Opinion ID: 2059329
Heading Depth: 1
Heading Rank: 4

Heading: Raising an Insanity Defense in the Criminal Case

Text: Although there is a general prohibition against nonconsensual disclosure of mental health information, exceptions are recognized by the Act. One such exception is found in section 10(a)(1) of the Act, which provides in pertinent part, that [r]ecords and communications may be disclosed in a civil, criminal or administrative proceeding in which the recipient introduces his mental condition or any aspect of his services received for such condition as an element of his claim or defense   . 740 ILCS 110/10(a)(1) (West 2000). In the case at bar, neither Steven nor his parents have introduced Steven's mental health care or treatment as an element of their defense to the civil claims filed against them. Plaintiff does not dispute this. Nevertheless, plaintiff claims that Steven forfeited his right to the confidentiality privilege in these proceedings by raising an insanity defense in his criminal case. As sole support for her position, plaintiff relies on this court's decision in Novak v. Rathnam, 106 Ill.2d 478, 88 Ill. Dec. 608, 478 N.E.2d 1334 (1985). In Novak, Robert Lee Endicott shot and killed Beverly Novak after he was released from Zeller Mental Health Center, where he had been involuntarily committed. At Endicott's homicide trial, Endicott asserted the defense of insanity and presented the testimony of four psychiatrists, including Rathnam, who had treated Endicott at Zeller. Endicott also introduced at his criminal trial all of his medical records from Zeller. Endicott received a not guilty by reason of insanity verdict. Subsequently, Beverly's father, David Novak, brought a wrongful-death action against Rathnam and Girmscheid, a psychologist who treated Endicott at Zeller, claiming that they had been negligent for approving Endicott's discharge. Before requiring Rathnam and Girmscheid to submit themselves for depositions, the circuit court certified a question for review pursuant to Supreme Court Rule 308, asking whether Rathnam and Girmscheid were barred from testifying by the Mental Health and Developmental Disabilities Act. In answering the certified question, we recognized that, pursuant to section 10(a)(1) of the Act, Endicott waived the privilege of keeping his mental health records confidential at his criminal trial by raising the insanity defense. Indeed, when a defendant raises an insanity defense and calls his own medical expert as a witness to establish the defense, he cannot thereafter assert the privilege to prevent the State, at the same trial, from calling other medical experts who treated him for the same condition. Novak, 106 Ill.2d at 483, 88 Ill.Dec. 608, 478 N.E.2d 1334. It had long been recognized that a defendant, by raising the insanity defense, opened the door to discovery of his mental health records. See People v. Newbury, 53 Ill.2d 228, 234, 290 N.E.2d 592 (1972). However, in Novak, we further determined that, once the confidentiality privilege had been waived, it could not be reclaimed in a subsequent proceeding. We reasoned that the testimony of Rathnam in favor of Endicott's defense at his trial was a public disclosure by Endicott of information protected by the Act and, as Wigmore puts it, took away its confidentiality. See 8 J. Wigmore, Evidence § 2389(4), at 860-61 (McNaughton rev. ed.1961); see also People v. Leppert, 105 Ill.App.3d 514, 61 Ill.Dec. 84, 434 N.E.2d 21 (1982). Consequently, we held that there was no legal basis for barring Rathnam and Girmscheid from testifying regarding Endicott's mental health treatment in the wrongful-death action against them. Plaintiff's reliance on Novak in the present case, however, is misplaced. The facts of Novak are inapposite and readily distinguishable. Insanity is raised as an affirmative defense when a defendant admits the offense charged but claims that, at the time of the offense, he was insane and therefore lacked substantial capacity either to appreciate the criminality of his conduct or to conform his conduct to the requirements of the law. People v. Kashney, 111 Ill.2d 454, 464-65, 95 Ill.Dec. 835, 490 N.E.2d 688 (1986). In the case at bar, the defense of insanity was never raised because Steven never went to trial in his criminal case. Steven entered a plea of guilty. A plea of guilty waives all nonjurisdictional defenses or defects. People v. Burton, 184 Ill.2d 1, 234 Ill.Dec. 437, 703 N.E.2d 49 (1998). By pleading guilty, then, the question of sanity was no longer an issue. Furthermore, no psychiatrist or mental health therapist ever made a public disclosure of Steven's mental health records or testified in open court regarding mental health treatment Steven had received. Under these circumstances it cannot be said that Steven waived the confidentiality privilege by raising an insanity defense in a prior criminal trial. The rationale employed in Novak for finding that the confidentiality privilege had been waived is not applicable under the facts of this case. Waiver of Confidentiality at Fitness Examination Plaintiff next contends, pursuant to section 10(a)(4) of the Mental Health Act, that Steven's mental health information is admissible in the pending civil litigation because Steven participated in a court-ordered fitness examination in his criminal case and, after being admonished that the information he revealed would not be kept confidential, provided the examining psychiatrist with information concerning his prior mental health treatment. Section 10(a)(4) of the Mental Health Act provides: Records and communications made to or by a therapist in the course of examination ordered by a court for good cause shown may, if otherwise relevant and admissible, be disclosed in a civil, criminal, or administrative proceeding in which the recipient is a party or in appropriate pretrial proceedings, provided such court has found that the recipient has been as adequately and as effectively as possible informed before submitting to such examination that such records and communications would not be considered confidential or privileged. Such records and communications shall be admissible only as to issues involving the recipient's physical or mental condition and only to the extent that these are germane to such proceedings. 740 ILCS 110/10(a)(4) (West 2000). As earlier noted, this claim was raised in the trial court and, before deciding whether defendant waived the privilege, the trial court allowed plaintiff to depose Dr. Markos concerning the admonishments he gave Steven before his fitness examination. At the deposition, Dr. Markos testified that he followed standard protocol. Dr. Markos testified, I do not believe that the instruction that I gave Mr. Steven Pfiel was in anyway different or was in variance from the instruction or admonishment that I have provided to the other defendants in the past.    What I informed Mr. Pfiel prior to the clinical examination was that any information he provided me with may be or could be contained in a report or reports that I submitted to the court, including the opinions. When asked if he mentioned anything about disclosure of the information in any civil proceedings, Dr. Markos answered, No, I did not. Based on Dr. Markos' testimony, there is no basis for allowing disclosure of Steven's privileged mental health records and communications pursuant to the exception provided in section 10(a)(4) of the Mental Health Act. When Dr. Markos admonished Steven regarding confidentiality, it was within the context of a fitness examination. There are strict rules governing the use of information revealed to an examiner in a fitness exam. Section 104-14(a) of the Code of Criminal Procedure of 1963 provides in relevant part: Statements made by the defendant and information gathered in the course of any examination or treatment ordered under Section 104-13, 104-17 or 104-20 shall not be admissible against the defendant unless he raises the defense of insanity or the defense of drugged or intoxicated condition, in which case they shall be admissible only on the issue of whether he was insane, drugged, or intoxicated. 725 ILCS 5/104-14(a) (West 2000). In subsection (b) of section 104-14, it provides that any further use of statements made in the course of a fitness examination, beyond what is allowed in subsection (a), must be with defendant's informed written consent. Based on this statutory scheme, it is reasonable to conclude that by participating in the court-ordered fitness examinations, Steven agreed to waive his confidentiality privilege only to the extent provided by the strict procedural rules contained in the Criminal Code. [4] Since admonishments given to Steven by Dr. Markos did not go beyond the typical cautionary warnings, we must also conclude that Steven did not waive his confidentiality privilege for purposes other than that which is provided for by the rules of criminal procedure. See People v. Gemeny, 313 Ill.App.3d 902, 909, 247 Ill.Dec. 71, 731 N.E.2d 844 (2000) (This legislative care in limiting permissible disclosure strongly suggests that we may not assume that eliminating confidentiality in one judicial setting means eliminating it in all settings). Steven was not notified as adequately and as effectively as possible    that such records and communications would not be considered confidential or privileged (740 ILCS 110/10(a)(4) (West 2000)). Consequently, the admonishments given to Steven at his fitness examinations were insufficient to allow disclosure of Steven's mental health information in the civil proceedings.