Opinion ID: 1139297
Heading Depth: 2
Heading Rank: 4

Heading: the doctor-patient privilege

Text: In October, after Mike had been at the Larned hospital for over four months, a notice was filed on his behalf of his intention to rely on insanity as a defense. At the close of the state's case the defense proffered the testimony of the psychologist, neurologist and psychiatrist from Larned who had examined him on his competency to stand trial, and who had testified on the pretrial motion to suppress. Before putting them on the stand, however, counsel asked for a ruling on the applicability of what is now K.S.A. 22-3302 (3) (Weeks 1974), dealing with proceedings to determine a defendant's competency to stand trial. The last sentence of that section provides: ... No statement made by the defendant in the course of any examination provided for by this section, whether the examination shall be with or without the consent of the defendant, shall be admitted in evidence against him in any criminal proceeding. The trial court made the following ruling: The statute makes it a privileged communication, anything the defendant may have told them during their examinations for determination of whether or not the defendant would be able to stand trial, but if the doctors that you have named doing that examination should testify on matters that might involve conclusions that would be based on what they might have been told by the defendant, the court rules that the privilege would be waived and cross-examination would be allowed as to any basis they may have for the conclusions they may testify to resulting from the interview with the defendant. We think that ruling was eminently correct. The purpose of the quoted portion of 22-3302 (3) is to facilitate a complete and thorough psychiatric examination of a defendant whose competency is in doubt, unhampered by any fear that what the defendant tells the doctor may be turned against him. Psychiatry being what it is, the need for free and open oral communication between the defendant and the doctor is obvious. Anything less would automatically cast doubt on the validity of the diagnosis. But the establishment of an insanity defense is an entirely different matter. For that purpose a notice is required whereby the defendant agrees to submit to such mental examinations as the court may order. (K.S.A. 22-3219 [Weeks 1974].) Further, under that statute a report of each mental examination, including any by physicians of defendant's own choosing, is to be filed with the court and supplied to counsel for each side. Where a defense is to be based on mental disease or defect, complete disclosure is the rule. The reason for this rule is apparent. If the proffered defense witnesses in this case had testified they presumably would have offered expert opinions couched in conclusionary terms. (K.S.A. 60-456.) On cross-examination the state would be entitled to elicit from each witness the data upon which his opinion was based. (K.S.A. 60-458. Cf., Casey v. Phillips Pipeline Co., 199 Kan. 538, 431 P.2d 518; Ziegler v. Crofoot, 213 Kan. 480, 516 P.2d 954.) In our adversary system no other way exists to test the credibility of an expert witness or the validity of his opinion. In the case of a psychiatric expert the underlying data would, presumably, be in large part the communications made by the subject to the doctor. In this connection a colloquy at the hearing on the motion to suppress is illuminating. The Larned neurologist was testifying on behalf of the defendant, and the state objected to his recitation of Mike's medical history as being hearsay. Defense counsel responded: ... I think it is rather important to all of us, including the court, to know the ingredients that made up the ultimate diagnosis of the man and to determine whether or not he was competent. I am going to ask this doctor to talk about the dates of the admissions in the past, and I think for him to draw some conclusions about that we are all entitled to know the ingredients that led up to it and that would justify his having drawn those conclusions, and the medical history he used is a part and parcel of it, all coupled with his knowledge of it. (Emphasis added.) We agree. The value of an expert's conclusion can only be assessed in the light of the data available to him or, as counsel put it, the ingredients that made up the ultimate diagnosis. In State v. Campbell, 210 Kan. 265, 500 P.2d 21, a psychiatrist was appointed as a commission to determine competency under former K.S.A. 62-1531, the predecessor to 22-3302. A similar claim of privilege was set up as to the defendant's communications to the doctor. We held that there was no privilege for three reasons. First, since the defendant had not sought out the doctor for any purposes relating to diagnosis or treatment, under K.S.A. (then 1971 Supp.) 60-427 ( a ) he was not a patient. Second, there is no doctor-patient privilege in felony cases under 60-427 ( b ). Third, since the condition of the defendant was an element of his defense, there was no privilege under 60-427 ( d ). The competency statute in effect when the Campbell case was tried contained no specific prohibition against the use of statements made to the sanity commission; the privilege was to be determined under the evidentiary rules relating to the doctor-patient privilege generally. The new statute alters that decision to the extent that, if a doctor is not called by the defendant, the privilege is absolute. We do not believe, however, that the statute was intended to extend the privilege beyond the extent necessary to effectuate its purpose. It is designed as a shield, not a sword. If the defendant proposes to alter the roles of the examining doctors from competency examiners to insanity defense experts, he must comply with the disclosure provisions of the insanity defense statute. If they take the stand, they, like any other experts, are subject to cross-examination as to the basis for their opinions. If the opinions are based on statements made by the defendant, those statements must be revealed, and to that extent the statutory privilege is waived. In this case the trial court properly ruled on the claim of privilege. The fact that the defendant then chose not to call the doctors does not mean that his right to defend was improperly impaired, and there was no error.