Opinion ID: 1946665
Heading Depth: 4
Heading Rank: 1

Heading: Evidence Presented at the Competency Hearing

Text: At the competency hearing in this case, appellant presented evidence that he had long suffered from Type I diabetes, causing him to experience erratic and abnormal swings in his blood sugar, and that he also had a long history of epileptic seizures. Dr. Thomas Hyde, a board-certified neurologist who examined and tested appellant on April 23, 2002, and October 6, 2003, testified that due to poorly controlled seizures and repeated hypoglycemic insults to the brain over the years, appellant was in a cognitively impaired state and had significant impairment in neurological function, especially in domains of attention and memory that would impair his ability to understand the proceedings that he would be involved with, and to participate and work with his counsel in an effective manner and that render him incompetent from the medical/legal standpoint. Dr. Hyde also testified that appellant's Full Scale IQ was found to be 55 and that people who are below 60 are really quite significantly impaired. Dr. David Pickar, a psychiatrist, [13] met with appellant on three different occasions  January, April, and September of 2003. He testified that appellant demonstrated perseveration, a symptom of frontal lobe dysfunction. Dr. Pickar also testified that during his September 2003 evaluation of appellant, he explored at some length appellant's understanding of the legal process. He found appellant unable to understand the fundamental nature of the defense-prosecution, defendant relationship and [u]nable to understand relationship with defense attorney. Dr. Pickar did not think that appellant got [ i.e., comprehended] the idea of pleading guilty. Dr. Pickar concluded that appellant does not have sufficient understanding of the legal process, or the ability to work appropriately with counsel in the context of a central nervous system disorder that involves dementia, probably secondary to epilepsy; and that he is not competent to stand trial, and that the deficits that are germane to this conclusion are not related to malingering. [14] The government's experts did not dispute that appellant had some degree of cognitive impairment. Dr. Raymond Patterson, [15] a forensic psychiatrist who had completed several hundred competency examinations, testified that he had no conflict with tests showing that appellant had some degree of neurological damage and acknowledged that there might be some mild dementia, but stated that this does not mean that [appellant] does not have the ability . . . to exaggerate as much as he might think he should to convince people that he doesn't know what's going on. Dr. Patterson opined that appellant certainly was malingering and certainly was . . . exaggerating symptoms . . . when they said he had an IQ of 55, because I simply don't believe he has an IQ of 55. Dr. Patterson cited specific examples of appellant's malingering: choosing how [he] respond[s] based on who [he's] talking to; appellant's ridiculous response to a question about the colors of the American flag, a question that even mentally retarded individuals and people with serious mental illness don't miss; appellant's claim to hear voices but his ability to concentrate and his lack of distraction, which are inconsistent with that affliction; and his exhibiting high-level planned behavior, such as injecting himself with insulin to get medical attention in the emergency room faster than other people. Dr. Patterson further testified that appellant's behaviors inconsistent with an IQ level of 55 included acting as a predator while at St. Elizabeths but not while in jail, where appellant appeared to be normal, like any other inmate who is not receiving mental health services. Dr. Patterson agreed with a statement in a discharge summary, attributed to Dr. William Richie, one of appellant's treating psychiatrists at St. Elizabeths, that appellant was capable of dissimulating, fabricating, prevaricating and malingering cognitive disabilities in excess of his documented deficits. Noting that the issue was whether or not [appellant] understands, rationally and factually these proceedings, the charges against him, the consequences; and can he, does he have the ability to assist his attorney, Dr. Patterson stated that In my view, he has both of those. Dr. Patterson thought that appellant's case was not a close call at all, explaining that when [appellant] adheres to his treatment regime, seems to do pretty well. When he doesn't, he runs into problems. The latter, in my view, are very much and directly related to his attempts to not have this matter go forward, and in part because he has been in a position where precisely that has happened before. Dr. Steven Lally, a clinical and forensic psychologist who had previously conducted between 200 and 250 competency evaluations, [16] spent 7½ to 8 hours with appellant at the D.C. Jail on October 24, 2003. Dr. Lally administered a neuropsychological screening test that showed that appellant was performing in the moderate to severely impaired range. Dr. Lally also administered a test for memory malingering that did not disclose malingering. Dr. Lally explained that the tests showed that appellant was answering in a . . . sort of careless random fashion, the reason for which the test cannot explain. Dr. Lally concluded that one should not put a lot of credibility [sic] in terms of [appellant's] performance in psychological tests. With respect to one of the tests, Dr. Lally also explained that if [the] test does not indicate malingering, it does not mean that the individual is not malingering. In other words, it's a test that's very effective when it does indicate malingering. But studies have shown that a number of malingerers . . . don't necessarily get caught with the [test]. On the basis of an interview with appellant, Dr. Lally concluded that appellant's behavior was inconsistent with the degree of impairment that appellant claimed, but was consistent with malingering. Dr. Lally noted that when he would stop taking notes during a meeting with appellant, appellant's speech became more spontaneous and his answers more accurate. Further, appellant mixed symptoms of various disorders and failed to remember details of the crime unless the detail was exculpatory. Dr. Lally testified that although appellant reported hearing voices, his symptoms were inconsistent with that condition. The symptoms that appellant reported were also inconsistent from one doctor's visit to the next, which Dr. Lally explained was a sign of malingering because malingerers don't always know how to respond. Dr. Lally concluded that appellant was malingering both psychotic symptoms and also some degree of cognitive impairment. Dr. Oliver testified that he found inexplicable inconsistencies between the November 2002 and September 2003 interviews he conducted with appellant. [17] During both interviews, appellant exhibited a good memory, was able to recite telephone and social security numbers, and could give background details. During the September 2003 interview, however, in contrast with the November 2002 interview, appellant had no knowledge about the charges and legal issues discussed. Unable to explain the differences in appellant's behavior, Dr. Oliver concluded that appellant was intentionally producing symptoms.