Opinion ID: 815387
Heading Depth: 4
Heading Rank: 2

Heading: Mental Competency Determinations

Text: The competency standard for standing trial involves an inquiry into whether a defendant has a rational as well as factual understanding of the proceedings against him or her, and whether the defendant has sufficient present ability to consult his lawyer -26- with a reasonable degree of rational understanding. Indiana v. Edwards, 554 U.S. 164, 170 (2008) (citing Drope v. Missouri, 420 U.S. 162, 171 (1975); Dusky v. United States, 362 U.S. 402, 402 (1960)). Pursuant to 18 U.S.C. § 4241, a district court shall order . . . a hearing [to determine the mental competency of the defendant] if there is reasonable cause to believe that the defendant may presently be suffering from a mental disease or defect rendering him mentally incompetent to the extent that he is unable to understand the nature and consequences of the proceedings against him or to assist properly in his defense. 18 U.S.C. § 4241(a); see also United States v. Brown, 669 F.3d 10, 17 (1st Cir. 2012) (A district court must sua sponte order a competency hearing if there is reasonable cause to believe that a defendant is mentally incompetent.). Courts are required to hold a competency hearing sua sponte whenever evidence raises a sufficient doubt as to the competence of the accused. Johnson v. Norton, 249 F.3d 20, 26 (1st Cir. 2001). Factors to consider in guiding a district judge's inquiry into whether an evidentiary hearing as to competence is warranted include a defendant's irrational behavior, his demeanor at trial, and any prior medical opinion on competence to stand trial. Id. at 27 (quoting Drope, 420 U.S. at 180). A district court may consider its own interactions with the defendant in determining whether there is reasonable cause for an examination or an evidentiary hearing. United States v. Curtis, 520 F.2d 1300, -27- 1304 (1st Cir. 1975). Even if a district court has found a defendant competent when the trial begins, a significant change in circumstances in the midst of trial may render a second competency hearing proper. Yehboah-Sefah v. Ficco, 556 F.3d 53, 82 (1st Cir. 2009). The conviction of a person legally incompetent to stand trial violates due process. See Johnson, 249 F.3d at 26. The court reviews the district court's decision not to hold a competency hearing or order a psychiatric examination for abuse of discretion, affirming the district court's decision as long as there was a sufficient evidentiary basis to support its decision. United States v. Sánchez-Ramírez, 570 F.3d 75, 80 (1st Cir. 2009) (standard of review of decision not to hold a competency hearing); Curtis, 520 F.2d at 1304 (standard of review of decision not to order psychiatric examination). To challenge a district court's finding of competency, an appellant must present facts sufficient to positively, unequivocally and clearly generate a real, substantial and legitimate doubt as to [her] mental competence. Brown, 669 F.3d at 17 (quoting United States v. Collins, 949 F.2d 921, 927 (7th Cir. 1991)). Maryea argues the district court violated her due process and statutory rights by failing to order a re-evaluation of her competency to stand trial after the injuries she suffered in the January 14th car accident. Specifically, Maryea asserts that the district court erred because the accident wrought a significant -28- change in circumstances warranting an evidentiary hearing on her mental competency. Maryea points to our decision in Johnson to support her argument stating that this case, like Johnson, involves a defendant in a criminal proceeding who was subjected to a physical injury worthy of creating a change of circumstances. In Johnson, this court found that a competency hearing was warranted when the defendant suffered a blow to the head on the morning of the first day of trial and also lost consciousness and vomited during trial. See 249 F.3d at 23, 28. In this case, Maryea cites to the following which, she claims, created sufficient doubt as to her mental competency after the accident that should have triggered the ordering of a mental competency hearing: (1) statements she made during the January 18, 2011 Status Conference that her pain was breaking through her medication and that she was damaged, broken, and rendered incapable of participating in her own defense;3 (2) her breakdown on the sixth day of trial when she received her medications late; (3) her rambling, incoherent and inconsistent testimony following the court's recess and questioning of Maryea on that sixth day following her receipt of her medication; (4) her erratic behavior on the seventh day of trial when, in response to the court's question concerning how she 3 At this Status Conference and based on Maryea's representations, the district court granted Maryea's request for a continuance. -29- was feeling, she stated that she was celestial and objected to her own counsel while attempting to address the court directly and through a subsequent pro se motion for a mistrial; and (5) Dr. Drogin's testimony as to the nature of Maryea's mental diagnosis as bipolar with psychotic features, and which provided the court with descriptions of the disorder that she was exhibiting at trial. Based on these incidents, Maryea argues that sufficient doubt was raised as to her competency, and only a trained expert could have accurately assessed her competency to continue. The government rejects these arguments, contending that the district court was not required to order a second competency evaluation for Maryea. First, the government argues that Maryea's post-accident behavior was not materially different from her pretrial behavior, particularly with respect to her speech patterns, unusual use of vocabulary, disagreements with her defense counsel and filing of pro se motions. Second, the government asserts that the district court was on notice as to Maryea's bipolar disorder and physical pain, and sufficiently reviewed the issue of the impact of physical pain on her psychological state on multiple occasions, namely during: (1) Maryea's motions for bail; (2) its order for a mental competency review; (3) its order for a medical examination following the accident; and (4) its direct evaluations and colloquies with Maryea on January 24 and 25, when it ordered additional delays to accommodate her need for medication and -30- proceeded only after she was questioned and evaluated. The government also contests Maryea's arguments that the testimony of the clinical psychologist at trial should have alerted the district court to doubt Maryea's competency, arguing that his testimony was consistent with the mental competency report which indicated that it would be unusual for physical pain to make a person incompetent as long as their mental disorder was reasonably under control. Finally, the government distinguishes this case from Johnson, noting that the district court in this case did not continue the trial following the defendant's injury. Rather, the court stopped the proceedings and only continued when Maryea had received her medication, had been treated, and the court was convinced that she was competent. The government likens this case instead to United States v. Sánchez-Ramírez where the defendant was found competent to stand trial prior to its commencement, then suffered a breakdown before closing arguments due to his failure to take prescribed medications. See 570 F.3d at 79. In SánchezRamírez, this court found no abuse of discretion when the district court did not conduct another competency hearing since the court relied on the fact that the defendant had already been found competent by experts, a defense motion for a competency hearing was not renewed -- suggesting that the reasons that gave rise to the motion were temporary -- and the district court was able to rely on its own observations of the defendant. Id. at 80-81. -31- The court agrees with the government that there was no abuse of discretion here. A close look at the record indicates that the district court had a sufficient evidentiary basis to support its decision not to order a second mental competency evaluation. Maryea was originally found competent to stand trial, and the district court's competency determination was neither objected to nor appealed. The district court's order for a medical examination and subsequent questioning of Maryea following the accident was thorough, and she made clear and coherent statements about her desire and ability to move forward with the trial. Maryea's behavior following the accident as well as her behavior subsequent to receipt of her medication on January 25 was not demonstrably different than her behavior prior to the accident. Additionally, the psychologist's testimony regarding her bipolar disorder, while revealing details about certain aspects of her psychological condition, did not contradict the competency report's conclusions that, with adequate treatment and medication, Maryea's experience of physical pain would not interfere with her competency. First, while the record does not end with the district court's initial competency determination, it is critical to note that that the initial competency evaluation ordered by the court on September 13, 2010, explicitly requested a medical and psychological evaluation to determine her competency to stand -32- trial, including an assessment of whether, and [] the extent to which her physical pain impacts that competency. It is thus clear that the district court was aware and sensitive to the fact, early on in the proceedings, that Maryea's physical pain could impact her mental state. The district court's finding of competency relied on the psychiatric report submitted by Dr. Drukteinis on November 10, 2010, and after the court ordered the parties to request any relief based on said report and found Maryea competent to stand trial, neither party objected nor appealed that determination. Second, within days of the accident, the district court granted Maryea's motion to continue filed immediately after the accident and ordered that Maryea undergo an independent medical examination as soon as possible (preferably within the next 24 hours, if feasible) to further evaluate and diagnose any injuries she may have sustained in the recent automobile accident and to determine whether the continuing effects of those injuries, if any, will prevent her from meaningfully participating in the ongoing criminal trial and assisting in her defense, including observing the evidence and communicating with her counsel. A report by the doctor who conducts the medical examination shall be filed with this court as soon as possible. . . . The district court also ordered that an MRI be conducted. Additionally, it appears from the record that Maryea's pain was acutely experienced due to failure to take her medications, and upon hearing of said pain, the court ordered a recess until her medications took effect. During the Status Conference conducted -33- following Maryea's taking of the medication, the court addressed the issue of her pain and engaged in a colloquy with her to affirm her ability to respond to questions intelligently. Not only did Maryea indicate her desire to proceed, but she demonstrated her ability to follow the court's line of questioning, to understand said questioning, to converse and interact with her attorney, and to provide coherent responses regarding her rights. See, e.g., Cody v. United States, 249 F.3d 47, 53 n.5 (1st Cir. 2001) (stating that the court's observation of the defendant's appearance and demeanor as he answered questions throughout the colloquy supported the court's competency determination) (citing United States v. Savinon-Acosta, 232 F.3d 265, 269 (1st Cir. 2000) (Courts have commonly relied on the defendant's own assurance . . . that the defendant's mind is clear. Further, the defendant's own performance in the course of a colloquy may confirm . . . his assurances.) (citation omitted)). In addition, following the accident, Defense counsel did not file a motion for a competency hearing, suggesting that the issues which gave rise to any competency concern were temporary in nature. See Sánchez-Ramírez, 570 F.3d at 81. Third, it does not appear from the record that, following Maryea's receipt of her proper medications, her behavior in court as it related to her defense was any different from her behavior prior to the accident. Specifically, transcripts from Maryea's -34- pre-trial hearings reveal that Maryea complained about her neck and back pain while also using unusual vocabulary in her oral and written statements to the court. In fact, the psychiatric report explicitly noted Maryea's evasiveness, tendency to speak in generalities, and her variable moods. However, the report nevertheless stated that it would be a very unusual circumstance that, with an individual's mental disorder under reasonable control, the mere presence of pain would make them not competent to stand trial. That Maryea's post-medication behavior appears consistent with her behavior prior to the accident is another factor supporting the conclusion that there was no abuse of discretion in the court's decision not to order a second competency evaluation. Finally, the district court did not err in failing to diagnose Maryea's courtroom behavior as identical to those characteristics of bipolar disorder flagged in the psychiatrist's evaluations of Maryea. As we just stated, following Maryea's medication for her extreme pain, the record does not show that Maryea conducted herself in a manner distinct from her behavior before the accident. Additionally, the psychiatrist's evaluation of Maryea did not contradict the court's later determination of Maryea's competency following the accident since his report stated that Maryea's experience of physical pain need not interfere with her mental competency so long as her disorder was under reasonable -35- control. The court's observations on the record and the record itself indicate that Maryea had reasonable control over her mental faculties after her pain medication had time to take effect. To conclude, this court finds that the district court had a sufficient evidentiary basis when it failed to sua sponte order a second competency evaluation. The facts of this case and the trial court's response to Maryea were almost identical to the facts and court's response in Sánchez-Ramírez, where no abuse of discretion was found by this court when a defendant had been originally found competent, an expert report confirmed that competency, no motion for a competency hearing was renewed following the change of circumstances, and the district court judge made observations on the record that there were no signs of mental impairment. Sánchez-Ramírez, 570 F.3d at 81.