On Wednesday, Judge Thomas O’Keefe Jr. ordered for Lishan Wang — who has been awaiting trial for the murder of Vajinder Toor since 2010 — to be forcibly medicated so he is mentally fit to stand trial.

Wang, who allegedly shot a Yale-New Haven Hospital postgraduate fellow in 2010, was deemed incompetent to stand trial and to represent himself in court by a panel of psychiatrists from the New Haven of Court Evaluations in April. The doctors found that Wang was suffering from psychotic symptoms and personality disorders including schizophrenia, “self-grandiosity” and “significant rigidity of thought.” Last month, Wang’s court-appointed health care guardian Gail Sicilia, and Mark Cotterell — a doctor at the psychiatric hospital  in which Wang has been treated — testified in favor of placing Wang on psychotropic drugs to counteract his delusions and enable him to stand trial. This motion, submitted on behalf of the state, was granted Wednesday, despite opposition from Wang and his attorney, Thomas Ullmann.

O’Keefe said his decision followed Spell v. United States, a 2003 U.S. Supreme Court precedent ruling that accused criminals can be forcibly medicated as long as stringent conditions are met.

“He’s extremely ill and we’re trying to return him to competency. This is the only alternative,” O’Keefe said. “It is with great reluctance and caution that I order this.”

Though Ullmann said he agrees that Wang is mentally ill, he said he will appeal O’Keefe’s decision because there are alternative, less invasive ways to bring Wang to competency.

Ullmann voiced concerns about the potential side effects of Olanzapine and Ziprasidene, the medication that would be used on Wang, and argued that a 50 to 70 percent efficacy rate does not constitute “clear and convincing evidence” — the legal standard for this motion to be granted — that Wang will be brought to competency.

“It is very difficult for medical personnel to give guarantees,” O’Keefe said, noting that such guarantees are not required. “I think a 50 to 70 percent success rate is a substantial likelihood of restoration.”

According to U.S. Supreme Court Justice Stephen Breyer’s Spell v. United States court opinion, forcibly medicating a defendant is only constitutional if the crime being trialed is serious, if the medication will not hinder the fairness of the trial and if there is clear and convincing evidence the defendant will be substantially more likely to be rendered competent after being medicated, among other conditions.

While Ullmann disagreed this threshold of evidence had been met, O’Keefe said he agrees with the doctors who said Wang’s medication is “necessary and medically appropriate.”

“I think it is substantially unlikely that the side effects will negatively affect the defendant’s ability to assist council,” O’Keefe said.

He added that Wang has not cooperated with health care providers while being treated at Whiting Forensic Division of Connecticut Valley Hospital

Eugene Calistro Jr. , who presented this claim in court Wednesday, said that while Wang can be polite and pleasant, he has also been known at the Hospital as “dismissive” and “argumentative,” and has accused Whiting staff of racial discrimination.

“Quite frankly this surprised me because my initial impression … is that Dr. Wang is intelligent, respectful, cooperative and doesn’t fit the image of the people who appear in court with this issues of competency,” O’Keefe said. “He is a rare case — he is the rare case that they talk about in Sell.”

Though Ullmann argued that this noncompliance is part of Wang’s mental illness, O’Keefe said forcible medication is the only remaining method to make Wang fit for trial.

O’Keefe granted Ullmann’s petition to stay his motion for 20 days and allow him time for an appeal to be filed.