Opinion ID: 1651278
Heading Depth: 2
Heading Rank: 1

Heading: Organic Brain Damage

Text: Stewart contends that the postconviction court erred in denying his claim that trial counsel was ineffective in failing to obtain a complete neuropsychological examination and a PET scan. He asserts that the testing and scan would have established that he had left-hemisphere, organic brain damage. Stewart also asserts that Dr. Michael Scott Maher, Dr. Fay E. Sultan, and Dr. Ervin B. Weiner, who evaluated him in preparation for resentencing, failed to provide competent mental health services to him. To evaluate the merits of these claims, we first review the relevant evidence presented during the penalty phase in 2001 and then summarize the evidence presented at the postconviction evidentiary hearing. During the 2001 penalty phase, Dr. Maher testified as an expert in forensic psychiatry. Dr. Maher diagnosed Stewart as suffering from posttraumatic stress disorder (PTSD) at the time of the crime. He explained that the PTSD was related to extreme childhood trauma and abuse and described Stewart's stepfather, Bruce Scarpo, as abusive to the point of inflicting torture on his family. Dr. Maher also testified that Stewart was intoxicated at the time of the offense. Dr. Maher opined that it [was] because of these aspects of [Stewart's] background, that he was compelled in an unthinking reactive way to commit these horrible eventsthis horrible event. Dr. Maher further opined that as a result of [Stewart's] mental illnesses, he had a very, um, substantial impairment in his capacity to conform his behavior to the requirements of law; that his ability to choose and do the right thing, was very severely impaired. Dr. Sultan, who testified as an expert in forensic psychology, opined that at the time of the offense Stewart was under the influence of extreme mental or emotional disturbance and that his capacity to conform his conduct to the requirements of the law was substantially impaired. Her diagnosis was based on three factors. First, she explained that he had a lifelong history of mental illness, including severe depression, and came from a family of individuals with serious mental problems, including bipolar disorder, manic depressive illness, and major depression. Dr. Sultan noted that Stewart had made three serious suicide attempts and that the clarity of his thinking and his judgment [had] been deeply affected by his mental illness. Second, Dr. Sultan discussed Stewart's terrible substance abuse problem, which would affect his ability to control his impulses. Third, Dr. Sultan testified that Stewart was very highly traumatized by his childhood and manifested many of the symptoms of post traumatic stress disorder. She explained that Stewart was not able to think situations through, was not able to control inappropriate or violent impulses, and did not have a clear rational mind. She stated that around the time of the murders, Stewart had reached a real despairing point in his life, a crisis point in his life and had deteriorated very rapidly. The State called Dr. Sidney Merin, who specialized in clinical psychology and neuropsychology. Dr. Merin testified that as a result of Stewart's background and his depression, Stewart had attempted suicide on several occasions since age twelve. Dr. Merin concluded that Stewart had a history of alcohol dependence and perhaps abused other substances. Dr. Merin stated that emotion from past events probably is what prompted [Stewart] to start drinking and [using] drugs, um, early in life, but he did not think that the emotional distress affected Stewart's thinking in terms of moral or legal issues. Dr. Merin concluded that although Stewart's behavior was an end product of extreme emotional distress, he did not think that Stewart was under extreme mental or emotional distress at the time of the murder. Dr. Merin also opined that he did not believe that Stewart's capacity to conform his conduct to the requirements of law was substantially impaired at the time of the offense. During the postconviction evidentiary hearing, Stewart called Dr. Hyman Eisenstein and Dr. Frank Balch Wood to testify about his mental health. In response, the State called Dr. Maher and Dr. Larry Habelson Wilf. Dr. Eisenstein, a psychologist certified in neuropsychology, explained that when he tested Stewart in preparation for the evidentiary hearing, Stewart had a full scale IQ of ninety-eight, with a discrepancy between verbal and perceptual tests of thirteen points. Dr. Eisenstein stated that this discrepancy was statistically significant and consistent with impaired left-brain functioning. Stewart's performance on other tests also consistently showed impairment in the left hemisphere. Dr. Eisenstein diagnosed Stewart as suffering from dementia due to head trauma, the DSM-IV-TR diagnosis that most closely matched Stewart's brain damage, and attention deficit/hyperactivity combined disorder (ADHD). Dr. Eisenstein opined that Stewart had a learning disorder and probably suffered from PTSD at the time of the offense. Dr. Eisenstein testified that left-hemisphere brain damage results in trouble with decision-making and impulse control, irritability, inflexible thinking, and constriction of affect. He further testified that alcohol would have affected Stewart in a negative manner and that ADHD and brain damage would have exacerbated each other. Dr. Eisenstein explained that the diagnoses of ADHD, PTSD, and alcohol abuse are symptoms of behavior manifestations of the underlying problem of organic brain damage and that the combination of those disorders led to the murder. He described Stewart's brain impairment as the driving force behind his behavior and concluded that Stewart committed the crimes in an unthinking and reactive way. Dr. Eisenstein stated that Stewart was under severe emotional stress most of his life because of his upbringing and opined that both statutory mental health mitigating factors were applicable to the Diaz murder. In addition to giving opinions about Stewart's mental and emotional health, Dr. Eisenstein critiqued the work of other experts who previously evaluated Stewart. While on the stand, Dr. Eisenstein read a report prepared by Dr. Weiner in 2001. Dr. Weiner's report indicated that he performed some neuropsychological testing on Stewart and found no indications of neuropsychological impairment that might indicate organic brain damage or dysfunction. Dr. Eisenstein explained that he did not credit Dr. Weiner's conclusions because he felt that Dr. Weiner should have done more testing. Dr. Eisenstein explained that it is not unusual for someone with brain damage to perform normally on some tests because brain damage may be specific to certain areas of the brain. He testified that Dr. Weiner administered tests designed to measure academic performance but did not administer a full memory examination or tests designed specifically for brain impairment. Dr. Eisenstein testified that he did not review the findings of Dr. Maher and Dr. Sultan, but he opined that unless those doctors had the benefit of a full neuropsychological battery of tests and expertise in interpreting those tests, they could not fully assess whether Stewart had brain damage. The defense also called Dr. Wood, a neuropsychologist. Dr. Wood testified that the PET scan, CT scan, and MRI of Stewart's brain all showed an enlarged left lateral ventricle that was not symmetrical to the right lateral ventricle. The PET scan showed a thinning and weakening of the activity of the left hemisphere in roughly the central posterior region. Dr. Wood opined that if a neuropsychologist had concluded that Stewart suffered from left-hemisphere brain damage, the findings from the PET scan would be corroborative of that diagnosis. Dr. Wood concluded that the abnormalities in Stewart's brain were chronic and not recent and that they [were] probably developmental in origin. In response, the State called Dr. Maher. Dr. Maher testified that in preparation for the penalty phase, he and trial counsel discussed competency, sanity, mitigation, and additional testing that might be useful to do on Mr. Stewart for his case. Dr. Maher explained that he did not think neuropsychological testing was indicated that is, reasonable and necessaryin this case. Dr. Maher testified that other psychiatrists and psychologists likewise examined Stewart and to his knowledge none of them recommended further or more extensive neuropsychological testing. Dr. Maher expressly disagreed with several aspects of Dr. Eisenstein's testimony. Dr. Maher testified that a psychiatrist can diagnose organic brain damage and that he had made such a diagnosis in other cases. Dr. Maher stated that the idea that only a neuropsychologist can identify signs or symptoms of neuropsychological impairment is faulty and that in fact [i]t is a part of a general medical evaluation to evaluate the workings of a person's brain. Dr. Maher further testified that he does not think that Dr. Weiner's battery of tests was inadequate and incomplete. He opined that what testing should be done is necessarily a case-by-case determination. He stated, [T]he term `full neuropsychological battery' ... is not a clear absolute definable term but instead calls for a clinical judgment about what is necessary. Dr. Maher noted that Dr. Merin, who examined Stewart and testified during the penalty phase on behalf of the State, was certified in neuropsychology. Dr. Maher also disagreed with Dr. Eisenstein's conclusions about Stewart's mental health. Dr. Maher testified that the results of Dr. Eisenstein's testing did not change his diagnosis that Stewart suffered from PTSD, rather than brain impairment or ADHD, at the time of the offense. Dr. Maher concluded that Stewart's above-average performance on the Wisconsin Card Sorting Test undermined Dr. Eisenstein's diagnosis of brain damage and opined that within all reasonable medical possibility [Stewart] does not have brain damage. Next, Dr. Maher disagreed with Dr. Eisenstein's diagnosis of ADHD. Dr. Maher explained that the diagnostic manual provided that ADHD should be excluded when other mental health problems, brain illness, or circumstances better explain the signs and symptoms of the disorder and in this case a diagnosis of PTSD better explained the total picture of Stewart's life. Overall, Dr. Maher opined that the horrible abuse that [Stewart] suffered in childhood and the resulting traumatic stress disorder was the driving force behind Stewart's criminal acts. The State also called Dr. Wilf, a nuclear medicine physician, who opined that Stewart's PET scan was normal. He stated that the apparent differences in the hemispheres of Stewart's brain may be explained in part by Stewart's head position in the scanner.
Stewart contends that the postconviction court erred in denying his claim that trial counsel was ineffective in failing to obtain a complete neuropsychological examination and a PET scan. He asserts that had counsel performed a more thorough investigation, evidence like that presented at the postconviction evidentiary hearing could have been presented at the penalty phase and would have resulted in a life sentence. The postconviction court denied this claim because it found that trial counsel's investigation of Stewart's mental healthwhich consisted of asking one expert to evaluate Stewart for any signs of neuropsychological impairment indicating brain damage or dysfunction and consulting two other qualified mental health expertswas reasonable. The postconviction court explained that Stewart failed to show that counsel performed ineffectively regarding brain damage mitigation when he specifically requested an evaluation for potential brain damage or dysfunction and his own mental health experts did not diagnose brain damage or otherwise advise counsel to pursue that avenue. The postconviction court further found that even if trial counsel was deficient, Stewart did not prove prejudice. We agree. Stewart did not demonstrate that counsel was deficient or that he was prejudiced. As noted by the postconviction court, in Darling v. State, 966 So.2d 366 (Fla.2007), this Court rejected a similar claim that counsel was deficient for failing to order a neuropsychological assessment and develop evidence of brain damage for the penalty phase. In that case, trial counsel presented penalty-phase expert testimony that Darling was abused by his father, had a low IQ, and had difficulties in school. The sentencing court found many nonstatutory mitigating factors related to Darling's background and childhood. Id. at 372. During a postconviction evidentiary hearing, Darling presented a psychologist and a neuropsychologist who testified that Darling suffered from frontal lobe damage, which would cause him to behave in socially unacceptable ways. Id. at 374. This Court determined that counsel's representation was reasonable, explaining: [I]n preparing for the penalty phase, trial counsel relied on the evaluation of psychiatric expert Dr. Michael Hercov. Darling's trial counsel confirmed that he relied on the evaluation performed by his expert, Dr. Hercov, and would not have ordered a neuropsychological evaluation absent a recommendation by Dr. Hercov. Also, Dr. David Frank established during the evidentiary hearing that Darling's irritability and changed behavior was the result of being abused rather than organic brain damage. Dr. Frank added that stuttering after being abused is a normal response produced by fear and anxiety. Dr. Frank also added that Darling's impulsivity, frequent fights, and poor planning were all indicative of the diagnosis that Darling had antisocial personality disorder. This Court has established that defense counsel is entitled to rely on the evaluations conducted by qualified mental health experts, even if, in retrospect, those evaluations may not have been as complete as others may desire. See State v. Sireci, 502 So.2d 1221, 1223 (Fla.1987). Even if the evaluation by Dr. Hercov, which found no indication of brain damage to warrant a neuropsychological workup, was somehow incomplete or deficient in the opinion of others, trial counsel would not be rendered ineffective for relying on Dr. Hercov's qualified expert evaluation. See id. Therefore, trial counsel was not ineffective for failing to order a neuropsychological evaluation. Id. at 377. Similarly, in Reese v. State, 14 So.3d 913, 918 (Fla.2009), this Court determined that trial counsel could not be deemed ineffective for failing to request a neuropsychological evaluation where at the time of the penalty phase neither a well-known death penalty mitigation expert nor experienced trial counsel had reason to believe further testing was warranted. As in Darling, there is competent, substantial evidence that Stewart's defense counsel consulted with numerous mental health experts. The defense presented two mental health experts, Dr. Maher and Dr. Sultan, at the penalty phase. The record shows that these penalty-phase experts testified about diagnoses other than brain damage that accounted for Stewart's behavior. Specifically, Dr. Maher opined that Stewart suffered from PTSD and substance abuse problems, and Dr. Sultan opined that Stewart suffered from a history of mental illness, substance abuse problems, and trauma from his abusive upbringing. Both experts opined that Stewart's childhood trauma and his substance abuse resulted in Stewart having a substantially impaired capacity to conform his behavior to the requirements of the law at the time of the offense. Additionally, while the record is not entirely clear as to whether they were retained by the defense, the record shows that prior to the conclusion of his trial Stewart was evaluated by four other mental health expertsDrs. Mussenden, Afield, Gonzalez, and Gamache. And finally, the postconviction hearing evidence established that the defense also consulted Dr. Weiner in preparation for the penalty phase. Stewart did not, however, establish that any mental health expert had recommended to trial counsel that Stewart undergo neuropsychological testing. Defense expert Dr. Eisenstein conceded that he was not aware of any of the above experts recommending neuropsychological testing. Moreover, unlike in Darling, Stewart's defense counsel consulted a neuropsychologist as part of his penalty-phase investigation. A March 2001 report by Dr. Weiner, a licensed psychologist, stated that counsel asked me to examine [Stewart] for any indications of neuropsychological impairment that might indicate organic brain damage or dysfunction. The report indicated that Dr. Weiner performed the testing that he deemed appropriate and concluded that Stewart did not have brain damage: [T]he test findings do not demonstrate neuropsychological impairments consistent with the presence of brain damage or dysfunction. Mr. Stewart is functioning in the average range of intelligence, with a measured IQ of 100, and his abilities to attend, remember, reason, form concepts, organize his visual impressions, coordinate his perceptual-motor functions, and alter his mental set are within normal limits. As explained in Darling and Reese, trial counsel's reliance on his retained experts is not proven unreasonable simply because another expert, in this case Dr. Eisenstein, questions the thoroughness of the prior evaluations. See also State v. Sireci, 502 So.2d 1221, 1223 (Fla.1987) (Counsel cannot be deemed ineffective under the standards set forth in Strickland v. Washington, 466 U.S. 668, 104 S.Ct. 2052, 80 L.Ed.2d 674 (1984), simply because he relied on what may have been less than complete pretrial psychiatric evaluations.). In this case, Stewart did not prove that a reasonable trial attorney should have known to not rely on the conclusions offered by the mental health experts who evaluated him. Thus, he did not prove that his counsel was deficient. Stewart also failed to demonstrate that he was prejudiced by trial counsel's investigation and presentation of mental health evidence. Stewart heavily relies on the fact that the jury recommended death by a vote of seven to five. Stewart's case, however, is not one in which the defendant nearly received a life recommendation despite defense counsel doing little investigation and wholly failing to present mental health mitigation evidence during the penalty phase. See, e.g., Rose v. State, 675 So.2d 567, 572-74 (Fla.1996) (vacating death sentence and remanding for new sentencing proceeding due to counsel's failure to meaningfully investigate mitigation); Phillips v. State, 608 So.2d 778, 782-83 (Fla.1992) (similar). Rather, Stewart's trial counsel consulted with several mental health experts and presented expert testimony during the penalty phase. Given this record, Stewart's speculation about the effect that additional evidence would have had on the jury is insufficient to undermine confidence in his sentence. See Derrick v. State, 983 So.2d 443, 462 (Fla. 2008) (explaining that speculation about whether additional evidence about defendant's upbringing and mental health could have altered the sentencing proceeding where the jury recommended death by a vote of seven to five was insufficient to prove prejudice). Stewart has also failed to show prejudice such that the Court's confidence in his sentence is undermined because he cannot demonstrate that the postconviction evidence would have changed the sentencing court's conclusion that the aggravating factors greatly outweighed the mitigating factors. See Hurst v. State, 18 So.3d 975, 1013 (Fla.2009) (Penalty phase prejudice under the Strickland standard is measured by whether the error of trial counsel undermines this Court's confidence in the sentence of death when viewed in the context of the penalty phase evidence and the mitigators and aggravators found by the trial court.). The sentencing court found three aggravating circumstances applicable to the murder: (1) Stewart previously had been convicted of violent felonies (first-degree murder, two attempted murders, armed robbery, aggravated assault, and attempted armed robbery); (2) he was under a sentence of imprisonment at the time of the murder; and (3) he committed the murder for pecuniary gain. The sentencing court gave aggravating circumstances one and three great weight and gave circumstance two modest weight. The sentencing court found and gave some weight to two statutory mitigating factorsextreme mental disturbance and substantially impaired capacity to conform conduct to the requirements of the law despite concluding that Stewart's mental disturbance did not rise to the level of extreme and his impairment was not substantial. Finally, the sentencing court found and weighed twenty-three nonstatutory mitigating circumstances: Stewart suffered physical brutality during childhood, witnessed physical violence against others, suffered gross emotional stress during childhood, demonstrated an inability to adapt to his surroundings, suffered abuse by an aunt while in her care, lacked role models, lacked a father during his tender years, learned at age twelve that the man he believed to be his father was his stepfather, suffered abandonment by his mother, lacked a mother during his tender years, suffered a lifelong obsession with his mother, abused alcohol as a child, was intoxicated at the time of the offenses, engaged in long-term alcohol abuse, had low-normal intelligence, had an eighth-grade education, endured homelessness, experienced mental illness and a family history of mental illness, was remorseful for the killing, demonstrated compassion for others while incarcerated, took an interest in spiritual development during incarceration, received a sentence of 130 years in prison on unrelated charges, and had a good prison record. Most of these nonstatutory mitigating factors were given some or modest weight, although a few were given little or no additional weight because they were cumulative to other mitigating factors. During the evidentiary hearing, Dr. Eisenstein testified that Stewart suffered from ADHD and left-hemisphere brain damage, which was the driving force behind his behavior, and opined that Stewart was under severe emotional stress most of his life because of his upbringing. Dr. Wood testified that the PET scan indicated chronic abnormalities in the left hemisphere of Stewart's brain and that the scan results would be corroborative of a diagnosis of brain damage. Dr. Wood stated generally that left-hemisphere brain damage can impede higher level cognitive processing, but he did not offer any opinion about how the brain abnormalities may have affected Stewart's behavior at the time of the offense. The sentencing court gave some weight to the statutory mitigating factor of extreme mental or emotional disturbance at the time of the offense because it was not convinced that Stewart's distress was extreme. The sentencing court credited the testimony of State expert Dr. Merin over that offered by Dr. Maher and Dr. Sultan. Dr. Merin had concluded that rather than mental illness or emotional disturbance, Stewart had a character or behavior disorder and suffered from general distress for most of his life. Dr. Eisenstein's postconviction testimony would have contradicted Dr. Merin's appraisal that Stewart had a character disorder but would not have dispelled the impression that Stewart's emotional stress was a life-long state, rather than an acute episode at the time of the murder. Thus, it seems unlikely that the evidence presented at the evidentiary hearing would cause the sentencing court to place significantly more weight on this mitigating factor. As to the impaired capacity statutory mitigating factor, the sentencing court concluded that Stewart's capacity was impaired due to the combination of factors presented to this Court regarding his background. However, based on Stewart's ability to methodically select his victim, lure the victim to an isolated location, shoot the victim twice from close range, and then burn the victim's car, the sentencing court found that Stewart had the capacity to choose his actions, and accordingly, the impairment was not substantial. Like Dr. Maher and Dr. Sultan, Dr. Eisenstein testified that Stewart's thinking processes [were] disorganized and scattered and that Stewart committed the crimes in an unthinking and reactive way. But also like the prior defense experts, Dr. Eisenstein did not explain how Stewart's allegedly substantially impaired capacity was consistent with Stewart's ability to devise and execute a plan to lure the owner of an expensive-looking car to an isolated location in order to rob him. As a result, it again seems unlikely that the evidence presented at the evidentiary hearing would have caused the sentencing court to place significantly more weight on this mitigation factor. Stewart's case does not seem distinguishable from Derrick, in which this Court concluded that postconviction expert testimony about previously unpresented brain damage was not particularly compelling where the expert never specifically discussed how Derrick's mental impairment would have affected this particular crime and never linked up any of the conditions of Derrick's childhood or sexual abuse to the facts of this crime. 983 So.2d at 461-62. Notably, the jury recommendation in Derrick was also by a seven-to-five vote. Nor is Stewart's case materially distinguishable from Owen v. State, 986 So.2d 534, 552-53 (Fla.2008), in which this Court determined that additional mental health mitigation did not undermine confidence in the sentence where the murder was calculated and deliberate and the postconviction expert did not offer an opinion as to whether Owen's actions on the night of the offense demonstrated impulsivity. See also Lynch v. State, 2 So.3d 47, 73 (Fla.2008) (Moreover, Lynch has not connected any cognitive impairment to the events of March 5, 1999, which, in contrast, reveal a carefully crafted murder plot.). Finally, Stewart has not established that the jury's sentencing recommendation and the trial court's sentence would have changed if the postconviction evidence had been presented to the jury and the sentencing court. The sentencing court explained that in its view, the convictions underlying the prior violent felony aggravating factorconvictions for murder, two attempted murders, armed robbery, attempted armed robbery, and aggravated assaultwere so egregious and so horrific that that factor alone far outweighed all the mitigation presented. Moreover, the sentencing court did find and evaluate mental health mitigation, and Stewart cannot demonstrate that this additional evidence would have undermined this Court's determination that the death penalty was proportionate. Thus, Stewart's postconviction presentation regarding evidence of brain damage did not undermine confidence in his death sentence.
In Ake v. Oklahoma, 470 U.S. 68, 84, 105 S.Ct. 1087, 84 L.Ed.2d 53 (1985), the United States Supreme Court concluded that in a sentencing proceeding, due process requires access to a psychiatric examination on relevant issues, to the testimony of the psychiatrist, and to assistance in preparation at the sentencing phase. While ordinarily a postconviction claim based on Ake is procedurally barred because it could have been raised on direct appeal, a defendant is entitled to litigate during postconviction a claim that a prior mental health expert's examination was so grossly insufficient that the expert ignore[d] clear indications of either mental retardation or organic brain damage. Raleigh v. State, 932 So.2d 1054, 1060 (Fla. 2006) (quoting Sireci, 502 So.2d at 1224). We affirm the denial of Stewart's postconviction claim. Stewart did not demonstrate that his mental health experts ignored clear indications of organic brain damage. At trial, Dr. Maher testified that he met with Stewart briefly and reviewed extensive records from other doctors and documentation such as police reports. Dr. Sultan explained that prior to the 2001 penalty phase, she met with Stewart for about twenty hours. She reviewed school and jail records, reviewed records about Stewart's suicide attempts, talked to Stewart's family members and friends, and administered psychological tests specifically an IQ test and the Minnesota Multiphasic Personality Inventory (MMPI). Dr. Weiner's report indicated that he met with Stewart in preparation for the penalty phase and administered the following intellectual and cognitive tests: Bender Visual Motor Gestalt Test; Boston Naming Test; Stroop Neuropsychological Screening Test; Verbal Fluency Test; Wechsler Adult Intelligence Scale-III (WAIS-III); Wechsler Memory Scale-III; and Wide Range Achievement Test-3. Stewart asserts that these evaluations were inadequate because Dr. Maher and Dr. Sultan were not qualified to conduct neuropsychological testing and because Dr. Weiner did not conduct a full battery of such tests. Stewart's claim is not persuasive. Without being familiar with what testing Dr. Maher and Dr. Sultan may have administered or reviewed, Dr. Eisenstein initially opined that unless those doctors had the benefit of a full neuropsychological battery and expertise in interpreting those tests, they could not fully assess whether Stewart had brain damage. Yet, elsewhere in his testimony, Dr. Eisenstein seemed to equivocate about whether Dr. Maher and Dr. Sultan could have been qualified to screen Stewart for brain damage. When asked if a psychiatric examination is inadequate for determining whether more testing for brain damage is necessary, he testified: No, that's not true. A good psychiatrist understands the issues, hopefully through a mental status examination and through a behavioral observation and understanding the pathology of brain impairment and the behavior manifestation. Of course, if there's history [a good psychiatrist] would understand... the need to do continuing evaluation and certainly would request that and would want that. Dr. Eisenstein further explained that he did not credit Dr. Weiner's conclusions because he felt that Dr. Weiner should have done more testing. He testified that Dr. Weiner administered tests designed to measure academic performance but did not administer a full memory examination or tests designed specifically to detect brain impairment. In contrast, Dr. Maher testified that a psychologist or a psychiatrist is qualified to determine if neuropsychological testing is warranted and opined that Dr. Weiner's testing was adequate to diagnose Stewart. Furthermore, while Dr. Eisenstein testified that the results of his testing indicated that Stewart likely had brain damagefor example, he considered the thirteen-point score discrepancy in Stewart's verbal and performance IQ scores to be significant he did not point to any test results available at the time of resentencing that should have alerted the prior experts to the need to perform additional neuropsychological testing. Stewart argues that Dr. Weiner should have known to investigate the thirteen-point discrepancy, but when Dr. Weiner administered the WAIS-III in 2001, Stewart had a verbal score of 98 and a performance score of 102. Finally, the record supports the postconviction court's characterization of Stewart's brain damage as possible brain damage rather than clearly established brain damage. Dr. Eisenstein and Dr. Wood opined that Stewart's left hemisphere was damaged, but Dr. Maher opined that Stewart's performance on the Wisconsin Card Sorting Test undermined the diagnosis of brain damage. And although the postconviction court did not find his testimony persuasive because he was unfamiliar with assessing brain scans for neurocognitive issues, Dr. Wilf opined that Stewart's brain scans indicated a normal brain. In summary, Stewart has not identified clear signs of brain damage that his penalty-phase mental health experts overlooked. See generally Raleigh, 932 So.2d at 1060 (Dr. Bordini's testimony did not establish that Dr. Upson missed any clear indications of mental retardation or organic brain damage, thereby rendering Dr. Upson's evaluation `grossly insufficient' under Sireci. ). An expert's evaluation is not rendered less than competent ... simply because [the] appellant has been able to provide testimony to conflict with that presented by the expert. Jones v. State, 732 So.2d 313, 320 (Fla.1999). Accordingly, Stewart is not entitled to postconviction relief based on Ake.