Title: Commonwealth v. Waweru

State: massachusetts

Issuer: Massachusetts Supreme Court

Document:

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SJC-11784 
 
COMMONWEALTH  vs.  PATRICK WAWERU. 
 
 
 
Essex.     April 6, 2018. - July 31, 2018. 
 
Present:  Gants, C.J., Gaziano, Budd, & Kafker, JJ. 
 
 
Homicide.  Armed Home Invasion.  Armed Assault with Intent to 
Murder.  Assault and Battery by Means of a Dangerous 
Weapon.  Reckless Endangerment of a Child.  Constitutional 
Law, Admissions and confessions, Voluntariness of 
statement, Trial jury-waived.  Evidence, Admissions and 
confessions, Voluntariness of statement, Privileged 
communication, Communication between patient and 
psychotherapist, Insanity.  Psychotherapist.  Privileged 
Communication.  Insanity.  Practice, Criminal, Capital 
case, Admissions and confessions, Voluntariness of 
statement, Waiver, Motion to suppress, Instructions to 
jury, Presumptions and burden of proof, Acquittal by reason 
of insanity, Reasonable doubt, Trial jury-waived. 
 
 
 
 
Indictments found and returned in the Superior Court 
Department on November 28, 2007. 
 
 
A pretrial motion to suppress evidence was heard by David 
A. Lowy, J., and the cases were tried before Richard E. Welch, 
III, J. 
 
 
 
Richard L. Goldman for the defendant. 
 
Kenneth E. Steinfield, Assistant District Attorney, for the 
Commonwealth. 
 
2 
 
 
 
KAFKER, J.  A jury convicted the defendant, Patrick Waweru, 
of murder in the first degree on the theories of premeditation 
and extreme atrocity or cruelty, among other offenses.  The 
defendant's primary defense at trial was that he lacked criminal 
responsibility for the murder because he suffers from mental 
illness.  On appeal, the defendant argues error as to (1) the 
motion judge's denial of his motion to suppress statements made 
to a psychiatrist who interviewed him in the presence of police 
officers guarding him at the hospital; (2) the jury instructions 
regarding the presumption of sanity, the consequences of finding 
the defendant not guilty by reason of insanity, the failure to 
take prescribed medications, and reasonable doubt; and (3) the 
denial of his request for a jury-waived trial.  For the reasons 
stated below, we affirm.  After a thorough review of the record, 
we also decline to exercise our authority under G. L. c. 278, 
§ 33E. 
 
1.  Background.  We summarize the facts that the jury could 
have found at trial, reserving certain details for our 
discussion of the legal issues. 
 
The defendant was in an on-again, off-again relationship 
with the victim.  The couple had two children together.  The 
victim's sister occasionally lived with the victim and the 
defendant, but the sister did not get along with the defendant.  
3 
 
The victim's mother also lived with the victim and the defendant 
for a time. 
 
The defendant has a history of mental illness.  In 2002, he 
was diagnosed with bipolar disorder II and a personality 
disorder with impulsive features.  He received outpatient 
medical health care.  In 2005, he was hospitalized for taking an 
overdose of his prescribed psychiatric medications.  He reported 
feeling that he was being "mistreated by his girlfriend and the 
legal system."  During his hospitalization, the defendant was 
diagnosed with a major depressive disorder, but the hospital 
clinicians did not find sufficient evidence to substantiate a 
bipolar disorder II diagnosis.  In early 2007, he was 
hospitalized and again diagnosed with bipolar disorder.1  He was 
prescribed mood stabilizing medication, Depakote; an 
antipsychotic medication, Risperdal; and an antidepressant.  
During this hospitalization, he threatened to kill the victim. 
 
At the time of his arrest, the defendant was working two 
jobs, one as a residential counsellor for a mental health 
facility, and the other at a nursing home.  The victim's sister 
testified that when the defendant and the victim were fighting, 
the defendant would periodically say that "even if he killed 
[the victim's sister] or [the victim], nothing would happen to 
                                                 
 
1 The hospital diagnosis was not specific as to whether this 
was bipolar disorder I or bipolar disorder II. 
4 
 
him because . . . he was bipolar." 
 
In early 2007, the defendant moved out of the apartment he 
shared with the victim.  Around this time, he told the victim's 
mother, "When you get to Kenya, be prepared to receive two 
coffins, because I'm going to kill these daughters of yours.  
And I'm starting with [the victim's sister].  [She] will not 
raise my children.  Instead, they'll be raised by the [S]tate."  
Later the same year, the victim, her children, and her mother 
moved to Delaware, primarily to get away from the defendant.  
The victim's sister remained in Massachusetts. 
 
On the weekend of October 14, 2007, the victim, her 
daughters, and her mother returned to Massachusetts, ostensibly 
for a Housing Court appearance related to the apartment the 
defendant and the victim had previously shared.2  During their 
visit, they stayed in the victim's sister's one-bedroom 
apartment in Lynn. 
 
The victim left her sister's apartment in the early morning 
on October 15.  She and the defendant spent the day running 
errands.  Later that day, the victim and the defendant drove 
back to her sister's apartment.  The victim called her sister 
                                                 
 
2 No actual court appearance had been scheduled.  The 
defendant indicated to the defense's expert witness, a forensic 
psychologist, that he intended to "speak with a clerk about 
reassessing the decision that had been made by the Housing Court 
sometime earlier."  The Commonwealth has characterized this as a 
"ruse" to lure the victim back to Massachusetts. 
5 
 
from outside, at approximately 9:27 P.M.  Her sister told her to 
come inside.  When the victim entered the apartment a few 
minutes later, she locked the door behind her.  The victim's 
sister observed that the victim appeared "somewhat calm, but 
nervous at the same time."  The victim sat with the rest of her 
family in the living room and spoke with them, while the 
defendant continued to wait outside. 
 
Approximately one-half hour after the victim arrived, the 
defendant appeared at the front door to the apartment and 
shouted through the door that he wanted his cellular telephone 
(cell phone) back.3  When the victim's mother heard the 
defendant's voice, she quickly placed a chair against the door 
and sat on it.  The victim's sister told the defendant that he 
would get his cell phone back.  She called each of her neighbors 
in the building to help facilitate a transfer of the cell phone, 
but no one answered.  The defendant asked for his cell phone a 
second time, and the victim's sister again responded that he 
would get his cell phone back.  The victim's mother told the 
victim and her sister that they should call the police.  At some 
point, the victim's mother moved the chair away from the door.  
Not long after, the defendant broke through the door with a two-
                                                 
 
3 There is no indication in the record whether, or why, the 
victim may have had the defendant's cellular telephone. 
6 
 
by-four piece of lumber taken from outside the apartment.4  The 
victim's mother testified that the defendant said something to 
her, but she could not understand him.  The defendant 
immediately hit the victim's sister over the head with the piece 
of lumber.  He then grabbed the sister by the collar, but she 
managed to pull away.  She staggered out of the apartment and 
went upstairs, screaming for help.  The victim's four year old 
daughter followed her. 
The defendant hit the victim over the head with the same 
piece of lumber he had used to hit her sister.  The victim fell 
to the ground and was seemingly knocked unconscious.  The 
defendant took out a knife that he had hidden in his sock.  The 
victim's mother attempted to grab the knife, but cut herself 
when the defendant pulled away.  The defendant bent down and 
stabbed the victim twenty-four times in the back, the chest, the 
head, the neck, and the left arm.  During the attack, their one 
year old daughter was crawling between the defendant, the 
victim, and the victim's mother.  After stabbing the victim, the 
defendant fled the scene and disposed of the murder weapon in a 
cemetery. 
The victim's sister was able to reach one of her neighbors, 
                                                 
 
4 The landlord had placed two-by-four pieces of lumber just 
outside the front door of the victim's sister's apartment in 
order to make repairs. 
7 
 
who telephoned the police.  The victim was still alive when the 
police arrived, but died shortly thereafter.  The defendant was 
subsequently arrested at his apartment.  The arresting officers 
observed that the defendant appeared to be "under the influence 
of something."  The defendant told the officers that he had 
"[taken] some pills."  He was admitted to Union Hospital for 
treatment of a suicide attempt.  The defendant was placed in the 
intensive care unit under police guard.  A psychiatrist at the 
hospital, Dr. Maureen McGovern, performed a suicide risk 
evaluation on the defendant.  He could not remember the night of 
the murder, but told the doctor that the victim "was the cause 
of all his problems" and that "he had thoughts about hurting 
her."5 
 
At trial, the defendant did not contest that he killed the 
victim, but argued that he lacked criminal responsibility at the 
time of the murder.  Defense counsel called an expert witness, a 
forensic psychologist, who had performed a psychological 
evaluation of the defendant.  The expert diagnosed the defendant 
with bipolar disorder II, with "mixed characteristics of 
                                                 
 
5 Dr. Maureen McGovern testified that the defendant said he 
had thoughts about "hurting" the victim.  One of the police 
officers on guard in the defendant's hospital room testified 
that he overheard the defendant say he had thoughts about 
"killing" the victim. 
8 
 
depression and hypomania."6  The hypomania was exhibited by 
"restlessness" and "agitation," and the depression was exhibited 
by "subjective reports of depression . . . [and] difficulty 
sleeping." 
 
The defense's expert witness testified that the defendant 
had been depressed, in part because he felt that the victim was 
keeping him from seeing their children.  The defendant indicated 
to the expert that he was having trouble sleeping in the days 
leading up to the murder.  He had also stopped taking his mood 
stabilizing medication because "he had been feeling good." 
 
The expert testified that the defendant indicated his 
"spirits went up" on the day of the murder because the victim 
had indicated a willingness to stay with him for a period of 
time to "help to extricate him from the depression that he was 
experiencing."  This tentative plan would involve the victim 
going back to Delaware, gathering a few items for herself and 
the children, and returning to stay with the defendant. 
 
The defense expert testified that, on the night of the 
murder, after waiting for the victim outside her sister's 
apartment for approximately ten to twenty minutes, the defendant 
                                                 
 
6 The defense's expert witness defined hypomania as being a 
state with many of the same symptoms as mania, but lasting a 
shorter duration.  These symptoms include "a heightened sense of 
self-esteem, a lessened sense of the need for sleep, 
changeability in mood states, [and] agitation." 
9 
 
began thinking she was not coming back.  The defendant believed 
the victim's sister and mother would not allow him to go to 
Delaware with the victim.  He indicated to the psychologist that 
"his intent was to go down [to the sister's apartment] and get 
[the victim] so they could be on their way to Delaware." 
 
The defendant explained to the psychologist that he was 
carrying a knife in his sock in order to kill himself.  He could 
not recall what happened after he reached the front door of the 
sister's apartment.  Given the defendant's inability to recall 
the murder itself, the defense expert was unable to reach a 
definitive conclusion as to whether the defendant lacked 
criminal responsibility at the time of the murder.  However, the 
expert testified that "[the defendant's] behaviors are 
consistent with an inability to conform his behavior to the 
requirements of the law." 
 
The Commonwealth called its own expert witness on rebuttal, 
a forensic psychiatrist, who testified that he was not convinced 
that the defendant was bipolar, and did not believe that the 
defendant had a mental disease or defect at the time of the 
murder.  The Commonwealth's expert further stated, "There's 
nothing that, in my opinion, . . . resulted in the lack of 
substantial capacity to conform [the defendant's] conduct to 
requirements of the law."  He also indicated that individuals 
with bipolar disorder usually "don't have a pattern of violence 
10 
 
directed at others." 
 
A jury convicted the defendant of murder in the first 
degree, home invasion, armed assault with intent to murder, 
assault and battery of the victim's sister by means of a 
dangerous weapon, and wanton and reckless endangerment of a 
child.  He was acquitted of assault and battery of the victim's 
mother by means of a dangerous weapon. 
 
2.  Discussion.  a.  Admission of statement to 
psychiatrist.  Prior to trial, the defendant sought to suppress 
statements he made to a psychiatrist after the murder.  His 
motion to suppress was denied.  On appeal, the defendant argues 
that the motion judge erred in denying his motion because the 
statements were (1) involuntary; (2) protected by the 
psychotherapist-patient privilege; and (3) obtained in violation 
of his due process rights.  We address each argument in turn. 
 
We summarize the motion judge's factual findings, 
supplemented by testimony from the hearing that was credited by 
the motion judge.  See Commonwealth v. Walker, 466 Mass. 268, 
270 (2013).  See also Commonwealth v. Jones-Pannell, 472 Mass. 
429, 431 (2015).  On the night of the victim's murder, police 
went to the defendant's residence.  Officers knocked on the 
defendant's apartment door and heard a large crash.  The 
officers knocked on the door again and asked, "Are you all 
right?"  The defendant answered "I can't walk."  Officers heard 
11 
 
what sounded like someone falling, and entered the residence to 
find the defendant holding the door.  The defendant confirmed 
his identity to the officers.  He was on the floor with his legs 
tucked under him.  The motion judge found that the defendant 
"appeared intoxicated and had blood on his jean pants."  The 
officers placed the defendant in custody.  They asked the 
defendant if he had taken drugs, and he responded affirmatively.  
There were drugs and packets of Clonazepam in the area around 
the defendant. 
 
The defendant was taken to Union Hospital.  He appeared to 
be conscious but under the influence.  He was placed in a single 
room in the intensive care unit and shackled to a hospital bed.  
The defendant's toxicity screens came back negative, but he had 
to be intubated because he was "lethargic to the point that he 
could not protect his own airways." 
 
Two officers arrived at the hospital to secure the 
defendant and keep him under observation.  When they arrived, 
the defendant was lying down while somewhat propped up in the 
hospital bed.  The officers noticed that the defendant's eyes 
were closed at times.  They sat in chairs located inside the 
room, "past where the defendant was occupying the bed."  Various 
hospital personnel visited the defendant, and the defendant was 
able to respond appropriately to their questions.  At no point 
did the officers give the defendant Miranda warnings. 
12 
 
 
The physician who admitted the defendant asked an attending 
psychiatrist at the hospital, McGovern, to do a psychological 
consultation on the defendant.  McGovern spoke with the 
defendant more than twelve hours after his arrest and in the 
presence of the police officers.  During this conversation, 
McGovern was located on one side of the bed and the officers 
were seated on the other.  The officers did not, however, engage 
McGovern or the defendant in conversation. 
 
McGovern asked the defendant medical questions, but did not 
give him Lamb warnings.7  See Commonwealth v. Lamb, 365 Mass. 
265, 270 (1974).  His responses appeared to be appropriate to 
the questions asked.  The defendant did not slur his speech, 
appear injured, or complain of pain.  His vital signs were 
normal.  McGovern further observed that the defendant was quiet, 
subdued, calm, and cooperative.  She noted that the defendant 
had been medicated with a blood thinner and a medication to 
reduce stomach acidity.  Neither of these medications affected 
his mental state.  Although he appeared slightly drowsy, he was 
able to maintain attention throughout the thirty-minute 
interview with the psychiatrist.  McGovern believed that the 
                                                 
 
7 In Commonwealth v. Lamb, 365 Mass. 265, 270 (1974), we 
held that when a psychotherapist conducts a court-ordered 
examination of a defendant, the psychotherapist must warn the 
defendant that the communications are not privileged.  We note 
that McGovern was not conducting a court-ordered examination.  
See Commonwealth v. Seabrooks, 433 Mass. 439, 450-451 (2001). 
13 
 
defendant was "cognitively intact"8 and had a "thought process 
[that] appeared goal oriented."9  However, she was concerned 
about his emotional stability and worried that he might attempt 
suicide again.  She diagnosed him with depression, with elements 
of mania. 
 
During her evaluation, McGovern asked the defendant if he 
wished to harm himself or others.  He indicated that he wanted 
to harm himself, and stated, "Since Friday, I was thinking I 
wanted to kill my girlfriend because she's the cause of my 
problems." 
 
i.  Voluntariness.  First, the defendant argues that his 
statements to McGovern were not given voluntarily, because they 
were given as a result of the defendant's debilitated condition.  
We disagree.  The motion judge correctly found that the 
statements were voluntary. 
 
"An admission by a defendant to a civilian is only 
admissible if voluntarily made."  Commonwealth v. Anderson, 445 
Mass. 195, 204 (2005).  See Commonwealth v. Kolenovic, 478 Mass. 
189, 198 (2017).  An admission is voluntary if it was "the 
                                                 
 
8 McGovern testified that "cognitively intact" means that 
the defendant did not appear to be delirious or demented.  
Rather, he appeared to understand where he was and "his general 
fund of knowledge was average." 
 
 
9 McGovern testified that "goal oriented" describes a 
thought process in which the patient understands the questions 
being asked of him or her and gives appropriate answers. 
14 
 
product of a 'rational intellect' and a 'free will,' and not 
induced by physical or psychological coercion."  Commonwealth v. 
Harris, 468 Mass. 429, 434-435 (2014), quoting Commonwealth v. 
LeBlanc, 433 Mass. 549, 554 (2001).  Courts evaluate 
voluntariness based on the totality of the circumstances.  See 
Harris, supra at 435.  See also Commonwealth v. Mello, 420 Mass. 
375, 384 (1995).  "Statements that are attributable in large 
measure to a defendant's debilitated condition, such as insanity 
. . . drug abuse or withdrawal symptoms, . . . [or] intoxication 
. . . are not the product of a rational intellect or free will 
and are involuntary."  Commonwealth v. Allen, 395 Mass. 448, 455 
(1985).  See Commonwealth v. Bell, 473 Mass. 131, 141 (2015), 
cert. denied, 136 S. Ct. 2467 (2016). 
 
Here, the motion judge found that the statements were made 
voluntarily because the defendant was "emotionally stable, 
cognitively intact, calm and cooperative, and not influenced by 
drugs or alcohol" during his conversation with McGovern.  There 
was ample evidence to support the motion judge's conclusion.  
The defendant's toxicity screen was negative, the conversation 
took place over twelve hours after the defendant was arrested, 
and his speech was not slurred.  Based on her conversation with 
the defendant, McGovern observed that he understood where he was 
and was able to understand the questions being asked of him and 
respond appropriately.  See Commonwealth v. Brown, 449 Mass. 
15 
 
747, 767 (2007) (trial judge's finding that statement was 
voluntary was supported by testimony that defendant did not have 
trouble understanding questions his friends posed to him, and 
friends did not have trouble understanding his answers); 
LeBlanc, 433 Mass. at 555 ("Although the defendant was 
emotionally upset, he spoke calmly when giving his statement, 
and there is no evidence that he was acting irrationally").  
While McGovern noted that the defendant's "insight and judgment 
[were] poor," this was based on his suicide attempt, not his 
responses to her questions. 
 
Further, the defendant did not present any evidence 
indicating that his statements to McGovern were the result of 
threats, promises, or trickery.  See Commonwealth v. Allen, 395 
Mass. 448, 456 (1985).  Nor were the police required to provide 
the defendant with Miranda warnings, as his statements were not 
made in response to a police interrogation and McGovern was not 
acting as an agent of the police.  See id. 453-454.  See also 
Commonwealth v. Trigones, 397 Mass. 633, 643 (1986).  
Accordingly, we discern no error in the motion judge's 
determination that the defendant's statements were made 
voluntarily.10 
                                                 
 
10 Moreover, the trial judge gave the jury a humane practice 
instruction after the jury heard testimony about the defendant's 
statements to McGovern.  The judge instructed the jury, in 
 
16 
 
 
ii.  Psychotherapist-patient privilege.  The defendant 
argues that his statements to McGovern were protected by the 
patient-psychotherapist privilege set forth in G. L. c. 233, 
§ 20B.  The statute provides:  "[I]n any court proceeding 
. . . , a patient shall have the privilege of refusing to 
disclose, and of preventing a witness from disclosing, any 
communication, wherever made, between said patient and a 
psychotherapist relative to the diagnosis or treatment of the 
patient's mental or emotional condition."  The motion judge 
determined that because the defendant's statements were made in 
the presence of two police officers, the privilege did not 
attach or, to the extent it did, the defendant had waived it.  
We review for prejudicial error.  See Commonwealth v. Dung Van 
Tran, 463 Mass. 8, 16 (2012).  We conclude that the privilege 
did attach and was not waived by the presence of the police 
officers, but also that there was overwhelming evidence of the 
defendant's premeditation and any error in the admission of 
McGovern's testimony would not have been prejudicial. 
 
A.  Waiver.  Under G. L. c. 233, § 20B, the 
psychotherapist-patient privilege attaches to any communications 
                                                                                                                                                             
relevant part, as follows:  "[B]efore you can consider [the 
defendant's statement], the Commonwealth has to prove to you 
. . . beyond a reasonable doubt, that the defendant's statement 
was voluntarily made[,] that is, that it was made as a product 
of his own free will and rational intellect." 
17 
 
between a "patient and a psychotherapist relative to the 
diagnosis or treatment of the patient's mental or emotional 
condition."  In communicating with McGovern for the purpose of a 
suicide risk evaluation, the defendant met the statutory 
definition of "patient"11 under § 20B, and McGovern, as a 
licensed, practicing psychiatrist, met the statutory definition 
of "psychotherapist."12  The suicide risk evaluation was also 
specifically targeted at diagnosing and treating the defendant's 
"mental or emotional condition."  Id.  Thus, the defendant's 
communications with McGovern during the suicide risk evaluation 
met the statutory requirements for the psychotherapist-patient 
privilege to attach.13 
                                                 
 
11 Under G. L. c. 233, § 20B, "patient" is defined as "a 
person who, during the course of diagnosis or treatment, 
communicates with a psychotherapist." 
 
 
12 Under G. L. c. 233, § 20B, "psychotherapist" is defined 
in relevant part as "a person licensed to practice medicine, who 
devotes a substantial portion of his time to the practice of 
psychiatry." 
 
 
13 The motion judge indicated that the psychotherapist-
patient privilege requires a "confidential relationship" before 
it can attach.  Although our prior cases have discussed the 
requirement that a "confidential relationship" exist between the 
patient and the psychotherapist, this was specifically in 
reference to the issue whether the person to whom the statement 
was made meets the statutory definition of "psychotherapist."  
See Commonwealth v. Mandeville, 386 Mass. 393, 409-410 (1982).  
A confidential relationship exists, such that the 
psychotherapist-patient privilege applies, whenever the 
statutory requirements of G. L. c. 233, § 20B, are met.  See 
Robinson v. Commonwealth, 399 Mass. 131, 135 (1987); 
 
18 
 
 
The Commonwealth contends that that the privilege was 
nonetheless waived because the communications between the 
defendant and McGovern were made in the presence of the police 
officers guarding the defendant in the hospital.  The statute 
contemplates that a patient may choose to waive the privilege.  
See G. L. c. 233, § 20B ("If a patient is incompetent to 
exercise or waive such privilege, a guardian shall be appointed 
to act in his behalf under this section" [emphasis added]).  
However, no explicit waiver occurred here.  Thus, we must 
determine whether the presence of police officers constituted a 
waiver, absent the patient's affirmative consent to waive the 
privilege. 
 
In interpreting the psychotherapist-patient privilege and 
the issue of waiver, we must look first to the text of the 
statute itself.  See Commonwealth v. Vega, 449 Mass. 227, 230 
(2007).  See also Usen v. Usen, 359 Mass. 453, 457 (1971) ("We 
are not free to water down the legislative policy embodied in 
[G. L. c. 233, § 20B,] by loose construction or by giving our 
approval to informal procedures different from those 
prescribed").  The plain language of G. L. c. 233, § 20B, does 
not waive or restrict the availability of the privilege based on 
the presence of others or the particular location.  To the 
                                                                                                                                                             
Commonwealth v. Clemons, 12 Mass. App. Ct. 580, 584 n.2 (1981).  
See also Mandeville, supra (adopting Clemons analysis). 
19 
 
contrary, the statute explicitly states that, "a patient shall 
have the privilege of refusing to disclose, and of preventing a 
witness from disclosing, any communication, wherever made, 
between said patient and a psychotherapist relative to the 
diagnosis or treatment of the patient's mental or emotional 
condition" (emphasis added).  Id.  The language here is 
expansive, not restrictive, broadly protecting "the private 
interest that patients have in speaking freely during 
psychotherapy, and the public interest in encouraging troubled 
people to seek therapy."  Conklin v. Feitelberg, 146 F. Supp. 3d 
430, 437 (D. Mass. 2015), quoting Vanderbilt v. Chilmark, 174 
F.R.D 225, 227 (D. Mass. 1997). 
 
Unlike many other States that require the communication to 
be confidential or not intended for further disclosure, the 
Commonwealth has no such requirement in the text of G. L. 
c. 233, § 20B.  Contrast Ala. Code § 34-26-2 (privilege applies 
to "confidential relations and communications"); Fla. Stat. 
§ 90.503 (privilege applies to "confidential communications," 
defined as those not intended to be disclosed to third parties, 
other than those expressly permitted in statute); Or. Rev. Stat. 
§ 40.230 (same); S.D. Codified Laws § 19-19-503 (same).  Indeed, 
in Massachusetts the privilege applies to psychotherapist-
patient communications, "regardless of the patient's awareness 
of such conversations, correspondence, actions and occurrences, 
20 
 
and any records, memoranda or notes of the foregoing."  G. L. c. 
233, § 20B.  See Robinson v. Commonwealth, 399 Mass. 131, 135 
(1987). 
 
The expansive scope of the privilege is limited by six 
specific exceptions defining when the privilege is waived and 
disclosure is permitted.  See G. L. c. 233, § 20B.  None of 
these exceptions turns on the presence of a third party.  We 
need not decide, however, whether the presence of a third party 
may still waive the privilege, as we conclude that the nature of 
the police presence here could not have done so. 
 
Here, the police presence served essential public safety 
purposes.  The defendant needed psychiatric services but also 
presented a grave danger to the public and hospital personnel.  
The police were deployed to guard the defendant and protect the 
public, including the hospital's medical personnel, and allow 
him to be treated despite those concerns.  Given their public 
safety responsibilities, the police should not be required to 
leave the defendant's hospital room to allow the defendant to 
speak with a psychotherapist alone.14  Nor should the 
psychotherapist be required to get so close to the defendant 
that only she and the defendant can hear one another.  
                                                 
 
14 This is true even if the defendant is shackled to the 
bed.  The police and not the courts are in the best position to 
know whether the defendant remains dangerous even while 
shackled. 
21 
 
Psychotherapists should not be tasked with putting their own 
safety at risk in order to treat a dangerous patient. 
In the absence of legislative direction to the contrary, we 
therefore conclude that police presence during a psychiatric 
consultation, which allows the defendant to receive necessary 
medical attention while protecting the public and medical 
personnel, does not waive the psychotherapist-patient privilege. 
Rather, allowing such consultations to go forward under police 
supervision, while leaving the privilege in place unless other 
exceptions providing for disclosure apply, properly balances 
both medical and public safety considerations.  See State v. 
Deases, 518 N.W.2d 784, 788 (Iowa 1994) (doctor-patient 
privilege not waived by presence of third party if third party 
is present to assist doctor or presence is necessary to enable 
defendant to obtain treatment); People v. Sanders, 169 Misc. 2d 
813, 819-820 (N.Y. Sup. Ct. 1996) (doctor-patient privilege not 
waived where police officer "was required to remain with the 
defendant at all times" and the defendant "did not have the 
option or ability to request a private session with the 
psychiatrist").  Cf. Secrest v. State, 679 A.2d 58, 62 (Del. 
1996) (third-party waiver "makes sense in situations where the 
patient is reasonably lucid and able to control access to the 
setting").  Accordingly, we hold that a patient who has been 
placed under police guard does not automatically waive the 
22 
 
psychotherapist-patient privilege by speaking to a 
psychotherapist in the presence of said police guard.15,16 
                                                 
 
15 Our holding is also in accordance with our case law on 
attorney-client privilege.  Attorney-client privilege is 
generally undermined by the presence of a third party.  See 
Commissioner of Revenue v. Comcast Corp., 453 Mass. 293, 306 
(2009).  There is an exception to this general rule, however, 
when the presence of the third party is "necessary for the 
effective consultation between client and attorney" (quotations 
omitted).  Id. at 307, quoting United States v. Kovel, 296 F.2d 
918, 922 (2d Cir. 1961).  In order to be "necessary," the third-
party presence must be "nearly indispensable or serve some 
specialized purpose in facilitating the attorney-client 
communications."  Comcast Corp., supra.  In such instances, the 
privilege still attaches.  Id. 
 
 
16 Although it was error to find that the defendant had 
waived the psychotherapist-patient privilege, we note that the 
statement may very well have been admissible under G. L. c. 233, 
§ 20B (c).  Subsection (c) provides that the psychotherapist-
patient privilege will not apply 
 
"[i]n any proceeding, except one involving child custody, 
adoption or adoption consent, in which the patient 
introduces his mental or emotional condition as an element 
of his claim or defense, and the judge or presiding officer 
finds that it is more important to the interests of justice 
that the communication be disclosed than that the 
relationship between patient and psychotherapist be 
protected." 
 
The defendant "introduce[d] his mental or emotional condition as 
an element of his claim or defense" by arguing at trial that he 
was not criminally responsible.  See Commonwealth v. Brandwein, 
435 Mass. 623, 630 n.8 (2002).  The motion judge also could have 
found it "more important to the interests of justice" that the 
defendant's statements be admitted, particularly given that 
there was no ongoing patient-therapist relationship between the 
defendant and McGovern, and McGovern's evaluation was the only 
examination conducted around the time of the murder, rendering 
the evaluation important to the truth-seeking function of the 
court.  See Commonwealth v. Seabrooks, 433 Mass. 439, 448-450 
(2001).  The defendant's apparent inability to recall the murder 
 
23 
 
 
B.  Prejudice.  Although the presence of the police 
officers did not waive the psychotherapist-patient privilege, we 
conclude that any error in the admission of McGovern's testimony 
would not have prejudiced the defendant because the evidence of 
the defendant's premeditation and criminal responsibility was 
overwhelming.  Perhaps most significantly, the defendant had 
repeatedly stated that "even if he killed [the victim's sister] 
or [the victim], nothing would happen to him because . . . he 
was bipolar."  He also made his intentions clear to the victim's 
mother months before the murder, stating, "When you get to 
Kenya, be prepared to receive two coffins, because I'm going to 
kill these daughters of yours.  And I'm starting with [the 
victim's sister].  [She] will not raise my children.  Instead, 
they'll be raised by the [S]tate." 
 
On the night of the murder, he acted in conformance with 
this plan:  first attacking the victim's sister, and then 
attacking the victim.  Further, the defendant appeared to act 
normally up until the night of the killing, even running errands 
                                                                                                                                                             
not only inhibited the jury's ability to evaluate his mental 
state but also interfered with defense counsel's own expert's 
ability to evaluate whether he lacked criminal responsibility.  
Insight into the defendant's mental state shortly after the 
crimes were committed would thus have been very helpful in 
evaluating his primary defense at trial.  The trial judge, 
however, would have had to make findings and weigh all the 
factors set out in Seabrooks, supra at 449-450, including 
whether the defendant consulted with counsel before speaking to 
McGovern, which he did not. 
24 
 
with the victim.  See Commonwealth v. Griffin, 475 Mass. 848, 
856-857 (2016).  There was also compelling evidence that the 
attack was planned.  He brought the murder weapon with him, 
hidden in his sock, to the victim's sister's apartment.  When he 
stabbed the victim in a very small, narrow space, he did so 
carefully enough to avoid injuring their one year old daughter, 
who was crawling between the defendant and the victim.  
Moreover, the defendant's own expert testified that the 
defendant "certainly understood the wrongfulness of the [murder] 
immediately after the events," because he fled the crime scene 
and disposed of the murder weapon.  Given the substantial 
evidence of premeditation and criminal responsibility, the 
admission of the defendant's statement to McGovern about wanting 
to kill his girl friend did not prejudice the defendant. 
 
iii.  Due process.  For the first time on appeal, the 
defendant argues that the admission of his statement to McGovern 
also violated his Federal and State due process rights because 
she did not provide him Lamb warnings indicating that the 
statement would not be confidential.  He cites two cases 
involving the Federal and State constitutional privileges 
against self-incrimination for this proposition.  "For the 
privileges [against self-incrimination] to attach, the State 
must compel the defendant to produce testimonial evidence."  
Commonwealth v. Seabrooks, 433 Mass. 439, 451 (2001).  As 
25 
 
previously discussed, the defendant's statement was voluntary 
and was not compelled.  Further, Lamb warnings were not 
required, as the psychotherapist's questioning was not court-
ordered or for the purposes of producing evidence against him.  
See Lamb, 365 Mass. at 270. 
 
b.  Jury instructions.  The defendant argues that the trial 
judge, who was not the motion judge, erred in instructing the 
jury for four separate reasons.  For the reasons discussed 
below, none of these arguments is persuasive. 
 
i.  Inference of sanity.  On the issue of criminal 
responsibility, the trial judge in this case instructed the jury 
as follows:  "[The Commonwealth has] to prove that the defendant 
was sane; that is, was criminally responsible.  If you feel it 
appropriate you may take into account that the great majority of 
people are sane, and that there is a resulting likelihood that 
any particular person is sane."  This instruction was given 
pursuant to our then-current case law, see Commonwealth v. 
Keita, 429 Mass. 843, 846 (1999) ("A jury instruction concerning 
the presumption of sanity should be given in every case in which 
the question of the defendant's criminal responsibility is 
raised"), as well as the Model Jury Instructions on Homicide in 
effect at the time.  See Model Jury Instructions on Homicide 51 
(1999).  In Commonwealth v. Lawson, 475 Mass. 806, 814-815 & n.8 
(2016), we held that, "given the meager weight of [the inference 
26 
 
that a defendant is probably sane because most people are sane] 
and the risk of juror confusion regarding the burden of proof, 
judges should not instruct juries regarding this inference." 
 
"Here, the defendant is entitled to the benefit of Lawson, 
as that case was released while the defendant's appeal was 
pending on direct review."  Commonwealth v. Muller, 477 Mass. 
415, 431 (2017).  As defense counsel objected to the sanity 
presumption at trial, even though Lawson had not yet been 
issued, we review for prejudicial error.  See Commonwealth v. 
Cole, 473 Mass. 317, 325 (2015). 
 
In this case, the trial judge "strongly and specifically 
instructed that the burden is on the Commonwealth to prove 
criminal responsibility beyond a reasonable doubt."17  Muller, 
                                                 
 
17 Regarding the burden of proof on criminal responsibility, 
the trial judge stated: 
 
"[A]s to all of these charges, the Commonwealth also has to 
prove to you that defendant did not lack criminal 
responsibility.  Remember the burden of proof is always on 
the Commonwealth.  The Commonwealth has to prove that the 
person committed the crime charged, and that he was at the 
time in such a mental state that he did not lack criminal 
responsibility.  If you're satisfied beyond a reasonable 
doubt that the defendant committed the crime -- any of the 
crimes that I have defined for you, you must decide whether 
the Commonwealth has met an additional burden.  The 
Commonwealth also must prove that the defendant was 
criminally responsible when he committed the crime 
charged. . . .  The Commonwealth must prove that the 
defendant was criminally responsible beyond a reasonable 
doubt.  The burden is not on the defendant to prove a lack 
of criminal responsibility.  Instead, the burden is on the 
 
27 
 
477 Mass. at 431, quoting Commonwealth v. Griffin, 475 Mass. 
848, 863 (2016).  Further, as discussed above, there was 
overwhelming evidence of criminal responsibility.  See Muller, 
supra, quoting Griffin, supra.  Thus, the defendant was not 
prejudiced by any such error due to the overwhelming evidence of 
criminal responsibility and the trial judge's detailed 
instructions on the burden of proof for criminal responsibility.  
See Griffin, supra. 
 
ii.  Consequences of not guilty verdict.  The trial judge 
instructed the jury on the consequences of finding the defendant 
not guilty by reason of insanity, as permitted by Commonwealth 
v. Mutina, 366 Mass. 810, 823 & n.12 (1975) (Mutina instruction) 
and our Model Jury Instructions on Homicide in effect at the 
time of trial.18  In Commonwealth v. Chappell, 473 Mass. 191, 
                                                                                                                                                             
Commonwealth to prove criminal responsibility beyond a 
reasonable doubt.  Under the law, the Commonwealth bears 
the burden of proving beyond a reasonable doubt the 
defendant committed the crime or crimes with which he's 
charged, and also that the defendant is criminally 
responsible for his conduct." 
 
 
18 The trial judge instructed: 
 
"[I]n in the event that the defendant is found not guilty 
by lack of criminal responsibility . . . , the District 
Attorney . . . may petition . . . for his commitment . . . 
if in that proceeding the Commonwealth proves beyond a 
reasonable doubt that the defendant is mentally ill at the 
present time, and that his discharge would create a 
likelihood of serious harm to himself or others. . . .  
[T]he order of commitment is thereafter periodically 
 
28 
 
205-206 (2015), we held that, going forward, Mutina instructions 
should "omit[] references to specific time frames for 
observation and mention[] the potential for successive 
commitment orders that could span the duration of the 
defendant's life."  The defendant argues for the first time on 
appeal that the jury instructions created a substantial 
likelihood of a miscarriage of justice for failing to include 
the supplemental jury instructions from Chappell. 
 
We have previously stated that it is not error for a judge 
to have given the Mutina instruction when it was the governing 
model jury instruction at the time of trial.  See Commonwealth 
v. Dunn, 478 Mass. 125, 139 (2017).  This is because we held in 
Chappell, 473 Mass. at 205, that the trial judge in that case 
did not err in providing the Mutina instruction.  Rather, in 
Chappell, the Mutina instruction was changed prospectively to 
"better explain to the jury 'what protection they and their 
fellow citizens will have if they . . . arrive at a verdict of 
not guilty by reason of [lack of criminal responsibility].'"  
Dunn, supra, quoting Chappell, supra at 206.  Thus, because the 
trial here took place before our decision in Chappell, the 
instruction was proper and did not create a substantial 
                                                                                                                                                             
reviewed[,] . . . [and] [i]f the Commonwealth fails to 
prove these matters beyond a reasonable doubt, the 
defendant is discharged." 
29 
 
likelihood of a miscarriage of justice.  See Commonwealth v. 
Piantedosi, 478 Mass. 536, 550 (2017). 
 
iii.  Reasonable doubt instruction.  The defendant claims 
that the trial judge's instruction on reasonable doubt created a 
substantial likelihood of a miscarriage of justice because it 
"was identical to the instruction that this court criticized and 
modified prospectively" in Commonwealth v. Russell, 470 Mass. 
464, 477-478 (2015).  Here, the trial judge instructed: 
"Proof beyond a reasonable doubt does not mean proof beyond 
all possible doubt, for everything in the lives of the 
human beings is open to some possible or imaginary doubt.  
On the other hand, it is not enough for the Commonwealth to 
establish a probability, even a strong probability, that 
the defendant is more likely to be guilty than not 
guilty. . . .  [P]roof beyond a reasonable doubt is proof 
that leaves you firmly convinced of the defendant's guilt.  
There are very few things in this world that we know with 
absolute certainty, and in criminal cases the law does not 
require proof that overcomes every possible doubt.  If, 
based on your consideration of the evidence, you are firmly 
convinced that the defendant is guilty of the crime 
charged, you must find him guilty.  If, on the other hand, 
you think there is a real possibility that he is not 
guilty, you must give him the benefit of the doubt and find 
him not guilty." 
 
Contrary to the defendant's assertion, the problematic language 
in Russell was not used in the trial judge's instruction here.  
See id. at 477 ("moral certainty" language required further 
clarification).19  Further, the trial judge's instruction 
                                                 
 
19 We also stated in Commonwealth v. Russell, 470 Mass. 464, 
479 (2015), that the new instruction provided therein was to 
 
30 
 
contains language we did not deem improper in Russell.  See id. 
at 471-474 (rejecting argument that "firmly convinced" language 
lowered Commonwealth's burden of proof, or that "real 
possibility" language shifted burden of proof).  Thus, the 
defendant's argument is without merit. 
 
iv.  Additional instruction on criminal responsibility.  
For the first time on appeal, the defendant argues that the jury 
should have been instructed that his "failure to take his 
prescribed medication did not preclude a finding that he was not 
criminally responsible."  The defendant asserts that because the 
jury were not provided with this instruction, there was a 
substantial likelihood of a miscarriage of justice.  The 
defendant's argument assumes that, without such an instruction, 
the jury may have found him criminally responsible on the basis 
of his failure to take his prescribed medication.  In support of 
his argument, he cites two prior cases involving instructions on 
voluntary alcohol or drug usage, Commonwealth v. Berry, 457 
Mass. 602 (2010), and Commonwealth v. DiPadova, 460 Mass. 424 
(2011).20 
                                                                                                                                                             
apply prospectively, not retroactively.  See Commonwealth v. 
Rakes, 478 Mass. 22, 48 n.23 (2017). 
 
 
20 Commonwealth v. Berry, 457 Mass. 602 (2010), and 
Commonwealth v. DiPadova, 460 Mass. 42 (2011), were decided 
after the defendant's trial, but while his case was pending on 
direct appellate review.  Thus, we must still decide whether the 
 
31 
 
 
In Berry, 457 Mass. at 618, we set out new jury 
instructions for cases involving the interplay of drug or 
alcohol usage and lack of criminal responsibility: 
"Where a defendant has an active mental disease or defect 
that caused her to lose the substantial capacity to 
appreciate the wrongfulness of her conduct or the 
substantial capacity to conform her conduct to the 
requirements of the law, the defendant's consumption of 
alcohol or another drug cannot preclude the defense of lack 
of criminal responsibility." 
 
We also stated that "[w]here the Commonwealth offers evidence 
that the defendant knew or had reason to know of the effects of 
drugs or alcohol on her latent mental disease or defect, or on 
the intensification of her active mental disease or defect," an 
additional instruction must be provided.  Id. at 617 n.9.21 
                                                                                                                                                             
absence of the defendant's proposed instruction created a 
substantial likelihood of a miscarriage of justice.  See 
Commonwealth v. Johnston, 467 Mass. 674, 704 (2014). 
 
 
21 That instruction was as follows: 
 
"However, if the Commonwealth has proved beyond a 
reasonable doubt that the defendant consumed drugs or 
alcohol knowing or having reason to know that the drugs or 
alcohol would activate a latent mental disease or intensify 
an active mental disease, causing her to lose the 
substantial capacity to appreciate the wrongfulness of her 
conduct or the substantial capacity to conform her conduct 
to the requirements of the law, then you would be warranted 
in finding the defendant criminally responsible for a crime 
in which you find she knowingly participated.  In deciding 
what the defendant had reason to know about the 
consequences of her consumption of drugs or alcohol, you 
should consider the question solely from the defendant's 
point of view, including her mental capacity and her past 
experience with drugs or alcohol." 
 
32 
 
In DiPadova, we further stated: 
"As in Berry, in this case, given the absence of a proper 
instruction, the jury could have misinterpreted the model 
instruction and concluded, erroneously, that even if the 
defendant's mental illness by itself caused him to lack 
substantial capacity, 'because [he] had consumed [drugs] 
that contributed to [his] incapacity, that would render the 
lack of criminal responsibility defense moot.'" 
 
DiPadova, 460 Mass. at 435-436, quoting Berry, 457 Mass. at 618.  
Unlike in Berry, there was also evidence in DiPadova, supra, 
that the defendant "knew at the time of the murder that drugs 
intensified the symptoms of his mental illness."  DiPadova, 
supra at 436-437.  We therefore clarified that the jury should 
have been instructed  
"(1) if the defendant's mental illness did not reach the 
level of a lack of criminal responsibility until he 
consumed drugs, he was criminally responsible if he knew 
(or should have known) that the consumption would have the 
effect of intensifying or exacerbating his mental 
condition; and, in contrast, (2) if the defendant's mental 
illness did reach the level of lack of criminal 
responsibility even in the absence of his consumption of 
drugs, it was irrelevant whether he took drugs knowing that 
they would exacerbate that condition." 
 
Id. at 437. 
 
The concerns at issue in Berry and DiPadova are markedly 
different from the ones presented here.  In each case, the jury 
received erroneous instructions regarding the interaction of 
mental illness and the voluntary consumption of alcohol or 
                                                                                                                                                             
 
Berry, 457 Mass. at 617 n.9. 
33 
 
drugs, which suggested that the consumption of the alcohol or 
drugs would negate a defense of lack of criminal responsibility.  
Here, the defendant does not identify any specific instruction 
as erroneous, such that it created juror confusion.  Nor could 
he.  As the trial judge remarked, "one thing I am not going to 
instruct [the jury] on is anything about the consumption of 
alcohol or substances.  There's just no evidence of that.  So I 
don't think this is an appropriate case for that."  No 
instruction on the use of drugs, or lack thereof, was requested 
by either party, and none was given.  Further, we discern 
nothing in the trial judge's instructions on criminal 
responsibility that would lead jurors to conclude that the 
defendant's failure to take his prescribed medication precluded 
the jury from finding him not criminally responsible.  The 
instructions appropriately focused the jury on whether the 
defendant was criminally responsible at the time of the murder, 
not on the effect, if any, that the failure to take prescribed 
medicine could have on this determination.  Cf. Commonwealth v. 
Shin, 86 Mass. App. Ct. 381, 388 (2014).  Thus, the jury 
instructions in this case do not create the same potential for 
juror confusion as existed in Berry or DiPadova.22 
                                                 
 
22 We further note that the failure to take prescription 
medication is not the same as the voluntary consumption of drugs 
or alcohol.  See State v. Eager, 140 Haw. 167, 175 (2017).  
 
34 
 
 
Although defense counsel did refer to the defendant's 
failure to take his medication, stating in closing argument that 
"[u]nless properly treated and medicated the disease takes over, 
and that's what happened to [the defendant]," the Commonwealth 
never introduced evidence or argued at trial that the defendant 
was criminally responsible because he voluntarily chose not to 
take the medication that treated his mental illness.  To the 
contrary, the Commonwealth primarily argued that the defendant's 
mental illness did not render him criminally irresponsible to 
begin with.  The prosecution only referred to the defendant's 
failure to take his medication to express skepticism that it 
negatively affected his behavior.  The prosecutor stated in her 
closing argument that "[i]t's a disease that waxes and wanes, 
that cycles over months, that even stopping his medications 
. . . would take days, weeks, or month[s] for the effect of that 
to be noticeable."23  In these circumstances, where the defendant 
                                                                                                                                                             
There are many reasons why an individual may fail to take his or 
her prescribed medication.  See Commonwealth v. Shin, 86 Mass. 
App. Ct. 381, 388 (2014) ("[M]entally ill people fail to take 
prescribed medication for a myriad of reasons, including, for 
example, side effects that may be otherwise dangerous to their 
health. . . .  In addition, some people are unable to obtain the 
appropriate medication because of lack of money or access to 
medical care, or problems with necessary paperwork . . ."). 
 
 
23 Further, the prosecutor had elicited testimony from the 
Commonwealth's expert that failure to take the defendant's mood 
stabilizing medication "would take weeks, months . . . to have 
an [e]ffect on this -- of the peaks and valleys [of the 
 
35 
 
argues for an instruction on a theory of criminal responsibility 
that was not presented at trial, we conclude that no such 
instruction was required.  Cf. Commonwealth v. Harris, 464 Mass. 
425, 434-435 (2013) (no curative instruction required where, 
evaluating jury instructions as whole, no jury could have 
improperly concluded Commonwealth was relieved of burden of 
proof). 
 
c.  Right to jury-waived trial.  The defendant requested a 
jury-waived trial, but his request was denied pursuant to G. L. 
c. 263, § 6, which does not provide defendants in a capital case 
the ability to waive their right to a jury trial.  The defendant 
asks that we find this statute unconstitutional, and in so 
doing, overturn our holding in Commonwealth v. Francis, 450 
Mass. 132, 137 (2007) (concluding G. L. c. 263, § 6, does not 
violate defendants' equal protection or due process rights).  In 
support of this argument, the defendant asserts that jurors are 
biased against finding defendants not criminally responsible, 
and that jurors may have difficulty understanding instructions 
on criminal responsibility.  Much like in Francis, these 
                                                                                                                                                             
defendant's mood].  It's not like a diabetic going off instantly 
today and tomorrow near trouble with their blood sugar.  This is 
a chemical that kind of the brain is in over a long period of 
time.  It takes the peaks and the valleys off.  Helps some 
people.  But it -- sometimes even on [the medication], a 
person's going to rocket right through the high into a manic 
episode, manic psychosis, that requires hospitalization." 
36 
 
"arguments are policy matters suitable for legislative 
consideration," not judicial intervention.  Id.24 
 
d.  Review under G. L. c. 278, § 33E.  We have reviewed the 
record pursuant to G. L. c. 278, § 33E, and discern no basis to 
set aside or reduce the verdict of murder in the first degree or 
to order a new trial.  Accordingly, we decline to exercise our 
authority. 
 
 
 
 
 
 
 
Judgments affirmed. 
                                                 
 
24 The defendant also notes that the third conviction of a 
habitual offender is considered a "capital case" for the 
purposes of G. L. c. 278, § 33E, see G. L. c. 279, § 25 (b), but 
is not considered a "capital case" under G. L. c. 263, § 6.  
Thus, "three-strike" habitual offenders are entitled to the same 
§ 33E review as defendants convicted of murder in the first 
degree, but may still waive their right to a jury trial.  The 
defendant fails to expand on this argument, but presumably sees 
this as an equal protection violation.  As we stated in 
Commonwealth v. Francis, 450 Mass. 132, 135 (2007), "[i]t is 
reasonable for the Legislature to treat defendants facing a 
charge of murder in the first degree differently from other 
defendants."  Further, we acknowledged that there was a 
difference between the definition of "capital" under G. L. 
c. 278, § 33E, and that under G. L. c. 263, § 6, but rejected 
the argument that any such difference requires allowing 
defendants charged with murder in the first degree the ability 
to waive their right to a jury trial.  See Francis, supra at 
137.  For substantially the same reasons stated in Francis, we 
discern no equal protection violation here.