# State of West Virginia ex rel. Aaron Jimmie Urban v. The Honorable David Hardy, Judge of the Circuit Court of Kanawha County

> West Virginia Supreme Court · November 12, 2025

URL: https://www.frixlaw.com/law-library/cases/11201777

## Case

- **Court:** West Virginia Supreme Court
- **Decided:** November 12, 2025
- **Precedential status:** Published
- **Opinion:** Opinion
- **Nature of suit:** Writ Application-Other
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/11201777

## How later opinions describe it (automated extraction)

- finding that pretrial detainee’s constitutionally protected liberty interest “in avoiding involuntary administration of antipsychotic drugs” can be overcome by an essential or overriding state interest

## Opinion text

IN THE SUPREME COURT OF APPEALS OF WEST VIRGINIA

September 2025 Term FILED
__________________ November 12, 2025
released at 3:00 p.m.
C. CASEY FORBES, CLERK
No. 24-547 SUPREME COURT OF APPEALS
__________________ OF WEST VIRGINIA

STATE OF WEST VIRGINIA EX REL. AARON JIMMIE URBAN
Petitioner,

v.

THE HONORABLE DAVID HARDY, JUDGE OF THE CIRCUIT COURT OF
KANAWHA COUNTY
Respondent.

____________________________________________________________

Petition for a Writ of Prohibition

WRIT DENIED
____________________________________________________________

Submitted: September 23, 2025
Filed: November 12, 2025

John Sullivan, Esq. John B. McCuskey, Esq.
Deputy Chief Public Defender Attorney General
Jesse L. James, Esq. Andrea Nease, Esq.
Assistant Public Defender Deputy Attorney General
Charleston, West Virginia Sandra M. Walls, Esq.
Counsel for the Petitioner Assistant Attorney General
Charleston, West Virginia
Counsel for the Respondent

SENIOR STATUS JUSTICE HUTCHISON delivered the Opinion of the Court.
SYLLABUS BY THE COURT

1. “‘A writ of prohibition will not issue to prevent a simple abuse of

discretion by a trial court. It will only issue where the trial court has no jurisdiction or

having such jurisdiction exceeds its legitimate powers. W. Va. Code 53-1-1.’ Syllabus

Point 2, State ex rel. Peacher v. Sencindiver, 160 W. Va. 314, 233 S.E.2d 425 (1977).”

Syl. Pt. 1, State ex rel. Healthport Technologies, LLC v. Stucky, 239 W. Va. 239, 800 S.E.2d

506 (2017).

2. “In determining whether to entertain and issue the writ of prohibition

for cases not involving an absence of jurisdiction but only where it is claimed that the lower

tribunal exceeded its legitimate powers, this Court will examine five factors: (1) whether

the party seeking the writ has no other adequate means, such as direct appeal, to obtain the

desired relief; (2) whether the petitioner will be damaged or prejudiced in a way that is not

correctable on appeal; (3) whether the lower tribunal’s order is clearly erroneous as a matter

of law; (4) whether the lower tribunal’s order is an oft repeated error or manifests persistent

disregard for either procedural or substantive law; and (5) whether the lower tribunal’s

order raises new and important problems or issues of law of first impression. These factors

are general guidelines that serve as a useful starting point for determining whether a

discretionary writ of prohibition should issue. Although all five factors need not be

satisfied, it is clear that the third factor, the existence of clear error as a matter of law,

should be given substantial weight.” Syl. Pt. 4, State ex rel. Hoover v. Berger, 199 W. Va.

12, 483 S.E.2d 12 (1996).

i
3. “‘The provisions of the Constitution of the State of West Virginia

may, in certain instances, require higher standards of protection than afforded by the

Federal Constitution.’ Syllabus Point 2, Pauley v. Kelly, 162 W. Va. 672, 255 S.E.2d 859

(1979).” Syl. Pt. 1, State v. Bonham, 173 W. Va. 416, 317 S.E.2d 501 (1984).

4. A circuit court’s ruling on involuntarily administering medication to

a defendant for competency restoration purposes must follow the four-part test established

in Sell v. United States, 539 U.S. 166 (2003): (1) first, a court must find that important

governmental interests are at stake; (2) second, the court must conclude that involuntary

medication will significantly further those concomitant state interests; (3) third, the court

must conclude that involuntary medication is necessary to further those interests; and (4)

fourth, the court must conclude that administration of the medication is medically

appropriate, i.e., in the patient’s best medical interest in light of his or her medical

condition.

5. The State has the burden of proof to demonstrate, by clear and

convincing evidence, that it has satisfied the four-part Sell test in a case where it seeks to

forcibly medicate a defendant solely to render that individual competent to stand trial.

ii
HUTCHISON, Justice:

The petitioner, Aaron Jimmie Urban, seeks a writ of prohibition to prohibit

the enforcement of an order entered by the Circuit Court of Kanawha County ordering that

he be involuntarily medicated for the purpose of competency restoration. In support of his

petition seeking extraordinary relief, the petitioner asserts that our state constitution

provides him with greater protections than those found in the federal constitution.

After finding the petitioner incompetent to stand trial on charges ranging

from grand larceny to child neglect creating a substantial risk of serious bodily injury or

death, among others, the circuit court ordered the petitioner committed to a state hospital

for competency restoration services. After the petitioner refused medication that his

treatment team believed would be beneficial in restoring his competency, the hospital

sought approval to involuntarily administer medication to the petitioner. By order entered

on September 20, 2024, the circuit court ordered that the hospital could involuntarily

medicate him for the purpose of competency restoration to stand trial.

After careful review of the record before us, the parties’ briefs and oral

arguments, and the applicable law, we find that the circuit court properly applied the test

found in Sell v. United States, 539 U.S. 166 (2003) to the facts of this case. Accordingly,

we deny the petitioner’s petition seeking a writ of prohibition.

1
I. FACTUAL AND PROCEDURAL HISTORY

During the January 2023 term of court, the petitioner was indicted by a

Kanawha County grand jury on charges of first-degree robbery, use or presentment of a

firearm during the commission of a felony, fleeing with reckless indifference to the safety

of others, child neglect creating a substantial risk of serious bodily injury or death, grand

larceny, and misdemeanor prohibited person in possession of a firearm. After failing to

appear for his initial arraignment, the petitioner was apprehended, and he appeared for his

arraignment on July 19, 2023. Statements made by the petitioner during his arraignment

caused the circuit court some concern about his competency, so the arraignment was

continued. Thereafter, counsel for the petitioner filed a motion for a competency

evaluation 1 and the circuit court ordered the petitioner to undergo an outpatient

psychological evaluation to determine his competency to stand trial.2

1
The motion indicated that the petitioner “may have mental health issues which
impact his ability to understand the legal issues in his case and participate in his own
defense.”
2
The circuit court asked the evaluator to determine:

(1) Is [the petitioner], by virtue of mental incapacity, unable to consult with
his attorney and to assist in the preparation of his defense with a
reasonable degree of rational understanding of the nature and object of
the proceedings against him? If so, is there a substantial likelihood that
he will attain such capacity within six months from [that] date?

(2) Was the [petitioner], on [the date of his alleged crimes], suffering from a
mental disease or defect to the extent that he lacked substantial capacity

2
At a hearing held on November 15, 2023, Steven Cody, Ph.D., provided

testimony about the petitioner’s competency evaluation that caused counsel to move for a

supplemental psychological evaluation, to which the State did not object. The circuit court

granted the motion and ordered that Dr. Cody conduct the supplemental evaluation.

Following the receipt of Dr. Cody’s supplemental psychological evaluation, the circuit

court found that the petitioner was “not competent to stand trial” pursuant to West Virginia

Code § 27-6A-1, which requires a criminal defendant to possess the ability “to consult with

his or her attorney with a reasonable degree of rational understanding, including a rational

and factual understanding of the procedure and charges against him or her.”3 In addition,

the circuit court found that there was “a substantial likelihood that the [petitioner] will

attain competency within the next ensuing ninety (90) days” and committed the petitioner

to William R. Sharpe, Jr. Hospital (hereinafter “Sharpe Hospital”) for competency

restoration services for a period not to exceed ninety days.4

either to appreciate the criminality (wrongfulness) of his conduct or to
conform his conduct to the requirements of the law?
3
The circuit court’s order with these findings was entered on January 19, 2024 in
the “Amended Order on Defendant’s Competency to Stand Trial.”
4
The circuit court’s order committing the petitioner to Sharpe Hospital for
competency restoration services was entered on January 19, 2024, but he was not admitted
to the hospital until March 14, 2024. In the interim, the petitioner asked his counsel to file
a motion seeking to allow him to proceed as a self-represented litigant, and the circuit court
held a hearing on the motion. Ultimately, the circuit court denied the petitioner’s motion.
3
The petitioner was admitted to Sharpe Hospital on March 14, 2024, for

competency restoration services. On June 7, 2024, the Chief Medical Officer at Sharpe

Hospital reported to the circuit court that “additional time was needed to attempt to attain

[the petitioner’s] competency to stand trial.” The circuit court agreed and ordered an

additional ninety (90) days of competency restoration services. On August 8, 2024,

Colleen M. Lillard, Ph.D., the Statewide Forensic Clinical Director, forwarded a request

by the petitioner’s attending psychiatrist at Sharpe Hospital, Dr. Aynampudi, seeking

approval to involuntarily medicate the petitioner.

According to the request, although the petitioner’s treatment team initially

felt that he would benefit from psychotropic medications, they did not prescribe the

medications because the petitioner was attending his competency group sessions, and he

had indicated his willingness to participate in an evaluation to determine whether he had

been restored to competency. Later, the petitioner refused to undergo that evaluation, and

he also refused to attend competency group sessions after May 16, 2024. Thereafter, the

petitioner’s treatment team prescribed paliperidone, a medication that it believed would

help his thought process. Although the petitioner took paliperidone “for a brief period,”

initially, he had since refused the paliperidone, which his treatment team believed would

help his thought process. The request noted that the petitioner had been diagnosed with

delusional disorder and included a detailed, proposed treatment plan, which initially

offered the petitioner paliperidone orally. The plan indicated that if the petitioner

continued to refuse this medication, he would be administered a long-acting injection of
4
paliperidone on a specific schedule. 5 The request noted that the petitioner lacked any

“comorbidities that would contraindicate psychiatric medications,” and identified the

potential side effects of paliperidone.6

The hearing on Sharpe Hospital’s request to involuntarily medicate the

petitioner took place on September 19, 2024. Both Dr. Aynampudi and the petitioner

testified. According to Dr. Aynampudi, the petitioner initially attended competency

restoration group sessions, but he stopped attending those on or about May 16, 2024. Dr.

Aynampudi further testified that the petitioner then refused paliperidone and also refused

to participate in his competency evaluation. These refusals led to Sharpe Hospital’s request

to involuntarily medicate the petitioner. As noted supra, under the proposed treatment

plan, the petitioner would be offered paliperidone orally, which Dr. Aynampudi testified is

an anti-psychotic medication that helps with delusions. If the petitioner refused the oral

medication, he would be given long-acting injectables. Dr. Aynampudi estimated that the

petitioner would receive a maximum of three injections. Dr. Aynampudi testified to a

reasonable degree of medical certainty that the petitioner would not be able attain

5
If the petitioner continued in his refusal to take paliperidone orally, he would be
given a long-acting injectable of paliperidone (234 mg) on Day 1. On Day 8, the petitioner
would be given another long-acting injectable of paliperidone (156 mg), and on Day 38
and every thirty days thereafter, he would be given another injectable of paliperidone (234
mg).
6
According to the request, the “side effects of Paliperidone include but are not
limited to nausea, vomiting, headache, constipation, and weight gain.”

5
competency without medication to treat his delusional disorder, and that with appropriate

medication, there was a substantial likelihood that competency could be restored within the

time remaining for the restoration of competency.7 The petitioner testified that he had been

misdiagnosed and confirmed that he was refusing the medication offered by his treatment

team. The petitioner also confirmed that he took the medication at issue on one occasion

and refused it thereafter because of the adverse side effects.8

By order entered on September 20, 2024, the circuit court granted the request

by Sharpe Hospital to involuntarily medicate the petitioner should he continue to refuse

treatment in order to regain competency to stand trial. In making its decision, the circuit

court relied upon the United States Supreme Court’s decision in Sell v. United States, 539

U.S. at 166, which sets forth a four-part test employed under the Due Process Clause of the

Fifth Amendment to the United States Constitution to determine whether mentally ill

criminal defendants may be involuntarily medicated to render them competent to stand

trial. On September 24, 2024, the petitioner filed the instant petition for writ of prohibition

7
West Virginia Code § 27-6A-3(g)(1) contains the following limitation with respect
to competency restoration: “a defendant may not be held in the mental health facility or
state hospital for a period longer than 240 days for competency restoration treatment.” We
note that during the September 19, 2024, hearing, there was a discussion about the time
remaining for competency restoration services for the petitioner. As the petitioner did not
assign error to the calculation, we do not address the time remaining for competency
restoration services here.
8
The petitioner testified that the medication made him feel “really tired and drowsy”
and it made him “not want to work out” or “get out of bed.”

6
seeking to prohibit enforcement of the circuit court’s order permitting Sharpe Hospital to

involuntarily medicate him.9 On March 13, 2025, we granted a rule to show cause and

scheduled this matter for oral argument.

II. STANDARD OF REVIEW

The petitioner asserts that the circuit court exceeded its legitimate powers by

ordering that he be involuntarily medicated for the purpose of competency restoration. “‘A

writ of prohibition will not issue to prevent a simple abuse of discretion by a trial court. It

will only issue where the trial court has no jurisdiction or having such jurisdiction exceeds

its legitimate powers. W. Va. Code 53-1-1.’ Syllabus Point 2, State ex rel. Peacher v.

Sencindiver, 160 W. Va. 314, 233 S.E.2d 425 (1977).” Syl. Pt. 1, State ex rel. Healthport

Technologies, LLC v. Stucky, 239 W. Va. 239, 800 S.E.2d 506 (2017).

Because the petitioner asserts that the circuit court exceeded its legitimate

powers, we are guided by our prior holding in State ex rel. Hoover v. Berger, 199 W. Va.

12, 483 S.E.2d 12 (1996):

In determining whether to entertain and issue the writ of prohibition
for cases not involving an absence of jurisdiction but only where it is claimed

9
Prior to the circuit court’s ruling at issue in the instant case, the petitioner,
proceeding as a self-represented litigant, filed an “Emergency Writ of Prohibition” in this
Court asserting, among other things, that (1) he was not arraigned within the proper
timeframe; and (2) he had refused the services of his court appointed counsel because he
was under a “Private Sector Partnership through Corporation aggregate in the National
Intelligence Community” and that he was only allowed to disclose “certain information to
authorized representatives of members pursuant to (The Classified Information Act).” By
order entered on December 6, 2024, we refused the petitioner’s writ.
7
that the lower tribunal exceeded its legitimate powers, this Court will
examine five factors: (1) whether the party seeking the writ has no other
adequate means, such as direct appeal, to obtain the desired relief; (2)
whether the petitioner will be damaged or prejudiced in a way that is not
correctable on appeal; (3) whether the lower tribunal’s order is clearly
erroneous as a matter of law; (4) whether the lower tribunal’s order is an oft
repeated error or manifests persistent disregard for either procedural or
substantive law; and (5) whether the lower tribunal’s order raises new and
important problems or issues of law of first impression. These factors are
general guidelines that serve as a useful starting point for determining
whether a discretionary writ of prohibition should issue. Although all five
factors need not be satisfied, it is clear that the third factor, the existence of
clear error as a matter of law, should be given substantial weight.

Id. at Syllabus Point 4.

With these standards in mind, we turn to the parties’ arguments.

III. ANALYSIS

The underlying facts that precipitated the petitioner’s request for

extraordinary relief are undisputed. On January 19, 2024, the circuit court entered an order

finding that the petitioner was not competent to stand trial. In addition, the circuit court

found that there was a substantial likelihood that the petitioner would obtain competency

within three months. Therefore, the circuit court committed the petitioner to Sharpe

Hospital for competency restoration services. On August 8, 2024, Sharpe Hospital sought

approval to involuntarily medicate the petitioner. After holding an evidentiary hearing, the

circuit court granted the request to involuntarily medicate the petitioner.

8
Before this Court, the petitioner contends that the circuit court lacked the

authority to enter an order permitting Sharpe Hospital to involuntarily medicate him for

competency restoration. He maintains that there is no judicial authority explicitly

authorizing circuit courts to issue an order regarding involuntary medication and the circuit

court’s reliance upon the four-part Sell test to conclude that he could be involuntarily

medicated was error. The State counters and argues that the statutory framework for

competency restoration provides circuit courts with the authority to order defendants to be

involuntarily medicated. The State further argues that the Sell test is the appropriate

method for deciding when a defendant can be involuntarily medicated for the purpose of

restoring his or her competency to stand trial.

A. Statutory Authority to Order the Involuntarily Administration of Medication

Initially, the petitioner contends that the circuit court lacked the authority to

enter the order at issue. We disagree. A review of the statutory framework regarding

competency restoration belies the petitioner’s argument. West Virginia Code § 27-6A-1

defines “competency restoration” as follows:

“Competency restoration” means the treatment or education
process for attempting to restore a criminal defendant’s ability
to consult with his or her attorney with a reasonable degree of
rational understanding, including a rational and factual
understanding of the court proceedings and charges against the
person. Competency restoration services may be provided in a

9
jail-based, outpatient, or inpatient setting as may be ordered by
the court.

With respect to competency restoration services, West Virginia Code § 27-

6A-3(d), provides circuit courts with the following authority:

If at any point in the proceedings the defendant is found not
competent to stand trial and substantially likely to attain
competency, the court of record shall in the same order, upon
the evidence, make further findings as to whether the
defendant, in order to attain competency, should receive
outpatient competency restoration services or if the attainment
of competency requires inpatient management in a mental
health facility or state hospital.

(emphasis added). There appears to be no dispute that the circuit court complied with this

statute. In its January 19, 2024, order, the circuit court found that the petitioner was not

competent to stand trial, and that there was a substantial likelihood that the petitioner would

“attain competency within the next ensuing three (3) months[.]” The circuit court then

ordered that the petitioner be committed to Sharpe Hospital.

Importantly, the circuit court committed the petitioner to Sharpe Hospital

pursuant to West Virginia Code § 27-6A-3. The medications and medical management of

individuals, such as the petitioner, who are court ordered to a state hospital pursuant to

West Virginia Code § 27-6A-3 are addressed in West Virginia Code § 27-6A-10, which

provides that:

10
[a]n individual with health care decision-making capacity may
refuse medications or other management unless court-ordered
to be treated, or unless a treating clinician determines that
medication or other management is necessary in emergencies
or to prevent danger to the individual or others: Provided , That
medication management intended to treat an individual’s
condition that causes or contributes to incompetency shall
constitute treatment.

(emphasis added).

This Court has held that in deciding the meaning of a statutory provision,

“[w]e look first to the statute’s language. If the text, given its plain meaning, answers the

interpretive question, the language must prevail and further inquiry is foreclosed.”

Appalachian Power Co. v. State Tax Dep’t of W. Va, 195 W. Va. 573, 587, 466 S.E.2d 424,

438 (1995); see also Syl. Pt. 2, Crockett v. Andrews, 153 W. Va. 714, 172 S.E.2d 384

(1970) (“Where the language of a statute is free from ambiguity, its plain meaning is to be

accepted and applied without resort to interpretation.”); and Syl. Pt. 2, State v. Epperly,

135 W. Va. 877, 65 S.E.2d 488 (1951) (“A statutory provision which is clear and

unambiguous and plainly expresses the legislative intent will not be interpreted by the

courts but will be given full force and effect.”).

We find that the plain language of West Virginia Code § 27-6A-10 permits

a circuit court to order the involuntary administration of medication to an individual under

certain specified circumstances. Although this statute does not include the term

“involuntary medication,” we find that it nonetheless authorizes circuit courts to order a

11
criminal defendant who has been deemed incompetent to stand trial to be medicated

regardless of his or her capacity to make health care decisions. The statute acknowledges

that individuals such as the petitioner may refuse medication unless one of the following

two circumstances is present: (1) the individual has been court-ordered to be treated; or (2)

a “treating clinician determines that medication or other management is necessary in

emergencies or to prevent danger to the individual or others.” Id. As the statute

contemplates, the petitioner in the instant case was court ordered to be treated, and we

conclude, therefore, that the circuit court possessed the authority to order the involuntary

administration of medication for competency restoration. For these reasons, we reject the

petitioner’s first argument.

B. The Sell Test

Having concluded that the circuit court had the statutory authority to enter

the order at issue, we now consider the petitioner’s argument that the circuit court’s reliance

upon Sell was misplaced because he is afforded higher standards of protection under the

West Virginia Constitution.

In Sell, the Supreme Court “considered the delicate balance between a

person’s liberty interests in being free from unwanted medication and the societal interest

in restoring to competency and bringing to trial a person accused of committing a serious

crime.” People In Interest of Joergensen, 524 P.3d 293, 295 (Colo. 2022). Although the

12
Supreme Court ultimately vacated an order authorizing the administration of antipsychotic

drugs in Sell, it set forth a four-part test under the Fifth Amendment’s Due Process Clause

that must be satisfied before the federal government can forcibly medicate a criminal

defendant for the purpose of rendering the defendant competent to stand trial.10 This four-

part test is as follows:

First, a court must find that important governmental interests are at
stake. . . . Second, the court must conclude that involuntary
medication will significantly further those concomitant state interests.
. . . Third, the court must conclude that involuntary medication is
necessary to further those interests. . . . [and] Fourth, [] the court must
conclude that administration of the drugs is medically appropriate,
i.e., in the patient’s best medical interest in light of his medical
condition.

Sell, 539 U.S. at 180-181.

The petitioner argues that the circuit court erred by relying on Sell because

the West Virginia Constitution affords him, as a criminal defendant, additional

constitutional protections that exceed the federal constitutional protections encompassed

in the four-part Sell test. We disagree and find the circuit court properly relied upon and

applied the Sell test.

10
The Fifth Amendment’s Due Process Clause applies only to the federal
government. It is the Fourteenth Amendment’s Due Process Clause that applies against
the States. However, the rights protected by the two due process clauses are co-extensive.
State ex rel. Riley v. Rudloff, 212 W. Va. 767, 778 n.12, 575 S.E.2d 377, 388 n.12 (2002).
13
When analyzing the first factor of the Sell test, the circuit court found, and

we agree, that the State’s interest in restoring the petitioner’s competency “qualifie[d] as

an important governmental interest” and that involuntarily medicating the petitioner

“would significantly further that interest based upon the likelihood that treatment would

expeditiously render the [petitioner] competent to stand trial and assist in conducting a

defense.” As we noted over fifty years ago, “the State has a legitimate interest in

determining the competency of a defendant to stand trial [and] [s]hould a defendant be

incompetent to stand trial, the State needs to be afforded an opportunity to restore the

defendant’s competency so that he may stand trial.” State ex rel. Walker v. Jenkins, 157

W. Va. 683, 689, 203 S.E.2d 353, 357 (1974); see also United States v. Bush, 585 F.3d

806, 813 (4th Cir. 2009) (“It surely is not an overstatement to observe that the government’s

ability to enforce the criminal laws in accordance with due process is the foundation on

which social order rests and from which individual liberties emanate. Thus, when an

individual commits a crime, he forfeits his liberty interests to the extent necessary for the

government to bring him to trial.”).

When analyzing the first Sell factor, the Supreme Court also recognized that

“[t]he Government’s interest in bringing to trial an individual accused of a serious crime is

important.” Sell at 180. According to his indictment, the petitioner is accused of, inter

alia, presenting a shotgun to an employee of 7-Eleven, Inc. during his first-degree robbery

of that establishment. This accusation clearly constitutes a “serious crime.”

14
With respect to the second Sell factor, the circuit court found that the

involuntary administration of medication “would significantly further” the State’s interest

in restoring the petitioner’s competency “based upon the likelihood that [the] treatment

would expeditiously render the [petitioner] competent to stand trial and assist in conducting

a defense.” This finding is supported by Dr. Aynampudi’s testimony that with appropriate

medication, there is a substantial likelihood that competency could be restored within the

time remaining for the restoration of competency.

The circuit court addressed the final two factors by finding that “the

medication is medically appropriate 11 and necessary 12 to further the State’s interest in

restoring the [petitioner’s] competency to stand trial.” The circuit court’s conclusion that

involuntary medication is necessary, requires a finding that “alternative, less intrusive

treatments are unlikely to achieve substantially the same results.” Id at 181. Dr.

Aynampudi’s uncontradicted testimony that the petitioner had stopped attending

competency restoration groups, had refused medication, and had refused to participate in a

competency evaluation supports the circuit court’s conclusion that the petitioner “had

stopped participating in all competency restoration therapies.” The petitioner’s refusal to

11
A finding that the administration of the medication is medically appropriate is the
fourth factor required in the Sell test.
12
The third factor of the Sell test requires a court to “conclude that involuntary
medication is necessary to further” the government’s interests. Sell, 539 U.S. at 181.
15
participate in less intrusive treatments demonstrates that those treatments are unlikely to

achieve the same results as the medication.

Importantly, before this Court, the petitioner does not assert that the circuit

court misapplied the Sell test, nor does the petitioner assert that the circuit court erred in

finding that that State satisfied the Sell test. Instead, he asks this Court to find that the West

Virginia Constitution requires greater protections than are required by the Sell test. The

enhanced guarantees to which the petitioner refers are the rights of “pursuing and obtaining

happiness and safety,” which are found in Article 3, § 1 of the West Virginia Constitution.

The petitioner correctly notes that these protections are not found in the United States

Constitution, and he also points out that this Court has recognized that “‘[t]he provisions

of the Constitution of the State of West Virginia may, in certain instances, require higher

standards of protection than afforded by the Federal Constitution.’ Syllabus Point 2, Pauley

v. Kelly, 162 W. Va. 672, 255 S.E.2d 859 (1979).” Syl. Pt. 1, State v. Bonham, 173 W. Va.

416, 317 S.E.2d 501 (1984). According to the petitioner, the right “of pursuing and

obtaining happiness and safety” is applicable to medical decisions and that “[e]very person

has a right to decide whether to take medication according to their own choices about the

impact it would have on their happiness and safety.”

We recognize that “[t]he forcible injection of medication into a

nonconsenting person’s body . . . represents a substantial interference with that person’s

liberty.” Riggins v. Nevada, 504 U.S. 127, 134 (1992) (quoting Washington v. Harper, 494
16
U.S. 210, 229 (1990)). However, as the State notes, the interest to refuse the unwanted

administration of antipsychotic medication is not absolute. See Washington v. Harper, 494

U.S. 210 (1990) (holding that a prison policy permitting the State of Washington to treat a

prison inmate who has a serious mental illness with antipsychotic drugs against his will, if

he is dangerous to himself or others and the treatment is in his medical interest, comported

with substantive due process requirements); Riggins v. Nevada, 504 U.S. at 134 (finding

that pretrial detainee’s constitutionally protected liberty interest “in avoiding involuntary

administration of antipsychotic drugs” can be overcome by an essential or overriding state

interest). Further, pursuant to Sell, it is possible for “a mentally ill defendant who is not

dangerous to himself or others within the meaning of Harper [] [to] be forcibly medicated

for the sole purpose of rendering him competent to stand trial.” U.S. v. Watson, 793 F.3d

416, 419 (4th Cir. 2015) (internal citation omitted).

Despite asserting that the West Virginia Constitution requires greater

protections than are required by the Sell test, the petitioner failed to propose any additional

procedures or factors that should be considered over and above those contemplated by the

Sell test.13

13
In response to questioning during oral argument, the petitioner identified
additional requirements that he believes should be required if this Court adopts the Sell
test. The petitioner argued, among other things, that this Court should apply the clear and
convincing standard of proof and require specificity in the circuit court’s findings regarding
medications. Except in extraordinary or exceptional circumstances, this Court,

17
As noted supra, the Sell test requires (1) a finding that important

governmental interests are at stake; (2) a conclusion that involuntary medication will

significantly further the concomitant state interests and that the administration of the

medication is substantially likely to render the defendant competent to stand trial without

side effects that will significantly interfere with the defendant’s ability to assist counsel;

(3) a finding that involuntary medication is necessary to further those interests; and (4) a

finding that the administration of the medication is medically appropriate. Sell at 180-181.

limit[s] a party to asserting the issues and arguments in an
appeal to those clearly set forth in a party’s brief … because
raising an issue or argument in an appellate brief provides the
necessary notice to both this Court and the opposing party as
to what they confront so each can adequately prepare and
discharge their respective responsibilities.

Argus Energy, LLC v. Marenko, 248 W. Va. 98, 103, 887 S.E.2d 223, 228 (2023). For
reasons that will be discussed, infra, we will address the proper standard of proof.
However, to the extent that the petitioner now seeks to assert that the circuit court’s order
was insufficient in some manner, we remind the parties that

A party seeking to petition this Court for an extraordinary writ
based upon a non-appealable interlocutory decision of a trial
court, must request the trial court set out in an order findings
of fact and conclusions of law that support and form the basis
of its decision. In making the request to the trial court, counsel
must inform the trial court specifically that the request is being
made because counsel intends to seek an extraordinary writ to
challenge the court’s ruling. When such a request is made, trial
courts are obligated to enter an order containing findings of fact
and conclusions of law. Absent a request by the complaining
party, a trial court is under no duty to set out findings of fact
and conclusions of law in non-appealable interlocutory orders.

Syl. Pt. 6, State ex rel. Allstate v. Gaughan, 203 W. Va. 358, 508 S.E.2d 75 (1998).
18
The Sell test is rigorous; it recognizes that involuntarily administering psychiatric drugs to

an unwilling person raises significant constitutional issues. Further, Sell, “requires an

individualized, fact-based examination of each case and each defendant.” Cotner v. Liwski,

403 P.3d 600, 605 (Ariz. 2017) (internal citation omitted). Although Sell permits forcible

medication when its test is satisfied, the Supreme Court cautioned that “those instances

may be rare.” Sell, 539 U.S. at 180. The petitioner has not identified how Sell is inadequate

under the West Virginia Constitution. We find that the rigorous Sell test satisfies the due

process standards articulated in the West Virginia Constitution.

For these reasons, we hold that a circuit court’s ruling on involuntarily

administering medication to a defendant for competency restoration purposes must follow

the four-part test established in Sell v. United States, 539 U.S. 166 (2003): (1) first, a court

must find that important governmental interests are at stake; (2) second, the court must

conclude that involuntary medication will significantly further those concomitant state

interests; (3) third, the court must conclude that involuntary medication is necessary to

further those interests; and (4) fourth, the court must conclude that administration of the

medication is medically appropriate, i.e., in the patient’s best medical interest in light of

his or her medical condition. Although we adopt the Sell test without expansion, we caution

that “[f]orcible medication is not justified every time an incompetent defendant refuses

treatment; on the contrary, ‘those instances may be rare.’” Watson, 793 F.3d at 419.

19
Having adopted the Sell test, we now turn to the proper standard of proof

required in cases involving the involuntary administration of medication for competency

restoration. Not having the benefit of any argument regarding the standard of proof before

it below, the circuit court applied the preponderance of the evidence standard of proof when

making its ruling during the September 19, 2024, hearing. Most other courts that have

examined this issue, though, have concluded that a higher threshold is mandated. See State

v. Holden, 110 A.3d 1237, 1243 (Conn. Supp. 2014) (“[M]ost courts in other jurisdictions

have required the government to prove the Sell factors by clear and convincing evidence.”).

The right to personal autonomy, including the right to make judgments about one’s medical

care is a highly prized (albeit not absolute) right under the federal and West Virginia

Constitutions. Baughman v. WalMart Stores, Inc., 215 W. Va. 45, 49, 592 S.E.2d 824, 828

(2003) (“The principle and right of personal autonomy and privacy is just as important as

the more traditional civil rights of freedom of assembly, speech, and religion.”).

Consequently, “[t]o ‘minimize[] the risk of erroneous decisions in this important

context,’[the Fourth Circuit Court of Appeals] set a deliberately high standard for the

government to satisfy before it may forcibly medicate solely to render an inmate competent

to stand trial.” Watson, 739 F.3d at 419-420 (internal citation omitted). This heavy burden

requires “‘evidence of such weight that it produces in the mind of the trier of fact a firm

belief of conviction, without hesitancy, as to the truth of the allegations sought to be

established,’ or ‘evidence that proves the facts at issue to be highly probable.’” Id at 420.

(internal citations omitted).

20
Given the important interests at stake and seeing no reason to depart from the

reasoning above, we likewise hold, as do most of our sister courts, that the State has the

burden of proof to demonstrate, by clear and convincing evidence, that it has satisfied the

four-part Sell test in a case where it seeks to forcibly medicate a defendant solely to render

that individual competent to stand trial. As stated, the circuit court did not apply the clear

and convincing standard, but only the preponderance standard. Ordinarily, when a trial

court applies an incorrect legal standard, the appellate court remands to the lower court

with directions for it to apply the proper standard. There is, however, a limited exception

to this rule. Where the evidence is such that it supports only one conclusion under the

proper standard, an appellate court may affirm without remanding. See Wright v. Lassiter,

921 F.3d 413, 418-419 (4th Cir. 2019) (“While we usually remand when the district court

has misapplied the relevant legal standard after a bench trial, we may affirm when the

evidence permits only one conclusion.”); see also Raleigh Wake Citizens Ass’n v. Wake

Cnty. Bd. of Elections, 827 F.3d 333, 345 (4th Cir. 2016) (quoting Pullman–Standard v.

Swint, 456 U.S. 273, 292 (1982)) (“[W]hen ‘the record permits only one resolution of the

factual issue,’ remand is unnecessary, and we may rule based on the record before us.”).

As discussed above, at the time the circuit court issued its ruling, it found

that the State had an important interest in bringing the petitioner, who is charged with

serious crimes, to trial. Further, the circuit court had the benefit of Sharpe Hospital’s

detailed, proposed treatment plan as well as the uncontradicted, expert testimony of Dr.

Aynampudi that there is a substantial likelihood that the petitioner’s competency could be
21
restored within the remaining allotted time if Sharpe Hospital could administer the

appropriate medication to the petitioner. Although Sharpe Hospital tried less intrusive

treatments such as competency group sessions, the petitioner refused those treatments after

approximately two months. Dr. Aynampudi also testified that paliperidone is an

antipsychotic medication that is appropriate for the class of disorders that encompasses

delusional disorder. Finally, the petitioner produced no expert evidence at the hearing to

contradict Dr. Aynampudi’s expert opinion (indeed, the petitioner produced no expert

testimony at all). Having carefully reviewed the record, we find that the only conclusion

that can be reached is that the State satisfied its burden by clear and convincing evidence.

For this reason, remand is unnecessary.

Based on the foregoing, we find that the petitioner is not entitled to the

extraordinary relief that he seeks. “Although all five [Hoover] factors need not be satisfied,

it is clear that the third factor, the existence of clear error as a matter of law, should be

given substantial weight.” Hoover at Syl. Pt. 4, in part. Having found no error, we also

find that the additional Hoover factors do not warrant consideration.

IV. CONCLUSION

The petition for a writ of prohibition is denied.

Writ Denied.

22

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/11201777. Public record. Not legal advice.