Title: Commonwealth v. Piantedosi
Citation: N/A
Docket Number: SJC-11802
State: Massachusetts
Issuer: Massachusetts Supreme Court
Date: December 18, 2017

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SJC-11802 
 
COMMONWEALTH  vs.  CHRISTOPHER PIANTEDOSI. 
 
 
 
Middlesex.     October 6, 2017. - December 18, 2017. 
 
Present:  Gants, C.J., Gaziano, Budd, Cypher, & Kafker, JJ. 
 
 
Homicide.  Mental Impairment.  Intoxication.  Insanity.  
Evidence, Intoxication, Insanity, Expert opinion.  Witness, 
Expert.  Constitutional Law, Fair trial.  Due Process of 
Law, Fair trial.  Fair Trial.  Practice, Criminal, Capital 
case, Fair trial, Instructions to jury, Acquittal by reason 
of insanity. 
 
 
 
 
Indictments found and returned in the Superior Court 
Department on June 7, 2012. 
 
 
The cases were tried before Diane M. Kottmyer, J. 
 
 
 
Robert S. Sinsheimer (Lisa A. Parlagreco also present) for 
the defendant. 
 
Emily K. Walsh, Assistant District Attorney (Nicole L. 
Allain, Assistant District Attorney, also present) for the 
Commonwealth. 
 
 
 
GAZIANO, J.  A jury in the Superior Court found the 
defendant guilty of murder in the first degree in the stabbing 
death of his longtime girl friend, on theories of deliberate 
2 
 
 
premeditation and extreme atrocity or cruelty.1  At trial, the 
defendant conceded that he had killed the victim but asserted 
that he lacked criminal responsibility for her death due to his 
involuntary intoxication from having taken prescribed 
antidepressant medications.  In this direct appeal from his 
convictions, the defendant challenges the judge's refusal to 
permit a defense expert to testify on direct examination to 
hearsay statements made by the defendant; the introduction of 
testimony by the Commonwealth's expert concerning what "drove" 
the defendant's behavior; and the judge's failure to instruct 
the jury that the consequences of a verdict of not guilty by 
reason of insanity would include a potential psychiatric 
commitment for life.  In addition, the defendant asks this court 
to exercise its extraordinary authority under G. L. c. 278, 
§ 33E, to reduce the verdict to murder in the second degree.  
For the reasons that follow, we affirm the defendant's 
convictions and, after a thorough review of the entire trial 
record, decline to grant relief pursuant to G. L. c. 278, § 33E. 
 
1.  Background.  We summarize the facts that the jury could 
have found, reserving other details for later discussion of 
particular issues. 
                     
 
1 The defendant also was convicted of malicious destruction 
of the victim's personal property.  See G. L. c. 266, § 127. 
3 
 
 
 
a.  Commonwealth's case.  The victim and the defendant were 
involved in an eighteen-year relationship and had a daughter, 
Alexa,2 who was a teenager at the time of these events.  The 
victim had a son from another relationship, whom she and the 
defendant were raising as their child.  The four lived as a 
family for approximately six years in an apartment in a three-
family house then owned by the defendant's parents, and 
thereafter for more than ten years in a rented house in 
Burlington.  In April, 2012, the defendant moved into his 
parents' house, explaining that he needed time and space away 
from the victim.  The victim confided to a friend that she had 
asked the defendant to leave due to his verbal and emotional 
abuse. 
 
In the early evening of May 3, 2012, the defendant went, as 
scheduled, to the house in Burlington to visit Alexa.  Alexa 
noticed that he was "kind of acting strange."  The defendant 
agreed to buy Alexa dinner, and the victim placed an order for 
takeout food delivery.  While the three were together in the 
living room, the defendant and the victim got into an argument.  
At trial, Alexa was not certain of the topic of the 
disagreement, but recalled that the defendant "started saying 
something and she [was] getting mad.  So they were kind of like 
                     
 
2 A pseudonym. 
4 
 
 
fighting back and forth."  The defendant instructed Alexa to go 
to her room, and she did so. 
 
At around 6:30 P.M., Alexa used a tablet computer, which 
she propped up on her window sill, to "video chat" with a 
friend, Ethan.3  Alexa and Ethan were able to see and hear each 
other using this computer program.  While they were talking, 
Alexa thought that she heard the doorbell or a knock on the 
door, and stepped out of her room believing that her takeout 
food delivery had arrived.  Ethan stayed connected to the video 
chat, waiting for Alexa to return. 
 
Alexa's parents were in the kitchen, arguing.  The victim, 
who appeared distraught, picked up the telephone and threatened 
to call the police.  The defendant snatched the telephone from 
her.  He then removed a small knife from his pants pocket and 
put it down on a living room table.  The victim seized the 
knife, pointed it at the defendant, and implored him to leave 
the house.  She repeatedly said, "Get out.  I'll call the cops.  
You're scaring me."  As the victim cried, the defendant hugged 
Alexa and said, "I love you."  Alexa replied, "Are you trying to 
kill her or something?" 
 
The defendant went into the kitchen and stood there, 
telling himself, aloud, that he was going to calm down.  He then 
turned abruptly, grabbed a butcher knife from a knife block on 
                     
 
3 Also a pseudonym. 
5 
 
 
the counter, and chased the victim.  The victim ran into Alexa's 
room in full view of Ethan, who watched from his computer 
screen. 
 
The victim was holding the bedroom door shut when the 
defendant broke down the door and burst into the room.  The 
force knocked the victim backwards onto the bed.  She screamed, 
"No, Chris, stop.  I love you."  Alexa entered the room shortly 
thereafter and attempted to pull the defendant away from the 
victim by grabbing him around the neck.  The defendant pushed 
her off. 
 
Through the video chat, Ethan watched the defendant shake 
the victim forcefully and then stab her in the chest while she 
was lying on the bed; Ethan screamed "Stop" into the computer 
microphone, but the defendant did not react.  Alexa was still in 
the room; she told the defendant that she was calling the 
police, grabbed her cellular telephone, and ran from the room.  
Ethan heard the victim say, "Remember," and the defendant 
respond, "No, you got to die.  You got to die."  The defendant 
stabbed the victim repeatedly until she fell off the bed onto 
the floor. 
 
Alexa ran out of the house, where she encountered the food 
delivery driver, who had just arrived.  Alexa sat in the vehicle 
with the driver and telephoned 911.  Alexa and the driver 
watched as the defendant walked away from the house toward his 
6 
 
 
vehicle.  The delivery driver described the defendant as "stone 
face[d]."  When police arrived, within minutes of Alexa's call, 
they found the victim's body on the floor in the space between 
the edge of Alexa's bed and the wall.  The victim had been 
stabbed more than thirty times and the kitchen knife was 
imbedded in her neck. 
 
The defendant left Burlington and eventually drove to 
western Massachusetts.4  The next day, May 4, 2012, the defendant 
drove his automobile into the parking lot of the State police 
barracks in Weston.  He got out of his vehicle and lay on the 
ground.  A public works employee driving nearby and saw the 
defendant lying in front of his vehicle.  The employee tried to 
rouse him but was unable to do so; the defendant remained 
unresponsive.  The employee went into the barracks and summoned 
police officers to help.  One of the officers, who recognized 
the defendant from a police bulletin and media reports, placed 
him under arrest.  Investigators searched the defendant's 
vehicle and found handwritten notes on the dashboard.  One note 
read, "Unarmed.  Just have to sleep."  Another portion of a note 
recounted the stabbing. 
                     
 
4 Burlington police tracked the defendant's cellular 
telephone to a location approximately thirty miles away, at a 
shopping mall in Leominster.  Police recovered the defendant's 
bloody clothing and his cellular telephone from a Dumpster 
behind the mall. 
7 
 
 
 
b.  Defendant's case.  After the Commonwealth rested its 
case-in-chief, the defendant presented evidence concerning the 
issue of his criminal responsibility on the day of the homicide.  
The defendant called two witnesses:  his father and Dr. Wade C. 
Meyers, a forensic psychiatrist.  The defendant also introduced 
medical records from his admissions to the Lahey Clinic and Holy 
Family Hospital, records relating to his psychiatric treatment 
at the county jail and Bridgewater State Hospital, and a May 7, 
2012, competency evaluation. 
 
The defendant's father provided background information 
about the defendant, including describing the defendant's 
"normal" relationship with the victim.  The father also 
testified to the defendant's psychiatric hospitalization a few 
days before the May 3, 2012, incident.  On April 29, 2012, the 
father visited the defendant at the Holy Family Hospital 
emergency room and observed that he was quiet and nontalkative.  
According to medical records, the defendant had been admitted to 
the hospital for self-inflicted injuries to his arms.  He was 
diagnosed with depression and prescribed Prozac (to be taken in 
the morning) and Trazodone (to be taken before bed). 
 
Upon the defendant's discharge on May 2, 2012, his father 
picked him up from the hospital and drove him to a pharmacy to 
8 
 
 
fill his prescriptions.5  The defendant was scheduled to attend 
an outpatient program beginning on May 3, 2012.  He spent the 
afternoon in his room but left to attend classes at a 
professional school that evening; several of the students in his 
class noticed that he seemed tired and unwell.  The next 
morning, the defendant did not come downstairs from his bedroom 
until approximately 11:30 A.M.; he was pale and dehydrated.  The 
defendant left the house shortly thereafter, telling his father 
that he was planning to pick Alexa up at school, because she had 
a half-day off, and take her out for ice cream. 
 
Meyers evaluated the defendant to determine his mental 
state at the time of the crime.  Based on interviews with the 
defendant, Meyers's review of past psychiatric records, 
neuropsychological testing, and other information, Meyers 
concluded that on May 3, 2012, the defendant did not have the 
capacity to appreciate the wrongfulness of his conduct and was 
not able to conform his conduct to the requirements of the law.  
Meyers opined that the defendant suffered from involuntary 
intoxication from the antidepressants Prozac and Trazodone.  He 
explained that possible side effects of those medications 
included "irritability, rage reactions, hostility, mania, 
                     
 
5 After the defendant's arrest, his father counted the 
Prozac and Trazodone pills remaining in the defendant's 
prescription bottles.  He testified that there was one pill 
missing from both bottles, which could have indicated that the 
defendant had taken his medications as prescribed. 
9 
 
 
insomnia, racing thoughts, a disinhibition of . . . behavior, 
impulsivity and trouble concentrating."  Meyers opined further 
that the defendant suffered from bipolar disorder, and therefore 
that he was more vulnerable to the toxic effects of Prozac and 
Trazodone.  He noted that Prozac and Trazodone contain warnings 
to screen for bipolar disorder because "taking those medications 
has a significant risk of swinging you into a manic episode."  
He stated that people with bipolar disorder who are treated with 
antidepressants generally are also treated with mood stabilizers 
to prevent possible manic episodes. 
 
In rebuttal, the Commonwealth called Dr. Alison Fife, a 
forensic psychiatrist.  Fife also had interviewed the defendant 
and reviewed the relevant treatment records and police reports.  
She disagreed with the conclusion that the defendant was 
intoxicated by therapeutic doses of Prozac and Trazodone.  She 
also did not agree with Meyers's diagnosis of bipolar disorder.  
Fife testified that a mental disease or defect did not "drive" 
the defendant to kill the victim.  When asked, in her opinion, 
what did "drive" the defendant to do so, she responded that 
feelings of anger, sadness, and rage "drove" the defendant's 
behavior. 
 
2.  Discussion.  a.  Limitations on direct examination of 
defendant's mental health expert.  The defendant contends that 
he was precluded from presenting a complete defense because the 
10 
 
 
judge did not permit the introduction of certain testimony by 
the defendant's medical expert concerning a conversation that 
the expert had had with the defendant during the forensic 
interview.  The defendant argues that the exclusion of these 
statements violated his rights under the due process clause and 
the Sixth Amendment to the United States Constitution.  Because 
the defendant objected, we review to determine whether the 
exclusion of the evidence was error, and if so, whether it was 
prejudicial.  See Commonwealth v. Aviles, 461 Mass. 60, 67 
(2011). 
In conducting his evaluation of the defendant's mental 
state, Meyers reviewed the defendant's mental health records, 
police reports, and other discovery material; interviewed 
collateral witnesses; and "met with [the defendant] on two 
occasions:  May 2[, 2013,] and July 19[, 2013,] for a total of 
about seven and a half hours."  On direct examination, defense 
counsel asked Meyers about certain statements the defendant had 
made to him during the course of these interviews.  Counsel 
inquired, "Were you able to learn anything from [the defendant] 
concerning his mental health history. . . that was of 
significance to you in forming your opinion?" 
The prosecutor objected to the question because the 
defendant's statements had not been admitted in evidence.  As an 
offer of proof, defense counsel represented that Meyers would 
11 
 
 
testify to statements made by the defendant "about experiencing 
manic-like symptoms in the past . . . hyperactivity, increased 
mood, . . . needing to sleep for a couple of days at a time, 
that sort of thing."  Counsel added that he wanted to raise with 
Meyers "some things about [the defendant's] mental health and 
employment histories and . . . the events on May 3."6  After a 
lengthy sidebar conference, the judge ruled that the statements 
made during Meyers's interviews of the defendant were not 
admissible on direct examination.  During the remainder of his 
direct testimony, Meyers testified that the defendant suffered 
from bipolar disorder.  As a basis for this opinion, Meyers 
stated that he had relied upon the defendant's "history from 
different sources and as well my history from him." 
 
The thrust of the prosecutor's cross-examination was that 
the defendant's prior treatment records did not support a 
                     
 
6 After the conclusion of Meyers's testimony, defense 
counsel provided the judge with another offer of proof.  Counsel 
represented that Meyers would have testified to the following: 
(1) the defendant's relationship with the victim; (2) the events 
of May 3, 2013, including "that morning when he woke up," "his 
plans with [his] daughter and communications with his daughter 
in the afternoon," and "his activities during the afternoon 
leading up to the time he arrived at [the victim's house]," "the 
events between 5:30 P.M. and approximately 6:45 P.M. -- that is, 
in the kitchen and living room area and the event itself"; 
(3) the defendant's employment history, including losing two 
potential jobs in late April, 2012, after having lost his truck 
driving position in March, 2012, that caused "a significant 
amount of stress, anxiety, and depression; and (4) the 
defendant's mental health history including instances of manic 
behavior. 
12 
 
 
diagnosis of bipolar disorder.  Pursuing this line of inquiry, 
the prosecutor asked Meyers about records admitted in evidence 
from the Lahey Clinic and Holy Family Hospital, treatment 
records from the Cambridge house of correction and Bridgewater 
State Hospital, and a May 7, 2012, competency evaluation 
conducted by Dr. Jodie Shapiro.  The prosecutor did not 
challenge Meyer's reliance on the defendant's out-of-court 
statements as the basis for his expert opinion that the 
defendant suffered from bipolar disorder.  On redirect 
examination, defense counsel did not ask Meyers any questions 
about statements made by the defendant concerning this subject. 
The question the defendant raises concerns the 
admissibility of testimony by an expert witness, on direct 
examination, concerning facts upon which the expert's opinion is  
based, and that are independently admissible, but that have not 
been introduced in evidence.  See generally Department of Youth 
Servs. v. A Juvenile, 398 Mass. 516, 531 (1986); Mass. G. Evid. 
§ 703 (2017).  Prior to our decision in Department of Youth 
Servs., we followed the traditional rule that an expert's 
opinion had to be "based on either the expert's direct personal 
knowledge, on evidence already in the record or which the 
parties represent will be presented during the course of the 
trial, or on a combination of these sources."  Commonwealth v. 
Barbosa, 457 Mass. 773, 784 (2010), cert. denied, 563 U.S. 990 
13 
 
 
(2011), quoting LaClair v. Silberline Mfg. Co., 379 Mass. 21, 32 
(1979).  In Department of Youth Servs., supra at 531, we 
expanded the permissible bases of expert opinion testimony to 
include "facts or data not in evidence if the facts or data are 
independently admissible and are a permissible basis for an 
expert to consider in formulating an opinion." 7  See 
Commonwealth v. Chappell, 473 Mass. 191, 203 (2015), quoting 
Department of Youth Servs., supra; Barbosa, supra at 785. 
Although an expert may formulate an opinion based on facts 
or data not admitted in evidence, but that would be admissible 
with the proper witness or foundation, "the expert may not 
testify to the substance or contents of that information on 
direct examination."  Commonwealth v. Chappell, 473 Mass. 191, 
203 (2015), quoting Department of Youth Servs., 398 Mass. at 
531.  The purpose of this limitation on expert witness testimony 
is to prevent the proponent of the opinion from "import[ing] 
inadmissible hearsay into the trial."  Commonwealth v. Goddard, 
476 Mass. 443, 448 (2017).  See Commonwealth v. Greineder, 464 
                     
 
7 In Department of Youth Servs. v. A Juvenile, 398 Mass. 
516, 531 (1986), we decided to take a "modest step" toward 
allowing an expert witness to state his or her basis of opinion, 
and declined to adopt then proposed Mass. R. Evid. 703 (the 
equivalent of Fed. R. Evid. § 703).  Under this broader 
evidentiary rule, the proponent of expert opinion testimony is 
permitted to disclose otherwise inadmissible facts or data to 
the jury "if their probative value in helping the jury evaluate 
the opinion substantially outweighs their prejudicial effect."  
Fed. R. Evid. § 703 (2012).  See Vassallo v. Baxter Healthcare 
Corp., 428 Mass. 1, 16 (1998). 
14 
 
 
Mass. 580, 583, cert. denied, 134 S. Ct. 166 (2013) 
("Disallowing direct testimony to the hearsay basis of an expert 
opinion helps prevent the offering party from slipping out-of-
court statements not properly in evidence in through the 'back 
door'"); Commonwealth v. Nardi, 452 Mass. 379, 392 (2008) 
(expert witness may not "under the guise of stating the reasons 
for his opinion" testify to inadmissible hearsay). 
We have emphasized that "[t]he thrust of [our] rule is to 
leave inquiry regarding the basis of expert testimony to cross-
examination" (citation omitted).  Barbosa, supra.  The opposing 
party then may, as a matter of trial strategy, elicit details of 
the facts or data underlying the expert's opinion.  Commonwealth 
v. Markvart, 437 Mass. 331, 338 (2002).  If the door is opened 
by the opposing party, on redirect examination, the proponent of 
the evidence then may introduce the details surrounding the 
source of the expert's opinion.8  Chappell, 473 Mass. 203-204.  
                     
8 For example, on cross-examination in this case, the 
prosecutor challenged Meyers's assumption that the defendant 
took his medications as prescribed following his release from 
the hospital.  Meyers agreed that he did not examine the 
defendant's pill bottles or "have any conversation with anyone 
else [other than defense counsel] about the number of pills" 
missing from those bottles.  Thereafter, on redirect 
examination, the judge permitted Meyers to testify to certain 
information he had obtained from the defendant during the 
forensic interview.  The judge ruled that the testimony was 
admissible on redirect examination "as a basis of [Meyers's] 
opinion . . . for the fact that it was said and the doctor 
relied on it."  Meyers then testified that he learned that the 
defendant felt nauseated and vomited soon after awaking midday 
15 
 
 
See Mass. G. Evid. § 705 (2017).  See generally Commonwealth v. 
Garcia, 470 Mass, 24, 36 (2014) (purpose of redirect examination 
is to "explain or rebut adverse testimony or inferences 
developed during cross-examination" [citation omitted]). 
The judge's decision to require compliance with this rule 
of evidence did not violate the defendant's constitutional right 
to present a full defense.  The rule limiting direct examination 
testimony of an expert witness "is a common-law evidentiary rule 
that operates in both civil and criminal cases and applies to 
both sides."9  Chappell, 473 Mass. at 204.  "A defendant's right 
to present a full defense . . . is not without limits . . . and 
as a general rule, does not entitle him to place before the jury 
evidence normally inadmissible" (quotations and citations 
omitted).  Id.  Here, Meyers testified that he interviewed the 
defendant, and that he diagnosed the defendant with bipolar 
disorder based in part upon learning the defendant's history.  
                                                                  
on May 3, 2012, and that this was evidence that the defendant 
had been compliant with taking his medication as prescribed. 
 
 
9 See Commonwealth v. Johnston, 467 Mass. 674, 696 (2014) 
(error for Commonwealth's expert psychiatrist to summarize  on 
direct examination statements provided by witnesses that 
defendant did not exhibit signs of mental illness during weeks 
and hours before killing); Commonwealth v. Nardi, 452 Mass. 379, 
392 (2008) (substitute medical examiner unable to testify to 
hearsay statements recorded in autopsy report); Commonwealth v. 
Jaime, 433 Mass. 575, 577-578 (2001) (Commonwealth's expert 
should have been precluded from testifying on direct examination 
that witnesses reported that defendant was his normal jovial 
self day before murder). 
16 
 
 
The underlying facts, which were not otherwise introduced in 
evidence, were not admissible on direct examination.  See 
Barbosa, 457 Mass. at 784; Mass. G. Evid. § 703. 
The defendant argues that the rule established in 
Department of Youth Servs. has been called into question by our 
subsequent decisions in Commonwealth v. Brown, 449 Mass. 747, 
768 (2007), and Commonwealth v. Rutkowski, 459 Mass. 794, 799-
800 (2011).  These cases, however, do not support the 
proposition that facts not otherwise in evidence are admissible 
on direct examination of an expert witness.  In both cases, we 
held that where a defendant's statements properly have been 
admitted in evidence, an instruction that the statements may be 
considered only as the basis of the expert's opinion is 
warranted.  See Rutkowski, supra; Brown, supra. 
 
Furthermore, we note that the judge's evidentiary ruling 
did not deprive the defendant of the ability to pursue an 
insanity defense.  The defendant was able to introduce testimony 
from his and the Commonwealth's medical experts, his medical 
records from four different facilities, and evidence from his 
competency examination, as well as statements by his father and 
his classmates as to his appearance and activities in the first 
twenty-four hours after he was released from the hospital.  See 
Chappell, 473 Mass. at 204-205 (noting that defendant was able 
to elicit excluded information by introducing medical records).  
17 
 
 
The defendant argues that the statements excluded from evidence 
would have described his conduct on May 3, 2012, and would have 
demonstrated that he had experienced psychiatric symptoms 
suggesting that he was suffering from a manic episode as a 
result of his bipolar disorder.  The transcript indicates that, 
on direct examination, referring to his review of "records" and 
"collateral material," Myers was able to provide a detailed 
description of the events of May 3, 2012. 
 
In describing the events on the day of the victim's death,  
Meyers testified that, on that day, the defendant made plans to 
take Alexa out for ice cream.  He arrived to pick up Alexa at 
around 5 P.M. and went into the house.  At first, the defendant, 
Alexa, and the victim "were conversing" and "things were fine."  
The victim ordered takeout food for Alexa, and the defendant and 
the victim got into an argument.  The victim attempted to stab 
the defendant; he grabbed the knife from her.  "At some point 
she picked up a knife again.  They went at it. This time . . . 
is in front of his daughter." 
 
In addition, Myers testified as to the defendant's mental 
health history.  This history included details involving the 
defendant's admission to Holy Family Hospital on April 29, 2012, 
and his subsequent treatment and prescriptions.  In Meyers's 
opinion, the defendant had exhibited symptoms of bipolar 
disorder prior to the May 3, 2012, incident.  Meyers testified 
18 
 
 
that the defendant had been struggling with depression, anxiety, 
and irritability for years, "which could be a sign of bipolar"; 
that the clinicians at the jail documented "the [defendant's] 
history of prior manic episodes"; Alexa witnessed the 
defendant's wide fluctuation in moods on May 3, 2012, ranging 
from "nice and sweet one moment, then screaming, then psycho and 
then nice again."  Meyers also described the defendant's May 7, 
2012, competency evaluation, at which Shapiro had noted that 
"approximately a week before [the evaluation, the defendant] had 
symptoms of what appeared to be mania.  He had described 
increased hypersexual feelings . . . sleep problems, increased 
energy and that had just been a week before so it sounded like 
the beginnings of a manic episode." 
 
b.  Admission of Commonwealth's expert witness opinion 
testimony on defendant's motivation.  The defendant argues that 
Fife, the Commonwealth's expert witness, improperly testified 
about what "drove" the defendant to kill the victim.  He 
contends that this testimony was impermissible, first, because 
Fife did not express her opinion in accordance with the standard 
set forth in Commonwealth v. McHoul, 352 Mass. 544, 546 (1967); 
and second, because Fife's testimony infringed on the jury's 
right to determine the ultimate question of the defendant's 
criminal responsibility.  As there was no objection to Fife's 
testimony, our review is limited to consideration whether there 
19 
 
 
was error, and if so, whether it created a substantial 
likelihood of a miscarriage of justice.  Commonwealth v. Wright, 
411 Mass. 678, 681 (1992), S.C., 469 Mass. 447 (2014). 
 
During Fife's testimony, the following exchange took place: 
Q.: "Based on your evaluation of the defendant and your 
review of the associated materials in this case, do 
you have an opinion to a reasonable degree of medical 
certainty as to whether mental illness drove this 
defendant to kill [the victim] on May 3, 2102?" 
 
A.:  "Yes, I have an opinion." 
 
Q.: "And what's that opinion?" 
 
A.:  "My opinion is that mental disease did not drive this 
behavior on that day." 
 
Q.: "And, again, based on your evaluation of the defendant 
and your review of the case materials, do you have an 
opinion to a reasonable degree of medical certainty as 
to whether a mental defect drove this defendant to 
kill [the victim] on May 3rd of 2012?" 
 
A.:  "Yes, I have an opinion." 
 
Q.: "And what's your opinion on that?" 
 
A.:  "My opinion is that there is no mental defect present 
at that time that drove his behavior." 
 
Q.:  "What in your opinion did drive him to kill her on 
that day?" 
 
A.:  "In my opinion, this individual, the defendant was 
angry, he was upset, he had feelings of depression, 
sadness mixed with danger [sic], mixed with rage and I 
think that those were the primary feelings that drove 
the behavior on that day." 
 
We conclude that there was no error in Fife's testimony 
about what drove the defendant's behavior.  A qualified expert 
20 
 
 
witness need not phrase his or her opinion in terms of the 
McHoul test.  See Commonwealth v. Amaral, 389 Mass. 184, 193 
(1983), citing Commonwealth v. Shelley, 381 Mass. 340, 348 n.4 
(1980), S.C., 411 Mass. 692 (1992); Commonwealth v. 
Gerhartsreiter, 82 Mass. 500, 509 (2012).  To the contrary, 
"Testimony in purely medical or psychological terms may in many 
instances be preferable; the expert may be best equipped to use 
medical and psychological concepts, and the testimony may not 
fit neatly in legal categories."  Shelley, supra.10 
                     
10 Defense counsel also questioned Fife on what drove the 
defendant's behavior, albeit in a hypothetical form. 
 
 
"Assume that an individual is in the midst of a 
breakup with his girl friend who has never exhibited any 
signs of physical violence towards that girl friend suffers 
from an apparent depressed mood, exhibits suicidal thoughts 
and behaviors, is hospitalized for three days due to that 
depressed mood and suicidal behaviors and thoughts, is 
prescribed Prozac and Trazodone, takes those medications 
for three or four days, exhibits symptoms of nausea and 
vomiting, then goes to his girl friend's home with his 
daughter present with a Chinese food delivery person on the 
way and then stabs her. 
 
 
"My question is you as a psychiatrist would it be 
reasonable to suggest that you would have to explore the 
possibility that that conduct was driven by a mental 
disease or defect? 
 
 
". . . 
 
 
"Would it be reasonable, Doctor, and would you have to 
explore the possibility that the Prozac and Trazodone drove 
that conduct . . . ?" 
21 
 
 
 
The defendant argues also that, in another portion of her 
testimony, Fife misstated the McHoul standard.  Fife stated that 
she relied on that standard, which she described as follows: 
 
"[The McHoul standard] states that at the time of the 
crime -- at the time of the crime -- at the time of the 
alleged crime, an individual has to first meet the criteria 
for mental illness, and then it splits from there so that 
if a person meets that criteria [do] they as a result of 
the mental illness either lack the substantial capacity to 
appreciate the wrongfulness, it's sometimes called the 
criminality, but the wrongfulness of their behavior at the 
time of the alleged crime as a result of the mental 
illness, or were they substantially less capable of 
conforming their behavior to the requirements of the law, 
again coming back to because of an active mental illness at 
the time of the crime." 
 
In an attempt to clarify her testimony, Fife strayed from the 
McHoul formulation and stated: 
 
"I think of that as the first part of it that whether 
or not there is a mental illness and then the prongs as if 
there's a mental illness because of that illness.  
Sometimes I think of it as but for the illness would the 
crime have happened.  You know, so . . ." 
 
 
We have cautioned that if an expert witness were to 
reference a legal standard, "[C]ounsel properly would be 
required to ask the expert to cast his opinion in terms of the 
legal standard set out in McHoul."  Shelley, 381 Mass. at 348 
n.4.  Fife did not do that; indeed, her statement was both 
incorrect and likely to have confused the jury.  Fife's effort 
to clarify her understanding of the McHoul standard did not, 
however, create a substantial likelihood of a miscarriage of 
justice.  The judge interrupted her midsentence to inform the 
22 
 
 
jurors that she would be the one to instruct the jurors "on the 
law that they will apply with respect to the standard" before 
they began deliberating.  In her final charge, the judge 
correctly instructed the jury as follows: 
 
"Criminal responsibility is a legal term.  A person is 
not criminally responsible for his conduct if he has a 
mental disease or defect, and as a result of that mental 
disease or defect lacks substantial capacity either to 
appreciate the criminality or wrongfulness of his conduct 
or to conform his conduct to the requirements of law." 
 
See Gerhartsreiter, 82 Mass. App. Ct. 509-510 (no error where 
expert witness misstated McHoul standard but judge provided 
proper legal standard). 
Moreover, Fife's testimony concerning what drove the 
defendant's behavior did not usurp the jury's role as the sole 
and exclusive finders of the facts.  An expert witness may not 
offer an opinion as to a defendant's guilt or innocence.  
Goddard, 476 Mass. at 446.  Commonwealth v. Lodge, 431 Mass. 
461, 467 (2000).  An expert witness is not precluded, however, 
from providing an opinion that reaches or approaches the 
ultimate issue in a case.  See Commonwealth v. Okoro, 471 Mass. 
51, 66 (2015), quoting Commonwealth v. Federico, 425 Mass. 844, 
847 (1997); Mass. G. Evid. § 704 (2017). 
In this case, Fife did not offer an opinion that the 
defendant was criminally responsible for the victim's death.  
She was permitted to testify that anger, sadness, and rage, not 
23 
 
 
mental illness, motivated his actions.  See Commonwealth v. 
Johnston, 467 Mass. 674, 699-700 (2014) (no error in expert 
testimony implying that defendant's resentment for victim, not 
mental illness, motivated killing); Commonwealth v. LaFave, 407 
Mass. 927, 934 (1990) (expert allowed to testify on issue of 
motive).  See also Commonwealth v. Goddard, 476 Mass. at 446-447 
(expert testimony that defendant's behavior was "planned" and 
"goal-directed" was admissible as relevant to issue of criminal 
responsibility). 
 
c.  Mutina instruction.11  In her final charge, the judge 
instructed the jury on the consequences of a verdict of not 
guilty by reason of lack of criminal responsibility, as set 
forth in Commonwealth v. Mutina, 366 Mass. 810, 823 & n.12 
(1975).  The judge instructed as to "what happens to a defendant 
if he is found not guilty by reason of lack of criminal 
responsibility."  At trial, the defendant did not object to this 
formulation of the instruction.  In this appeal, however, the 
defendant argues that the instruction created a substantial 
likelihood of a miscarriage of justice because the judge failed 
adequately to inform the jury of the real possibility that the 
defendant could be committed for life. 
                     
11 We have considered the additional arguments in the 
defendant's reply brief filed pursuant to Commonwealth v. 
Moffett, 383 Mass. 201, 207-208 (1981), and conclude that they 
are unavailing. 
24 
 
 
In Chappell, 473 Mass. at 205-206, we modified the model 
Mutina instruction set forth in our Model Jury Instructions on 
Homicide, effective at the time of the defendant's trial.  The 
provisional instruction set forth in Chappell, supra at 209 
(Appendix), informs the jury that "[t]here is no limit to the 
number of such renewed orders of commitments as long as the 
defendant continues to be mentally ill and dangerous; if these 
conditions do continue, the defendant may remain committed for 
the duration of his [or her] life."  Nonetheless, we concluded 
also that the Mutina instruction as set forth in the 2013 Model 
Jury Instructions on Homicide accurately stated the law, and 
that the judge did not err in giving the then-existing Mutina 
instruction.  Id. at 205-206. 
In cases decided after Chappell, we have said that it is 
not error for a judge "like the judge in Chappell . . . [to 
give] the Mutina instruction that, at the time of trial, was the 
governing model jury instruction."  Commonwealth v. Dunn, 478 
Mass. 125, 139 (2017).  See Commonwealth v. Griffin, 475 Mass. 
848, 862 (2016).  The Mutina instruction the judge gave in this 
case, three years before we decided Chappell, was proper and did 
not create a substantial likelihood of a miscarriage of justice. 
 
d.  Review pursuant to G. L. c. 278, § 33E.  We have 
carefully reviewed the entire record pursuant to our duty under 
G. L. c. 278, § 33E, and we discern no reason to order a new 
25 
 
 
trial or to reduce the conviction of murder in the first degree 
to a lesser degree of guilt. 
 
 
 
 
 
 
 
Judgments affirmed.