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No Hearing Required for Emergency Dose of Antipsychotic Medication for Mississippi Prisoner

by David M. Reutter

On May 4, 2023, the U.S. Court of Appeals for the Fifth Circuit affirmed dismissal of a Mississippi prisoner’s claim that his due process rights were violated when a doctor dosed him without his consent with psychotropic medication.

Chaz Pinkston, the Court noted, had “a complex psychiatric profile,” one that “includes narcissistic personality disorder and a history of hunger strikes.” In 2016, he was housed in the medical unit at the state penitentiary in Parchman when he complained of a skin problem.

“Dissatisfied with the nurse’s response,” the Court recalled, “Pinkston began yelling, imitating animal noises, and kicking against his cell door” and “continued for more than three hours.” He also “threatened violence against medical staff,” the Court added, inciting fellow prisoners, “many of whom were also psychiatric patients,” to begin “to act similarly.”

Dr. Hendrick Kuiper, medical director at the prison for contracted healthcare provider Centurion Health, heard the disturbance from his office one floor below Pinkston’s cell. He went to the cell and asked the prisoner to desist. When he did not, Kuiper ordered Pinkston to receive two injections: Haldol, an antipsychotic, and Benedryl, an antihistamine as a prophylactic against any complication from the Haldol. After the injections, Pinkston went to sleep, and nearby prisoners quieted down.

Pinkston then filed a pro se civil rights suit in federal court for the Northern District of Mississippi against Kuiper. Proceeding under 42 U.S.C. § 1983, he alleged that forcibly medicating him violated his substantive due process rights. The district court agreed, and it entered final judgment for Pinkston. Dr. Kuiper appealed.

The Fifth Circuit began by noting that the “decision to medically intervene falls within the Eighth Amendment’s ambit.” Any injury resulting “in an alternative world” where the doctor made the opposite decision would be “reviewable under the deliberate indifference standard,” the Court said, so “[t]he standard for evaluating Dr. Kuiper’s decision and its consequences does not change merely because in this world, Dr. Kuiper made that decision differently.”

The parties and the district court, however, framed the dispute as a substantive due process claim under the Fourteenth Amendment, relying on Washington v. Harper, 494 U.S. 210 (1990), which found individuals possess a “significant interest in avoiding the unwanted administration of antipsychotic drugs.” That decision in turn was relied upon in Riggins v. Nevada, 504 U.S. 127 (1992), to recognize a pre-trial detainee’s Fourteenth Amendment interest in avoiding repeated injections over a six-month period. So based on those precedents, the district court found Dr. Kuiper was required to ‘hold a hearing before providing care to a plainly distressed Pinkston.”

But the Fifth Circuit found those precedents did not articulate “constitutional standards governing the isolated administration of a single dose of an antipsychotic in a threatening, time-sensitive prison situation.” It also found that under United States v. Lanier, 520 U.S. 259 (1997), it cannot “apply the Fourteenth Amendment’s due-process catchall when another, more specific constitutional provision applies.”

The Court then turned to determine whether an Eighth Amendment violation occurred. It found the “record is devoid of evidence that Dr. Kuiper subjectively disregarded significant risk to Pinkston.” To the contrary, Kuiper believed medicating Pinkston was necessary to avoid danger both to Pinkston and others. Injecting Benedryl to prevent risk of harm from Haldol “further supports our conclusion that Dr. Kuiper believed his actions [were] consistent with Pinkston’s medical need.”

Finally, the Court found that even if the Fourteenth Amendment applied, there would be no violation. It agreed with the holding in Hogan v. Carter, 85 F.3d 1113 (4th Cir. 1996), which approved a doctor’s administration of an emergency dosage of an antipsychotic medication to an enraged prisoner without a hearing.

Thus the district court’s order was reversed with instructions to enter judgment for Dr. Kuiper. At the Court, Pinkston was represented by attorneys from Rights Behind Bars in Washington, D.C. and Wilmer Cutler Pickering Hale and Dorr, L.L.P., in D.C. and Boston. See: Pinkston v. Kuiper, 2023 U.S. App. LEXIS 11136 (5th Cir.).  

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Related legal case

Pinkston v. Kuiper