Pough v. State of Florida

FIRST D ISTRICT COURT OF APPEAL
S TATE OF FLORIDA
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No. 1D2025-2661
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R ODNEY POUGH,
Appellant,
v.
STATE OF FLORIDA ,
Appellee.
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On appeal from the Circuit Court for Gadsden County.
Christopher D. Bufano, Judge.
May 13, 2026
N EFF , J.
Rodney Pough appeals a final order authorizing the Florida
Department of Children and Families (“DCF”) to involuntarily
administer psychotropic medication to him as a forensic client
committed to Florida State Hospital pursuant to Chapter 916,
Florida Statutes. Upon review of the order and the transcript of
the hearing, we affirm.
Facts
Pough was found incompetent to proceed to trial on a felony
charge in Escambia County and committed to the DCF. He has
been a patient at Florida State Hospital since May 23, 2025. The
administrator of Florida State Hospital petitioned the circuit court

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pursuant to section 916.107(3), Fla. Stat. (2025), for an order
authorizing involuntary treatment, including the administration
of psychotropic medications, on the basis that Pough was clinically
incompetent 	to 	provide 	express 	and 	informed 	consent 	to
treatment.
At the September 24, 2025 evidentiary hearing, Scarlett Varn,
a nurse practitioner with fifteen years of experience at Florida
State Hospital and Pough’s attending provider, testified on behalf
of the State. Ms. Varn testified that Pough’s working diagnosis is
unspecified 	schizophrenia, 	with 	rule-outs 	of 	schizoaffective
disorder (bipolar type), bipolar disorder with psychotic features,
and personality disorder, and that without consistent medication
she cannot rule out these differential diagnoses. She described his
symptoms 	as 	including 	poor 	sleep, 	paranoid 	and 	persecutory
ideation, auditory and visual hallucinations—including persistent
command hallucinations of both a homicidal and suicidal nature—
and 	grandiosity 	with 	religious 	and 	sexual 	themes 	and
preoccupations.
Ms. 	Varn 	further 	testified 	that 	Pough 	has 	engaged 	in 	a
pattern of unwanted and inappropriate sexual advances toward
female staff, including a July 18, 2025 incident in which he pinned
a staff member in a stairwell and attempted to kiss her and
propose sexual engagement. He also struck another patient for
touching his drawings, resulting in an emergency treatment order.
During 	that 	emergency 	treatment 	period 	(August 	28 	through
September 	2, 	2025), 	Pough 	received 	olanzapine 	and 	his
inappropriate sexual behaviors notably decreased. Pough is not
currently 	taking 	any 	medication. 	Ms. 	Varn 	testified 	that 	his
prognosis without treatment is poor and with treatment is good.
Defense counsel did not cross-examine Ms. Varn.
Pough testified that he opposes forced medication, believes it
harms him, and prefers medical marijuana. He denied the sexual
assault allegations and conceded striking the other patient, though
he attributed that act to the other patient having assaulted him.
Following a brief argument from defense counsel, the trial
court granted the petition on the record. The judge followed up his
oral pronouncement with a written order titled “Order Approving

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Treatment.” This written order is a pre-printed form order that
follows the statutorily required language from section 916.107(3).
The judge checked the applicable boxes and signed the order.
Pough timely appealed.
Analysis
“A trial court’s order requiring a forensic client committed to
a state mental health facility to accept involuntary psychotropic
treatment must be supported by competent, substantial evidence.”
Miller v. N. Florida Evaluation & Treatment Ctr., 287 So. 3d 681,
684 (Fla. 1st DCA 2019) (citing Dinardo v. State, 742 So. 2d 287,
289 (Fla. 1st DCA 1998)).
I. Statutory Requirements
Section 916.107(3)(a)3., Fla. Stat., requires the trial court to
determine by clear and convincing evidence that: (1) the client has
a mental illness; (2) the treatment not consented to is essential to
the care of the client; and (3) the treatment is not experimental
and does not present an unreasonable risk of serious, hazardous,
or irreversible side effects. The court must also consider the client’s
treatment preference, the likelihood of adverse side effects, and the
client’s prognosis with and without treatment. § 916.107(3)(a)3.a.–
d., Fla. Stat.
The trial court’s form order expressly reflects consideration of
each of these statutory factors. Further, the hearing transcript
contains 	competent, 	substantial 	evidence 	for 	each 	of 	these
findings. Ms. Varn’s uncontroverted testimony established that
Pough suffers from a serious mental illness; that the requested
medications are essential to his care and to the safety of others;
that the medications are not experimental and do not present an
unreasonable 	risk 	of 	serious, 	hazardous, 	or 	irreversible 	side
effects, and that any side effects that do develop can be controlled;
that Pough’s preference is against medication (which the court
considered); and that his prognosis without treatment is poor and
with treatment is good. Thus, the statutory requirements are
satisfied and supported by competent, substantial evidence.
II. Constitutional Requirements

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Pough argues that the trial court’s order is constitutionally
infirm because the court made no explicit finding that he was a
danger to himself or others and therefore was required to—but did
not—conduct the four-factor analysis prescribed by Sell v. United
States, 539 U.S. 166, 180–82 (2003). We disagree.
A forensic client in state custody retains a significant liberty
interest 	under 	the 	Due 	Process 	Clause 	of 	the 	Fourteenth
Amendment 	in 	avoiding 	the 	unwanted 	administration 	of
antipsychotic drugs. Washington v. Harper, 494 U.S. 210, 221
(1990). The Sell framework governs only the narrow circumstance
in which the government seeks to involuntarily medicate a forensic
client solely for the purpose of restoring competency to stand trial.
Sell, 539 U.S. at 180-82; see also Howell v. State, 133 So. 3d 511,
523 (Fla. 2014) (observing that Sell applies in Florida in cases
involving the involuntary medication of forensic clients to restore
competency to stand trial). Where the court’s authorization of
involuntary treatment rests on independent grounds, such as the
defendant’s dangerousness or his clinical incompetence to make
his own medical decisions, the Sell analysis is not required. Sell,
539 U.S. at 181–82; Miller, 287 So. 3d at 685.
In Miller, this Court affirmed an involuntary medication order
even after concluding that the trial court had erroneously relied on
the original commitment order to establish dangerousness. We
held that the order was independently supported because the
defendant was not competent to make his own medical decisions
and medication was essential to his care, and that those findings
were 	sufficient 	to 	authorize 	involuntary 	treatment 	without
application of the Sell factors. Id.
The same is true here. The form order expressly found Pough
“clinically incompetent and/or has refused to give express and
informed written consent to treatment.” Ms. Varn testified that
Pough minimizes the severity of his mental illness, refuses all
conventional 	treatments 	under 	any 	circumstances, 	and 	lacks
meaningful 	insight 	into 	his 	condition 	or 	the 	gravity 	of 	his
circumstances. While Ms. Varn did not use the precise language
employed 	in 	Miller, 	her 	testimony 	establishes 	the 	functional
equivalent of clinical incompetence to make treatment decisions.

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This 	is 	the 	clinical 	incompetence 	ground 	this 	Court 	found
sufficient in Miller to bypass the Sell analysis.
Pough also contends the trial court gave insufficient weight to
his 	treatment 	preference. 	The 	statute 	requires 	the 	court 	to
consider 	the 	client’s 	preference, 	not 	to 	defer 	to 	it. 	§
916.107(3)(a)3.a., Fla. Stat. Pough’s stated preferred alternative,
medical marijuana, is not clinically indicated for a patient with
psychosis and is unavailable in the institutional setting. The court
was not required to credit that preference over the uncontroverted
clinical judgment of his treating provider.
Finally, we note that the record contains sufficient evidence of
dangerousness that independently supports the order, even in the
absence of an explicit written finding. Indeed, on this record, a
dangerousness finding would have been well-supported: Ms. Varn
testified—and Pough’s own concession confirms—that he struck
another patient. Ms. Varn further testified that Pough pinned a
female staff member in a stairwell and attempted to kiss her and
propose sexual engagement, and that female staff alter their daily
movements out of fear of him. While the United States Supreme
Court has recognized “a significant liberty interest in avoiding the
unwanted administration of psychotropic drugs,” Washington, 494
U.S. 	at 	221, 	a 	forensic 	client’s 	liberty 	interest 	in 	refusing
medication may be overridden where the safety of others is placed
at risk. Youngberg v. Romeo, 457 U.S. 307, 324 (1982) (“The State
also has the unquestioned duty to provide reasonable safety for all
residents 	and 	personnel 	within 	the 	institution.”). 	The
administrator 	of 	Florida 	State 	Hospital 	has 	a 	duty 	to 	his
employees and to the other forensic clients to provide a reasonably
safe environment. The law, as well as common sense, dictates that
a 	mentally 	incompetent 	person 	like 	Pough 	may 	not 	refuse
medication 	where 	the 	evidence 	demonstrates 	the 	requested
treatment 	will 	reduce 	the 	likelihood 	he 	will 	sexually 	assault
nursing staff or engage in violence against others. As stated in
Cruzan by Cruzan v. Dir., Missouri Dept. of Health, 497 U.S. 261,
280 (1990), “[a]n incompetent person is not able to make an
informed and voluntary choice to exercise a hypothetical right to
refuse 	treatment 	or 	any 	other 	right. 	Such 	a 	‘right’ 	must 	be
exercised for [him], if at all, by some sort of surrogate.” Here, that

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choice was properly made by the trial court, based on the evidence
before it, and in accordance with the statutory framework.
Conclusion
Competent, substantial evidence supports the trial court’s
findings under section 916.107(3)(a), Fla. Stat. The Sell framework
is not implicated because the involuntary medication order does
not rest solely on restoration of competency to proceed to trial. The
uncontroverted 	record 	establishes 	that 	Pough 	minimizes 	the
severity of his mental illness, refuses all conventional treatment
under any circumstances, and lacks meaningful insight into his
condition—the 	clinical 	incompetence 	ground 	this 	Court 	found
sufficient in Miller to authorize involuntary treatment without a
Sell analysis. We affirm.
A FFIRMED.
KELSEY and NORDBY , JJ., concur.
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Not 	final 	until 	disposition 	of 	any 	timely 	and
authorized motion under Fla. R. App. P. 9.330 or
9.331.
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Jessica J. Yeary, Public Defender, and Laurel Fletcher Mobley,
Megan 	Lynne 	Long, 	and 	Lori 	A. 	Willner, 	Assistant 	Public
Defenders, Tallahassee, for Appellant.
James Uthmeier, Attorney General, and Brandon M. Elyakim,
Assistant 	Attorney 	General, 	Tallahassee, 	and 	Kathi 	Lee
Kilpatrick, Department of Children and Families, Chattahoochee,
for Appellee.