Opinion ID: 1946665
Heading Depth: 3
Heading Rank: 1

Heading: Appellant's Competence to Stand Trial or Plead Guilty

Text: Constitutional due process requires that a criminal defendant be mentally competent for a trial to proceed. Higgenbottom v. United States, 923 A.2d 891, 897 (D.C.2007) (citation omitted). In a competency proceeding, the relevant inquiry is whether a defendant has a rational and factual understanding of the proceedings against him and whether he can consult with his lawyer and assist in preparing his defense. See id.; see also Dusky v. United States, 362 U.S. 402, 80 S.Ct. 788, 4 L.Ed.2d 824 (1960) (per curiam) (establishing the requirements of rational and factual understanding and competent consultation with a lawyer) and Drope v. Missouri, 420 U.S. 162, 171, 95 S.Ct. 896, 43 L.Ed.2d 103 (1975) (requiring a defendant to be able to assist in preparing his defense).
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.
Upon this evidence the trial court found that there was no doubt that Mr. Wallace suffers some cognitive deficits, but that it was evident from the record that these impairments do not preclude him from the rational understanding of the charges and proceedings against him, nor do they preclude him from consulting with his lawyers. The court concluded that appellant is malingering and remains competent to stand trial in this case. Appellant accuses the trial court of look[ing] past the mountain of scientific evidence showing the [appellant's] incompetence and seiz[ing] upon a red herring: the prosecution's charges of `malingering'. . . . We are satisfied, however, that the trial judge did not ignore or overlook appellant's evidence of impairment. First, acknowledging the conflicting evidence, the court told the parties that this is a difficult difficult case. Second, explaining its finding that appellant was malingering, the trial court specifically relied on the testimony that, on one of the tests for malingering, appellant gave careless responses which invalidated the test results, and that even when an individual passes a malingering test it does not mean you do not have malingering. It just means they didn't choose to do it in a way that is detected in [the] test. Appellant emphasizes the evidence that he passed two tests designed to detect malingering and asserts that the court's finding that he was malingering cannot be squared with the evidence, but the trial judge's explanation identified evidence that, we agree, supports her conclusion. Third, the trial court's finding that appellant was competent to stand trial is not plainly contrary to the neurological evidence of appellant's impairment. The defense and prosecution experts agreed that cognitive impairment does not necessarily mean incompetence: Dr. Hyde acknowledged that an individual with organic brain damage can be competent, and Dr. Patterson testified that cognitive impairment and brain damage do not necessarily render someone incompetent to stand trial and that a person's having dementia does not mean that he is incompetent. Further, there was no consensus, even among defense experts, that appellant suffered from psychosis or any other mental illness. [18] Appellant suggests that the trial court should have given more weight to the competency determinations by doctors who saw appellant over the course of his several-month-long inpatient stays at St. Elizabeths than to the views of the doctors who saw appellant on fewer, more abbreviated occasions. However, in exercising her discretion, the trial judge was entitled to credit the view of the government's experts that those doctors simply got it wrong. [19] Cf. United States v. Chischilly, 30 F.3d 1144, 1150 (9th Cir.1994) ([t]o the extent that [the trial judge], from his courtroom observations, assigned more weight to the Government's expert than to the contrary, . . . he was acting within his discretion to do so as a part of his fact-finding and credibility-weighing functions.). In some instances, this court accords greater weight to the opinions and diagnoses of a treating physician than to the opinions of non-treating physicians who have been engaged to provide medical evaluations. See, e.g., Washington Metro. Area Transit Auth. v. District of Columbia Dep't of Employment Servs., 926 A.2d 140, 146 (D.C.2007) (noting that the law affords the diagnosis of a treating physician more weight than the conflicting opinion of a non-treating physician in a worker's compensation determination); Kralick v. District of Columbia Dep't of Employment Servs., 842 A.2d 705, 711 (D.C.2004) (same, citing case authority). However, with respect to competency determinations in criminal cases, neither this court nor others have required deference to treating physicians or to doctors who saw a defendant on multiple occasions as an inpatient. [20] Moreover, even if the trial court had given special weight to the views of appellant's treating physicians, no different result would have been required. None of the experts who testified at the competency hearing were appellant's treating physicians. But Dr. William Richie was one of appellant's treating psychiatrists at St. Elizabeths, and the St. Elizabeths discharge summary discussed at the competency hearing attributed to Dr. Richie the statement that appellant has [a] selective memory and is capable of dissimulating, fabricating, prevaricating and malingering cognitive disabilities in excess of his documented deficits. [21] And although other doctors who saw appellant on an inpatient basis at St. Elizabeths in 2002 and 2003 opined that he was unable to participate in court proceedings or to assist counsel with his defense, see supra note 14, experts appear to agree that an individual who is mentally incompetent to stand trial at one point in time may be competent to stand trial at a later time. For example, while Dr. Boss found appellant incompetent to participate in court proceedings in January 2002, she also commented that it may be useful for Mr. Wallace if defense counsel can spend even more time with him to go over the details of his cases and legal strategy. Multiple repetitions, in addition to frequent discussion, may help [him] recall what he needs to know in order to better inform his choices and ability to participate. See also Carmichael, 479 A.2d at 327 (noting that a doctor at St. Elizabeths had confirmed that Carmichael was incompetent to stand trial, but three months later this same doctor reported that the subject's mental condition had improved enough so that he was fit to stand trial). Notably, the record indicates that appellant did receive competency training while at St. Elizabeths. All of this is to say that even if the court had been required to accord special significance to the views of the St. Elizabeths doctors that appellant was incompetent to stand trial at the time the doctors expressed those views, deference to those doctors' views did not require the court to find that appellant was incompetent to stand trial in November 2003 or to enter a plea in January 2004. The trial court weighed the evidence and found that while . . . there is dementia and impairment, the evidence of malingering is far more powerful than the evidence of significant progressive deterioration. In essence, appellant's disagreement is with the weight the trial judge accorded to the conflicting expert opinions about competency. To disturb the trial court's findings, however, this court would have to re-weigh the evidence. That we may not do. Our case law is clear that when there is a plausible explanation presented by two competing groups of experts, the decision is one for the fact finder. See Jackson v. Condor Mgmt. Group, Inc., 587 A.2d 222, 225 (D.C.1991) (When a case turns on controverted facts and the credibility of witnesses, as this one does, it is peculiarly one for the [finder of fact]. The fact that some of the witnesses may be experts does not alter this rule. (internal citation omitted)). This principle applies with respect to expert medical testimony just as it does to other expert evidence. See Washington Metro. Area Transit Auth. v. District of Columbia Dep't of Employment Servs., 770 A.2d 965, 970 (D.C.2001) (In evaluating conflicting medical testimony, as in weighing evidence generally, the hearing examiner has wide latitude. The examiner is entitled to draw reasonable inferences from the evidence presented, and her decisions are especially weighty when they involve credibility determinations. (internal quotation marks and citation omitted)). And it applies with respect to competency hearings just as it does to other proceedings. See, e.g., Ray v. Duckworth, 881 F.2d 512, 516 (7th Cir. 1989) (holding that [b]ecause of the potential for divergent and often conflicting opinions on the issue of the defendant's competency, we must be careful to give due regard to the trial court's superior ability to draw the appropriate inferences from its observation of the defendant and expert witnesses, as well as the examination reports before it, and noting that the trial court was making a credibility determination when it chose to believe the expert opining that appellant was malingering). In this case, the trial court was presented with two permissible views of the evidence as to competency. . . . Villegas, 899 F.2d at 1341. [T]he court's choice between them cannot be deemed clearly erroneous. Id.; see also Izquierdo, 448 F.3d at 1278 (same). We can find no clear error in the court's November 2003 determination that appellant was competent to stand trial. Accordingly, appellant has not met the substantial burden he must meet to show that withdrawal of his plea was necessary to correct a manifest injustice. Williams v. United States, 595 A.2d 1003, 1006 (D.C.1991); see also Higgenbottom, 923 A.2d at 897 (We review a court's competency determination . . . for abuse of discretion, the exercise of which we will not lightly disturb. (internal quotation marks and citation omitted)).
Just before the plea proceedings commenced on January 5, 2004, the court was advised that appellant had been hospitalized for twelve days during December 2003. The court inquired of defense counsel whether he had seen any significant difference in [appellant's] functioning since this latest episode in the hospital. Although defense counsel responded that he had not, [22] the information about appellant's post-competency-hearing hospitalization arguably raised anew the issue of appellant's competency. This court has held that where the issue of a defendant's mental competence [has] been raised on the record, the trial court must conduct a specialized hearing to determine the competence of a defendant who seeks to plead guilty. Edwards, 766 A.2d at 988 (quoting Hunter v. United States, 548 A.2d 806 (D.C.1988)). The trial judge did not conduct a second competency hearing, and so we must address the issue of how this bears on appellant's motion to withdraw his guilty plea. The issue is an important one because the record reveals that appellant suffered a major seizure on December 18, 2003, and while hospitalized underwent an EEG that showed what Dr. Hyde, in a letter dated January 8, 2004, called markedly abnormal brain activity. [23] And, in her November 10, 2003 competency ruling, the trial judge had specifically noted Dr. Hyde's testimony that seizures can result in loss of consciousness and confusion in post seizure, as well as an impairment of cognitive function. We addressed a similar situation in Edwards, where the court conducted a plea proceeding and accepted Edwards' guilty plea while unaware of his diminished mental capacity, which was later documented in an evaluation by a clinical psychologist, Dr. Levin. Dr. Levin's evaluation described the substantial brain damage and marked changes in cognitive functioning that Edwards had sustained after a beating by police years earlier. See 766 A.2d at 984, 987. We noted that even though the trial court had been unaware of this history during the plea proceeding, the trial judge's denial of Edwards' post-sentencing motion to withdraw his plea was informed by Dr. Levin's evaluation. Id. at 988. We rejected Edwards' claim that the court had erred in denying his motion to withdraw, noting that the denial was based primarily on [the trial judge's] personal observations of and conversations with Edwards, factors to which we accord great deference. Id. We also noted that Dr. Levin never opined that Edwards was incompetent to enter a plea, id., and that the trial judge had clearly considered Dr. Levin's report but rejected it as unpersuasive on the issue of Edwards' competence at the time of the plea. Id. at 988 n. 10. We reason similarly here. It appears that Judge Broderick was not aware of the details of appellant's December 2003 hospitalization and EEG at the time of the plea proceeding, but information about both did inform her denial of Wallace's motion to withdraw his guilty plea. Judge Broderick noted that appellant's EEG taken on December 24, 2003 evidenced permanent and irreversible brain damage, that appellant had a major seizure on December 18, 2003, eighteen days before his plea hearing, and that Dr. Hyde found that [appellant] became confused for several days after `a bout of severe seizures.' However, like the trial judge in Edwards, Judge Broderick found the evidence relating to the December 2003 episode unpersuasive on the issue of competence, stating that [n]o evidence was presented that there was a change in the Defendant's [competency] since the time of the competency findings. We find no clear error in the court's assessment. Even if we discount the lay opinions of defense counsel that there was no change in Wallace's functioning between the time of the competency hearing in November 2003 and January 2004, the record does not compel a conclusion that appellant's competency had diminished from November 2003 to January 2004. As noted, Dr. Hyde's letter of January 8, 2004, interpreting appellant's December 24, 2003 EEG stated that the EEG showed markedly abnormal brain wave activity, with slowing over the frontal lobes, consistent with permanent and irreversible frontal lobe damage. But Dr. Hyde did not suggest in his letter that the new EEG showed that appellant was incompetent at the time of his plea. [24] Indeed, Dr. Hyde had earlier testified that an abnormal EEG does not mean that an individual is incompetent to stand trial, agreed that an EEG look[ed] at . . . in isolation does not tell much about competency, and explained that it is possible [for an individual] to have both normal and abnormal studies. Also of particular note, Dr. Hyde had explained during the competency hearing that you will see a lot of abnormalities in the post-seizure period. Taken together, Dr. Hyde's statements suggest that it was to be expected that appellant's EEG taken six days after his December 2003 seizure would show abnormal brain activity, and that no conclusion can be drawn from that EEG that appellant was less competent to enter a plea on January 5, 2004 (seventeen days post-seizure) than he had been at the time of the competency hearing. Moreover, the December 2003 EEG appears to be cumulative of evidence already on the record. In his January 8, 2004 letter, Dr. Hyde referred to the 2003 EEG as providing  additional evidence of abnormal slowing over the frontal lobes (emphasis added). This had already been shown by other abnormalities on neurological examination reflecting his underlying brain damage, including clumsy fine motor movements with the left hand, bilaterial grasp reflexes, and poor complex motor sequencing in the hands bilaterally. Dr. Hyde testified about these same abnormalities at the competency hearing, stating that in April 2003, appellant had clumsiness on a number of fine motor movements, and `primitive reflexes,' often seen in individuals with frontal lobe dysfunction, and noting that there ha[d] been some progressive brain damage since appellant's 2000 EEG (which had also shown bilateral slowing over the cerebella hemispheres). [25] Cf. Williams, 595 A.2d at 1005 & n. 2 (psychological report introduced at post-plea hearing had no bearing on defendant's competency because it added nothing to what was already known at the time of the plea). Dr. Hyde's January 8, 2004 letter discussed not only appellant's December 24, 2003 EEG, but also the facts that appellant's mental status fluctuates in response to his seizure disorder and that appellant often is confused for several days after a bout of severe seizures. It is not clear from the record whether appellant's December 18, 2003 seizure was part of a bout of severe seizures, or whether, if appellant was confused after the December 18 seizure, that confusion (perhaps several days of confusion) had resolved or subsided by the end of his twelve-day hospital stay. However, in denying appellant's motion to withdraw, the trial judge emphasized that [a]ll the evidence was considered, and one piece of important additional record evidence was an evaluation by Dr. Lally, setting out his findings from a 2.75-hour interview of appellant that Dr. Lally conducted at D.C. Jail on December 31, 2003, i.e., after appellant had been discharged from Greater Southeast Community Hospital. [26] During this visit with appellant, Dr. Lally observed that appellant was alert and oriented to person, place, and time and that appellant's speech was clear and at a normal volume. Although appellant's speech tended to be slower with lengthy delays in his response to questions about court-related matters, there was no evidence of a thought disorder in the form or content of his thinking. Appellant's expression of affect was somewhat constricted, but generally appropriate. In short, this evaluation by Dr. Lally  the only expert evaluation in the record that is based on an interview of appellant after his December 2003 seizure but before his January 5, 2004 guilty plea  contained nothing that required the trial judge to conclude that appellant's competence to stand trial or plead guilty had diminished between the November 2003 competency hearing and the January 2004 plea proceedings. We reach the same conclusion about the other new evidence that appellant presented with his Rule 32(e) motion. Appellant contends that his Bureau of Prison medical records generated since his guilty plea  one dated October 22, 2004, and the other dated January 7, 2005,  confirm that he is incompetent and not malingering. [27] The trial judge refused to consider these records, reasoning that they were not relevant to appellant's competency during the plea. The trial court applied the appropriate standard. As the Supreme Court instructed in Dusky, it is a defendant's present ability that should be evaluated during competency evaluations. 362 U.S. at 402, 80 S.Ct. 788. The trial judge did not abuse her discretion in holding that appellant's mental evaluations on dates nine and twelve months after the guilty plea have little if any relevance on the issue of whether appellant was competent when he entered his guilty plea. Cf. United States v. Collins, 430 F.3d 1260, 1267 (10th Cir.2005) (noting that a defendant's competency can change over time) and Rogers v. Snyder, No. 00-007, 2001 WL 652032, , 2001 U.S. Dist. LEXIS 8866, -17 (D.Del.2001) (disallowing new evidence suggesting that petitioner was not competent to stand trial in March 1996 as it was not relevant to whether petitioner was competent to enter a guilty plea in 1993). Finally, as we did in Edwards, we accord great deference to Judge Broderick's personal observations of and conversations with appellant, which informed her judgment that appellant was competent to plead guilty on January 5, 2004. The trial judge noted in her order denying the motion to withdraw that she carefully assessed the Defendant at every question during the plea proceeding and that the Defendant's mental state was understood and considered by the Court at the time of the plea. For all the foregoing reasons, we cannot conclude that the trial court abused its discretion in denying the Rule 32(e) motion to withdraw on the grounds of appellant's (claimed) mental incompetency to enter a plea.