The state can force a man acquitted of murder by reason of insanity to undergo electroconvulsive therapy, or shock treatment, to control his aggression, a state judge ruled yesterday.

Michael Lawrence, 33, admitted that he killed vacuum cleaner salesman Melchor Tabag in 1999, dismembered the body and disposed of it at a refuse station. A state judge found Lawrence not guilty in 2002 due to a mental disease and committed him to the Hawaii State Hospital.

Hospital staff had administered medication to control Lawrence's aggression, but it did not work, said Dr. Ernest Alaimalo, staff psychiatrist.

The state says Lawrence assaulted a doctor at the hospital on May 2. The doctor had just completed performing an annual physical examination on him when Lawrence punched the doctor eight to 10 times in the face and had to be pulled off the doctor, the state says.

An Oahu grand jury charged Lawrence with second-degree assault. The trial is on hold pending a determination of Lawrence's mental fitness.

His lawyer, Deputy Public Defender Jerry Villanueva, said the state switched to a different medication, which has been effective, and has taken other steps to prevent violent outbursts.

“;He's not actually attacked anyone since May 2, 2008. He's being monitored by staff, closely monitored,”; he said.

Alaimalo said the state stopped using the new medication in January because it posed a health risk by lowering Lawrence's white blood cell count. In the meantime, the staff keeps Lawrence in wrist restraints attached to another restraint around his waist and has him under one-to-one monitoring.

Alaimalo said shock treatment is only recommended in emergencies, when a patient poses a danger to himself or others.

“;We're kinda at the end of our rope,”; he said.

Shock treatment is primarily used to treat major depression but also is used to reduce aggression, for bipolar disorder and to treat mania, he said.

Circuit Judge Virginia Crandall says the state can force Lawrence to undergo shock treatment for one year.

If it wants to apply more treatment after that, the state will have to ask for another court order.