Opinion ID: 1427436
Heading Depth: 1
Heading Rank: 4

Heading: There Was Sufficient Evidence Before the State Trial Court to Raise a Reasonable Doubt as to McMurtrey's Competency to Stand Trial

Text: Evidence concerning McMurtrey's competence to stand trial included evidence about McMurtrey's medications, as well as reports and testimony from doctors and prison officials presented to the trial court at relevant stages of the proceedings. We first provide an overview of the evidence before the Arizona court pre-trial and during trial, pre-sentencing, and sentencing. We then explain why this evidence is sufficient to raise a reasonable doubt as to McMurtrey's competence.
On December 9, 1980, eight months before trial, attorney Polis filed a motion for a competency examination and a hearing to determine McMurtrey's competency to stand trial under Arizona Rule of Criminal Procedure Rule 11 (Rule 11). Polis requested that the examination be conducted in a hospital atmosphere so that McMurtrey could be examined in a drug-free state and subjected to intensive psychiatric and neurological tests to determine the extent of his medical problems. The motion, which the State opposed, stated that McMurtrey could not adequately assist counsel because of McMurtrey's poor memory about the crime, the court's administration of anti-psychotic drugs, McMurtrey's history of mental health problems, and his need for medication. Attached to the motion was an excerpt of a medical report showing that McMurtrey had been admitted to the psychiatric unit of a hospital at age fifteen. McMurtrey's motion was supported by an examination done by Dr. David Gurland, a psychiatrist retained by McMurtrey. In a letter dated November 7, 1980, Dr. Gurland noted that McMurtrey had a history of head injuries and mental health problems, along with a longstanding history of psychological problems that stemmed from unresolved issues surrounding McMurtrey's father's fatal shooting of McMurtrey's mother and her lover when McMurtrey was seven years old. Dr. Gurland opined that McMurtrey, who began suffering seizures as an adolescent, had a marginal adjustment to high school, with a schizoid personality. Dr. Gurland also expressed concern about the effects of McMurtrey's numerous motorcycle accidents, which had caused head trauma. Dr. Gurland questioned the Pima County Prison's decision to prescribe Thorazine and Atarax, concluding that the medications, while in some cases capable of providing effective treatment for seizures and anxiety, were potentially harmful to McMurtrey's damaged liver. Dr. Gurland stated that, because of McMurtrey's mental health issues, he did not believe that McMurtrey understood at the time of the crime the difference between right and wrong or the significance of the Ranch House Bar incident. He described McMurtrey's mental state as fragile and was concerned that, with the stress of the upcoming trial, McMurtrey's mental state would deteriorate further without proper medication. Dr. Gurland recommended that McMurtrey be hospitalized as soon as possible so that he could receive appropriate medication, have his seizure history evaluated, have an EEG and a CAT scan because of the seizures, and receive tests to investigate the functioning of his liver. He concluded that a Rule 11 exam was warranted. Superior Court Judge William Druke, who handled such motions, took the competency examination motion under advisement and ordered Polis to arrange for McMurtrey to be examined by the Court Clinic to determine if reasonable grounds existed to hold a Rule 11 evaluation. As a result, court psychologist Cynthia Ginnetti met with McMurtrey on January 13, 1981. In a letter to the court, Dr. Ginnetti stated that McMurtrey demonstrate[d] a good understanding of the charges against him and of the legal process generally. However, Dr. Ginnetti expressed concern over McMurtrey's spotty memory about the crime, noting that this does impair his ability to assist counsel, particularly if a defense of self-defense is pursued. Dr. Ginnetti recommended EEG testing to check for temporal lobe damage. Polis hired psychiatrist Leonardo Garcia-Bunuel to meet with McMurtrey in January 1981 and review his records. McMurtrey told Dr. Garcia-Bunuel that he had experienc[ed] auditory and visual hallucinations since age fifteen. When asked about the incident at the Ranch House Bar, McMurtrey stated that he remembered men at the bar threatening to slice the one percent tattoo off of his arm. [5] McMurtrey recalled that the men grabbed him and that McMurtrey had pulled a gun on the men. He remembered seeing himself shoot the gun, as though he were a bystander, unable to do anything. On several occasions during the interview, McMurtrey rocked back and forth in his chair. Dr. Garcia-Bunuel noted that such behavior is a common side effect of certain drugs like Atarax and Thorazine, and that he, like Dr. Gurland, questioned whether McMurtrey should be receiving those medications. To determine if McMurtrey was faking some of his symptoms, Dr. Garcia-Bunuel led him into some traps. The doctor reported that McMurtrey did not fall victim to any of them. In fact, Dr. Garcia-Bunuel stated that he felt very strongly that McMurtrey is not faking in any way, that he is, and has been, honest throughout. Dr. Garcia-Bunuel concurred in Dr. Gurland's evaluation and recommended that McMurtrey undergo a complete neurological evaluation, including EEG testing, a brain scan, and a skull examination. Based on these reports, Polis filed a motion requesting a neurological examination, which Judge Druke granted. The tests revealed no abnormalities. On February 4, 1981, neurologist Harvey Buchsbaum met with McMurtrey. In a letter to the Pima Deputy County Attorney, Dr. Buchsbaum discounted any concerns of significant neurological damage, concluding that the tests revealed no evidence of neurological disease and that McMurtrey's action in the bar fits better with a rage attack instead of a psychomotor seizure. After reviewing Dr. Buchsbaum's report, Judge Druke decided that there was no need to do anything further, and no testimony was taken. At Polis's urging, the court agreed to review the reports offered by the defense, but on February 20, 1981, Judge Druke stated that he was unable to find reasonable grounds to believe the defendant is incompetent to stand trial and summarily denied the Rule 11 motion and referred the case back to Judge Arnold. On March 6, 1981, Dr. Gurland wrote to Polis to inform him that McMurtrey had been moved to the psychiatric unit of a local hospital because of suicidal ideation and a psychotic breakdown. [6] Dr. Gurland stated that McMurtrey was experiencing memory and anxiety problems and that, as a result, McMurtrey was incompetent to stand trial. He further noted that McMurtrey was able to understand and follow the court proceedings, and would not be incompetent in those areas. Dr. Gurland recommended that McMurtrey receive Valium to alleviate his high anxiety level. The same month, Dr. Gurland again examined McMurtrey. Dr. Gurland diagnosed McMurtrey as exhibiting mixed neuroses, depression, and anxiety, and noted that stress was the major factor triggering McMurtrey's mental health problems. On March 13, 1981, four months prior to trial, McMurtrey was examined for an hour by Dr. John LaWall, the State's primary psychological expert in this case. McMurtrey told Dr. LaWall that he had suffered auditory and visual hallucinations since the age of fifteen and that he had been hospitalized for these hallucinations. McMurtrey also explained that he occasionally saw people and weapons that were not really there and that since age fifteen he has experienced blackouts  periods in which he loses touch with his surroundings but apparently does not lose motor control. McMurtrey admitted that he had used drugs in the past, including amphetamines and LSD, but told Dr. LaWall that his current illicit drug use was minimal. McMurtrey told Dr. LaWall about his motorcycling and his affiliation with the one percenters. McMurtrey mentioned that he was a frequent visitor to the Ranch House Bar and that, although he had a dim recollection of the events of August 10, 1979, which Dr. LaWall termed partial alleged amnesia, McMurtrey did remember drinking approximately a fifth of whisky and possibly taking a barbiturate. Dr. LaWall noted that McMurtrey was taking Dilantin, [7] Elavil, [8] and Librium. [9] Based on his one-hour interview with McMurtrey, and a review of the reports discussed above, Dr. LaWall found it difficult to diagnose any mental disorder. He concluded that McMurtrey was oriented to time, place and person, that he did not suffer from epilepsy or partial seizures, but that, in his opinion, [t]here are a number of elements in his history which tend to suggest a variety of disorders and that McMurtrey might suffer from atypical dissociative disorder. He thought that at the time of the crimes McMurtrey understood his actions and the difference between right and wrong. Finally, Dr. LaWall stated that, in his opinion, McMurtrey was competent to stand trial because he was capable of understanding the nature of the proceedings and because he was able to assist in his own defense.
The record shows that, during McMurtrey's trial, which began on July 1, 1981, and lasted for seven days, McMurtrey was ill on at least three occasions. On the third day of trial, attorney Polis complained to the court that McMurtrey's medication was responsible for McMurtrey getting ill constantly in the courtroom. Judge Arnold called for a recess on account of the nausea. Polis also alerted the court to McMurtrey's nausea on each of the final two days of the trial. At trial, Dr. LaWall and Dr. Gurland testified as to their March examinations of McMurtrey. Dr. Gurland, who examined McMurtrey in November 1980 and again in March 1981, testified that McMurtrey was treated with Thorazine. He called Thorazine a major tranquilizer, used for more significant degrees of agitation or emotional upset. Dr. Gurland testified that he was uncertain how long McMurtrey had been receiving Thorazine, but that he believed that McMurtrey had been medicated with it by jail physicians for some time. Dr. Gurland noted that in November 1980 McMurtrey was taking approximately double the recommended dosage of Thorazine; he stated that the average person would be laid out for the next seven or eight hours if given such a dose. Dr. Gurland also noted that McMurtrey had been prescribed Dilantin, Elavil, Atarax, and Librium during his incarceration. Dr. Gurland testified that the amount of Librium prescribed to McMurtrey was five times the addictive dose. [10] Dr. José Santiago, who treated McMurtrey during his one-week hospitalization, testified about McMurtrey's current mental state to provide corroborative evidence in support of McMurtrey's defense that the shooting was a product of his chronic insanity or mental illness. He diagnosed McMurtrey as suffering from, among other conditions, a major depressive disorder that impaired his ability to control his emotions. Dr. Santiago explained his diagnosis as follows: Well, what I mean is that because of the illness, because of the difficulty with the emotions, the patient is unable to interpret what he sees and what happens around him in a logical, coherent fashion. Now remember that I made that observation in connection with a thought disorder. Mr. McMurtrey does not have a thought disorder, so he is able to, in essence, process the cues around him. In the emotional disorder which is what Mr. McMurtrey has, what he is unable to control is his emotions and his emotions[,] in turn, impair gravely on his ability to function when he is under that particular acute phase of the illness. Dr. Santiago stated that fear and stress will provoke a major depressive disorder episode and that McMurtrey's mood disorder was evidence of mental illness. He further noted that some people who suffer from a depressive disorder may not know right from wrong. When pushed by the prosecutor to express his opinion whether McMurtrey was sane on the night of the incident, Dr. Santiago stated, If you want me to hypothesize, the fact that [McMurtrey] has a mental illness would support the possibility that he might be insane at the time of the offense. Dr. Santiago described the medications administered to McMurtrey while in jail, which included Thorazine, an anti-psychotic drug, Dalmane, which he called a sedative hypnotic drug, [11] and Chloral Hydrate, a sedative. He also described the medications administered during McMurtrey's hospitalization, which included Thorazine and Elavil, an antidepressant.
Before sentencing, the state trial court's probation department obtained information concerning McMurtrey's incarceration at the county jail. A form [12] completed by a nurse indicated that McMurtrey was taking Phenobarbital, Dalmane, and Ativan. [13] The court also received various incident reports from corrections officers. These incident reports indicated that between January and July 1981, McMurtrey set fires, passed out, threw food, fought with other inmates, and assaulted a corrections officer. Jail personnel modified or reduced his medications before McMurtrey was seen by a doctor. McMurtrey also injured himself on three separate occasions. On February 26, 1981, he was found in his cell with blood dripping from his arms and a pool of blood at his feet. Shortly thereafter, McMurtrey was hospitalized. On July 16, 1981, three days after being convicted, McMurtrey smashed his head against a window. Nine days later, on July 25, 1981, he smashed his head against a door. The probation department also referred McMurtrey to psychiatric social worker Carolyn Ford, who examined McMurtrey on July 28, 1981. According to Ford's evaluation, McMurtrey spoke in an extremely loud, rambling, tangential, at times philosophical, and at times, crude manner, and his behavior was highly agitated and impulsive, interspersed with periods during which he appeared to be sleepy. Ford was not able to evaluate credibly McMurtrey because she found that his behavior was purposefully manipulative and cunning, designed to intimidate, harass, and in general keep people away from him. Prior to sentencing, McMurtrey moved for a new trial. In the motion, he argued that the change in his medication during trial prevented him from receiving a fair trial. Specifically, the motion stated: As the evidence adduced at his trial demonstrates, Mr. McMurtrey had severe mental health problems. These problems were aggravated during times of stress, and were treated by psychoactive drugs during the entire time of his incarceration and trial. These drugs included Thorazine, Ativan, Valium, Elavil, Dilantin as well as others. In the middle of trial Mr. McMurtrey's medication was changed and his already unstable mental health further declined. This additional instability, occasioned by the change in medication, in turn adversely affected his demeanor at trial until, on the last day, he was essentially on the verge of a nervous breakdown. This change in demeanor, it is Mr. McMurtrey's contention, operated to deny him a fair trial as Constitutionally guaranteed because the jury viewed a man in a chemical straight jacket. The trial judge denied the motion in a two-page minute order.
On August 28, 1981, the day of sentencing, attorney Polis drew the court's attention to McMurtrey's one-page patient order sheet that listed the variety and quantity of drugs prescribed to McMurtrey before and during the trial. This patient order sheet made clear that, during trial, McMurtrey was prescribed Valium, [14] Ativan, Librium, and Dalmane. [15] The following conversation took place between the court and attorney Polis: Judge: What import does the medical records and change in medication have on the defense's position in this case? You see, it puts me sort of at a disadvantage to have this handed to me the day of sentencing. Polis: I understand that. Just makes the record complete with respect to what medication he received in the jail and the changes in it. If the Court would review that, you would see  Judge: I'm not a doctor. I really wouldn't know what it meant if I reviewed it. A change in medication means nothing without some sort of expert to testify as to what effect, if any, it would have on the defendant's position. All I can say [is] I observed Mr. McMurtrey all during the course of the trial and the only opinion I have is that he didn't appear to be under the influence of any drugs to the extent that it would deprive him of his ability to be aware of what was going on. At the end of the sentencing hearing, the following exchange took place: Judge: Mr. McMurtrey, I haven't heard from you in regard to the position you are in. Do you have anything to say to the Court before sentence is imposed? McMurtrey: Sir, I don't know if I'm speaking to the Court when I speak, but I would like to speak to the Creator, the Creator of this court and the Holy Creator, would that be all right? Judge: I talk to Him all the time. So you go right ahead. McMurtrey: (Kneeling.) Sir, I'm speaking to You in a voice at this time because I have others around me that need to know my thoughts. I ask that You give them the wisdom to make Your correct decision and the rest of us the strength to hold that wisdom. Amen. That is all I have sir. The court then denied McMurtrey's motion for post-trial relief. In its minute order, the court stated: The Court feels that there is no evidence whatsoever that Mr. McMurtrey's medical treatment at the jail had any effect on his ability to defend himself. The Court observed Mr. McMurtrey during the trial; he appeared alert and in control of himself.... Judge Arnold then sentenced McMurtrey to death plus twenty-one years.
We agree with the district court that the evidence before the state trial court regarding McMurtrey's behavior, medications, and memory problems was sufficient to raise a reasonable doubt as to McMurtrey's ability to assist counsel, despite Dr. LaWall's testimony to the contrary. Moore v. United States, 464 F.2d 663, 666 (9th Cir.1972) (holding that records showing defendant's history of mental illness and instability raised reasonable doubt even though psychiatric report before his guilty plea found him competent); see also Torres v. Prunty, 223 F.3d 1103, 1110 (9th Cir.2000): In the face of this evidence, and under the Pate standard for triggering a competency hearing, the modest evidence of [the defendant's] competence does not fairly support the trial court's conclusion that no hearing was required. [A doctor's] previous conclusion that [the defendant] was competent to stand trial does not obviate the need for a hearing. Nor does the evidence that [the defendant] was able to assist his attorney at trial in minor ways. The state trial court had before it a significant body of evidence that McMurtrey received a wide variety of antipsychotic and anti-anxiety medications over the course of his incarceration. By the time of sentencing, Judge Arnold had been presented with evidence that McMurtrey was prescribed Atarax, Ativan, Chloral Hydrate, Dalmane, Dilantin, Elavil, Librium, Thorazine, and Valium. This evidence came in the form of pre-trial reports from doctors, trial testimony, documents in the pre-sentence report, and documents attached to the motion for a new trial. The medications alone should have raised concerns for Judge Arnold. See Moran v. Godinez, 972 F.2d 263, 265 (9th Cir.1992), overruled on other grounds, 509 U.S. 389, 113 S.Ct. 2680, 125 L.Ed.2d 321 (1993) (holding that the trial court's failure to inquire about the four psychiatric medications defendant was taking, among other factors, raised reasonable doubt about competence); Miles v. Stainer, 108 F.3d 1109, 1112 (9th Cir.1997) (finding that state court's failure to ask defendant whether he had been taking his psychotropic medication before accepting his guilty plea raised reasonable doubt about defendant's competence to plead guilty, and therefore competency hearing should have been held). When presented with the evidence regarding McMurtrey's medications at sentencing, however, Judge Arnold simply noted that he was not a doctor and that, as such, he could not evaluate what the effects of the medications might have been. [16] Other evidence presented at trial raised further doubts about McMurtrey's competence. The district court summarized some of this evidence as follows: The [state trial court] learned during trial that McMurtrey was prescribed a variety of anti-anxiety medications, had been hospitalized for a suicide attempt, and suffered from a major depressive disorder that impaired his ability to control emotions. The court also observed McMurtrey become repeatedly physically ill during trial and, prior to sentencing, received documentation of McMurtrey's increasingly volatile and aggressive behavior in jail. The court was aware of counsel's concern that McMurtrey was on the verge of a nervous breakdown and operating in a chemical straight jacket, as well as medical records documenting Valium injections during trial to treat extreme agitation. Finally, the court observed McMurtrey at sentencing as he knelt to address the Creator of this court and requested a correct decision without providing any coherent statement concerning himself, the crime or sentence. We agree with the district court that this evidence raised a reasonable doubt as to McMurtrey's competence. The jail incident reports presented to Judge Arnold in the presentence report illustrating McMurtrey's increasingly erratic and volatile behavior were striking, especially alongside evidence that McMurtrey was prescribed substantial doses of powerful and potentially incompatible medication. We also agree with the district court that Dr. LaWall's pre-trial evaluation of McMurtrey is not dispositive evidence that McMurtrey was competent at the time of trial. Dr. LaWall met with McMurtrey for one hour in March 1981. His observations from a brief interview conducted four months before trial cannot overcome a reasonable doubt concerning defendant's competence to stand trial. See Moore, 464 F.2d at 666 (Once there is [evidence raising a reasonable doubt as to the competency to stand trial] from any source, there is a doubt that cannot be dispelled by resort to conflicting evidence.). Further, as the Supreme Court noted in Drope, 420 U.S. at 181, 95 S.Ct. 896, Even when a defendant is competent at the commencement of his trial, a trial court must always be alert to circumstances suggesting a change that would render the accused unable to meet the standards of competence to stand trial. Judge Arnold's responsibility to be alert for changing conditions is especially strong because the court was on notice from Dr. Gurland that the stress brought about by trial might cause McMurtrey's mental state to further deteriorate. The time lag between Dr. LaWall's examination and trial is also particularly important because McMurtrey does not allege a longstanding mental disease, but instead argues that medications prescribed by prison medical personnel temporarily undermined his competency. Finally, Dr. LaWall's conclusions are weakened because they did not reflect consideration of the effect that McMurtrey's medications would have on his competence to stand trial. See Moran, 972 F.2d at 268 (noting that expert's report was all the weaker as an indication of [the petitioner's] competency to waive his constitutional rights because it says nothing about the effects of any medication). In sum, Dr. LaWall's testimony did not overcome the other evidence in the record about McMurtrey's competence. McMurtrey's due process rights were therefore violated. See James v. Singletary, 957 F.2d 1562, 1571 (11th Cir.1992) (noting that the trial of an incompetent defendant is per se prejudicial). We therefore affirm the district court's conclusion that because a bona fide doubt existed as to McMurtrey's competence to stand trial and be sentenced, a competency hearing should have been conducted.