, worsened, they said, by his time in prison. The lawyers, worried that their client might not be able to help in his own defense, were joined by the prosecutors in asking for a second hearing to determine whether Dr. Sell was competent to go to trial.

Dr. Sell's psychiatrist said he was not. At the government's request, Dr. Sell was examined at the Medical Center for Federal Prisoners in Springfield, Mo., and found mentally incompetent to stand trial.

On April 14, 1999, Dr. Sell was ordered hospitalized for treatment. That July, the court ordered that he be given antipsychotic drugs against his will but a month later it agreed to a delay, pending another hearing. The months turned to years.

Dr. Sell lost his dental practice and his $250,000 home in Creve Coeur, Mo. Mary Sell pleaded guilty to 10 counts of mail fraud in September 1998 and was sentenced in January 2000 to two years in prison.

In August 2000, another magistrate granted the government's request to medicate Dr. Sell by force. Dr. Sell's lawyers then began a series of appeals. In its decision not to rehear the case last May, the United States Court of Appeals for the Eighth Circuit split 5 to 4.

Theodore B. Olson, the solicitor general, said in his brief to the Supreme Court that the appeals court was correct in finding that the government had an essential interest in bringing Dr. Sell to trial, that there were no less intrusive means to do so and that antipsychotic medicine was appropriate for his condition.

Dr. Sell's lawyers argued that if the appeals court decision was allowed to stand, "a mentally incompetent individual will lose his right to refuse medication based solely on the government's unproven assertion that the individual is guilty of a nonviolent crime."

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