Source: https://prosechicago.wordpress.com/tag/fitness/
Timestamp: 2019-04-20 16:36:06+00:00

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The due process clause of the fourteenth amendment prohibits the conviction and sentencing of a defendant who is not fit to stand trial. U.S. Const., Amend. XIV; People v. Johnson, 206 Ill. 2d 348, 361, 794 N.E.2d 294, 303 (2002). In Illinois, a defendant is presumed fit to stand trial and is considered unfit only if his mental or physical condition prevents him from understanding the nature and purpose of the proceedings against him or assisting in his own defense. 725 ILCS 5/104-10 (West 2000); People v. Shum, 207 Ill. 2d 47, 57, 797 N.E.2d 609, 615-16 (2003).
When a bona fide doubt as to defendant’s fitness to stand trial exists, the court must order a fitness hearing to resolve the question of fitness before the case proceeds any further. 725 ILCS 5/104-11(a) (West 2000); Johnson, 206 Ill. 2d at 361, 794 N.E.2d at 303; People v. Griffin, 178 Ill.2d 65, 79 227 Ill.Dec. 338, 687 N.E.2d 820 (1997).
The test for incompetence [fitness] is also well settled. A defendant may not be put to trial unless he ” `has sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding . . . [and] a rational as well as factual understanding of the proceedings against him.’ ” DuskyUnited States, 362 U.S. 402, 402 (1960) (per curiam).
A fitness examination order is NOT evidence of a bona fide doubt per the First District Illinois Appellate Court in People v. Hill, 345 Ill.App.3d 620, 803 N.E. 2d 138 (2003), 2003 Ill. App. (1st) 021387. “[W]e find that the trial court’s decision to appoint an expert to examine a defendant has no bearing on the court’s ultimate conclusion as to whether a bona fide doubt as to the defendant’ fitness to stand trial has been raised.” (Hill Id at 627) This overturned People v. Cleer, 328 Ill. App. 3d 428 (2002), where the court determined that the grant of a fitness examination implicitly demonstrated the trial judge’s bona fide doubt concerning defendant’s fitness for trial.
[O]nce facts are brought to the attention of the trial court, either from observation of the defendant or the suggestion of counsel, that raise a bona fide doubt of the defendant’s fitness to stand trial, the trial court has a duty to hold a fitness hearing. People v. Brandon, 162 Ill.2d 450, 456, 205 Ill.Dec. 421, 643 N.E.2d 712, (1994); see 725 ILCS 5/104-11() (West 1996).
It is well settled in Illinois that where no bona fide doubt as to a defendant’s competency to stand trial exists, a psychiatric report shows defendant fit and the defendant moves for or acquiesces in the withdrawal of a petition requesting a fitness hearing, there is no abuse of discretion where the court fails to hold a fitness hearing sua sponte. Hill (Supra); People v. Hicks, 35 Ill. 2d 390, 394, 220 N.E.2d 461 (1966); People v. Mayhew, 18 Ill. App. 3d 483, 488, 309 N.E.2d 672 (1974).
Therefore, defendants have a statutory right to refuse to answer questions at a BCX exam and this act does not permit the Court to revoke or alter bail for violation of the condition of bail to appear at a BCX exam and answer questions. The Court may hold the defendant in contempt only if they refuse to show up for the exam.
A professional forensic psychiatric exam is not really necessary to determine fitness, but is necessary to determine if the defendant suffers from mental illness. Fitness and mental illness are two different issues and determination of such is not equivalent. Fitness is determined by a judge; mental illness is diagnosed by a licensed physician or psychologist. A forensic exam is evidence that may be used in the fitness hearing to determine fitness by the trier of the facts, along with any other evidence produced by the defense, the state, or the court.
The Illinois Supreme Court has repeatedly held that when determining whether a bona fide doubt of defendant’s fitness exists, courts should consider the following factors: “the defendant’s irrational behavior, the defendant’s demeanor at trial and any prior medical opinion on the defendant’s competence to stand trial”. [emphasis added] People v. Harris, 206 Ill.2d 293, 304, 276 Ill.Dec. 286, 794 N.E.2d 181, 190 (2002).
There is no fixed sign, symptom, or behavior that mandates a determination of fitness. “The question is often a difficult one in which a wide range of manifestations and subtle nuances are implicated.” People v. Eddmonds, 143 Ill. 2d 501, 518 (1991) (quoting Drope v. Missouri, 420 U.S. 162, 180 (1975)). Some doubt of a defendant’s fitness is not enough. People v. Walker, 262 Ill.App.3d 796, 803, 200 Ill.Dec 345, 635 N.E.2d 684 (1994).
No single factor in itself raises a bono fide doubt of a defendant’s fitness to stand trial; the fact that a defendant suffers a mental disturbance or requires psychiatric treatment such as psychotropic drugs does not necessarily raise a bona fide doubt. Walker, 262 Ill. App. 3d at 803, 200 Ill.Dec. 345, 635 N.E.2d 684; People v. Shum, 207 Ill. 2d 47, 59, 797 N.E.2d 609, 615-16 (2003); People v. Easley, 192 Ill. 2d 307, 322, 736 N.E.2d 975, 986 (2000) Even evidence of extreme disruptive behavior and a sociopathic personality does not compel the conclusion that a bona fide doubt exists as to a defendant’s fitness to stand trial. People v. Smith, 253 Ill.App.3d 948, 953, 192 Ill.Dec. 742, 625 N.E.2d 897 (1993) “Fitness speaks only to a person’s ability to function within the context of a trial. It does not refer to sanity or competence in other areas. A defendant can be fit for trial although his or her mind may be otherwise unsound.” Easley, 192 Ill. 2d at 320, 736 N.E.2d at 986.
Evidence presented at the fitness hearing may include a report from forensic clinical services, or from private psychiatrists and psychologists retained by either side. The report may state that the defendant is fit or unfit for trial and the examiners detailed reasoning and clinical judgment as to why he came to that conclusion, or may simply be a statement that the examiner was unable to make this determination at the exam because the defendant was unable or unwilling to cooperate with questions.
Court determinations of fitness are made by a court hearing and not by the forensic examiner.
Whether a bona fide doubt as to a defendant’s fitness has arisen is generally a matter within the discretion of the trial court. People v. Sandham, 174 Ill.2d 379, 382, 220 Ill.Dec. 611, 673 N.E.2d 1032 (1996). “[W]hether the doubt is ‘bona fide’ is relevant only to the initial determination to hold a fitness hearing.” (Emphasis in original and added.) People v Murphy 160 Ill.App.3d 781 at 783, 112 Ill.Dec. 295, 513 N.E.2d 904 (1987)” Brown, 252 Ill.App.3d at 383. “Whether a bona fide doubt of a defendant’s fitness exists involves a fact-specific inquiry” (emphasis added). See Eddmonds, 143 Ill.2d at 518, 161 Ill.Dec. 306, 578 N.E.2d at 959 (1991), quoting Drope, 420 U.S. at 180, 95 S.Ct at 908, 43 L.Ed.2d at 118 (“there are no fixed or immutable signs which invariably indicate the need for further inquiry to determine fitness to proceed; the question is often a difficult one in which a wide range of manifestations and subtle nuances are implicated’”)” People v. M. Tapscott, 386 Ill.App.3d 1064, 899 N.E.2d 597, 326 Ill.De. 380 (2008).
The terms “psychotic”, “irrational”, “delusional”, “hallucinating”, and “competent” are frequently misused by layman, including judges and attorneys.
“Psychotic” refers to an abnormal condition of the mind, and is a generic psychiatricterm for a mental state often described as involving a “loss of contact with reality“. Psychosis is a descriptive term for the hallucinations, delusions, sometimes violence, and impaired insightthat may occur. It is a diagnosis of exclusion and requires that other diagnoses such as metabolic derangement or PTSD flashback be excluded. So a new-onset episode of psychosis cannot be considered a symptom of a psychiatric disorder until other relevant and known causes of psychosis are properly excluded, or ruled out. Many clinicians improperly perform, or entirely miss this step, introducing avoidable diagnostic error and misdiagnosis. It is a term best avoided by laymen due to its non-specificity and history of inappropriate use.
A hallucinationis defined as sensory perception in the absence of external stimuli. (See FN1) (For example: talking to a person not seen by others or believing that “God told me to kill him,”) Hallucinations are different from illusions, or perceptual distortions, which are the misperception of external stimuli. Hallucinations may occur in any of the senses and take on almost any form, which may include simple sensations (such as lights, colors, tastes, and smells) to experiences such as seeing and interacting with fully formed animals and people, hearing voices, and having complex tactile sensations.
Delusions are false beliefs, both bizarre (For example: “the judge is a Martian”or “the television told me to kill him”) and non-bizarre (For example: “there is a conspiracy against me by the Mayor”) , that a person holds on to, without adequate evidence (See FN1).
Rationality is commonly understood to mean the exercise of reason when thinking. Reason itself is subject to various interpretations such as judgment and logic, often assessed subjectively by one person in another. Differences in religious and political beliefs, values, and interests can cause reasonable individuals to disagree on what is reasonable, as it were. Failure to hear evidence, either through judicial or attorney misconduct, incompetence at law, or bias, proving an assertion by a defendant may be falsely attributed to irrationality. Therefore, it is important to hear explanations and evidence about assertions made by a defendant before concluding that they are irrational.
Another common meaning of rational is “sane, lucid or as “opposed to insane”. Psychological definitions of rational are dichotomized by the use of reason (logical thought), on the one hand, and as sane and lucid on the other. Unqualified understanding can simply mean knowing the facts (without connoting rationality in any sense) or appreciating the meaning of (connoting at least some level of rationality). Rationality helps to characterize the quality of understanding needed but the meaning of rationality itself in the context of CST is in need of clarification.
The term “competent” refers to fitness to stand trial also known as CST in a legal setting. The competency evaluation, as determined by the Dusky standard, is whether the accused “has sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding—and whether he has a rational as well as factual understanding of the proceedings against him.” Being determined incompetent is substantially different from undertaking an insanity defense; competence regards the defendant’s state of mind at the time of the trial, while insanity regards his state of mind at the time of the crime.
725 ILCS 5/104-13(e) Upon request by the defense and if the defendant is indigent, the court may appoint, in addition to the expert or experts chosen pursuant to subsection (a) of this Section, a qualified expert selected by the defendant to examine him and to make a report as provided in Section 104-15.
Fitness hearings are collateral civil proceedings and when they are held without following the statutory requirements of the law, as well as in violation of requirement for the judge to state on the record a legally sufficient basis of an order for a fitness examination (behavioral clinical examination = BCX), claiming the defendant is unfit, then the orders for fitness exam and any discussion about fitness are void ab initio.
Where the public policy of the State of Illinois is violated, the order is void, Martin-Tregona v. Roderick, 29 Ill.App.3d 553, 331 N.E.2d 100 (1st Dist. 1975). As statutes are public policy, violation of statutes makes the orders voidable.
The U.S. Supreme Court in Drope v. Missouri, 420 U.S. 162 (1975) held that a defendant has a due process right to be present at any hearing where fitness is discussed, regardless of behavior or mental health. Illinois fitness statutes only allow exclusion from hearings based on physical illness. If the fitness statute requiring presence of defendant is violated the hearings were illegal – violated public policy as expressed by the U.S. Supreme Court and are therefore voidable.
A defense attorney may not waive appearance of the defendant without the defendant’s consent when fitness is at issue, as the statute causes the defendant to possess a due process right to be present.
The right to be present is not an express right under the United States Constitution, but is implied, arising from the due process clause of the fourteenth amendment. U.S. Const., amend. XIV, §1; Kentucky v. Stincer, 482 U.S. 730, 745, 96 L. Ed. 2d 631, 647, 107 S. Ct. 2658, 2667 (1987); United States v. Gagnon, 470 U.S. 522, 526, 84 L. Ed. 2d 486, 490, 105 S. Ct. 1482, 1484 (1985); Snyder v. Massachusetts, 291 U.S. 97, 105-06, 78 L. Ed. 674, 678, 54 S. Ct. 330, 332 (1934). Article I, section 8, of the Illinois Constitution grants criminal defendants the express right “to appear and defend in person and by counsel.” Ill. Const. 1970, art. I, §8. Accordingly, both the federal constitution and our state constitution afford criminal defendants the general right to be present, not only at trial, but at all critical stages of the proceedings, from arraignment to sentencing. Illinois v. Allen, 397 U.S. 337, 338, 25 L. Ed. 2d 353, 356, 90 S. Ct. 1057, 1058 (1970); People v. Bull, 185 Ill. 2d 179 (1998); People v. Bean, 137 Ill. 2d 65, 80-83 (1990); People v. Martine, 106 Ill. 2d 429, 439 (1985).
“[E]ven where a defendant has the general right to be present because the proceeding is a ‘critical’ stage, a defendant’s absence is not a per se constitutional violation. Rather, a defendant’s absence from such a proceeding will violate his constitutional rights only if the record demonstrates that defendant’s absence caused the proceeding to be unfair or if his absence resulted in a denial of an underlying substantial right.” People v. Lindsey, 201 Ill. 2d 45, at 57 (2002). To show a constitutional violation of the right to be present, there must be evidence that defendant’s due process rights were violated by his absence from the courtroom, i.e., that defendant’s physical absence from the proceedings caused the proceedings to be unfair or that his physical absence from the proceedings resulted in the denial of an underlying constitutional right. There has been no showing on this record. Consequently, we find no constitutional violation.” Lindsey, 201 Ill. 2d at 60.
There is no constitutional right to a jury at a hearing to determine fitness to stand trial. The present Illinois Fitness Statute only requires a jury trial if the defendant requests a jury trial. People v. Haynes, 174 Ill.2d 204, 220, 673 N.E.2d 318, 326 (1996). In People v. Melka, Ill. App. (1st) 981077, the defendant cited section 104-12 of the Code of Criminal Procedure of 1963, which provides as follows: “Right to Jury. The issue of the defendant’s fitness may be determined in the first instance by the court or by a jury. The defense or the State may demand a jury or the court on its own motion may order a jury. However, when the issue is raised after trial has begun or after conviction but before sentencing, or when the issue is to be redetermined under Section 104-20 or 104-27, the issue shall be determined by the court.” 725 ILCS 5/104-12 (West 1996).
In Melka, the defense did not demand a hearing prior to the initial trial. Therefore, the Appellate Court held that “it appears that the statute provides that the issue shall be determined by the court.” [the default position of the statute in cases where the defendant fails to demand a jury trial on a fitness issue] The defendant cited People v. Thomas, 43 Ill. 2d 328, 253 N.E.2d 431 (1969); People v. Burson, 11 Ill. 2d 360, 143 N.E.2d 239 (1957); and People v. James, 130 Ill. App. 2d 532, 263 N.E.2d 705 (1970), all of which involved prior versions of section 104-12. The prior statutory law did require that the trial judge impanel a jury for a fitness hearing. See, e.g., James, 130 Ill. App. 2d at 533, 263 N.E.2d at 706 (quoting Ill. Rev. Stat. 1967 ch. 38 sec. 104-2). The current, applicable statute does not so provide.
However, when the defense attorney fails to communicate with the defendant, due to ineffective assistance of counsel, if the defendant was thereby denied the right to request a jury trial, the defendant may have grounds to argue that due to ineffective assistance of counsel they were denied a jury trial which they had decided was necessary to preserve their rights.
Even if there is no request for a fitness exam and no bona fide doubt of fitness, a defendant may still use the defense of not sane at time of the offense (temporary insanity or lack of intent due to an altered state of consciousness, not caused by defendant – i.e. not drunk and not under influence of self-ingested illicit drugs. A post-traumatic-stress-disorder (PTSD) flashback would theoretically fit in this category.). People v. Lowe, 109 Ill. App. 2d 236 (4 Dist. 1969).
A mental state problem at the time of the offense does not equate to an insanity defense. People v. Lee, 128 Ill. App. 3d 774 (1 Dist. 1984) Fitness is a legal term and not a psychiatric opinion. If there is no memory of events at the time of the offense, or no knowledge by the defendant of the event, then there is no general insanity defense.. People v. Kashney, 129 Ill. App. 3d 218 (1 Dist. 1984).
Lack of memory for the event is not proof of general incompetence to take care of self or represent self but may prove no intent, which is an affirmative defense, as an element of many crimes is intent, (Stahl, (supra)) as with, for example, those charged with aggravated battery of a peace officer, without knowledge that the person was a peace officer, at the time of the offense, or without intent to harm them as they were delusional or in an altered mental state at the time (such as a PTSD flashback) then there is no probable cause under the Illinois battery statute. Probable cause exists “if ‘the facts and circumstances within [the officer’s] knowledge and of which they had reasonably reliable information’ would suffice to ‘warrant a prudent person believing’ that a person has committed a crime.” Burke v. Town of Walpole, 405 F.3d 66, 80 (1st Cir.2005) (quoting Roche v. John Hancock Mut. Life Ins. Co., 81 F.3d 249, 254 (1st Cir.1996).
If defendant’s experts opine he is not sane at the time of the offense, then the state is not authorized to request a general fitness exam. The state holds no legal right under the statutes to plead insanity for the defense, when the defense is only pleading that the insanity was limited to the time of the offense. However, the defendant is unfit for trial as he cannot provide assistance to the defense attorney. A discharge hearing must occur at this point. People v. Sedlacek, 2013 Ill. App. LEXIS 172 (5 Dist. March 2013). The Department of Mental Health is not required to house defendants who are unfit for trial but not in need of mental health treatment and not committable. People v. Lang, 62 Ill. App. 3d 688, 378 N.E.2d 1106 (1 Dist. 1978). Least restrictive environment is required by law, unless the defendant is proven in an evidentiary hearing to be too dangerous to release or under civil commitment proceedings he is found to be a danger to himself or others. Treatment may still be mandated, whether as an inpatient in a secure facility or as an outpatient, for a period of time to be determined by statute, by the court, and by the treating physician.
As the IL fitness statute, 725 ILCS 5/104 does not differentiate between someone who is unfit or insane and someone who is temporarily insane or has a temporary altered mental status, there is a large hole in the law that leaves the latter subject to inappropriate and perhaps overly harsh and burdensome denial of their liberty rights. It would be appropriate for a court to certify a question to the IL Supreme Court as to whether this law is unconstitutional concerning those who have temporary insanity or an altered mental state that causes them to commit an offense. In addition, this would be an appropriate issue of first impression to be addressed by direct appeal if the fitness statute dispositions are used for a person with temporary insanity or an altered mental state at time of offense who is fit and sane at other times.
However, the IL statutes for fitness do NOT differentiate between how a person found insane versus one found temporarily insane should be handled. There is a total absence of law pertaining to the disposition of persons found temporarily insane, with lack of intent, and therefore not guilty by reason of temporary insanity. It is fundamentally unfair to confine them to a mental institution if they are unlikely to be in that temporarily insane state again, or if they are not dangerous while in that state.
However, there is no legal penalty to the court or state if they refuse to hold the hearing within 45 days. This is often abused and the courts may grant continuance after continuance, or keep reordering the fitness exam. The law allows this to toll speedy trial.
As section (b) of 725 ILCS 5/104-17 conflicts with section (a) in that it states that if the discretionary placement by order of court is with the Department of Human Services it must be in a secure facility until a treatment plan is developed and then the DHS will determine if the treatment should be inpatient or outpatient, a question needs to be certified to the Illinois Supreme Court to determine if section (a) over-rides section (b) in the case of those defendants eligible for bail and determined not to be dangerous.
It appears on its face that mandating a secure facility when a defendant is eligible for bail and not dangerous, is a violation of equal protection and discriminatory against those placed in the Dept. of Human Services when they do not have the funds to pay for private mental health treatment on an outpatient basis due to indigency. Therefore, section (b) appears fundamentally unconstitutional, but this is an issue of first impression that must be tested by the courts.“725 ILCS 5/104-17. Commitment for Treatment; Treatment Plan. (a) If the defendant is eligible to be or has been released on bail or on his own recognizance, the court shall select the least physically restrictive form of treatment therapeutically appropriate and consistent with the treatment plan. (b) If the defendant’s disability is mental, the court may order him placed for treatment in the custody of the Department of Human Services, or the court may order him placed in the custody of any other appropriate public or private mental health facility or treatment program which has agreed to provide treatment to the defendant. If the defendant is placed in the custody of the Department of Human Services, the defendant shall be placed in a secure setting. During the period of time required to determine the appropriate placement the defendant shall remain in jail. If upon the completion of the placement process the Department of Human Services determines that the defendant is currently fit to stand trial, it shall immediately notify the court and shall submit a written report within 7 days. In that circumstance the placement shall be held pending a court hearing on the Department’s report. Otherwise, upon completion of the placement process, the sheriff shall be notified and shall transport the defendant to the designated facility. The placement may be ordered on either an inpatient or an outpatient basis.
As a retired physician and former Medical Director of a Psychiatry/Psychology group practice, I recommend that during fitness exams that the defendant should have a right set in the statutes to have a tape recording, video recording, or silent witness present (especially if they are mentally incompetent, youthful, or have been abused by police or medical staff in the past and need someone’s presence to keep them calm and cooperative).
There is NOTHING in the American Psychiatric Association’s ethical standards or the Association of Psychiatry and the Law ethical standards that suggest universally that a silent witness or recording would interfere with the examiner’s ability to obtain an accurate examination. Of course, in some situations a witness could be intimidating and that would interfere with the exam, but there are also instances, such as with a child, with a person with PTSD or who is claustrophobic, or the mentally ill or mentally challenged that a person would be comforted and more likely to give accurate answers to the examiner if they were present. The stated policy of the Cook County Circuit Court Forensic Examiner that witnesses universally interfere with exams has no basis in fact.
Unless this is done, the defendant will have no due process means of having the medical examiner’s interview reviewed by other professionals for standard of care and accuracy. The defendant would have no way of refuting a false mental health diagnosis made by an incompetent examiner outside the standard of care of the profession. This would deny due process.
This poses a dilemma for the court as the court must itself determine mental competency for self-representation without any guidelines at present.
Regardless of the result of the forensic clinical exam and the examiner’s report, I recommend that the judge should question the defendant and have this on the record. Particularly with very intelligent and legally savvy defendants who refuse to answer questions at a fitness exam because they feel the fitness order was illegal and unjustified or because they disagree with the court’s dicta [U.S. Supreme Court dicta in Estelle v. Smith, 451 U.S. 454 (1981) that the defendant has no constitutional fifth amendment right to have a witness present during a fitness exam or a recording of the fitness exam], it is important for the judge to question the defendant on the record to verify fitness and competence for self-representation. The answers to these questions can then be utilized by the court in lieu of a professional’s fitness exam report to determine the issue of fitness, but not the issue of mental illness. A professional forensic psychiatric exam is not really necessary to determine fitness, but is necessary to determine if the defendant suffers from mental illness.
if the defendant is able to control his behavior and emotions so that he can effectively listen, take notes, and formulate questions including questions to a stand-by counsel regarding courtroom procedure.
90. If all of these issues are answered in the affirmative then the defendant should be considered fit for purposes of trial and competent for purposes of self-representation. If the defendant meets all these criteria but due to PTSD may have a flashback triggered with the questioning of a particular witness due to the topic discussed, the court has plenary power, as an ADA accommodation, to allow a stand-by counsel to question that witness with prior guidance from pro se defendant. There is to date no case barring this type of order.
91.Unfortunately, courts are left to formulate criteria for mental competence for self-representation with the United States Supreme Court holding in abeyance further decisions upon the criteria for mental competence for self-representation until further cases reach the Court.
 Freudenreich, Oliver (3 December 2012). “Differential Diagnosis of Psychotic Symptoms: Medical “Mimics””. Psychiatric Times. UBM Medica. Retrieved October 2013.
 725 ILCS 5/104-13. Fitness Examination.
(a) When the issue of fitness involves the defendant’s mental condition, the court shall order an examination of the defendant by one or more licensed physicians, clinical psychologists, or psychiatrists chosen by the court. No physician, clinical psychologist or psychiatrist employed by the Department of Human Services shall be ordered to perform, in his official capacity, an examination under this Section.
Aggravated battery as defined in subdivision . . . (d)(4) . . . is a Class 2 felony.

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