PHOENIX – Experts say anti-psychotic drugs likely will be the primary treatment for the suspect in the Arizona shooting rampage that wounded Rep. Gabrielle Giffords, as doctors try to make him mentally fit to stand trial.
It's not known whether Jared Lee Loughner will agree to take such medications. But if he refuses, prosecutors can ask a court to order that he be forcibly medicated.
Loughner will be transported in the coming days to a federal facility in Missouri after a judge ruled Wednesday that he's mentally incompetent to stand trial. The criminal case cannot resume until the judge determines Loughner understands the case against him.
Christopher Slobogin, an expert in criminal and mental health law at Vanderbilt University Law School, said anti-psychotic drugs are effective in restoring mental competency in at least three-fourths of cases.
"The bottom line is that he probably wouldn't have a right to refuse," said Slobogin, a co-author of the book "Psychological Evaluations For The Courts."
U.S. District Judge Larry Burns found Loughner incompetent to stand trial after the 22-year-old college dropout was examined by two mental health experts who concluded he suffers from schizophrenia.
One therapist found Loughner's mental health has declined in the past two or three years. He determined Loughner doesn't grasp the gravity of the charges and instead is fixated on inconsequential issues. The other therapist concluded Loughner suffers from delusions, gave nonsensical answers to questions and doesn't understand the role of judges or jurors.
Neither expert thought Loughner was faking his mental health problems. A hearing to revisit Loughner's mental competency is set for Sept. 21.
Loughner has pleaded not guilty to 49 federal charges stemming from the shooting, which wounded Giffords and 12 others and killed six people, including a 9-year-old girl and a federal judge.
Robbie Sherwood, spokesman for the U.S. attorney's office in Arizona, which is prosecuting Loughner, declined to say whether prosecutors were prepared to ask that Loughner be forcibly medicated if he refuses the drugs. "The process has to play out," Sherwood said.
A call and email to lead Loughner attorney Judy Clarke weren't immediately returned Thursday afternoon.
A 2003 U.S. Supreme Court decision allows for forcible medication to be used in restoring mental competency.
Under that decision, prosecutors must show a compelling interest is at stake, that forced medication would further that interest, and that less intrusive means are unlikely to result in similar results. The medication must be shown to likely make a defendant competent without doing harm or preventing the person from assisting his or her lawyers.
A prominent case in which forced medication was used was the Elizabeth Smart kidnapping in Utah in 2002.
One of the two people charged, Wanda Eileen Barzee, was deemed unfit to stand trial and rejected voluntary medication on religious grounds. But a judge had Barzee forcibly medicated with anti-psychotic drugs. Her competency was later deemed restored.
The other person charged in the kidnapping, Brian David Mitchell, was deemed competent for trial in federal court after twice being found unfit in a parallel state case. Mitchell refused treatment while at a state hospital, and a judge decided against forced medications for him.
Barzee is serving a 15-year sentence in a federal prison hospital in Texas. Mitchell was sentenced Wednesday to life in prison.
Restoring competency means that defendants understand the charges against them and can assist in their defense. A defendant, for instance, should be able to tell his or her lawyer that a witness who is testifying isn't being truthful about something so that the witness can be questioned about it.
Anti-psychotic drugs are the primary treatment for mentally incompetent defendants.
In cases where the drugs don't bring defendants back to competency, it's usually because they are resistant to the medication or suffer side effects that could range from headaches and constipation to diabetes and sudden death, Slobogin said.
Other treatments include therapy where people are taught how to change their ways of thinking, and education efforts where they learn how to cooperate with their lawyers.
Stephen J. Morse, a professor of law and psychiatry at the University of Pennsylvania, said most people charged in criminal cases who are deemed mentally incompetent to stand trial are restored to competency through treatment within six months.
"He's likely to be restored," Morse said of Loughner.