Opinion ID: 1940368
Heading Depth: 1
Heading Rank: 2

Heading: reports and testimony regarding competency

Text: The circuit court's initial determination of incompetency was reached solely on the basis of the record; the parties stipulated to waive any hearing on the issue. In the experts' initial reports, Dr. Myers and Dr. Berland concluded that Alston was incompetent to proceed, while Dr. Mhatre concluded that Alston was competent. The circuit court's later determination of competency was based on the experts' reevaluation reports, DOC reports, and a hearing. The experts' conclusions did not change upon reevaluation. The reports and testimony from each expert and witness are summarized herein. Reports and Testimony of Dr. Myers Dr. Myers' initial report indicated that Alston appreciated the charges against him, his sentence, and the range of possible outcomes in his postconviction proceedings. The report noted past suicide attempts, depression, and a 1995 diagnosis of bipolar disorder. Dr. Myers found that Alston's legal filings and DOC medical records were indicative of paranoia but could not determine if they were signs of actual paranoia or manipulation. As a whole, however, he stated that actual paranoia was most consistent with his clinical presentation. He described Alston's facial expressions as inappropriate at times, his speech rate as increased and pressured, his thought content as involving some fantasy-based thinking, and his moods as shifting rapidly between being elevated to irritable. But he also noted that Alston was oriented to person, place, and date, had a good attention span, possessed a quick and efficient memory, and performed in the average range of intellectual functioning. He found that Alston's legal filings indicated a coherent and organized thought process but that his interview presented mood variations and episodic bouts of a circumstantial, vague thought process ... consistent with Bipolar Disorder, Hypomanic Episode. And he reached the opinion that, because of Alston's disturbed thought process and mood disturbance, it would be difficult for Alston to consult with his attorney with a reasonable degree of rational understanding or to testify relevantly. In his 2002 reevaluation report, Dr. Myers found Alston's speech normal in volume and tone but increased in rate, tangential, and rambling at times. He indicated that Alston expressed delusional ideas but denied hallucinations or suicidal ideation. As before, Dr. Myers found Alston within the average range of general intelligence and oriented to time, person, and place. He concluded that Alston continued to show evidence of bipolar disorder and hypomanic episode with psychotic features and that, although Alston appreciated the nature of the legal process and competency determination to be made, he would have difficulty consulting with his attorney due to his mild grandiose and paranoid delusional thinking and illogical, shallow thought process. Dr. Myers also acknowledged indications of intentional embellishment by Alston but concluded that Alston's delusional thinking appeared genuine given his consistency of symptoms over numerous years and the cyclical nature of bipolar disorder. At the March 20, 2003, competency hearing, Dr. Myers testified that he had witnessed four hours of consistent behavior by Alston that included irritability, low frustration-tolerance, an increased volume of speech, pressured speech, inflated sense of self-worth, inappropriate facial expressions, hyper-religiosity, a theme of paranoia, and a superficiality of thought process. Dr. Myers noted some elements of malingering but stated that malingering was not the primary explanation for Alston's symptoms. He found that Alston exhibited symptoms of both a hypomanic episode and embellishment and that the ambivalence shown by Alston's multiple legal filings juxtaposed with statements expressing a desire to die reflect Alston's irritability and depression. Dr. Myers explained that Alston's ability to stay calm in the courtroom is inconsistent with full-blown mania but not with a hypomanic episode and that his concerns regarding Alston's competency stem from Alston's thought process disorder that results in rambling speech with superficial content. Reports and Testimony of Dr. Berland Dr. Berland administered MMPI-2 testing of Alston, which he found indicated no attempt by Alston to fake or exaggerate symptoms of mental illness and reflected symptoms of psychotic disturbance, mood disturbance, and possibly antisocial thinking patterns. In his initial report, Dr. Berland noted that it was indicative of a genuine symptom report that Alston admitted certain symptoms and denied others. During their meeting, Alston exhibited paranoia and admitted to auditory and visual hallucinations. Dr. Berland also found that DOC records filed by Alston contained loosened associations and an illogical flow of words and ideas. He indicated the finding of elements of delusional thinking seen in genuinely disturbed people that would be less likely utilized by malingerers and ultimately found the presence of a genuine psychotic disturbance that would prevent Alston from consulting with his attorney with a reasonable degree of rational understanding. Upon reexamination, Dr. Berland again administered MMPI-2 testing and concluded that the results indicated the presence of a chronic psychotic disturbance, specifically delusional paranoid beliefs, hallucinations, and biologically determined mood disturbance. Dr. Berland found no evidence of malingering or exaggeration of symptoms, and concluded that indications of antisocial thinking were in part the result of a manic disturbance. Dr. Berland indicated that Alston's answers to questions would initially be relevant and devolve into delusional rambling and that Alston exhibited a factual appreciation of the nature of the proceedings against him but expressed irrational beliefs about them as well. At the March 20, 2003, competency hearing, Dr. Berland testified that his diagnosis of chronic psychotic disturbance was based on consistent, delusional thinking exhibited in Alston's legal filings, more than seven hours of personal contact, and the DOC reports. Dr. Berland described his own significant experience with malingerers within a unit of the Florida State Hospital that specialized in the detection of malingering. He found indications of psychotic thinking, both in Alston's presentation and test results, and testified that objective indicators from MMPI-2 testing showed that Alston was open about his symptoms and trying in a very primitive and psychotic way to hide his mental illness. Dr. Berland stated that the testing also indicated symptoms of paranoid thinking and mania and that Alston's illness is in the chronic range, meaning he has had psychosis for at least two years and thus is not distressed by it but rather is familiar with and tries to hide it. He added that DSM-IV indicates prolific and voluminous writing as a symptom of manic disturbance. Dr. Berland noted that malingering would be inconsistent with Alston's stated desire to move forward with the death penalty, and stated that psychosis and an ability to manipulate are not mutually exclusive. He concluded that Alston's psychosis, in the form of both mood and perceptual disturbance, can only be treated by medication. Reports and Testimony of Dr. Mhatre Dr. Mhatre's initial report indicated that Alston repeatedly expressed that he wished to be executed or freed, but not left imprisoned. Dr. Mhatre's conclusions were as follows: [Alston], in my medical opinion, is not clinically depressed at this present time. The despair and despondency he is experiencing at this present time is consistent with a person whose freedom has been taken away and is on death row. His decisions appear to be logical, well thought out, and with a purpose. It is therefore, my medical opinion, he should be considered competent to proceed in a post conviction phase. Dr. Mhatre also indicated the following impression: adjustment reaction with mild depression and antisocial personality disorder. He advised that Alston's psychiatric problems are not severe enough to require psychiatric intervention. In his reevaluation report, Dr. Mhatre noted that DOC records indicated Alston had refused to take medications and that physicians and counselors felt he did not show signs of psychopathology but rather of adjustment reaction with mixed emotional features and antisocial personality disorder. Dr. Mhatre reported that Alston admitted his guilt of the crime for which he was convicted but urged that Assistant State Attorney Angela Corey wanted him on death row because he had information implicating the police department regarding another murder. Regarding Alston's reports of frustration, mild depression, and a desire to receive his death sentence, Dr. Mhatre found Alston slightly depressed. Regarding grandiose statements by Alston, such as that he had found a cure for AIDS and breast cancer, Dr. Mhatre concluded that Alston was malingering. He also found no evidence of bipolar affective disorder or hallucinations. Dr. Mhatre acknowledged symptoms of paranoia and delusion, but noted that Alston's changing clinical presentation from an earlier bipolar affective disorder diagnosis to the different clinical presentation of paranoia and delusion was a sign of malingering. He diagnosed Alston as suffering from antisocial personality disorder and a mild degree of depression. Ultimately, Dr. Mhatre concluded that Alston's symptoms did not rise to the level of affecting his competency, finding him capable of assisting in his own defense, exhibiting appropriate courtroom behavior, and challenging State witnesses. At the March 20, 2003, competency hearing, Dr. Mhatre described Alston as in full control of his emotions, his thinking was pretty rational, very coherent. He testified that although Alston exhibited delusions of grandeur, a symptom of bipolar disorder, he did not exhibit other symptoms, such as elated mood, flight of ideas, pressured speech, or physical hyperactivity. He acknowledged that a person with bipolar disorder may be diagnosed differently at different times but stated that it is highly unusual for only half the symptoms to be exhibited at a single time. Dr. Mhatre emphasized Alston's very high level of functioning and that Alston had a very rational conversation about different legal issues with his attorney in Dr. Mhatre's presence. He noted that Alston appeared to convey different delusions to different people and tended to exhibit a smirking facial expression when conveying delusions. In the absence of other symptoms, Dr. Mhatre concluded that Alston's delusions were malingering. He diagnosed Alston with antisocial personality disorder and noted that malingering is a big part of that diagnosis. Reports and Testimony of DOC Staff The regular DOC reports ordered by and filed with the circuit court indicated the following. Dr. Gloria Calderon, a staff psychiatrist at UCI, conducted a psychological evaluation of Alston in November 2001, found no evidence of psychotic psychopathology, and diagnosed him with adjustment disorder with mixed feature and antisocial personality disorder. Dr. J. McKinsey conducted a second psychological evaluation of Alston in January 2002, found no evidence of major thought or affective disorder, and agreed with Dr. Calderon's diagnosis. Monthly appointments with DOC psychological specialist Lisa Wiley, M.A., were scheduled. Alston refused to attend a number of these appointments, but Wiley was able to observe him briefly on a few of those occasions, when she attempted to gain his participation. Specifically, Alston refused to attend the December 2001 appointment; attended the January 2002 appointment and complained of illegalities by the court; refused to attend the February 2002 appointment but participated that same month in a counseling session, in which he exhibited rational thinking with a tendency to digress; refused to attend the March 2002 appointment and exhibited rambling speech pattern; attended the April and May 2002 appointments, at which he denied mental health concerns and exhibited rambling conversation with loosely organized thought pattern; refused to attend the June and July 2002 appointments; attended the August 2002 appointment and made suspicious allegations; was interviewed by Dr. Calderon in August 2002 and was found to exhibit euthymic mood, appropriate affect, rational thinking, a tendency to ramble, and no delusional material or loosening of associations; attended the September 2002 appointment, at which he exhibited a tendency to ramble and expressed a desire to be found competent; attended the October 2002 appointment, at which he reported mood problems but exhibited an inconsistent affect; attended the November 2002 appointment, at which he exhibited rambling, euthymic mood, and an inconsistent affect; and refused to attend all appointments from December 2002 through March 2003. In those final four months, the reports indicated that Alston exhibited sadness and a restricted range of affect and emotions, appeared subdued, but maintained rational conversation. At the March 20, 2003, competency hearing, Wiley testified that she observed death row inmates as a group once each week and, over the prior couple of years, had interviewed Alston once a month for thirty to forty-five minutes except on those occasions when he refused to attend. Wiley testified that Alston was classified as psychiatric grade two under the care of her psychology department, as opposed to grade three, which would place him under the care of a psychiatrist and regular observation. He was placed in grade two after Dr. McKinsey and Dr. Calderon diagnosed him with adjustment disorder. Wiley stated that the UCI staff were familiar with Alston's discussion of secret agents and coded colors, but that they had not observed the types of behavior usually referred to the psychology department, such as non-eating, sleep problems, or intentional self-harm. In speaking with Alston, Wiley found his delusional speech could be redirected to rational conversation, and she testified that she had never seen someone with bipolar disorder or psychotic symptoms able to turn on and off his symptoms in that way. Dr. Calderon also testified at the hearing. Dr. Calderon stated that she had seen Alston three or four times in 2000, once in 2001, and conducted an evaluation of him in August 2002. She testified that she was aware of Dr. Myers' earlier report and findings when she conducted the 2002 evaluation but found no symptoms of bipolar disorder. Dr. Calderon diagnosed Alston with adjustment disorder with mixed disturbance of emotion and conduct, but found no evidence of psychotic disorder, hallucinations, or delusional thinking. In addition to Wiley and Dr. Calderon, Sergeant Michael Young, the administrative sergeant at UCI who oversees the day-to-day basic operation of death row, testified at the competency hearing. Sergeant Young has daily contact with Alston, who had been on disciplinary confinement for close to two years as of the date of the competency hearing. Sergeant Young expressed his impression that Alston preferred disciplinary confinement to mingling with the general population of death row and that Alston would purposely violate rules whenever his removal from disciplinary confinement drew near. He noted that Alston had received numerous disciplinary reports, mostly for disobeying verbal orders or violating mailing restrictions. He stated that Alston mailed three to four items to governmental officials per day and involved the staff frequently. Sergeant Young stated that Alston took on a different demeanor when removed to interview rooms for mental assessments or legal calls, but that the theatrics are gone when Alston returned to his cell. He stated that Alston was rational, coherent, calm in his cell and could turn [his strange behavior] off at a whim. He further indicated that he had only seen Alston's delusional behavior when he is out of cell and he's got a forum or audience.