Title: Commonwealth v. George
Citation: N/A
Docket Number: SJC-12173
State: Massachusetts
Issuer: Massachusetts Supreme Court
Date: June 21, 2017

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SJC-12173 
 
COMMONWEALTH  vs.  RICHARD GEORGE. 
 
 
 
Worcester.     December 8, 2016. - June 21, 2017. 
 
Present:  Gants, C.J., Lenk, Hines, Gaziano, Lowy, & Budd, JJ. 
 
 
Sex Offender.  Constitutional Law, Sex offender.  Due Process of 
Law, Sex offender, Substantive rights.  Evidence, Sex 
offender, Expert opinion, Relevancy and materiality.  
Witness, Expert. 
 
 
 
 
Civil action commenced in the Superior Court Department on 
October 11, 2013.  
 
 
The case was tried before Beverly J. Cannone, J.  
 
 
The Supreme Judicial Court granted an application for 
direct appellate review. 
 
 
 
David B. Hirsch for the defendant. 
 
Nathaniel R. Beaudoin, Assistant District Attorney, for the 
Commonwealth. 
 
 
 
HINES, J.  After a jury trial in the Superior Court, the 
defendant, Richard George, was determined to be a sexually 
dangerous person (SDP) pursuant to G. L. c. 123A.  In accordance 
with the statute, the judge committed the defendant to the 
2 
 
Massachusetts Treatment Center (treatment center) for an 
indeterminate period of from one day to life.  The defendant 
filed a timely appeal challenging the commitment on the grounds 
that (1) a diagnosis of antisocial personality disorder (ASPD) 
is a constitutionally inadequate basis for commitment as an SDP; 
and (2) the judge erroneously admitted expert opinion testimony 
on the likelihood of reoffense and the results of the Static-99R 
risk assessment tool.  We allowed the defendant's application 
for direct appellate review to clarify the relevance of an ASPD 
diagnosis in the sexual dangerousness calculus.    
 
We conclude that an ASPD diagnosis is a sufficient 
predicate for sexual dangerousness so long as other evidence 
establishes a nexus between that condition and the factors 
warranting confinement to a secure facility.  Also, we discern 
no error in the judge's evidentiary rulings requiring reversal.  
Therefore, we affirm the judgment and order for the defendant's 
civil commitment to the treatment center as an SDP. 
 
Background.  1.  Pretrial proceedings.  In October, 2013, 
the Commonwealth filed a petition pursuant to G. L. c. 123A, 
§ 12, seeking an adjudication that the defendant is an SDP.  In 
April, 2014, a Superior Court judge found probable cause to 
believe that the defendant is an SDP and committed him to the 
treatment center for examination and diagnosis.  Two qualified 
3 
 
examiners1 submitted reports, opining that the defendant is an 
SDP within the meaning of G. L. c. 123A, § 1.  The trial on the 
Commonwealth's petition commenced in September, 2015.   
 
2.  The trial.  Through records admitted at trial pursuant 
to G. L. c. 123A, § 14 (c), and the testimony of the two 
qualified examiners, the Commonwealth presented evidence from 
which the jury could have found beyond a reasonable doubt the 
statutory elements necessary for the defendant's commitment as 
an SDP.  This evidence detailed the defendant's prior 
convictions of sexual offenses and included expert opinion 
testimony on two issues:  (1) whether the defendant suffered 
from a mental abnormality or personality disorder that 
predisposes him to commit sexual offenses; and (2) whether the 
defendant likely would reoffend because of that mental condition 
if not confined to a secure facility.  The defendant offered no 
evidence at trial.   
 
The jury could have found the following facts.  The 
defendant was convicted of two different sexual offenses as 
defined in G. L. c. 123A, § 1.  In 1978, when the defendant was 
                     
 
1 "A qualified examiner is either (1) a physician who is 
licensed by the Commonwealth and certified or eligible to be 
certified in psychiatry by the American Board of Psychiatry and 
Neurology; or (2) a psychologist who is licensed by the 
Commonwealth.  In all cases, a qualified examiner is designated 
as such by the Department of Correction and has at least two 
years of experience with diagnosis or treatment of sexually 
aggressive offenders."  Green, petitioner, 475 Mass. 624, 625 
n.3 (2016), citing G. L. c. 123A, § 1. 
4 
 
seventeen years of age, he sexually assaulted a nine year old 
girl.  After first going down a bike path with the victim's 
eleven year old sister, the defendant asked the victim if she 
too wanted to go down the bike path.  As they went down the 
path, the defendant pushed the victim down to the ground, got on 
top of her, and, over the victim's clothing, fondled her breasts 
and genital area.   
 
After the victim began to scream for her sister, the 
defendant let her get up from the ground and warned if she told 
anyone, she would be killed.  Thereafter, the defendant was 
charged and convicted of indecent assault and battery on a child 
under the age of fourteen.  Following conviction, the defendant 
was sentenced to a term of probation for three years.   
 
Approximately twelve years later, the defendant was 
convicted of aggravated rape and rape.  The convictions stemmed 
from the rape of a forty-nine year old woman, who was the mother 
of a woman the defendant had dated previously.  The defendant 
went to the victim's home and asked to speak with her daughter, 
who was not home.  Following a conversation with the victim, the 
defendant asked if he could use her restroom.  He reported to 
the victim that the toilet was not functioning.  When the victim 
went to investigate, the defendant attacked her.  Putting his 
hands around her throat, the defendant pulled the victim down to 
the floor and sexually assaulted her vaginally and anally.  
5 
 
After sexually assaulting the victim, the defendant physically 
assaulted her with an iron and a knife.  The victim sustained a 
broken jaw, a fractured skull, and a cut on her neck. 
 
Based on the sexual and physical assault, the defendant was 
convicted of several rape charges, including one count of 
aggravated rape and two counts of rape.  As a result of the 
aggravated rape conviction, the judge sentenced the defendant to 
imprisonment for a term of from fifteen to twenty-five years.   
 
At trial, the Commonwealth presented evidence from the two 
qualified examiners, Gregg A. Belle, Ph.D., and Dr. Katrin 
Rouse-Weir, Ed.D.  Both qualified examiners interviewed and 
diagnosed the defendant with ASPD, and agreed that this 
particular mental condition constituted a personality disorder 
as defined by G. L. c. 123A, § 1.  In support of the diagnosis, 
the examiners considered a range of factors, including the 
defendant's disciplinary history while incarcerated, his history 
of sex offender treatment, and statements the defendant made in 
other evaluations regarding his sexual offenses.  Dr. Belle 
characterized the defendant's incarceration and disciplinary 
history as "somewhat difficult."  Specifically, the defendant 
received approximately fifty-three disciplinary reports alleging 
violations of prison rules, some of which resulted from 
threatening and sexually explicit statements the defendant 
allegedly made to female staff.  Another disciplinary report 
6 
 
resulted from an incident where the defendant masturbated in 
front of a female correctional officer.  The defendant's 
sexually threatening and explicit behavior was a factor in his 
transfer to a higher security facility.   
 
Although the defendant participated in sex offender 
treatment, he was terminated from the treatment program on 
several occasions.  He was terminated on one occasion because of 
sexually explicit letters he wrote to female staff.  The 
defendant also made sexually threatening statements regarding 
his plans on release, warning that he was going to commit a rape 
when he was released from prison and identifying the female 
staff member that he planned to rape.  In 2006, the defendant 
was again terminated from the treatment program for engaging in 
consensual oral sex with a wheel-chair bound inmate.   
 
Considering the defendant's criminal sexual history 
together with the nature of the numerous violations of 
institutional rules, Belle explained that this conduct 
exemplified "one of the hallmark traits of an antisocial 
personality disorder."  Belle also concluded that the defendant 
has demonstrated, "over a period of time, a persistent pattern 
. . . [of] an inability to control his sexual impulses."  
According to Belle, the defendant's continued engagement in a 
"pervasive pattern" of sexually threatening behavior while 
incarcerated, "speak[s] to the statutorily defined personality 
7 
 
disorder" that he characterized as ASPD.  Similarly, Dr. Rouse-
Weir noted that the statements made to female staff "involved 
sexual aggression, which is relevant . . . with regard to his 
risk."  Rouse-Weir went on to note that the defendant's 
aggression, irritability, lack of remorse, and lack of regard 
for the rights of others had "a sexual element."  She added that 
the continued demonstration of aggression with sexualized 
elements directed toward female staff exclusively was a "chronic 
characteristic associated with [his ASPD]."  
 
Belle and Rouse-Weir also opined on the significance of the 
defendant's score on the Static-99R risk assessment tool.2  The 
Static-99R risk analysis completed by Belle yielded a score of 
four, which Belle opined translated to a "moderate-high" risk to 
sexually reoffend.  Belle also explained that a score of four 
corresponded to an eleven per cent risk that the defendant would 
reoffend sexually over a five-year period.  Rouse-Weir, on the 
other hand, opined that the defendant's Static-99R risk analysis 
yielded a score of six, which falls within the "high-risk 
category" as defined by the Static-99R.   
                     
 
2 The Static-99R is an actuarial tool, designed to predict 
the recidivism risk of sexual offenses in adult male sex 
offenders who have been convicted of at least one sexual 
offense.  See Doe, Sex Offender Registry Bd. No. 10800 v. Sex 
Offender Registry Bd., 459 Mass. 603, 636 n.33 (2011).  
Initially developed in 1999, the Static-99 has since been 
revised and renamed "Static-99R."  
  
8 
 
 
Discussion.  The defendant challenges the commitment, 
arguing that commitment as an SDP based on an ASPD diagnosis 
violates substantive due process and that the erroneous 
admission of expert opinion testimony on the likelihood of 
reoffense and the scores on the Static-99R predicting a 
"moderate high" or "high" risk of reoffense usurped the jury's 
role as fact finder.  We address both arguments in turn. 
 
1.  Antisocial personality disorder.  Raising the issue for 
the first time on appeal,3 the defendant claims that commitment 
as an SDP based on an ASPD diagnosis as the predicate mental 
condition violates substantive due process.  Borrowing from the 
United States Supreme Court's analysis of a civil commitment 
statute in Kansas v. Crane, 534 U.S. 407 (2002), the defendant 
contends that the use of the ASPD diagnosis sweeps too broadly, 
permitting what amounts to unconstitutional preventive 
detention.  As the argument goes, the ASPD diagnosis fails to 
distinguish "the dangerous sexual offender whose serious mental 
illness, abnormality, or disorder subjects him to civil 
commitment from the dangerous but typical recidivist convicted 
                     
3 Although the defendant raised this argument in a motion in 
limine, defense counsel withdrew the motion prior to the start 
of trial.  Also, the defendant did not object to the antisocial 
personality disorder (ASPD) diagnosis at trial or move for a 
directed verdict.  Thus, the issue is waived.  However, we 
address the issue to determine whether the admission of the 
evidence created a substantial risk of a miscarriage of justice.  
See Commonwealth v. Fay, 467 Mass. 574, 583 n.9, cert denied, 
135 S. Ct. 150 (2014).   
9 
 
in an ordinary criminal case."  Id. at 413.  We reject the 
defendant's argument as it misapprehends the evidentiary weight 
to be accorded to an ASPD diagnosis in the sexual dangerousness 
calculus.   
 
The definition of an SDP in G. L. c. 123A, § 1, makes it 
abundantly clear that an ASPD diagnosis, standing alone, does 
not justify commitment as an SDP.  An SDP is defined as any 
person "who has been . . . convicted of . . . a sexual offense 
and who suffers from a mental abnormality or personality 
disorder which makes the person likely to engage in sexual 
offenses if not confined to a secure facility."4  A "personality 
disorder" is defined as "a congenital or acquired physical or 
mental condition that results in a general lack of power to 
control sexual impulses."  Id.  Although we have not been called 
on to parse the definition of "personality disorder," the 
Appeals Court has correctly recognized ASPD as a type of 
personality disorder, which in conjunction with other relevant 
evidence, may justify commitment as an SDP.  See, e.g., Souza, 
petitioner, 87 Mass. App. Ct. 162, 169 (2015) (noting that ASPD 
diagnosis is "adequate to satisfy the definitional requirements 
of an SDP in G. L. c. 123A, § 1"); Commonwealth v. Husband, 82 
Mass. App. Ct. 1, 5 (2012) (same); Commonwealth v. Mazzarino, 81 
                     
 
4 The Commonwealth does not contend that the defendant 
suffered from a "mental abnormality." 
10 
 
Mass. App. Ct. 358, 369 (2012) (commitment based on ASPD 
diagnosis "combined with other evidence" suggesting ASPD made 
respondent likely to reoffend sexually if not confined does not 
violate due process protections under Fourteenth Amendment to 
United States Constitution or art. 12 of Massachusetts 
Declaration of Rights). 
 
Accordingly, a "personality disorder" as defined in G. L. 
c. 123A, § 1, is relevant to the sexual dangerousness calculus 
only if the "condition . . . results in a general lack of power 
to control sexual impulses."  Contrary to the defendant's 
assertion, our law does not permit the indefinite and 
indiscriminate commitment of persons solely because of an ASPD 
diagnosis.  The diagnosis requires an individualized review, and 
it is relevant only if it is predictive of a lack of control 
over the proclivity for criminal conduct and the conduct is 
likely to be sexual in nature.  Not all offenders diagnosed as 
having ASPD can be so categorized.  Instead, our cases have held 
true to the underlying statutory purpose to subject only those 
persons who because of a prescribed mental condition cannot 
control their impulses to commit a sexual crime to the 
possibility of civil commitment as an SDP.5  
                     
 
5 The defendant urges this court to follow the reasoning in 
Matter of State of N.Y. v. Donald DD, 24 N.Y.3d 174, 190 (2014) 
(ASPD diagnosis alone absent diagnosis of any other "condition, 
disease or disorder alleged to constitute a mental abnormality" 
11 
 
 
Here, two qualified examiners opined that the defendant 
suffered from ASPD and determined that because of this condition 
the defendant was likely to engage in sexual offenses if not 
confined in a secure facility.  The qualified examiners did not 
base their opinion on this diagnosis alone.  Rather, they also 
relied on evidence, separate and apart from the defendant's 
criminal history, suggesting that ASPD made the defendant 
"likely to engage in sexual offenses" if not civilly committed.  
G. L. c. 123A, § 1.  Belle predicated his conclusion that the 
defendant lacked the ability to control his sexual impulses not 
only on the defendant's criminal history, but also on his 
incarceration history.  Belle noted that he considered behaviors 
in which the defendant has engaged as constituting a "persistent 
pattern in which he has shown an inability to control his sexual 
impulses."  While incarcerated, the defendant had a history of 
making "physically threatening," "sexually assaulting," and 
sexually explicit statements directed toward female staff 
                                                                  
is insufficient to meet test set out by Supreme Court in Kansas 
v. Crane, 534 U.S. 407, 413 [2002]).  However, we are not 
persuaded by the court's analysis, which, as the dissent in that 
case points out, concludes that because ASPD does not, in every 
case, predispose the individual to commit sex crimes, the 
diagnosis can never satisfy the definitional requirements of the 
statute.  Id. at 194 (Graffeo, J., dissenting).  As we conclude 
here, G. L. c. 123A requires a determination on a case-by-case 
basis whether in a given case the ASPD diagnosis meets the 
definition of an SDP. 
12 
 
members, including threatening to break a woman's leg and 
threatening to rape another.  
 
Similarly, Rouse-Weir based her conclusion on the 
defendant's criminal history as well as his incarceration 
history, including his participation in sex offender treatment 
programs, and his disciplinary history.  Rouse-Weir noted that 
the defendant participated in, but failed to successfully 
complete, sex offender treatment, and received fifty-three 
disciplinary reports and associated sanctions.  With respect to 
disciplinary reports, Rouse-Weir, like Belle, pointed out that 
during the initial period of the defendant's incarceration, his 
disciplinary reports related to the use of threatening language 
and sexually aggressive statements toward female staff, which 
sometimes resulted in the defendant being transferred to higher 
security facilities.   
 
Both Belle and Rouse-Weir conceded that ASPD affects a 
large percentage of the ordinary prison population,6 and that the 
disorder tends to "burn out or mitigate" once an individual 
reaches his forties.  However, Rouse-Weir explained that unlike 
                     
 
6 On cross-examination, Belle affirmed ASPD is prevalent in 
fifty to seventy per cent of the general prison population.  
Similarly, the United States Supreme Court has noted that an 
estimated forty to sixty per cent of the male prison population 
is diagnosable with ASPD.  See Crane, 534 U.S. at 412, citing 
Moran, The Epidemiology of Antisocial Personality Disorder, 34 
Soc. Psychiatry & Psychiatric Epidemiology 231, 234 (1999).   
 
13 
 
other individuals diagnosed with ASPD, the defendant's lack of 
remorse and his lack of regard for others' rights "ha[d] a 
sexual element."  Moreover, although Belle determined that the 
defendant did not meet the criteria for a paraphilic disorder,7 a 
factor highly relevant to the SDP calculus, Rouse-Weir opined 
that the defendant showed "a deviant sexual interest."  This 
"deviant sexual interest," combined with the defendant's ASPD, 
where it resulted in an inability to control sexual impulses, 
was a sufficient predicate for sexual dangerousness. 
 
2.  Qualified examiner testimony.  Prior to trial, the 
defendant filed motions in limine to exclude expert opinion 
testimony regarding his likelihood of reoffense and to preclude 
the admission of "subjective, value judgment labels," for the 
scores derived from the Static-99R.  Both motions were denied.  
He argues on appeal that the judge erred in denying the motions 
because the qualified examiner testimony on both issues 
improperly invaded the province of the jury.   
 
a.  Expert testimony regarding likelihood of reoffense.  To 
commit a person as an SDP, the jury must determine that the 
                     
 
7 A paraphilic disorder is characterized as recurrent, 
intense sexually arousing fantasies, sexual urges, or behaviors 
generally involving (1) nonhuman objects, (2) the suffering or 
humiliation of oneself or one's partner, or (3) children or 
other nonconsenting persons that occur over a period of at least 
six months.  Paraphilic disorders as defined in the Diagnostic 
and Statistical Manual of Mental Disorders, include, but are not 
limited to, exhibitionistic disorder, fetishistic disorder, and 
pedophilic disorder.     
14 
 
person has been "convicted of a sexual offense, suffers from a 
mental abnormality or personality disorder that renders him a 
menace to the health and safety of others, and is likely to 
engage in sexual offenses if not confined."  Commonwealth v. 
Fay, 467 Mass. 574, 580, cert. denied, 135 S. Ct. 150 (2014), 
citing G. L. c. 123A, §§ 1, 14.  The defendant correctly 
concedes that our law allows for expert opinion testimony to 
"touch on an ultimate issue of the case [where] that testimony 
aids the jury in reaching a decision."  Commonwealth v. 
MacDonald, 459 Mass. 148, 163 (2011).  See Mass. G. Evid. § 704 
(2017).  Nevertheless, he contends that the qualified examiners' 
testimony was improper because it would not aid the jury in 
determining whether the mental abnormality or personality 
disorder is likely to cause the individual to reoffend unless 
confined.  We disagree.   
 
A qualified examiner's opinion testimony is "the essential 
basis for a finding of sexual dangerousness."  Green, 
petitioner, 475 Mass. 624, 630 (2016).  In an SDP trial, the 
jury's task involves assessing the risk of reoffending, which in 
turn involves a complex balance of factors, including "the 
seriousness of the threatened harm, the relative certainty of 
the anticipated harm, and the possibility of successful 
intervention to prevent that harm."  Commonwealth v. Boucher, 
438 Mass. 274, 276 (2002).  "Because the trier of fact in G. L. 
15 
 
c. 123A proceedings must decide '[w]hether a person suffers from 
a mental abnormality or personality defect, as well as the 
predictive behavioral question of the likelihood that a person 
suffering from such a condition will commit a sexual offense,' 
and because these are 'matters beyond the range of ordinary 
experience,' expert evidence is required in order to commit a 
person to the treatment center or to keep a person confined 
there."  Johnstone, petitioner, 453 Mass. 544, 549-550 (2009), 
quoting Commonwealth v. Dube, 59 Mass. App. Ct. 476, 483 n.12 
(2003).  See Commonwealth v. Bruno, 432 Mass. 489, 511 (2000).   
 
Thus, the expert's role in opining on the ultimate issue to 
be decided by the jury is settled in our jurisprudence.  The 
judge did not err in admitting qualified examiner testimony on 
the ultimate issue.  Indeed, given the centrality of expert 
opinion testimony to the SDP adjudication, it would have been an 
error of law for the trial judge to exclude that testimony.  
 
b.  Static-99R risk category labels.  The defendant argues 
that the admission of the qualified examiners' testimony 
categorizing his Static-99R score as "moderate-high" and "high" 
also invaded the jury's province, and thus constituted error.  
He contends that the Static-99R categories represent a "wholly 
subjective" assessment and create a risk that the jury will 
shift responsibility for determining the likelihood of reoffense 
to the qualified examiners.  We conclude that the risk 
16 
 
categories lack probative value in the sexual dangerousness 
calculus and should not be admitted at trial.   
 
The Static-99R measures ten static risk factors that have 
been shown to increase one's risk for sexual recidivism, and 
adjusts the numerical score upwards or downwards depending on 
risk factors that the qualified examiner determines are 
significant in the particular individual's case.  See Doe, Sex 
Offender Registry Bd. No. 10800 v. Sex Offender Registry Bd., 
459 Mass. 603, 636 n.33 (2011).  Each numeric score corresponds 
to a percentage reflecting the risk of sexual reoffense and a 
risk category label ("low," "low-moderate," "moderate-high," and 
"high").  See Hanson, Babchishin, Helmus, Thornton, & Phenix, 
Communicating the Results of Criterion Referenced Prediction 
Measures:  Risk Categories for the Static-99R and Static-2002R 
Sexual Offender Risk Assessment Tools, 29 Psychological 
Assessment 582, 584 (2017). 
 
As a threshold matter, the Static-99R is itself a limited 
tool; it estimates only the "the relative risk of sexual 
recidivism based on commonly available demographic and criminal 
history information."  Id.  It does not identify the likelihood 
of sexual recidivism for a specific individual.  As Belle 
explained in his testimony, the Static-99R results were not 
specific to the defendant, and "[o]ne of the cautions about the 
17 
 
Static-99R is that it is looking at groups of individuals that 
may or may not be similar to [the defendant]."   
 
While the combination of the Static-99R raw score and the 
corresponding percentage reflecting the risk of sexual reoffense 
provide "precise, numeric estimates of recidivism risk," the 
category labels do not.  Id. at 583.  The test's developers have 
acknowledged that the meaning of risk category labels is often 
unclear.  "There is only a loose association in natural language 
between verbal labels for likelihood [e.g., 'low,' 'low-
moderate,' 'moderate-high,' and 'high'] . . . and numeric 
probabilities."  Id.  Further, test developers have conceded 
that the lack of clarity is exacerbated by the absence of 
accepted standards or metrics connecting the risk category 
labels to "specific meanings, such as recidivism rates, 
psychological features, or expected treatment needs."8  Id. 
Consequently, "substantial variation" exists among sex offenders 
ascribed identical risk category labels.  Id.   
                     
 
8 To resolve the shortcomings of the Static-99R risk 
category labels, test developers have created new risk category 
labels.  We take no position on the admissibility of those 
labels.  See Hanson, Babchishin, Helmus, Thornton, & Phenix, 
Communicating the Results of Criterion Referenced Prediction 
Measures:  Risk Categories for the Static-99R and Static-2002R 
Sexual Offender Risk Assessment Tools, 29 Psychological 
Assessment 582, 592 (2017) (new risk categories "have 
sufficiently improved conceptual coherence and have sufficient 
empirical support to replace the original categories").  
18 
 
 
 Given this view of the risk category labels by the experts 
who develop and use them, we are not persuaded that such 
testimony aids the jury in determining sexual dangerousness.  
Cf. Simon v. Solomon, 385 Mass. 91, 105 (1982) ("expert 
testimony on matters within the witness's field of expertise is 
admissible whenever it will aid the jury in reaching a 
decision").  Accordingly, we conclude that the admission of 
qualified examiners' testimony characterizing the defendant's 
Static-99R score as "moderate-high" or "high" was error.    
 
The defendant filed a pretrial motion to exclude the 
Static-99R risk category labels, which the judge denied.  Thus, 
we must determine whether the improper admission of Static-99R 
risk category labels was nonprejudicial, that is "whether 'the 
error did not influence the jury, or had but very slight 
effect."  Commonwealth v. Christian, 430 Mass. 552, 563 (2000), 
quoting Commonwealth v. Flebotte, 417 Mass. 348, 353 (1994).  
See Commonwealth v. Grady, 474 Mass. 715, 718, 721 (2016).  We 
conclude that that the erroneous admission of testimony 
regarding the Static-99R risk category labels does not warrant 
reversal.  
The expert testimony regarding the defendant's Static-99R 
risk category was appropriately limited; it was presented as 
only one of many factors in the SDP calculus.  For example, 
Rouse-Weir explained that the Static-99R is an actuarial tool 
19 
 
only, and that examiners have agreed to use the actuarial 
instrument "in a limited fashion."  Also as explained to the 
jury, the qualified examiners considered several "dynamic 
factors,"9 which the Static-99R test does not take into account.  
For example, Belle and Rouse-Weir considered matters such as 
substance abuse history, "deviant sexual interests," "cognitive 
distortions," and "intimacy deficits," all of which are relevant 
to sexual dangerousness.  In addition, the qualified examiners 
included in the sexual dangerousness calculus the defendant's 
family history, educational and work background, incarceration 
records, treatment history, and release plans.  Given the 
limited nature of the use of the Static-99R in the qualified 
examiners' over-all risk assessment analysis of the defendant, 
we conclude that the admission of testimony regarding the risk 
category labels was nonprejudicial.    
Recognizing that our holding as to risk category labels 
modifies the manner in which the Static-99R may be used in SDP 
proceedings, we take this opportunity to clarify that our 
holding is limited.  Both the Static-99R score and the 
corresponding percentage reflecting the risk of sexual offense 
in qualified examiners' testimony continue to be admissible.  
Our holding makes inadmissible the risk category labels only, as 
                     
 
9 Dynamic risk factors are "more fluid" and can change over 
time.   
20 
 
the risk category labels, unlike the Static-99R score and the 
corresponding percentage reflecting the risk of sexual 
reoffense, provide little aid to the jury in rendering its 
decision. 
 
Conclusion.  Under G. L. c. 123A, an ASPD diagnosis is 
adequate to satisfy the definitional requirements of an SDP 
where the Commonwealth also proves that, as a result of the 
ASPD, the individual is likely to engage in sexual offenses if 
not confined, and in this case there was no error requiring 
reversal.  Therefore, we affirm the judgment and order for the 
defendant's civil commitment as an SDP. 
 
 
 
 
 
 
 
So ordered.