Sleep Forensics : Trailblazing a New Discipline. The experience at the Minnesota Regional Sleep Disorders Center

Though the Albert Jackson Tirrell Case of 1846 is recognized as the first criminal case to successfully utilize the “sleepwalking” defense in an American court of law, much remains to be understood about the spectrum of overt extreme behaviours attributed to parasomnias such as RBD. As clinical research to further characterize such bizarre sleep-related behaviours would be largely impractical, if not ethically challenged, the Minnesota Regional Sleep Disorders Center (MRSDC) only just decided to make ourselves available to the legal community as a medico-legal consultant to review criminal and/or civil cases possibly involving a sleep disorder. Despite anticipating that legitimate “sleepwalking” cases in a court of law to be exceedingly rare, our initial modus operandi is based upon the premise that the most extremely violent expressions of parasomnias resulting in serious misfortune would ultimately find its way to the judicial system for resolution. For 3 months, from August 1, 2006-Nov. 1, 2006, the sleep forensics team at the MRSDC were contacted by various attorneys to place their medico-legal cases (Total Cases = 18) in consideration for a formal review to assess whether a sleep disorder may have been involved. The vast majority of inquiries came from private attorneys (N = 14) whereas four inquiries where placed by government officials such as public defenders (N = 2) and public prosecutors (N = 2). Attorneys were most often directed to the MRSDC based upon their review of the medical literature. Other referrals were the result of the MRSDC staff's frequent involvement with a multitude of media outlets including local television, the New York Times, National Geographic Television, and the BBC. Cases considered for review originated from across the United States with Minneapolis/Saint Paul relegated to only a small share (N = 4). Single cases also came from abroad including Canada and Germany. The diversity of the charges/claims associated with potential cases included: sexual assault (N = 7), driving while intoxicated (N = 3), murder/attempted murder (N = 3), burglary (N = 2), gross negligence resulting in death (N = 1), life insurance policy claim (N = 1), and a class action law suit (N = 1); After a preliminary screen, sleep disorder subtypes possibly implicated in these claims included: parasomnias (N = 11), Zolpidem toxicity alone (N = 4), parasomnia pseudo-suicide (N = 1), sleep deprivation (N = 1), and narcolepsy (N = 1). Of the total cases presented to our center for consideration, only 5 cases were accepted to render a formal medical expert testimony. Upon acceptance of a case, the presenting attorney was overtly informed that our ideal role is as amicus curiae- or a “friend” to the court. Cases were reviewed in a rigorous and scientific manner analyzing objective verifiable evidence that had been accepted by both the prosecution and defense teams while using principles accepted by consensus from the community within sleep medicine. Of the accepted cases, 4 out of 5 were associated with either a public defender or prosecutor and as such the case was completed pro bono (at no cost) – which is consistent with our mission to be an educational resource to the community in the development of public policy concerning issues surrounding sleep, and to advance the development in the understanding of concepts of consciousness which remain in stark contrast to the outdated Model Penal Code of the 1950's still in use in the American court system today. In the 5 cases under review, we attempted to determine beyond a reasonable doubt whether to support or refute a claim of an association with a sleep disorder. The legal questions were varied and concerned determining : I) whether sleep deprivation resulting in a motor vehicle mishap and consequent death fulfils the criteria for a gross negligence felony (N = 1), II) to what degree would altered levels of consciousness in parasomnias render the defendant unaware and thereby not responsible for criminal acts such as sexual assault or burglary (N = 3), and III) could an apparent suicide actually be an expression of a parasomnia pseudo-suicide whereby the individual did not intend to kill himself and as such the family should still be entitled to his life insurance policy. Our venture to become a recognized educational resource to the legal community has allowed us to further develop support for a subdivision of sleep forensics within the MRSDC at Hennepin County Medical Center. As such, to maintain our goals we adhere to a strong multi-disciplinarian approach and have recently developed a substantial interaction with the University of Minnesota School of Law. This experience has allowed us to further refine our mission to not only include the advancement of medicine and science by continuing to define the spectrum of behaviours in parasomnias but also to strengthen ourselves as a general resource of sleep medicine education to the community, to assist in the development of public policy concerning issues surrounding sleep, and to advance the development in the understanding of concepts of consciousness which remain in stark contrast to the outdated Model Penal Code of the 1950's still in use in the American court system today.