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COMMISSIONER OF CORRECTION v. WILLIAM B. COLEMAN (SC 18721)
Rogers, C. J., and Norcott, Palmer, Zarella, McLachlan, Eveleigh and Harper, Js. Argued October 25, 2011--officially released March 13, 2012

William E. Murray, with whom were David McGuire and, on the brief, Aubrey E. Ruta and Michael T. Grant, for the appellant (defendant). Lynn D. Wittenbrink, assistant attorney general, with whom were Ann E. Lynch, assistant attorney general, and, on the brief, Neil Parille, assistant attorney general, George Jepsen, attorney general, and Richard Blumenthal, former attorney general, for the appellee (plaintiff). Martha F. Davis and Hope R. Metcalf filed a brief for Professors of Law, Human Rights and Bioethics as amici curiae.

Opinion

NORCOTT, J. Broadly stated, the issue raised in this appeal1 is whether the state of Connecticut may forcefeed an inmate who is engaged in a hunger strike as a form of protest. The defendant, William B. Coleman, appeals from the judgment of the trial court granting the application of the plaintiff, Theresa C. Lantz, the former commissioner of correction (commissioner),2 for a permanent injunction permitting the department of correction (department) to forcibly restrain and feed the defendant to prevent life-threatening dehydration and malnutrition. On appeal, the defendant contends that the trial court improperly determined that: (1) the state's interests outweigh the defendant's common-law right to bodily integrity; (2) the forcible administration of artificial nutrition and hydration to the defendant does not violate his right to free speech and privacy under the first and fourteenth amendments to the United States constitution; and (3) international law does not prohibit the force-feeding of the defendant. We disagree and, accordingly, affirm the judgment of the trial court. The record reveals the following relevant facts and procedural history. The defendant currently is serving a fifteen year sentence, execution suspended after eight years, with a maximum discharge date of December 30, 2012, at the McDougall-Walker correctional institution following his convictions on charges pertaining to his relationship with his ex-wife. On September 17, 2007, approximately two weeks after the Appellate Court issued its decision affirming his convictions, the defendant began a hunger strike. At that time, he weighed approximately 237 pounds. On January 9, 2008, by which time the defendant's weight had dropped to 162 pounds, the commissioner sought both a temporary and a permanent injunction authorizing the department to restrain and force-feed the defendant if it became medically necessary given the health risks associated with hunger strikes. In response, the defendant asserted several special defenses, including the common law, constitutional and international law grounds raised in this appeal.3 On January 23, 2008, the trial court granted the temporary injunction, with a trial set to follow on the permanent injunction. Following a trial to the court, the trial court granted the commissioner's application for a permanent injunction. In its memorandum of decision, the trial court found the following facts. ``[The defendant] has been determined to be mentally competent every time he has been evaluated during his incarceration. [He] has never been diagnosed as suicidal. He is presently engaged in a protest, taking the form of a hunger strike . . . protesting what he claims to be a broken family and criminal judicial system that led to his wrongful conviction. [The defendant] maintains that he is innocent of the

crimes of which he was convicted. [He] also insists that his conviction is a form of ongoing abuse to his two sons . . . with whom he has had no contact since his conviction in 2005, and who are in the sole custody of his ex-wife. Through his protest, [the defendant] wants to raise awareness of what he perceives to be the misuse and abuse of the criminal and family judicial system; in particular, the assertion of false criminal allegations in the context of divorce proceedings. ``The defendant clearly knows about the dangers of organ failure and death that could result from the refusal of nutrition, having had many discussions about such problems with [the department's] health staff and having heard the testimony at the temporary injunction hearing. [The defendant] insists that the termination of his protest does not depend on receiving anything from the [department], or the outcome of his habeas corpus proceedings4 or the outcome of this case. He is clearly willing to continue this protest with no goal, other than the vague one of publicizing his perception of defects in the justice system.'' The trial court also noted the following events that had ensued subsequent to its order granting the temporary injunction. Throughout the course of his hunger strike, the defendant's voluntary ingestion of nutrients and liquids has varied: at some points, the defendant has voluntarily consumed ice chips, milk, orange juice, coffee and tea, or a liquid nutritional supplement; at other points, he has refused to ingest food or liquids in any form. Approximately one year after his hunger strike began, the defendant stated that the strike ``need[ed] to be cranked up again,'' at which point he ceased all oral intake, including fluids. As a result of increasing signs of dehydration, on September 22, 2008, when the defendant's weight was just 139 pounds, Edward Blanchette, a physician and the clinical director of the department, determined that forced intravenous hydration was necessary to prevent death or irreversible harm. ``On October 16, 2008, [the defendant] said `I lost another [eight] pounds. I didn't think I would be going much longer,' and `I don't want to go to church but I'd like to see a priest.' Beginning that day, the defendant showed low values of potassium, which is an important electrolyte to regulate certain bodily processes, putting the defendant at risk for heart irritability and cardiac [arrhythmias]. The defendant weighed 129 pounds on October 17, 2008. On October 23, 2008, Blanchette determined that the defendant was at an ever increasing risk of sudden death or irreversible complications because of his hunger strike. Blanchette determined that it was necessary to place a nasogastric . . . tube through which liquid nutritional supplement would be given unless the defendant would agree to voluntarily accept at least some liquid nourishment. The defendant

declined, so a [nasogastric] tube was placed for the first time on October 23, 2008. ``[The defendant] had been told on a number of occasions that if he was to be force-fed, it would be through a [nasogastric] tube, which would be inserted through his nose and threaded down into his stomach. This is the simplest, safest method and the preferred procedure to provide artificial nutrition. The [nasogastric] tube utilizes the gastrointestinal system, and, in general, has fewer risks of complication than any other artificial nutrition method. Placing [a nasogastric] tube does not usually cause pain and is normally well tolerated. ``[Suzanne] Ducate [a physician and director of psychiatric services of the department] has never had any patient experience . . . great pain with the placement of a [nasogastric] tube. That includes patients of smaller stature than the defendant, as well as persons receiving a larger diameter [nasogastric] tube. The placement of a [nasogastric] tube is neither a difficult nor a risky procedure; doctors are trained in the placement of such tubes in their first year as medical students by practicing on each other. Serious complications from the placement of a [nasogastric] tube are rare. ``On October 27, 2008, a second [nasogastric] feeding was done. [The defendant] claims he suffered excruciating pain on each occasion. He refused to sip water, however, to facilitate the insertion of the tube into his large nasal cavities and down his throat. On each occasion, he twisted during the procedure and the [nasogastric] tube kinked on the first attempt but was successfully placed on the second attempt. Contrary to his assertion, he did not vomit. There was no perforation of his mucosa. A liquid nutritional supplement was inserted directly into [the defendant's] stomach via the [nasogastric] tube on each occasion. ``After the second feeding, [the defendant] resumed taking liquid nutritional supplements. . . . By December 1, 2008, he weighed 154 pounds. For the next two months, his weight was relatively stable. . . . Since the time he started taking nutritional supplements in late October of 2008, his health and appearance [had] improved markedly. But it is clear that [the defendant] may resume his fasting at any time and that, but for the [intravenous fluid] and [nasogastric] intervention, he would have died long before [the] trial [on the permanent injunction]. It is also clear that if the [department] lacked the legal means to force-feed him during his incarceration, he would starve to death before his sentence is completed. ``Inmates outnumber staff in Connecticut prisons and [the] staff carry no weapons inside the prison. Behavioral protests in a prison setting are not allowed by the [department] because of their negative impact on security and safety, having led to disturbances and riots

in Connecticut prisons in the past. When there is a death in a correctional facility, the facility is locked down, meaning that all normal activities such as showers, work, school assignments, religious services, recreational activities, visits and substance abuse programs cease, and often inmates are fed in their cells. ``Inmates expect [the department] staff to intervene and protect them and other inmates from harm and become upset when that does not happen. If correctional staff does not intervene when another inmate is harming himself, the staff will have difficulty with the inmates. It is [then Deputy Director Brian] Murphy's opinion that allowing [the defendant] to die via his hunger strike would adversely affect [the department] staff's ability to do their job safely and securely. ``Suicides and suicide attempts are considered security risks in prison, both to the life of the self-harming inmate as well as [to] other inmates. Inmates react when there is a suicide attempt or a suicide. When an inmate either attempts or commits suicide or other self-injurious behavior, other inmates require higher levels of counseling, and sometimes engage in the same types of behavior. Ducate is of the opinion that there is a greater than 70 percent likelihood that if [the defendant] were permitted to starve to death, there would be similar reactions as to other inmate suicides. Inmates would be distressed, would go on [hunger strikes] themselves, and would attempt suicide. She is also of the opinion that, with the media attention surrounding [the defendant's] protest, inmates would quickly find out [about the defendant's] death, regardless [of] whether it occurred at a prison or at a hospital, and the impact on other inmates in correctional facilities would be the same. She is of the opinion that if [the defendant] were permitted to starve himself, other inmates would mimic or copycat his behavior. ``Permitting the defendant in this case to die would also adversely impact staff morale. Inmate deaths upset [department] staff members, and allowing a healthy inmate to die would certainly lower staff morale. It is probable that some staff would require time off, would have to visit the employee assistance program for state employees, and would require counseling. Staff morale impacts security within correctional facilities. ``Even an inmate in just a generally weakened condition from [a] lack of nutrition presents a security issue in a correctional setting. Staff can be required to intervene for a variety of reasons, including increased vulnerability to other inmates. Monitoring a hunger striker requires a significant commitment of limited resources in a prison setting, causing additional security and order concerns. ``[Additionally] since September, 2007, a significant amount of medical and custodial staff time, and

resources ha[ve] been dedicated to caring for the defendant because of his self-induced hunger strike. He has taken an inordinate amount of Blanchette's and Ducate's time. Staff has been utilized to restrain or monitor the defendant on a frequent basis, impacting their ability to respond to another emergency in the prison. In addition, [the defendant] has been occupying, for much of the time since September, 2007, 1 of only 124 prison infirmary beds available in a correctional setting for approximately 20,000 inmates and needed for patients with mental health or physical ailments.'' On the basis of the foregoing facts, the trial court determined that the commissioner had met the burden of proof as to the application and that the defendant could not prevail on his special defenses. Accordingly, that court granted the commissioner's application for a permanent injunction. The trial court authorized the commissioner to treat the defendant by means of hospitalization, intravenous fluids and nourishment, nasogastric feeding, and any other health care measures medically necessary to preserve his life and health, by use of reasonable force if necessary. The court ordered the commissioner, however, to first inquire whether the defendant intends to physically resist and, until and unless he did so on any one occasion, not to restrain him for such procedures. This appeal followed. Additional facts will be set forth as necessary. We begin our analysis by reviewing the standard of review following the grant of a permanent injunction. ``A party seeking injunctive relief has the burden of alleging and proving irreparable harm and lack of an adequate remedy at law. . . . A prayer for injunctive relief is addressed to the sound discretion of the court and the court's ruling can be reviewed only for the purpose of determining whether the decision was based on an erroneous statement of law or an abuse of discretion. . . . Therefore, unless the trial court has abused its discretion . . . the trial court's decision must stand.'' (Internal quotation marks omitted.) Maritime Ventures, LLC v. Norwalk, 277 Conn. 800, 807

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Connecticut Law