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At an evidentiary hearing in New Haven Superior Court last week, Public Defender Tom Ullmann pressed state psychiatrist Dr. Mark S. Cotterell on the specific steps he will follow in the event that Dr. Lishan Wang is forcibly medicated and subsequently has an adverse reaction.
Whether Dr. Wang will in fact be forcibly medicated, as a recent Connecticut Supreme Court decision found he can be, will be up to the U.S. Supreme Court.
The public defender’s appeals bureau has decided to seek a writ of certiorari before the nation’s highest court and has requested a stay of the state Supreme Court’s order that Dr. Wang be forcibly medicated. Senior Assistant State’s Attorney Eugene Calistro Jr. said at the hearing Thursday that the state’s appeals bureau has not yet responded to the public defender’s motion for a stay.
What this means for this groundbreaking murder case, one that has been ticking away for six years with no resolution, is that efforts to restore Dr. Wang to mental competency so that he might stand trial are again on hold. It is now up to the U.S. Supreme Court to decide if it will hear the Wang case. That decision could take months.
Dr. Wang, 50, was first charged in 2010 with the murder of Dr. Vanjinder Toor and the attempted murder of his wife outside their Branford condo. Dr. Wang was sent to Whiting Forensic Division of Connecticut Valley Hospital for evaluation, which back then declared him incompetent to stand trial.
He was later deemed competent to stand trial and represented himself until his competency was challenged about a year ago. Since then Dr. Wang has been back to Whiting, where he now resides, having again been declared incompetent against to stand trial..
To be declared mentally competent a defendant must be able to understand the charges against him and to assist his attorney in the case. So far Dr. Wang has had difficulty with both parts of the two-prong test. Competency is not the same as the criminal defense a person raises at trial.
Dozing off in Court
In court last Thursday, Dr. Wang paid no attention to the proceedings, staring at the ceiling lights, blinking his eyes repeatedly or seemingly dozing off. He never once looked at the judge or showed any signs of animation as he has done in the past.
The court session started 90 minutes late because Dr. Wang was not brought to New Haven on time. When he arrived, he was wearing a sweatshirt; his feet were shackled. He sat down at the defense table next to Ullmann and they shook hands.
While his appearance in court looked as if he were medicated, he was not. He has repeatedly refused to be medicated and has made his feelings known to the staff at the hospital, Dr. Cotterell said. Doctors have tried unsuccessfully to restore his competency through measures such as talk therapy. Wang does not believe he is mentally ill and says he will resist taking anti-psychotic drugs, such as Olanzapine, the drug now scheduled to be administered. This drug is used to treat schizophrenia.
Making His Needs Known
Dr. Cotterell has observed Dr. Wang’s personality for six years and after outlining the steps his hospital takes in administrating drugs and assuring Ullmann of the hospital’s protocol, he reminded Ullmann that his client is not shy when it comes to letting his feelings be known.
“With respect to Lishan Wang, he will bring to our attention every one of his concerns. He will not be shy about telling us if he doesn’t feel well. Will he actively resist? I hope we will not have to make it into a daily struggle in order to carry out the order of the court,” he said.
Monitoring Forced Medication
Superior Court Judge Thomas V. O’Keefe Jr. had ordered the evidentiary hearing in which Ullmann and Calistro questioned Dr. Cotterell about the medical monitoring process when and if it gets underway. Before the court session began, Judge O’Keefe observed that he was not a doctor.
“I will leave it up to Dr. Cotterell. I am going to listen,” he said of the hearing about to unfold. “I don’t know if an order is needed. Ullmann said he would have some requests after the testimony. Calisto told the judge, “I am not so sure there should be an order at this point,” he said, adding the Connecticut Valley Hospital would monitor Dr. Wang’s health. They would bring to the court 24 – 7 any problems,” he said. He also noted that Dr. Wang has his own health care guardian, Gail Sicilia, whom Judge O’Keefe appointed to the case. She was also in court.
Calistro went first, asking Dr. Cotterell if there had been any change in Dr. Wang’s mental status since the spring 2016. “Has his diagnosis changed?” Calistro asked. Dr. Cotterell said it had not, that he was still mentally incompetent.
And the hospital “will monitor any potential side effects, 24 – 7 as testified previously?” Calistro asked.
“Yes,” replied Dr. Cotterell.
And What About Blood Draws?
One issue not previously discussed was the drawing of blood, one of the ways in which doctors at the hospital test the impact of an anti-psychotic drug. Calistro asked if before the treatment began bloodwork would be taken. Cotterell said yes, “at the beginning of procedure, we need blood work.”
At a meeting last week with Dr. Wang, the blood work issue came up, Dr. Cotterell said. Dr. Wang, he said, “was opposed to it. He did not agree with need for it and he said that he would not cooperate.”
Calistro indicated in court that blood draws were not specifically addressed in the forced medication procedure.
“Would the court have to order forced blood draws?” he asked Dr. Cotterell.
“As treaters we would have to be totally transparent. To monitor we have to draw blood. If the treatment is to go forward it would be a necessary corollary and an inevitable part of the court’s decision.”
Cotterell also said that knowing Dr. Wang is concerned and knowing that the judge is interested in the course of treatment, he expected the hospital would be monitoring the impact of the medication “at least once a month.”
During this dialogue Dr. Wang did not open his eyes.
Calistro asked Dr. Cotterell if he had been able to discuss or obtain a personal or family history on Dr. Wang’s family cardiology.
“He has not shared that with us,” Dr. Cotterell said. Nor would Dr. Wang agree to an EKG. “He has decided not to cooperate with that,” he added.
In explaining the hospital process, Dr. Cotterell said after treatment is administered, “We monitor, whether adverse or beneficial,” a process that typically takes from four to six weeks. That is usually how long it takes to see possible change with a particular medication, he said.
So if the Wang case gets beyond the appeals and forced medication is underway, when would the hospital present the court with its first report as to whether the meds are working or not?
Cotterell said, “I fully expect the first full report would be about 60 days after the treatment. We would have provided the medication, done the monitoring and done our report.”
He added that if there were “any more serious effects, we would be in touch quickly with the health care guardian with what we are seeing….We might start on one medication and decide to consider another medication.”
Calistro had no further questions.
The Public Defender Makes His Case
Ullmann stood. He quickly asked Dr. Cotterell if there was “currently a monitoring protocol set by the examining team?”
Dr. Cotterell replied, “I am not sure we have reduced to writing what our standard practice is. Lots of people receive medication in a psychiatric hospital like Whiting.” He said patients are seen frequently by nurses and are invited to talk with staff. “We know when a person is taking a medication, we have to monitor if it is having a good effect or not. This is what we do. Every day, every week, every month at the hospital. It is what we do.”
Dr. Cotterell added that a number of clients – they are called clients, not patients – are under court order, usually by a probate court, to receive medication. It is ordered and administered. “This is not unusual for us to do that.”
Ullmann observed that “forced medication is what I am taking about. In this particular case, Dr. Wang will not voluntarily take the medication. Is there a special monitoring protocol for forced medication,” he asked.
The judge interjected, saying, “This is a hospital.”
Ullmann asked if Dr. Wang’s blood pressure will be taken every day. Dr. Cotterell replied, “There is a written protocol where weight, blood pressure are measured at least monthly. We will do what is appropriate at that time. We might check once a day or every other day. Maybe check their weight once a week.”
Ullmann also asked Dr. Cotterell what kinds of symptoms or improvements he would be looking for.
Dr. Cotterell discussed Dr. Wang’s organizational methodology, whether he talks about one topic and pivots to another. He also raised persecution issues Dr. Wang has discussed in the past. “Are those thoughts still there?” Dr. Cotterell asked.
Ullmann asked if he would be correct to assume the hospital starts off with low dosages and then increases them. Dr. Cotterrell replied that their standard is to “start low and go slow… We would not go above standard range unless we had to.”
Ullmann sought to determine specific dosages but Calistro objected saying this went beyond the monitoring process. Ullmann then asked if the doctor would contact the health guardian if there was a “readily observable spike?”
The judge interjected. “Spike of what,” he asked.
Dr. Cotterell said the hospital observes “the standard of care. If we know there is a court guardian we have contact, maybe in one day or two days. If it is something less bothersome, maybe in a few days. We have done this for decades. We know that we need to maintain contact with the person who ordered it. We are not going to sit on a serious side effect. It is not how we have done business and it is not how we are going to do business,” he said.
Health Guardian Testifies
The next witness was Sicilia, Dr. Wang’s court-appointed health care guardian. Ullmann asked if she had been present at a recent 90-minute interview with Dr. Wang. She said she had been. Medications were discussed. She said she expected to have monthly contact with the hospital staff. She also said she would file a report regarding her observations about Dr. Wang. She spent about two minutes on the stand.
Ullmann was not happy with the timeframe she outlined.
“I need to know that the court-ordered guardian will report to me every two weeks and to the court once a month. I am not looking to micro-manage the situation,” Ullmann added.
“You could have fooled me,” the judge retorted.
Ullmann noted that forced medication was an “unusual process” and that he would feel better with more reporting rather than less reporting.
After going back and forth, the judge observed that Dr. Wang is in a hospital staffed by doctors who are expert in their fields. Then the judge asked Sicilia if she would talk to Attorney Ullmann “every two weeks if he called you?” Sicilia replied, “Yes.”
The monitoring procedure was settled with an understanding but not a court order. The next Wang hearing was set for Dec. 7 in New Haven Superior Court when an update will be given on the status of the U.S. Supreme Court appeal.
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