Case Title: Conley v. Commonwealth

Citation: 

Docket Number: 060120

State: virginia

Court: Virginia Supreme Court

Date: 2007-04-20T00:00:00Z

Document:
Present:  All the Justices 
 
MARK ANTHONY CONLEY 
 
OPINION BY 
v.  Record No. 060120 
      JUSTICE LAWRENCE L. KOONTZ, JR. 
 
  April 20, 2007 
COMMONWEALTH OF VIRGINIA 
 
 
FROM THE COURT OF APPEALS OF VIRGINIA 
 
 
In a jury trial held in the Circuit Court of Albemarle 
County, Mark Anthony Conley was convicted on one count of 
abduction with intent to defile, Code § 18.2-48, and two counts 
of forcible sodomy, Code § 18.2-67.1.  In this appeal, the sole 
issue we consider is whether the trial court erred in permitting 
a licensed clinical social worker to testify as an expert that 
Conley’s nephew (“the victim”), suffered from post-traumatic 
stress disorder (“PTSD”).1 
BACKGROUND 
 
Our resolution of the issue presented in this appeal does 
not require a recitation of the trial evidence that led to 
Conley’s criminal convictions.  It suffices to relate that the 
Commonwealth introduced evidence to support the allegations that 
Conley coerced the victim, who was under the age of thirteen at 
that time, into engaging in unlawful acts of oral sex.  The 
                     
1 We consider a similar issue with regard to expert 
testimony by a licensed professional counselor in Fitzgerald v. 
Commonwealth, 273 Va. ___, ___ S.E.2d ___ (2007) (this day 
decided). 
 
 
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focus of our analysis in resolving the issue presented is upon 
the challenged testimony at trial of the Commonwealth’s expert 
witness, Anna H. Vanhoy. 
 
Vanhoy is a licensed clinical social worker2 who provided 
treatment services to the victim, subsequent to Conley’s 
criminal acts, upon a referral by the child’s pediatrician.  
Prior to trial, the Commonwealth designated Vanhoy as an expert 
witness who would be asked to give an expert opinion that the 
victim suffered from PTSD.3 
 
Conley filed a motion in limine to exclude Vanhoy’s 
anticipated testimony.  Conley principally asserted in the 
motion, and thereafter during oral argument on it, that Vanhoy 
                     
2 A “[s]ocial worker” is “a person trained to provide 
service and action to effect changes in human behavior, 
emotional responses, and the social conditions by the 
application of the values, principles, methods, and procedures 
of the profession of social work.”  Code § 54.1-3700.  A 
“clinical social worker” is a “social worker who, by education 
and experience, is professionally qualified at the autonomous 
practice level to provide direct diagnostic, preventive and 
treatment services where functioning is threatened or affected 
by social and psychological stress or health impairment.”  Id. 
3 Post-traumatic stress disorder is a recognized mental 
disorder by the American Psychiatric Association in the 
Diagnostic and Statistical Manual of Mental Health Disorders.  
For purposes of our resolution of this appeal, PTSD is 
essentially a constellation of certain characteristic symptoms 
that manifest subsequent to a psychologically traumatic event 
that is outside the range of common experience. 
 
 
3
was not qualified to render an expert opinion that the victim 
suffered with PTSD because “she’s not a medical doctor.”4 
 
In response, the Commonwealth contended that Vanhoy 
possessed sufficient training, experience, and knowledge to 
testify as an expert regarding her diagnosis that the victim 
suffered with PTSD.  The Commonwealth conceded that Vanhoy could 
not give an expert opinion that the victim’s PTSD was caused by 
sexual abuse. 
 
The trial court denied Conley’s motion in limine, rejecting 
Conley’s assertion that only a medical doctor may qualify to 
render an expert opinion regarding the diagnosis of PTSD.  The 
trial court indicated that Vanhoy’s qualification as an expert 
would depend on a showing that she possessed sufficient 
expertise in the diagnosis and treatment of PTSD. 
 
At trial, the Commonwealth and Conley conducted extensive 
voir dire of Vanhoy regarding her qualification as an expert in 
the diagnosis and treatment of PTSD.  Vanhoy testified that 
currently she is a licensed clinical social worker who works 
with families and children as a private practice therapist.  Her 
testimony revealed that she received a bachelor’s degree in 
                     
4 Conley also contended in the motion in limine that 
Vanhoy’s testimony was inadmissible for lack of probative value, 
carried a high risk of prejudice, and would improperly address 
 
 
4
psychology and a master’s degree in social work, and her 
educational background involved “training towards making 
diagnos[es] of a variety of emotional disorders.” 
 
Regarding her experience with the diagnosis and treatment 
of PTSD, Vanhoy testified that during graduate school she took a 
family violence course where PTSD was “one of the more 
significant diagnoses.”  Also during graduate school she 
interned at a family violence and rape crisis center where she 
worked with victims of sexual trauma.  She estimated that over 
50% of the individuals she encountered there suffered from “all 
stages” of PTSD. 
 
Vanhoy further testified that after graduate school she 
worked for approximately two years in a family preservation 
clinic.  There, she performed in-home services with families and 
children in crisis, carrying a caseload of six families at a 
time.  Vanhoy related that some of the children she worked with 
had been sexually abused or had experienced episodes of 
violence, and estimated that 20% of the care recipients had 
PTSD. 
 
Continuing, Vanhoy testified that she worked for 
approximately two and a half years as a clinical social worker 
                                                                  
an ultimate issue of fact.  However, these assertions are not at 
issue in this appeal. 
 
 
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at a state hospital for children and adolescents.  In this 
setting, she provided evaluation and treatment for children who 
presented a large variety of psychological diagnoses.  She 
“mainly” performed psycho-social evaluations but “also ran 
support groups as well as carried some individual therapy 
clients.”  Vanhoy estimated that approximately 25% of the 
children she treated had PTSD.  Vanhoy stated, however, that 
since patients are often given a concurrent diagnosis where 
another disorder is given greater weight than PTSD, a “much 
greater number would have been impacted by PTSD.”  Vanhoy 
estimated that of the children she treated at the state 
hospital, between 50% and 75% of those were impacted by PTSD. 
 
Vanhoy testified that she subsequently entered private 
practice as a therapist.  In this capacity, she worked with an 
adult female with chronic PTSD and a “couple” of small children 
who were diagnosed with PTSD.  At the time of trial, Vanhoy 
practiced at a clinic implementing a “multi-disciplinary 
approach” to therapy.  Vanhoy testified that in this environment 
she encountered issues regarding various mental disorders, but 
only had one patient whom she would have diagnosed with PTSD. 
 
Vanhoy further testified that, in addition to her work 
experience, she regularly reviews scholarly literature on 
psychology, has done a presentation on borderline personality 
 
 
6
disorder, and has been on the board of directors of an agency 
that provides services to victims of domestic violence, sexual 
assault, and child sex abuse. 
 
On cross-examination during voir dire, Vanhoy testified 
that she had personally diagnosed six or seven cases of PTSD 
during her career.  Vanhoy conceded that she had never qualified 
to testify as an expert witness on PTSD or published any 
articles or scholarly works regarding PTSD, and that she cannot 
prescribe medication. 
 
At the conclusion of voir dire, the Commonwealth moved to 
qualify Vanhoy as an expert in the field of diagnosis and 
treatment of PTSD.  Over Conley’s objection, the trial court 
ruled that Vanhoy was qualified to testify as an expert 
regarding the diagnosis and treatment of PTSD. 
 
Upon direct examination during the trial, the Commonwealth 
elicited substantially the same testimony from Vanhoy regarding 
her educational background and professional experience.  Vanhoy 
then testified regarding her treatment of the victim, recounting 
that she first met with him ten months prior to trial after a 
referral from his pediatrician.  Beginning with the initial 
therapy session, Vanhoy recounted that she conducted therapy 
sessions with the victim approximately once a week and continued 
to do so until the time of trial. 
 
 
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Vanhoy testified that she initially diagnosed the victim 
with depressive disorder, but that since counseling with him 
over a period of time, she had “diagnosed him with [PTSD].”  
Vanhoy explained that PTSD is caused by a traumatic event such 
as “witnessing or experiencing violence, being in combat or a 
natural disaster,” or experiencing “physical or sexual abuse.”  
Vanhoy stated that the victim exhibited a “multitude” of the 
symptoms associated with PTSD. 
 
At the conclusion of the evidence, the jury found Conley 
guilty of the charged offenses.  By order entered on December 
16, 2005, the Court of Appeals denied Conley’s petition for 
appeal for reasons stated in a prior unpublished per curiam 
opinion.  Conley v. Commonwealth, Record No. 0097-05-02 (June 8, 
2005).  This appeal followed.5  [App. 157-158]. 
DISCUSSION 
 
Previously, we have not been called upon to address the 
particular issue whether a licensed clinical social worker may 
be qualified to render an expert opinion regarding the diagnosis 
of a mental disorder over the defendant’s objection.  Cf. 
                     
5 The Court of Appeals initially dismissed Conley’s appeal 
because he failed to timely file a transcript or written 
statement of facts.  Conley filed a petition for writ of habeas 
corpus in this Court seeking leave to file a delayed appeal to 
the Court of Appeals.  We granted the writ and Conley proceeded 
to file his appeal in the Court of Appeals. 
 
 
8
Johnson v. Commonwealth, 267 Va. 53, 66-67, 591 S.E.2d 47, 54 
(2004)(licensed clinical social worker, without objection, 
qualified as an expert regarding Dissociative Identity Disorder 
and borderline personality disorder).  However, the general 
principles pertaining to the qualification of an expert witness 
are well-established.  Generally, to qualify as an expert the 
witness needs only to have a degree of knowledge of a subject 
matter beyond that of persons of common intelligence and 
ordinary experience so that the witness’ opinion will have value 
in assisting the trier of fact in understanding the evidence or 
determining a fact in issue.  See Velazquez v. Commonwealth, 263 
Va. 95, 103, 557 S.E.2d 213, 218 (2002).  An expert witness may 
acquire the requisite knowledge of a subject matter through 
experience and observation in a variety of ways, including 
participation in a vocation, without formal training or 
education.  See Norfolk & Western Ry. Co. v. Anderson, 207 Va. 
567, 571, 151 S.E.2d 628, 631 (1966); Neblett v. Hunter, 207 Va. 
335, 339, 150 S.E.2d 115, 118 (1966).  Whether to permit a 
witness to qualify as an expert on a given subject matter is an 
issue submitted to the discretion of the trial court, and on 
appeal we will not reverse the trial court’s ruling in this 
regard unless it plainly appears that the witness was not 
qualified.  Atkins v. Commonwealth, 272 Va. 144, 153, 631 S.E.2d 
 
 
9
93, 97 (2006); Johnson v. Commonwealth, 259 Va. 654, 679, 529 
S.E.2d 769, 783 (2000). 
 
Notwithstanding these general principles regarding the 
qualification of an expert witness, Conley contends that we have 
established in Combs v. Norfolk & Western Ry. Co., 256 Va. 490, 
496-97, 507 S.E.2d 355, 358-59 (1998), and in John v. Im, 263 
Va. 315, 321, 559 S.E.2d 694, 697 (2002), that only a medical 
doctor may give an expert opinion regarding the cause of a 
physical human injury.6  Upon this premise, Conley contends that 
because only a medical doctor may give an expert opinion 
regarding the cause of a human injury and “causation of a human 
injury is a component part of a diagnosis” as we stated in 
Combs, 256 Va. at 496, 507 S.E.2d at 358, then it necessarily 
follows that a non-physician may not also render an opinion 
regarding any medical diagnosis.  Accordingly, Conley maintains 
that the trial court erred in qualifying Vanhoy as an expert in 
the diagnosis and treatment of PTSD and permitting her to give 
an expert opinion that the victim suffers with PTSD, regardless 
of any knowledge Vanhoy was shown to have gained by virtue of 
                     
6 In John, we noted that the holding in Velazquez is limited 
to the unique context of permitting a sexual assault nurse 
examiner to render an expert opinion regarding the cause of a 
victim’s injuries in a rape case.  See John, 263 Va. at 321 n.2, 
559 S.E.2d at 697 n.2. 
 
 
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her training and experience in diagnosing PTSD as a licensed 
clinical social worker. 
 
Conley’s reliance upon Combs and John is misplaced.  In 
Combs, we held that the trial court abused its discretion in 
permitting a biomechanical engineer to give an expert opinion 
regarding the cause of the plaintiff’s ruptured disc.  256 Va. 
at 497, 507 S.E.2d at 359.  Noting that “the question of 
causation of a human injury is a component part of a diagnosis,” 
and that the statutory definition of the “practice of medicine” 
contained in Code § 54.1-2900 includes making a “diagnosis,” we 
concluded that the question of causation of a human injury is 
part of the practice of medicine.  Id. at 496, 507 S.E.2d at 
358.  Thus, we held that only a medical doctor is qualified to 
give expert opinion regarding the cause of a human injury.  Id. 
at 496-97, 507 S.E.2d at 358-59. 
 
Subsequently, in John, consistent with our holding in 
Combs, we held that a licensed Ph.D. psychologist was not 
qualified to give an opinion that the plaintiff had suffered a 
“mild traumatic brain injury . . . as a result of the impact and 
the sudden acceleration-deceleration of her head” in a car 
accident.  263 Va. at 318, 321, 559 S.E.2d at 695, 697.  We 
again reasoned that an opinion regarding the causation of a 
particular human injury is a component part of a diagnosis, 
 
 
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which is a part of the practice of medicine, and because the 
psychologist was not a medical doctor, he was not qualified to 
give an expert opinion that the plaintiff had suffered a mild 
traumatic brain injury as a result of the accident.  Id. at 321, 
559 S.E.2d at 697. 
 
Combs and John initially may be distinguished factually 
from the present case in that those cases, unlike the present 
case, involve causation issues regarding physical human 
injuries.  PTSD, while arguably a form of human injury, is a 
mental disorder.  Moreover, we are of opinion that Combs and 
John do not, and were not intended to, establish a categorical 
rule in this Commonwealth that only a medical doctor may qualify 
to render an expert opinion regarding the diagnosis of PTSD or 
any other recognized mental disorder.  See Ward v. Commonwealth, 
264 Va. 648, 653, 570 S.E.2d 827, 831 (2002) (permitting 
testimony by a psychologist in a rape case as to the victim’s 
mental condition).  Additionally, we note that in the present 
case, unlike the circumstances in Combs and John, the proffered 
expert was not offered to testify regarding the cause of the 
victim’s diagnosed mental disorder. 
 
Beyond question, the diagnosis and treatment of mental 
disorders is not a field of expertise reserved exclusively to 
medical doctors.  Rather, the provision of mental health care 
 
 
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frequently occurs through other professionals who are educated 
and trained for the specific purpose of providing therapy to 
those with mental disorders.  See Jaffee v. Redmond, 518 U.S. 1, 
15-17 (1996) (“[t]oday, social workers provide a significant 
amount of mental health treatment”).  The particular category of 
mental health professionals at issue in this case pertains to 
clinical social workers who, under the relevant statutory 
scheme, in order to provide direct mental health services are 
required to be licensed by the Board of Social Work, a health 
regulatory board within the Department of Health Professions.  
See Code § 54.1-3706 (requiring those engaged in “the practice 
of social work” to be licensed); Code § 54.1-3703 (“the Board of 
Social Work shall regulate the practice of social work”); Code 
§ 54.1-2400(3)(including among the general powers and duties of 
a health regulatory board the licensure of qualified applicants 
to practice within a particular profession). 
 
By statute, a professional attaining a license and other 
qualifications prerequisite to becoming a clinical social worker 
may “provide direct diagnostic, preventive and treatment 
services where functioning is threatened or affected by social 
or psychological stress or health impairment.”  Code § 54.1-3700 
(emphasis added).  The language of Code § 54.1-3700 clearly 
authorizes a licensed clinical social worker to, among other 
 
 
13
things, diagnose mental disorders.  Furthermore, Code § 16.1-356 
authorizes licensed clinical social workers to perform 
competency evaluations for juveniles, an undertaking that 
involves making diagnoses of mental disorders and other 
conditions impacting mental health. 
 
Accordingly, we hold that licensed clinical social workers 
who are authorized to diagnose mental disorders by statute in 
appropriate circumstances, may render expert testimony regarding 
such diagnoses.  However, it remains incumbent upon the trial 
court to determine whether a particular licensed clinical social 
worker has the skill, knowledge, and experience regarding the 
pertinent subject matter to qualify as an expert. 
 
Thus, we turn to the issue whether in the present case the 
trial court abused its discretion in ruling that Vanhoy 
qualified to give an expert opinion regarding the victim’s PTSD 
diagnosis.  The record shows that Vanhoy held a bachelor’s 
degree in psychology and a master’s degree in social work.  Her 
graduate work as a whole involved “training towards making 
diagnos[es] of a variety of emotional disorders,” including 
PTSD, with one course in particular that focused on PTSD.  
Vanhoy regularly reads literature pertaining to the field of 
psychology, including PTSD. 
 
 
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Vanhoy’s years of work experience reflect her focus on the 
treatment of children and families in crisis, although she has 
treated adult individuals as well.  During her career she has 
diagnosed at least six patients with PTSD, but has worked with a 
far larger number of individuals in a variety of settings who 
had been diagnosed with PTSD. 
 
Vanhoy began treating the victim ten months prior to trial 
and met with him almost weekly up until trial.  During this 
process, she obtained information relevant to the victim’s 
mental condition and developed a list of symptoms from which she 
could make a diagnosis.  She based the victim’s PTSD diagnosis 
on the fact that he exhibited a “multitude” of symptoms of PTSD. 
 
The record clearly reflects that Vanhoy possessed extensive 
educational and occupational experience in the diagnosis and 
treatment of mental disorders, including PTSD.  Furthermore, she 
personally observed and evaluated the victim’s mental condition 
over a substantial period of time.  Thus, the record supports 
the conclusion that the trial court did not abuse its discretion 
in ruling that Vanhoy qualified as an expert to give her opinion 
regarding the victim’s PTSD diagnosis. 
CONCLUSION 
 
For these reasons, we hold that the Court of Appeals 
correctly held that the trial court did not err in allowing a 
 
 
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licensed clinical social worker to testify as an expert witness 
regarding her diagnosis that the victim suffered with PTSD.  
Accordingly, the judgment of the Court of Appeals will be 
affirmed. 
Affirmed.