from the United States District Court for the Eastern
District of Louisiana
JOLLY, HO, and ENGELHARDT, Circuit Judges.
C. HO, CIRCUIT JUDGE:
medication to ensure that a mentally troubled criminal
defendant is competent to stand trial implicates profound
liberty interests under the Due Process Clause. To protect
those interests, the Supreme Court has established a
four-prong test that prosecutors must satisfy before a court
may compel the medication of the accused. See Sell v.
United States, 539 U.S. 166 (2003).
date, however, neither the Supreme Court nor this court have
stated what burden of proof the government must carry under
the four-prong test. But our sister circuits overwhelmingly
agree that the government must establish the four factors by
clear and convincing evidence, and not just by a
preponderance of the evidence. The parties here agree as
well. We now join our sister circuits and adopt the same
burden of proof today.
it is not clear from the record what burden of proof the
district court applied here, and because of the sensitivity
of the interests involved, we vacate and remand so that the
district court can apply the clear and convincing evidence
James allegedly threatened to kill her aunt and uncle in
violation of 18 U.S.C. § 875(c). After she was arrested
and taken into custody, the district court held a hearing to
determine whether James was competent to stand trial, in
light of her stated belief that everyone involved in this
prosecution, including her own lawyer, was conspiring against
her. Prior to the February 7, 2018, hearing, James underwent
a court-ordered psychiatric and psychological evaluation
conducted by Dr. Tennille Warren-Phillips, a licensed
psychologist, at the Bureau of Prisons (BOP) federal
detention center in Houston, Texas. Dr. Warren-Phillips
diagnosed James with General Personality Disorder and
Obsessive-Compulsive Disorder, but nevertheless initially
concluded that she was competent to stand
attorney, however, was concerned about her own fraught
interactions with James. So she requested an independent
independent evaluation conducted by Dr. Loretta Sonnier, a
forensic psychiatrist, concluded that James was not
competent to stand trial. As reflected in her December 21,
2017 report, Dr. Sonnier diagnosed James with
"schizoaffective disorder, bipolar type"-a
condition marked by "fixed false beliefs" that
"affect her judgment." Dr. Sonnier further
concluded that psycho-tropic medication would be
"substantially likely" to render James competent to
hearing held on February 7, 2018, the district court found
James was not competent to stand trial.
was then sent to a medical facility in an effort to restore
her competency. Dr. Hayley Blackwood, a forensic
psychologist, informed the court of her conclusion that James
suffered from Delusional Disorder, Persecutory Type, and
would need to be medicated to stand trial. In a preliminary
letter submitted to the court, Dr. Blackwood said: "[W]e
believe there is an increased likelihood that with
[psychotropic medication], [James] could be restored to
competency to stand trial in the foreseeable future."
She repeated this conclusion in her full report to the court.
held an administrative hearing and reaffirmed Dr.
Blackwood's conclusions. Dr. Judith Cherry, who oversaw
the hearing, concluded that "[a]ntipsychotic medication
is  recognized as a safe and standard treatment for
Delusional Disorder. The evidence presented is clear, and
persuasive that involuntary treatment with antipsychotic
medication is medically appropriate and the only viable
option to restore Ms. James to mental competence to stand
consistently refused consent to be medicated. So the
government requested a hearing under Sell to
determine whether it could ...