Com. v. Adames, A.

J-A24030-25 2026 PA Super 9

COMMONWEALTH OF PENNSYLVANIA : IN THE SUPERIOR COURT OF

: PENNSYLVANIA

Appellant :

:

:

v. :

:

:

ANGEL LUIS ADAMES : No. 310 MDA 2025

Appeal from the Order Entered February 5, 2025

In the Court of Common Pleas of Berks County Criminal Division at

No(s): CP-06-CR-0002761-2024

BEFORE: DUBOW, J., KUNSELMAN, J., and BECK, J.

OPINION BY DUBOW, J.: FILED: JANUARY 14, 2026

The Commonwealth appeals from the order entered in the Berks County

Court of Common Pleas on February 5, 2025, denying its Motion in Support of

Medication Over Objection.1 It contends that the court erred in concluding

that it did not present sufficient evidence to satisfy the factors outlined in U.S.

v. Sell, 539 U.S. 166 (2003), to support its request to involuntarily medicate

Angel Luis Adames (“Appellee”) so as to render him competent to stand trial.

Following our review, we are constrained to affirm.

We glean the relevant factual and procedural history from the certified

record. Appellee lived in an apartment in Spring Township that was on the

second floor of three-unit apartment building. Gregory S. Crammer rented

the first floor unit, from which Mr. Crammer ran his business. Over time,

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1 An order denying a state’s motion to compel psychotropic medication is

immediately appealable as a collateral order. Commonwealth v. Sam, 952

A.2d 565, 573 n. 10 (Pa. 2008).

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Appellee developed a belief that Mr. Crammer was a terrorist and, on the

evening of June 24, 2024, he decided to kill him. Accordingly, Appellee broke

into the building’s basement holding his semi-automatic handgun, forced his

way through the interior door leading into the first floor, and waited in Mr.

Crammer’s bathroom. When Mr. Crammer came to work the next morning,

Appellee shot and killed him. Appellee then called 911 and reported that he

had shot Mr. Crammer five times.

On June 28, 2024, the Commonwealth filed a criminal complaint

charging Appellee with murder, aggravated assault, and burglary. Appellee

subsequently underwent a psychiatric evaluation with Dr. Larry A. Rotenberg.

On September 10, 2024, at Appellee’s formal arraignment, the court

entered an order finding Appellee incompetent to stand trial based on the

psychiatric evaluation and report of Dr. Rotenberg. Pursuant to 50 P.S. §

7402(b) of the Mental Health Procedures Act (“MHPA”), discussed infra, the

court committed Appellee to Norristown State Hospital for involuntary

inpatient treatment for 60 days, beginning when he was transferred from

Berks County jail to the hospital. Prison officials transported Appellee on

October 15, 2024. The court scheduled a status hearing for January 9, 2025.

In December 2024, the hospital sent a letter to the court stating that

Appellee was incompetent to stand trial but requesting that the court order

the involuntary administration of medication over Appellee’s objections “for

the purpose of restoring competency.” Tr. Ct. Op., 4/16/25, at 1. The

Commonwealth filed a Motion in Support of Medication Over Objection on

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January 9, 2025. The Commonwealth did not attach the hospital’s letter to

its motion and the letter is not in the certified record.

The court heard evidence on the motion at the January 9, 2025 status

hearing. After the parties stipulated that Appellee was incompetent to stand

trial, the Commonwealth presented testimony from one of the police officers

who had responded to Appellee’s 911 call, and the court admitted the criminal

complaint into the record.

The court then qualified Dr. Rocio Nell-Badra (“Dr. Nell”), Appellee’s

treating psychiatrist at Norristown State Hospital, as an expert in forensic

psychiatry.2 Dr. Nell testified that she performed Appellee’s initial intake

evaluation and that she observes him every day more than once a day,

including at the daily morning group meetings when he chooses to attend.

She opined that, based on her evaluation, treatment, and experience as a

psychiatrist, Appellee suffers from a delusional disorder with paranoid

ideation.

Dr. Nell explained that Appellee clearly described the development of

his fixation on Mr. Crammer as a terrorist that became the focus of his thinking

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2 Dr. Nell has over fifty years’ experience in the medical field and became

board-certified in psychiatry in 1995, and board-certified in forensic psychiatry

in 2007. She has worked at Norristown State Hospital, where she served as

both the Director of Admission and Medical Director over a 12-year period,

then at the Mongomery County Emergency Service (“MCES”) as a psychiatrist

for 32 years, followed by 11 years at the county jail where she conducted over

2,500 criminal evaluations. She then returned to the forensic unit at

Norristown State Hospital where she has served as a psychiatrist for the past

8 years. N.T. Hr’g, 1/9/25, at 10-12.

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and his life which he believes justified his actions in killing Mr. Crammer. She

further testified that when she challenged Appellee on his distorted thoughts,

he incorporated her into his delusional system and now considers her and the

other medical staff to be terrorists. Dr. Nell opined that Appellee’s paranoid

ideation “makes him extremely dangerous.” N.T. Hr’g, 1/9/25, at 14.

As an example, Dr. Nell testified that just a few days before the hearing,

Appellee tried to incite a riot at the morning group meeting based on his

paranoid beliefs that the medical staff and anyone else who disagrees with

him is an enemy. She also testified that she “stopped that.” She also stated

that when she mentioned the upcoming hearing to Appellee, he told her “he

didn’t need any problem here.” Id. When she responded to him by

referencing the riot he tried to start on the unit, she testified that “he readily

admitted to it and said that was totally justified because you are a terrorist.

That’s his frame of mind. That’s his thinking. . . [and t]hat makes him

extremely dangerous.” Id.

She further testified that she has had him on constant “vigil observation”

since his attempt to cause a riot because she believes he “is capable of

planning things discreetly” and that she has been in fear for her and some of

her staff members’ lives. Id. She noted, however, that “the people that he

gets along with are providing the supervision and so far we have not had a

riot.” Id. at 14-15.

Dr. Nell further testified that she prescribed Zyprexa, an anti-psychotic

medication, in an attempt to treat Appellee’s delusional disorder, but Appellee

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refuses to take it. She opined that without medication Appellee’s likelihood of

successful treatment of his mental health disorder is “extremely poor,

guarded.” Id. at 15. She also opined that Zyprexa and other anti-psychotic

medications have been successful in treating individuals suffering delusional

disorders; however, she also opined that some paranoid delusions are more

difficult to treat “because of a strong component of narcissism and self-

centeredness” supporting “rigid ideation,” which she “believe[s] is a factor

here.” Id. at 16. She stated

So the idea is to start with one antipsychotic, see the effect that

it has, and then match with other medications, other

antipsychotics or mood stabilizers until we get the ultimate result.

So following that plan[,] the prognosis is much better if treated

but is not an absolute guarantee it would be effective.

Id.

Dr. Nell also testified that it is general practice to find the right

medication for each individual patient and make adjustments to “clear the

mind of the patient” so he “become[s] able to be in reality.” Id. at 17-18.

She opined that if treatment of his mental illness becomes successful with

appropriate medication and Appellee becomes competent to stand trial, the

medication would not interfere with his ability to aid in the defense of his case.

Id. at 17. Of most significance, however, the ADA did not ask Dr. Nell and

she did not opine that the medication was substantially likely to render him

competent to stand trial.

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Dr. Nell also testified that there are no less intrusive alternative methods

to treat Appellee’s mental illness and that the medication she has prescribed

for him is in his best interest because, as with all patients suffering paranoid

delusions, mental illness must to be treated, “[e]ven if the situation that they

are going to face [is] an unpleasant one[.]” Id. at 19 She concluded that

Appellee “is a severe risk to others, not to himself” because the “danger and

delusions are directed to others.” Id. at 22-23.

Following argument, the trial court took the matter under advisement.

On February 5, 2025, the court entered an order denying the Commonwealth’s

motion, concluding that the Commonwealth failed to meet the Sell

requirements necessary to overcome Appellee’s right to refuse medication

because Dr. Nell’s testimony could not support a finding that the medication

was “‘substantially likely to render the defendant competent to stand trial.’”

Order, 2/5/25, at ¶1.

The Commonwealth filed a motion to reconsider, asserting that it

presented sufficient evidence to involuntarily medicate Appellee because he

presents a danger to others. On February 24, 2025, the court summarily

denied the Commonwealth’s motion for reconsideration.

The Commonwealth appealed, raising the following issues for our

review:

A. Did the trial court err in denying the Commonwealth’s motion

in support of medication over objection as the involuntary

medication of [Appellee] over his objection was necessary to

become competent to stand trial?

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B. Did the trial court err in denying the Commonwealth’s motion

in support of medication over objection as the involuntary

medication of [Appellee] over his objections was necessary to

treat him as he is a danger to himself or others?

Appellant’s Br. at 4.

In its first issue, the Commonwealth argues that it presented sufficient

evidence to permit the involuntary administration of medication to render

Appellee competent to stand trial. Id. at 15. We review sufficiency challenges

under a de novo standard of review while viewing the evidence in the light

most favorable to Appellee. Commonwealth v. Chambers, 188 A.3d 400,

409 (Pa. 2018).

The involuntary medication of a defendant implicates a constitutionally-

protected liberty interest. Sell, 539 U.S. at 178; see also Sam, 952 A.2d at

585 (acknowledging that both the 4th Amendment of the U.S. Constitution and

Article 1, Section 8 of the Pennsylvania Constitution provide the right to be

free from “‘unreasonable’ intrusions” such as involuntary medication).

Accordingly, the Commonwealth carries the burden to prove by clear and

convincing evidence that the governmental interest in bringing a defendant to

trial overrides this constitutionally protected liberty interest. See In re

Hancock, 719 A.2d 1053, 1057-58 (Pa. Super. 1998) (in the context of the

Mental Health Procedures Act (“MHPA”), applying a clear and convincing

standard of proof to “help balance the need to provide mental health

treatment against the individual's rights by providing necessary treatment for

persons who are mentally ill.”).

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In Sell, supra, the U.S. Supreme Court provided a framework for courts

to apply when presented with a request to compel the involuntary

administration of medication to a mentally ill defendant to render the

defendant competent to stand trial for serious crimes. 539 U.S. at 169.

The Constitution permits the Government involuntarily to

administer antipsychotic drugs to a mentally ill defendant facing

serious criminal charges in order to render that defendant

competent to stand trial, but only if the treatment is [1] medically

appropriate, [2] is substantially unlikely to have side effects that

may undermine the fairness of the trial, [3] taking account of less

intrusive alternatives and [4] is necessary significantly to further

important governmental trial-related interests.

Id. at 179 (citing Washington v. Harper, 494 U.S. 210 (1990),3 and Riggins

v. Nevada, 504 U.S. 127 (1992)).

The first element of the Sell test is for the court to determine if there is

an “important governmental interest” that overrides the individual’s liberty

interests. Sell, 539 U.S. at 180. The Court broadly defined the government’s

interest as protecting society from dangerous criminals as well as its need to

provide expedient justice in a fair trial. Id. The Commonwealth has met this

requirement.

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3 In Harper, discussed infra, a state prison administered antipsychotic

medication to a severely mentally ill prisoner against his will and the prisoner

filed a civil rights action, claiming, inter alia, that the prison’s failure to provide

a judicial hearing before administering the medication violated the Due

Process, Equal Protection, and Free Speech clauses of the U.S. Constitution.

The U.S. Supreme Court determined that the prison did not violate Harper’s

constitutional rights because it followed state policy and procedures that

adequately protected his civil rights.

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With respect to the second prong, Sell requires courts to find that

“involuntary medication will significantly further those concomitant

[governmental] interests.” Id. at 181 (emphasis omitted). The Sell court

found that to satisfy this second prong, a court “must find that administration

of the drugs is substantially likely to render the defendant competent to stand

trial.” Id. (emphasis added). Competency to stand trial “involves

consideration of such matters as whether, once medicated, the inmate will be

able to communicate with counsel, react to trial developments, and express

emotions.” Sam, 952 A.2d at 574 n.12.

In Appellee’s case, there is no dispute that the Commonwealth’s interest

in bringing Appellee to trial for the serious and violent crime of pre-meditated

murder is important for the protection of society and to provide justice for the

victim’s family. With respect to the second Sell factor, however, the trial

court found that the Commonwealth did not establish that the involuntary

administration of medication was “substantially likely to render [Appellee]

competent to stand trial.” Tr. Ct. Op., 4/16/25 at 5; see Sell, 539 U.S. at

181.

Based on our de novo review, we are constrained to agree with the trial

court that the Commonwealth failed to present sufficient evidence to establish

that involuntarily medicating Appellee was substantially likely to render him

competent to stand trial. The Commonwealth failed to ask the question

directly, and Dr. Nell merely opined that Appellee’s prognosis is better with

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psychotropic treatment and that the medication would not interfere with his

ability to aid in his defense. She did not specifically testify that once

medicated, Appellant would be able to “communicate with counsel, react to

trial developments, and express emotions.” Sam, 952 A.2d at 574 n.12. In

other words, she did not conclude that there was a “substantial likelihood”

that the involuntary administration of medication would render Appellee

competent to stand trial. Accordingly, we are constrained to conclude the

Commonwealth failed to provide sufficient evidence to satisfy the second Sell

factor and the trial court properly denied the motion.

In its second issue, the Commonwealth argues that the court erred in

denying its motion to reconsider by failing to find that “due to the

dangerousness of [Appellee’s] delusion,” alternate grounds exist to compel his

involuntary medication. Appellant’s Br. at 20-21. The Commonwealth relies

on the Sell court’s observation that ”a court need not consider whether to

allow forced medication for [purposes of rendering a defendant competent to

stand trial], if forced medication is warranted for a different purpose, such as

the purposes set out in Harper related to the individual's dangerousness, or

purposes related to the individual's own interests where refusal to take drugs

puts his health gravely at risk.” Id. at 19-20 (quoting Sell 539 U.S. at 181-

82). The Commonwealth notes that “[w]hile at the time of the hearing

[Appellee] had not yet become aggressive, Dr.Nell[] opined that [Appellee]

was ‘extremely dangerous’ and he posed a ‘severe risk’ to others. In fact, she

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feared for her life and the safety of her personnel.” Appellant’s Br. at 22.4

Stated another way, the Commonwealth argues that it presented sufficient

evidence to establish that Appellee’s mental illness is likely to cause harm if

not treated with involuntary medication.

As an initial matter, we address whether the Commonwealth preserved

this issue for our review. Appellee argues that the Commonwealth waived

appellate review of this issue because its Motion in Support of Medication Over

Objection referenced only the Sell factors as a basis to order involuntary

medication and did not mention Appellee’s dangerousness as a basis for

seeking involuntary medication. Appellee’s Br. at 23-24. Based on our review

of the certified record and Sell, we reject Appellee’s request that we find the

issue waived. The Commonwealth presented evidence to the trial court at the

hearing on the motion that Appellee posed a danger to others; the Sell

opinion, in referencing Harper, acknowledges that dangerousness caused by

mental illness may be a ground for administering involuntary medication.

Accordingly, since the trial court had the opportunity to consider Dr. Nell’s

testimony that Appellee presented a danger to others, and the Commonwealth

asked the court to reconsider its order in light of that evidence, we conclude

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4 The Commonwealth also broadly asserts, without citation to the notes of

testimony, that Dr. Nell “was clear that no other treatment was available to

[Appellee] other than medication.” Id. at 21. Our review of the notes of

testimony reveal that other treatment options, such as cognitive behavioral

therapy and other non-pharmacological therapies, were never raised or

discussed during the hearing.

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the Commonwealth preserved the issue for appellate review. We also

conclude, however, that the issue garners no relief.5

The Harper court addressed only whether a state’s procedures which

allow for the involuntary medication of a dangerous mentally ill prisoner

protect that individual’s rights to substantive and procedural due process. 494

U.S. 213. In referencing Harper, the Commonwealth implicitly acknowledges

that there are due process requirements that must be met before confined

individuals whose mental illness presents a danger to himself or others may

be involuntarily medicated. In Pennsylvania, our legislature has provided

those requirements in the MHPA, so the issue before us is whether the

Commonwealth has complied with those requirements.

In this case, the trial court ordered that Appellee be held in Norristown

State Hospital pursuant to Section 7402(b) of the MHPA after concluding “with

reasonabl[e] certain[ty] that involuntary commitment will provide the

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5 The trial court summarily denied the motion for reconsideration without

providing its reasons for doing so. In its Rule 1925(a) Opinion, it observed

that the Commonwealth’s argument “is contradicted by its expert witness,

who testified that most patients are treated under Harper and that hospital

staff only request a Sell hearing when a patient does not present as overtly

aggressive.” Tr. Ct. Op., at 6-7. The court’s comment does not address the

issue of whether the court could have concluded Appellee’s dangerousness

allowed it to order involuntarily medication on that basis alone. We, however,

“are not limited by the trial court's rationale and may affirm its decision on

any basis” that is apparent from the record. Commonwealth v. Hunter, 60

A.3d 156, 162 n.18 (Pa. Super. 2013).

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Defendant with the capacity to stand trial.” Order, 9/10/24; 50 P.S. §

7402(b).

The MHPA also provides, however, that “[w]henever a person who is

charged with crime, or who is undergoing sentence, is or becomes severely

mentally disabled, proceedings may be instituted for examination and

treatment under the civil provisions of this act in the same manner as

if he were not so charged or sentenced.” 50 P.S. § 7401(a) (emphasis

added). The civil provisions of the MHPA that are applicable are set forth in

Sections 7301-7306.

Relevant to this appeal, Section 7304(b)(1) directs that to obtain court-

ordered involuntary treatment, the county administrator or director of the

hospital facility must petition the court of common pleas after following the

procedures provided in Section 7304(b)(2). Section 7304(b)(2) provides the

details that the county administrator or facility director must include in its

petition, instructs how a petition must be presented to the court, and

mandates when the court must hold a hearing after the petition is filed. Id.

at Sections 7304(b)(2) – (5).

Here, the Commonwealth failed to provide any evidence to the trial court

demonstrating that the hospital director or the county administrator followed

the procedures mandated by the legislature. Although the trial court

referenced a “letter” it received from the hospital, the Commonwealth did not

seek to admit that letter into the record and, as noted above, the letter is not

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in the certified record. Moreover, the Commonwealth did not reference any

Section 7401(b)(1) petition it submitted to support its Motion in Support of

Medication Over Objection or its Motion for Reconsideration. Accordingly, we

conclude the court did not err in denying the Commonwealth’s motion for

reconsideration.

We emphasize that we are not minimizing, and in fact are troubled by,

the risk that the defendant may pose to the staff at Norristown Hospital if he

is not medicated. The MHPA, however, properly imposes administrative

requirements before a court may order that a hospital involuntarily administer

medication and it is the responsibility of the Commonwealth to provide the

trial court with evidence that the hospital has complied. The Commonwealth

failed to do so in this case and thus, we are constrained to affirm the trial

court’s denial of the Motion to Administer Medication Over Objection.

In sum, following our review, we conclude that the court properly

concluded that the Commonwealth did not present sufficient evidence to allow

the court to find that the Commonwealth satisfied the Sell factors. Further,

because the Commonwealth provides no evidence that it sought involuntary

medication pursuant to Pennsylvania’s MHPA policy and procedures, we are

constrained to affirm the trial court’s order.

However, we are mindful that Appellee’s behavior, treatment, and

competency to stand trial may have changed over time and, thus, today’s

disposition is limited only to the resolution of the Commonwealth’s January 9,

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2025 motion and its February 24, 2025 motion to reconsider. Today’s order

is, accordingly, not subject to res judicata.

Order affirmed.

Judgment Entered.

Benjamin D. Kohler, Esq.

Prothonotary

Date: 01/14/2026

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