Opinion ID: 1527587
Heading Depth: 1
Heading Rank: 4

Heading: the psychiatrists' reliance on out-of-court statements and materials

Text: Early in his direct examination, Dr. Byrd was asked to describe the events which led up to Melton's hospitalization. Dr. Byrd concededly was not personally present when those events occurred, and Melton's counsel objected, characterizing the proposed testimony as hearsay. The following colloquy ensued: THE COURT: Of course it's hearsay. Of course it's hearsay. It's an exception, however, Mr. Fulton [Melton's counsel]. Go ahead, Doctor. MR. KELLY [Counsel for the District]: It certainly is, Your Honor. THE COURT: Mr. Fulton, please be seated. Go ahead. MR. FULTON: If I might, Your Honor, could we come to the bench? THE COURT: Mr. Fulton, no. We won't get the case started. We'll never get started at the rate we're going. Go ahead, Mr. Kelly. In conformity with this preemptive ruling, both psychiatrists were subsequently permitted to relate information which they received from Melton's motherthe alleged punch on the noseor from hospital records which had not been introduced into evidence. The mother, who apparently left for Florida during the trial as a result of a death in the family, did not testify and was not subject to cross-examination. Melton contends that he was thus denied an important liberty interest on the basis of what he describes as hearsay evidence, that he was deprived of the opportunity to confront and cross-examine those persons who had first-hand knowledge of the facts, and that the trial judge's summary ruling on his objection led to the admission of the alleged hearsay without the judge having made certain preliminary findings said to be required by law. We begin by noting that the testimony by Dr. Byrd and Dr. Cornet as to what they learned from others was not admitted in order to prove the truth of the matter asserted. See McCORMICK, supra, § 246, at 729. The trial judge specifically instructed the jury that any out-of-court statements by third parties which were reported in the experts' testimony were to be considered only for the purpose of evaluating the reasonableness and correctness of the doctors' conclusions, and not to establish the truth of the matters asserted by [the declarants]. As the court explained in United States v. Williams, 447 F.2d 1285, 1290 (5th Cir.1971) (en banc), cert. denied, 405 U.S. 954, 92 S.Ct. 1168, 31 L.Ed.2d 231 (1972), [a]n expert's opinion is derived not only from records and data, but from education and from a lifetime of experience. Thus, when the expert witness has consulted numerous sources, and uses that information, together with his own professional knowledge and experience, to arrive at his opinion, that opinion is regarded as evidence in its own right and not as hearsay in disguise. (Emphasis added.) The problem raised by Melton cannot, however, be avoided simply by calling the evidence expert testimony rather than hearsay. Labels cannot perform juridical alchemy. By resort to expert testimony, the District was able to bring to the jury's attention matters that could obviously prejudice Melton, including, e.g., reports that he had punched his mother, and that on an earlier occasion he had threatened his sister with a screwdriver. Melton was never able to cross-examine those who accused him of these antisocial acts. Such a procedure presents obvious problems of basic fairness. Courts are not blind to these concerns and have attempted to fashion rules which afford reasonable latitude to expert witnesses but simultaneously protect the rights of litigants against whom expert testimony has been offered. The tension between these competing interests is at the heart of this case.
The admission or exclusion of expert testimony, as we have noted, is committed to the trial court's broad discretion. Coates, supra, 558 A.2d at 1152. That discretion is guided in the District of Columbia by the principles underlying Rule 703 of the Federal Rules of Evidence, which provides as follows: The facts or data in the particular case upon which an expert bases an opinion or inference may be those perceived by or made known to [the expert] at or before the hearing. If of a type reasonably relied upon by experts in the particular field in forming opinions or inferences upon the subject, the facts or data need not be admissible in evidence. (Emphasis added). See STEFFEN W. GRAAE & BRIAN T. FITZPATRICK, THE LAW OF EVIDENCE IN THE DISTRICT OF COLUMBIA 7.20 (1989), quoted in L.C.D. v. District of Columbia ex rel T-A.H.D., 488 A.2d 918, 921 n. 8 (D.C.1985) (Rule 703 is an expression of the law as it has developed here). According to the Advisory Committee's Note to Rule 703, the rule is designed to broaden the basis for expert opinions beyond that current in many jurisdictions and to bring the judicial practice into line with the practice of the experts themselves when not in court. The critical inquiry, then, is whether the facts or data to which Dr. Byrd and Dr. Cornet alluded in reaching their conclusions in the present case were of a type on which experts in their profession reasonably rely. [10] As the court stated in Jenkins, supra, 113 U.S.App.D.C. at 304, 307 F.2d at 641, a case dealing with the admissibility of expert psychiatric testimony, the better reasoned authorities admit opinion testimony based, in part, upon reports of others which are not in evidence but which the expert customarily relies upon in the practice of his profession.... `This court ... will not close the doors of the courts to the light which is given by a diagnosis which all the rest of the world accepts and acts upon, even if the diagnosis is in part based upon facts which are not established by the sworn testimony in the case to be true.' [11] The court declined to `shut its eyes to a source of information which is relied on by mankind generally in matters that involve the health and may involve the life of their families and of themselves ....' Id. at 304, 307 F.2d at 641 (quoting Sundquist, supra note 11, 221 N.W. at 393); see also Reed v. United States, 584 A.2d 585, 591 (D.C.1990).
Consistently with these principles, this court has held that psychiatrists may offer opinions based on reports not in evidence if such reports are reasonably relied upon in the practice of their profession. Testimony similar to much of that at issue here has been held to be admissible. See In re Gahan, 531 A.2d 661, 666 n. 7 (D.C.1987) ([t]he court, as factfinder, was entitled to learn the factors underlying Dr. Carter's opinion that Gahan was likely to inflict harm on himself by ceasing to eat); Attorney Grievance Comm'n v. Nothstein, 300 Md. 667, 676-84, 480 A.2d 807, 812-16 (1984) (psychiatrist permitted to base his conclusion as to attorney's mental state on descriptions of attorney's behavior provided by the attorney's wife and by his partner). In the present case, the inquiry for Dr. Byrd and Dr. Cornet was whether Melton, if left to his own devices without supervision by the hospital, would be likely to pose a danger to himself or to others. In light of the wide latitude afforded to trial judges in relation to the admission or exclusion of expert testimony, the precise issue on appeal is whether the trial judge abused his discretion in rulingalbeit implicitly and without appreciable articulation [12] that in assessing Melton's dangerousness, a psychiatrist would reasonably rely on the reports and observations of family members and the records of Melton's past hospitalizations. We do not find this issue to be an especially troublesome one. The Advisory Committee's Notes to Rule 703 recognize that a physician in his [or her] own practice bases his [or her] diagnosis on information from numerous sources and of considerable variety, including statements by patients and relatives, reports and opinions from nurses, technicians and other doctors, hospital records, and X rays. Most of them are admissible in evidence, but only with the expenditure of substantial time in producing and examining various authenticating witnesses. The physician makes life-and-death decisions in reliance upon them. His [or her] validation, expertly performed and subject to cross-examination, ought to suffice for judicial purposes. (Emphasis added). The conclusion that a competent psychiatrist charged with assessing dangerousness would obtain information from the patient's relatives, as well as from his hospital records, is also dictated by what Justice Frankfurter has described as the saving grace of common sense. [13] Where else would the doctor go for such information? Indeed, as the United States points out in its brief as amicus curiae, a psychiatrist could be roundly criticized within and without the profession for not interviewing family members; by ignoring information which the profession views as vital, the psychiatrist would, at least, undercut the reliability of his or her opinion. See, e.g., People v. Britz, 123 Ill.2d 446, 460-63, 124 Ill.Dec. 15, 22-23, 528 N.E.2d 703, 710-11 (1988), cert. denied, 489 U.S. 1044, 109 S.Ct. 1100, 103 L.Ed.2d 242 (1989). [14] This is not to say that everything a family member tells a psychiatrist is necessarily reliable or true. [F]riends or relatives of an outpatient may seek his return to the institution because they feel uncomfortable in his presence or are dissatisfied with the progress he is making towards rehabilitation. In re Richardson, 481 A.2d 473, 480 (D.C.1984). Psychiatrists are well aware that this may occur. See Bernard L. Diamond & David W. Louisell, The Psychiatrist as an Expert Witness: Some Ruminations and Speculations, 63 MICH.L.REV. 1335, 1353 (1965). Indeed, they consider valuable for purposes of diagnosis any or all information provided by patients or relatives, whether the information is true or false. See 4 JACK B. WEINSTEIN & MARGARET A. BERGER, WEINSTEIN'S EVIDENCE § 803(4)[01], at 803-150 (1990). In any event, a properly qualified expert is assumed to have the necessary skill to evaluate any second-hand information and to give it only such probative force as the circumstances warrant. In re Agent Orange Prod. Liab. Litig., 611 F.Supp. 1223, 1245 (E.D.N.Y.1985) (Weinstein, J.), aff'd, 818 F.2d 187 (2d Cir.1987), cert. denied, 487 U.S. 1234, 108 S.Ct. 2898, 101 L.Ed.2d 932 (1988); see also State v. Schreuder, 726 P.2d 1215, 1223 (Utah 1986). [15] Accordingly, the court should accord an expert wide latitude in choosing the sources on which to base his or her opinions. See Soden v. Freightliner Corp., 714 F.2d 498, 505 (5th Cir.1983). But the court may not abdicate its independent responsibilities to decide if the bases meet minimum standards of reliability as a condition of admissibility. See FED. R.EVID. 104(a). If the underlying data are so lacking in probative force and reliability that no reasonable expert could base an opinion on them, an opinion which rests entirely upon them must be excluded. FED.R.EVID. 401, 402. The jury will not be permitted to be misled by the glitter of an expert's accomplishments outside the courtroom. Agent Orange, supra, 611 F.Supp. at 1245. Because Rule 703 was intended to bring judicial practice into line with the practice of experts when they are not in court, see Advisory Committee's note quoted supra at page 902, the judge may not substitute his or her judgment for the expert's as to what data are sufficiently reliable, provided that such reliance falls within the broad bounds of reasonableness. In re Japanese Elec. Prods. Antitrust Litig., 723 F.2d 238, 277-79 (3d Cir.1983), rev'd on other grounds sub nom. Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 106 S.Ct. 1348, 89 L.Ed.2d 538 (1986); see also United States v. Hill, 655 F.2d 512, 514-16 (3d Cir.1981) (error to exclude psychiatric testimony as to criminal defendant's susceptibility to entrapment), cert. denied, 464 U.S. 1039, 104 S.Ct. 699, 79 L.Ed.2d 165 (1984). The proper inquiry is not what the court deems reliable, but what experts in the relevant discipline [reasonably] deem it to be. Japanese Elec. Prods., supra, 723 F.2d at 276 (bracketed word added). The assumptions which form the basis for the expert's opinion, as well as the conclusions drawn therefrom, are subject to rigorous cross-examination. Id. at 277. Juries are intelligent enough, in light of the availability of such cross-examination, to ignore what is unreliable or unhelpful. Id. at 279. [16] In most cases, therefore, objections to the reliability of out-of-court material relied upon by a psychiatrist will be treated as affecting only the weight, and not the admissibility, of the evidence. Bertolotti v. Dugger, 883 F.2d 1503, 1517 (11th Cir.1989), cert. denied, ___ U.S. ___, 110 S.Ct. 3296, 111 L.Ed.2d 804 (1990).
In its discussion of how the judge should determine whether minimum standards of reliability, Agent Orange, supra, have been met, the majority of the panel adopted the following test: a trial judge will properly admit expert opinion based on hearsay testimony under Rule 703 when (1) the judge is persuaded that experts in the field commonly rely on the particular type of hearsay information in addressing the specific type of problem raised in the case before the court, and (2) the judge concludes that the information (if not admissible for its truth under an exception to the hearsay rule) is of a type for which the underlying reliability of the data can be sufficiently explored through cross-examination of the testifying expert. Of course, a trial judge [3] should exclude an expert opinion, including the facts and data upon which it relies (even if of a type reasonably relied on most of the time), if admission in evidence would create a substantial danger of undue prejudice or would mislead the jury. Melton I, 565 A.2d at 645 (emphasis added; citations and internal quotations marks omitted). The panel majority then strongly implied that in a great many cases, if not in most, a psychiatric's expert reliance on out-of-court statements by lay observers will not pass muster. We are not stating categorically that expert reliance on hearsay observations by laypersons will always fail to satisfy the second prong of the test set forth supra at page 645. But, given the possibility that lay observers in some contexts ( e.g., a family with a mentally ill member) may not be disinterested, and given, further, that the expert's inability to vouch for the lay observer's reliability will not necessarily undermine the expert's own aura of authority, [17] a trial court must be very careful to evaluate whether the proffered expert testimony and its underlying sources can be effectively scrutinized before the jury. Id. at 646. Melton urges us to adopt the panel majority's three-part test. We have no quarrel with the first and third prongs of this articulation, but are unable to agree with the second. The United States has filed an excellent brief as amicus curiae in which it has effectively marshalled the arguments against the division's second prong. We cannot improve upon the government's Summary of Argument, which we reproduce below in slightly edited form, annotated by authorities which, in our view, support the various propositions articulated therein: The panel opinion's holding, mandating classification and compartmentalization of the `type' of [information] underlying expert opinion or inference in order to determine its source and susceptibility to cross-examination, constitutes a significant, ill-advised change in this court's long-established jurisprudence. The decisions of this court have held that an expert's opinion is not inadmissible simply because it is based on [what would otherwise be] inadmissible hearsay if persons within the field of expertise customarily or reasonably rely upon such [information] in arriving at opinions. This rule is consistent with other jurisdictions' reasoned analysis. There are adequate safeguards to ensure the integrity and fairness of proceedings when an expert opinion relying in part on inadmissible evidence is proffered: (1) this court's three-part Dyas test for the qualification of experts; [18] (2) this court's rule that the profession must customarily rely upon such inadmissible hearsay evidence;[ [19] ] (3) the trial court's broad discretion to exclude expert testimony that is more prejudicial than probative, founded on incompetent evidence, or mere speculation;[ [20] ] (4) the opposing party's right to cross-examine on the underlying data and introduce contrary evidence;[ [21] ] (5) the trier-of-fact's ability to determine the reliability and weight to be given to such evidence;[ [22] ] (6) the risk of nonpersuasion borne by the party with the burden of proof;[ [23] ] (7) the trial court's discretion to direct a verdict.... where there is insufficient evidence to support a jury's finding;[ [24] ] and (8) this court's authority to take corrective measures on appellate review, should the trial court abuse its discretion. Moreover, the proposed rule would introduce new, intractable problems of law and administration.[ [25] ] It does not account for expert testimony founded only in part on otherwise inadmissible hearsay; it would lead to unwieldy hearings necessitating formidable, fine distinctions between types of hearsay and whether they are `sufficiently' susceptible to cross-examination; and it would prevent the jury from hearing probative expert opinions that are developed in accordance with accepted professional norms and methodology, including relevant psychiatric testimony.[ [26] ] In the final analysis, we view Rule 703 as having been intended to permit expert witnesses, provided that minimal standards of reliability have been met, to rely in the courtroom on the same data which they use in the office or laboratory. The panel majority's second prong would effect a substantial and in our view unnecessary intrusion upon the expert's sources. Accordingly, we decline to adopt it, and adhere instead to Judge Weinstein's articulation in Agent Orange, supra, 611 F.Supp. at 1245, which we have quoted at page 903 of this opinion. [27]
Even if, as we have concluded, the psychiatric witnesses testified on the basis of the kind of data on which experts in their field reasonably rely, we have some concern for another reason about the admission and use of the evidence. If we look at the substance rather than the form of what occurred, the second-hand testimony about Melton having punched his mother came to the jurors' attention in such a way that they might well have considered it for the truth of the out-of-court statement. This may also have occurred with respect to some other incidents. On October 17, 1985, Dr. Byrd testified that Melton became impulsive and lost control of his temper, which is a characteristic of a schizophrenic. And he punched his mother in the nose and became very angry with her. The trial judge gave no contemporaneous instruction as to the purpose for which this testimony was received. It was not until four days later, during his final instructions, that the judge told the jurors, with respect to testimony by Dr. Byrd and Dr. Cornet as to information given to them by other individuals, that these statements are admitted only to demonstrate the information relied upon by the doctors in forming their conclusion. They are to be considered by you only for the purpose of evaluating the reasonableness and correctness of the doctors' conclusions. They are not to be considered by you as actual proof of the incidents described. They are hearsay and as such are not admissible to establish the truth of the matters asserted by them. This court has recently noted that some students of the law of evidence consider the distinction sought to be articulated in such a limiting instruction as most unlikely to be made by juries. Samuels, supra note 10, 507 A.2d at 153 n. 5. As Judge Salzman aptly remarked for the court in that case, [c]onceptual problems are bound to arise when a judge tells a jury that the jury may consider psychiatric diagnoses based on medical records customarily relied on in professional practice, but then tells the jury that it may not consider the `truthfulness' of those records for any other purpose. Id. With his customary eloquence, Justice Cardozo made a similar point for the Court in a somewhat different context in Shepard v. United States, 290 U.S. 96, 104, 54 S.Ct. 22, 25, 78 L.Ed. 196 (1933): Discrimination so subtle is a feat beyond the compass of ordinary minds. The reverberating clang of those accusatory words would drown all weaker sounds. It is for ordinary minds, and not for psychoanalysts, that our rules of evidence are framed. See also Clark v. United States, 593 A.2d 186, 191 (D.C.1991). The conceptual problems to which we referred in Samuels are especially serious with respect to a discrete dramatic act like punching one's mother on the nose. To tell the jurors that they are to consider the testimony about the punch as a basis for the expert's finding of dangerousness, but not with respect to whether Mr. Melton punched his mother, may call for mental gymnastics which only the most pristine theoretician could perform. We suspect that the reaction of that elusive individual, the reasonable person, would be that you cannot believe that the testimony about the punch tends to show that Melton is dangerous unless you first believe that he actually punched his mother. See Clark, supra, 593 A.2d at 193-94; Giles v. United States, 432 A.2d 739, 745-46 (D.C.1981). Since the expert apparently believed that he punched her, the jury was likely to believe it too. The distinction sought to be made may therefore become ephemeral. Thompson v. United States, 546 A.2d 414, 421 (D.C.1988). The problem is a perplexing one, because it is difficult to articulate reasonable or workable limits on any rule which would exclude testimony of the kind here at issue and still vindicate the policies underlying Rule 703. In the present case, however, the appeal was at least initially predicated upon the lack of a finding by the trial judge that the out-of-court statement was of a kind reasonably relied upon by experts in the field, with only a conditional allusion to the potential difficulty the jury might have with the task of confining its consideration of such evidence to the purposes for which it was received. [28] Similarly, no contention was made in the trial court that a limiting instruction would be ineffective, or even that such an instruction ought to have been given earlier, or in a different and more emphatic form. Unfortunately, the abbreviated way in which the trial judge dealt with the socalled hearsay issue made it difficult for Melton's counsel to expound his theory fully. [29] As we have previously noted, the trial judge has the authority to exclude otherwise admissible expert testimony if he or she is of the opinion that such testimony would be more prejudicial than probative. In the present case, at least, if Melton's mother had been available to testify, [30] it would have been a permissible exercise of the judge's discretion to condition admission of the expert testimony (regarding the allegation that Melton punched the mother) on the District's also calling the mother to testify and on its making her available for cross-examination. Given the posture of the issue both in the trial court and on appeal, however, we conclude that Melton has failed to show that the trial judge abused his discretion in receiving the evidence. See Samuels, supra note 10, 507 A.2d at 153.
Unfortunately, the trial judge never made an explicit finding that psychiatric experts reasonably rely on the kind of evidence which the District presented through the testimony of Dr. Byrd and Dr. Cornet. His sole articulated explanationthat an exception to the hearsay rule applied cannot be viewed as the substantial equivalent of such a finding. Although Melton's counsel never explicitly directed the judge's attention to the need to address the question of reasonable reliance, this may well be so because the judge denied counsel's request to approach the bench. We decline to remand the case, in spite of the trial judge's failure to make an explicit finding on the question on which the admission of the contested evidence depended, because we are satisfied that to do so would be both unnecessary and futile. The authorities cited in this opinion, and especially the Advisory Committee's note to Rule 703, persuade us that the drafters of that Rule viewed psychiatric reliance on information provided by family members and hospital records as reliable in principle. In the present case, in which the issue was whether Melton was likely to injure himself or others, the failure to make such an inquiry would have been subject to justifiable criticism. The accounts by different family members tended to substantiate each other and to corroborate the psychiatric testimony as to the effects of failure to receive medication. We discern no appreciable possibility that the judge would make a finding that such reliance was unreasonable, when that result would be so contrary both to the teachings of the authorities which we have cited and to the judge's own rulings in this case. The proper finding should have been made explicitly, but there was more than ample basis in the record for the judge to overrule Melton's objection. By contrast, the record gives us no reason whatever to conclude that the statements and records which the two psychiatrists described in their testimony are not of the kind reasonably relied on by experts in the field. As the court stated under very similar circumstances in Lawson, supra note 27, 653 F.2d at 302 n. 7, Lawson points out quite correctly that Dr. Sheldon never testified, and the district court never found, that this information was of the type reasonably relied upon by psychiatrists.[ [31] ] The court must make such a finding in order to satisfy the requirements of Rule 703. United States v. Hollman, 541 F.2d 196, 201 (9th Cir.1976); Bauman v. Centex Corp., 611 F.2d 1115, 1120 (5th Cir.1980). We may take judicial notice, however, that psychiatrists customarily use such information to make a diagnosis. See Notes of Advisory Committee to Rule 703. The district court's error, under the circumstances in this case, is harmless. To remand the case simply for the purpose of requiring the judge to make the prescribed finding now would be a symbolic rather than a practical act, which we view as unnecessary and as incompatible with [g]ood judicial husbandry, United States v. Dogan, 314 F.2d 767, 772 (5th Cir.1963). Accordingly, we decline to prolong this already protracted proceeding further by remanding the case.