Opinion ID: 852874
Heading Depth: 2
Heading Rank: 3

Heading: Administration of Medicines

Text: Counsel for McManus have wisely focused most of their attention on questions relating to his fitness to stand trial. We have likewise given these claims careful attention. During McManus's pretrial incarceration, he was on a fourteen-month-long regimen of Elavil, an anti-depressant drug. On April 17, 2002, his anti-depressant was changed to Effexor. Seven days later, jury selection began. On April 29th, the first day of the trial, McManus reported symptoms of a panic attack requiring repeated visits to the hospital and doses of Lortab, Xanax, Versed, and morphine. The court ordered a week's continuance. McManus contends (1) that the trial court erred by denying his motion for mistrial because the change in his anti-depressant and the subsequent administration of various drugs rendered him incompetent, (2) that the State was obligated to disclose exculpatory evidence about the medications, and (3) that the trial court erred in refusing to admit a news article discussing jurors' impressions of his demeanor during trial. We address these contentions in turn.
During the course of the trial, McManus moved for a mistrial on numerous occasions, arguing that the various drugs, as administered, rendered him incompetent. On May 7, 2002, the trial court held a hearing on McManus's written verified motion for mistrial. It denied McManus's written motion and all oral motions. On appeal, McManus contends that the trial court erred in denying his motions because he was incompetent to stand trial. [8] On appeal, the trial judge's discretion in determining whether to grant a mistrial is afforded great deference because the judge is in the best position to gauge the surrounding circumstances of an event and its impact on the jury. We therefore review the trial court's decision solely for abuse of discretion. After all, a mistrial is an extreme remedy that is only justified when other remedial measures are insufficient to rectify the situation. Mickens v. State, 742 N.E.2d 927, 929 (Ind.2001) (citations and quotation marks omitted). Generally, alleged errors in determination of competency are subject to the usual rules of appellate review, and are waived if the defendant proceeds to trial without objection. Budd v. State, 499 N.E.2d 1116, 1118 (Ind.1986). Even though McManus did not raise competency as an issue before his trial, his motion for mistrial was properly before the trial court because his alleged incompetency did not occur until after the trial commenced. We therefore review the trial court's determination that McManus was competent to stand trial and the denial of his motion for mistrial. To be competent at trial, a defendant must be able to understand the nature of the proceedings and be able to assist in the preparation of his defense. Timberlake v. State, 753 N.E.2d 591, 598 (Ind.2001). We have defined this standard as whether or not the defendant currently possesses the ability to consult rationally with counsel and factually comprehend the proceedings against him or her. Brewer v. State, 646 N.E.2d 1382, 1384 (Ind.1995). The trial and conviction of one without adequate competence is a denial of federal due process and a denial of a state statutory right as well. Id. The trial court as trier of fact is vested with discretion to determine if reasonable grounds exist for believing a defendant is competent to stand trial, and on appeal a determination by the trial court of the issue is viewed from a deferential perspective. Where the evidence is in conflict, we will normally only reverse this decision if it was clearly erroneous, unsupported by the facts and circumstances before the court and the reasonable conclusions that can be drawn therefrom. Id. (citation omitted). On the first day of trial, McManus suffered pain and symptoms of a panic attack and was transported to the hospital for treatment. On the following day, McManus again complained of pain and anxiety and was transported to the hospital, during the lunch break, where he was given Versed to calm him down, morphine for pain, and Xanax for anxiety. Before releasing him to jail personnel, Dr. Reza Mohammadi, an emergency room physician, prescribed McManus Lortab and Xanax and reported that this man  I could not talk with him when he was in such a state of anxiety. I mean, he was  you could  you could not get any information on  from him nor could you carry on a conversation with him being so anxious. Tr. at 815. The trial court then questioned Dr. Mohammadi as follows: [Court.] Now, let me ask you first about the medication you gave him today. Can that medication be what I would call mind altering or affect a person's mental processes? [Doctor.] Absolutely. [Court.] And to what extent and in what respect? [Doctor.] Well, again, it's a broad range. Unfortunately, I cannot specifically say in one way or another, but  for example, if the medicine is given to someone who's not having any problems like this gentleman, it would probably put you to sleep and you will not be able to interact, period, but when someone is as anxious as this gentleman was, it probably would bring him down to a level that he can actually communicate, and  so I would not  for example, with  just to give you an idea, with people whom we prescribe this type of medicine on, we instruct them not to drive for  within four to six hours and  because we believe it does alter their decision making and so on and so forth. [Court.] Would he be able to think rationally? [Doctor.] I think  I think he can think rationally now as opposed to when he was so anxious, yes. [Court.] But the medications you gave him today, would it prevent him from thinking rationally? [Doctor.] I would say that he would  it would alter the way he would perceive things. Now, in the spectrum of what we are dealing with today, I would say that he would be thinking more rationally now than he was when he was so anxious, if that answers your question. [Court.] Yes. And how about the medications that you prescribed for him, the Xanax and the Lortab, how would they affect his mind and his judgment? [Doctor.] I believe he can  he can make judgments in  if he was given enough time to make the judgment at, and again, it's a decision that if, in fact, this man is not  if his condition is not controlled, he would not be able  in the state of mind he presented today, he would not be able to answer any questions rationally, period, and now that he's on medicine, he may be  in my view, he can possibly now proceed and give some rational answers, but these medicines do alter  alter people's judgment in the vast majority of people, yes, they do. Tr. at 816-17. On cross examination, the State questioned Dr. Mohammadi as follows: [Prosecutor.] [I]f he were in the courtroom, would he realize that he was sitting next to his two attorneys? He'd realize those were his attorneys? [Doctor.] I believe so, yes. [Prosecutor.] And he would know that we're the prosecution? [Doctor.] If so advised, yes. [Prosecutor.] Yeah. And he would know that we're trying to find him  have him found guilty, and he'd know they're trying to help him be found not guilty? [Doctor.] I believe so. [Prosecutor.] Now, after you administered the medication to him, did you notice a difference in his demeanor? [Doctor.] Yes. [Prosecutor.] And it was what? [Doctor.] He was calm and forthcoming with more information. Tr. at 820. Following this testimony, McManus moved for a continuance or a mistrial. The trial court denied both motions and continued with the trial. Before recessing for the day, the State called ten more witnesses to the stand. Tr. at 839-977. That evening, McManus was once again transported to the hospital for treatment. During the morning of May 1st, jail personnel administered two pertinent medications to McManus, Effexor and Xanax. Tracy Sander, the jail nurse, testified that these drugs would make a person very drowsy, but are routinely prescribed. Tr. at 988. Sanders also testified that she was able to communicate with McManus. McManus then renewed his motion for a mistrial. McManus's counsel added that McManus was nauseous and lightheaded. Tr. at 989. The trial court denied the motion, finding no evidence suggesting that McManus was unable to assist in his defense or participate in the trial. Tr. at 990. As the fourth witness of the day began to testify, McManus requested a recess and complained of similar symptoms. During the recess, the trial court questioned Ken Mitz of the Vanderburgh County Sheriff's Department regarding McManus's condition. Mitz reported that McManus was in the infirmary and hyperventilating. Tr. at 1059-60. The jail nurse administered a shot to McManus to ease his breathing, rendering him incapacitated for several hours. After brief argument, the trial court ordered a continuance of one week. On May 2, 2002, Dr. Willard Whitehead changed McManus's medication regimen. On May 7th, the trial court held a hearing on McManus's verified motion for mistrial. As of that date, McManus was taking one milligram of Xanax three times a day, forty milligrams of Popranolol three times a day, and the antidepressant Remeron. The court called Dr. Whitehead, a psychiatrist. He examined McManus on May 2nd and May 7th. The trial court's direct examination of Dr. Whitehead proceeded in relevant part as follows: [Court.] Well, if he is having hyperventilation episodes, do you think that the  that the treatment regimen that he is on, including the drugs that he is being  that are being administered to him are going as far as you could possibly go at this point to get him ready to sit through the trial? ... [Psychiatrist.] Well, if you look at treatment for anxiety dis-anxiety problems or hyperventilation  actually, we got off the Internet a thing on managing hyperventilation. That's something as a psychiatrist I've never seen before. I called some emergency  an emergency room doctor and talked with him about what it looked like. The only way to confirm what it is, apparently, is to check an arterial blood gas, which I don't think we could do here very well, but we got some stuff off the Internet on managing it, and one thing they said to use was a benzodiazepine like Xanax. Xanax is quick. It's effective. Much more often than not you would expect it to work. You wouldn't want to give someone so much that they would become intoxicated with it. When you get into a problem with Mr. McManus, I asked to have him checked for intoxication  and this is the only copy we have of this  but they had a Matt Hill, who is an investigator who is apparently trained in working with intoxication, examine him and he thought that Mr. McManus was not cooperating and trying to skew the findings of the evaluation towards looking intoxicated. ... [Court.] The next question is, if this trial is terminated and we try him again a month from now or two months from now, is there any reason to believe that his situation would be any different then? ... [Psychiatrist.] If it is an anxiety situation related to this stressor and, like he says, he wants to get this taken care of and over with, and on medication, there's a chance he would do better. In fact, that  that could happen by tomorrow.... You have two different treatment strategies on board. Now, you have the Xanax, which is relatively fast acting. You're doing a little bit of a tightrope between intoxicating and undertreating. You want to get the right level, but that should be doable pretty rapidly. Unfortunately, it's hard to tell if you're intoxicating him because of his strange findings on examination. You also have a medicine called Propranolol or Inderal going which blocks adrenaline. Again, that's fast acting. ... It blocks adrenaline, so if you start to get afraid, the adrenaline goes out there and just  your body stays pretty cool. So he's on that, too. That's another one that could be increased and  in fact, he's on 40 milligrams three times a day now. His blood pressure looks good, so you could increase that to be more aggressive with his treatment. I would say right now, the Xanax is equivocal because of the findings on his neurological exam. If you wanted to increase anything right now that might work quickly, it would be the Propranolol to block the fright response. Mistrial Hearing Tr. at 12-14, 16-18. Dr. Whitehead also indicated that McManus was being uncooperative. At the conclusion of the hearing, the trial court held as follows: Okay. I'm going to deny the motion. I'm convinced that it's either self-induced, or if not self-induced, it's something that's caused by this trial. I think these  this  these doctors are giving him the optimum treatment he can get. I'm convinced that we're not going to face any better situation the next time than what we're facing right now and I believe we can get through this trial in a proper fashion and that's what I want to do. Mistrial Hearing Tr. at 69. Following the denial of McManus's motion, the trial proceeded to its conclusion without incident. At the hearing on McManus's motion to correct error, Dr. Roger Maickel, an expert in forensic toxicology and pharmacology, testified that the drugs administered to McManus may impair functional cognitive skills. Dr. Maickel based his opinions on medical records. It is apparent that the trial court based its decision on continual reports from medical professionals who maintained contact with McManus throughout the trial. While the testimony was often equivocal, the consensus of the witnesses was that the medications assisted McManus in participating in his trial. Without the medications, McManus proved to be unable to cope with the stress of the proceeding. McManus's situation is markedly different from the defendant who requires medication to attain competence so that the trial can begin. Before trial, McManus was competent and participated in preparing his case. The administration of medication appeared to manage a sudden onset of stress, rather than to medicate a diagnosed psychosis. Reliance on psychotropic drugs during trial is obviously to be approached with great care, and competency hearings to evaluate the effects on a defendant's ability to appropriately participate in his or her defense are very important. In the case at bar, we cannot say that the trial court's competency determination was clearly erroneous and therefore affirm the denial of McManus's motion for mistrial.
McManus next contends that the State failed to disclose exculpatory evidence of the various drugs administered to him in violation of Brady v. Maryland, 373 U.S. 83, 83 S.Ct. 1194, 10 L.Ed.2d 215 (1963). Under Brady, the suppression by the prosecution of evidence favorable to an accused upon request violates due process where the evidence is material either to guilt or to punishment, irrespective of the good faith or bad faith of the prosecution. Id. at 87, 83 S.Ct. 1194. The transcript and record are replete, however, with references to every drug administered to McManus. Indeed, McManus moved the trial court for continuances and mistrial arguing incompetence due to improper administration of medication and proffered extensive evidence relating to McManus's medications. At moments when it mattered, evidence about McManus's medication was laid out for all to see.
At the sentencing hearing, McManus tendered a news article purporting to relate jurors' perceptions of McManus during the trial. He contends that the trial court erred by excluding the exhibit. The trial court has inherent discretionary power on the admission of evidence, and its decisions are reviewed only for an abuse of that discretion. Jones v. State, 780 N.E.2d 373, 376 (Ind.2002). Indiana's Evidence Rule 606(b) reads as follows: Upon an inquiry into the validity of a verdict or indictment, a juror may not testify as to any matter or statement occurring during the course of the jury's deliberations or to the effect of anything upon that or any other juror's mind or emotions as influencing the juror to assent to or dissent from the verdict or indictment or concerning the juror's mental processes in connection therewith, except that a juror may testify (1) to drug or alcohol use by any juror, (2) on the question of whether extraneous prejudicial information was improperly brought to the jury's attention or (3) whether any outside influence was improperly brought to bear upon any juror. A juror's affidavit or evidence of any statement by the juror concerning a matter about which the juror would be precluded from testifying may not be received for these purposes. McManus does not argue any of the three exceptions. He contends only that the defense was unaware of the medications administered to him and was therefore unable to account for his cool demeanor. This was not a ground for permitting impeachment of the verdict.