Court Opinion

ID: 9476348
Source: CourtListenerOpinion
Date Created: 2023-08-05 05:53:39.559919+00
Date Added: 2024-06-11T17:45:15.950727
License: Public Domain

HARRISON L. WINTER, Chief Judge,
dissenting:
Unquestionably, Murray Bowman Brown currently suffers from a variety of serious *992health problems, including heart and lung disease, hypertension, diabetes and an ulcer — all of which may render the prospect of proceeding to trial an extremely risky proposition. In August 1985, Brown was sent to the Springfield Medical Center for an evaluation of his mental competence to be tried. After thirty days, the doctors there concluded that Brown was mentally competent to stand trial. Unfortunately, the evaluation furnished little insight into Brown’s principal physical ailments or the consequences that would likely attend the ordeal of a trial. Moreover, it was limited to information about Brown’s condition at the time of the examination. For the subsequent period, uncontradicted evidence from Brown’s treating physicians establishes that his condition has deteriorated markedly since August 1985, to the point where subjecting Brown to trial would pose a substantial risk to his life and health.
Despite the evidence of Brown’s deteriorating condition, the majority opinion relies primarily on the outdated Springfield report in affirming the denial of Brown’s motion for a continuance on the grounds of ill health. The majority also relies upon the district court’s observations of Brown at several earlier proceedings, notwithstanding Brown’s absence from his own competency hearing in November 1985 — an absence necessitated by his recent hospitalization, but which the district court deemed insufficient to justify postponing the competency determination.
At the May 1986 status conference, convened for the purpose of assessing Brown’s health, the district court denied Brown’s renewed motion for a continuance, and scheduled trial for June 2. The court found that Brown’s physical and mental impairments did not preclude him from adequately assisting his counsel at trial. There was, however, no finding that subjecting Brown to trial would not pose a serious risk to his life and health — Brown’s principal basis for seeking a continuance. The court conceded that Brown’s condition would “probably get progressively worse,” and concluded therefrom that “defendant will have to be tried as soon as. possible.”
Because I conclude that Brown should not have been forced to trial when the evidence established that to do so would gravely threaten his health and survival, I respectfully dissent. I find it unnecessary to consider Brown’s claimed denial of his right of allocution.
I.
My resolution of the merits necessitates an expression of view about the government’s contention that, by entering a conditional plea of guilty pursuant to F.R. Crim.P. 11(a)(2), Brown waived his right to challenge the denial of his motion for a continuance. In light of the recent amendment to Rule 11, I reject the government’s contention.
The 1983 Amendment to Rule 11 explicitly authorizes the use of conditional pleas. “With the approval of the court and the consent of the government,” a defendant may enter a plea of guilty that is conditioned upon the right to appeal an adverse pretrial ruling.4 Nothing in the Amendment or the accompanying Advisory Committee Note suggests that it is limited to any particular type of pretrial ruling. To the contrary, the Advisory Committee made clear that the Amendment was intentionally broad in scope and was designed to avoid the futility and waste of insisting upon full trials for the sole purpose of preserving appellate review of pretrial issues. Indeed, it would be particularly anomalous to require a defendant like Brown to subject himself to trial when the very issue he seeks to appeal is his inability effectively to participate in, and physically survive, the rigors of such a proceeding.5
*993Although the district court indicated its belief that Brown probably could not appeal the denial of the continuance without actually subjecting himself to trial, it nonetheless expressly consented to the entry of the conditional plea. While the government did not make its consent so explicit, it sufficiently manifested such consent by submitting for court approval the written plea agreement, in which the condition was clearly set forth. See Adv.Comm. Note to 1983 Amend, (requirement, under Rule 11(a)(2), that conditional plea be in writing, removes concern that it will be entered without government’s “considered acquiescence”). In more pragmatic terms, the government made no objection to the procedure used, and cannot realistically now claim that it did not accept the conditional plea. Accordingly, Brown has, in my view, effectively preserved his right to challenge the decision denying his motion for a continuance.
II.
As I stated before, the majority relies on two grounds for affirming the district court’s denial of Brown’s motion: (1) the evidence from physicians at the Springfield Center who observed Brown for thirty days in the summer of 1985, and (2) the district court’s own observations of Brown. I address these seriatim.
A.
The report from the Springfield Center concluded that Brown was “mentally competent to stand trial.” Consistent with the limited statutory basis for the examination (to determine mental competency to be tried, 18 U.S.C. § 4241), the report spoke principally about his mental and intellectual capabilities. Much of the report and related testimony had no bearing on the potential detriment to his physical health that would result from subjecting Brown to a trial.6 Nor did it provide much insight into how Brown could cope with the extended stress and fatigue from a long trial, in terms of his ability to assist his attorneys. As the district court emphasized, these doctors were evaluating Brown in a very controlled and structured environment — four weeks under close supervision. Although the district court and the majority opinion rely on this factor to discount the testimony of Dr. Fisher, one of Brown’s two regular physicians, I think this was error. Brown’s condition in a closely controlled setting, removed from many everyday stresses, is hardly indicative of what his condition would likely be in the midst of a prolonged trial. Moreover, we have previously expressed our belief in the heightened value to be placed on the testimony of a treating physician. See Leonard v. Schweiker, 724 F.2d 1076, 1078 (4 Cir.1983) (social security context); Mitchell v. Schweiker, 699 F.2d 185, 187 (4 Cir.1983) (“the opinion of a claimant’s treating physician ... is entitled to great weight for it reflects an expert judgment based on a continuing observation of the patient’s condition over a prolonged period of time”).7
*994The majority properly notes that a district court is free to discount the testimony of physicians — even treating ones — when the court lacks confidence in their qualifications, abilities, candor or objectivity. Had these “classic credibility issues” been the basis for the district court’s downplaying of Dr. Fisher’s testimony, my conclusion might be different. However, the court explicitly grounded its criticism of that testimony on the fact that Dr. Fisher had not observed Brown in the type of structured treatment setting that was available at Springfield — a setting ill-suited to provide insight into a patient’s likely response to the ordeal of a trial. While the district court cryptically referred to Dr. Fisher’s report as “rather cursory,” there is nothing in the record from the proceedings following this November 1 hearing that suggests any shortcomings in the subsequent, uncontradicted reports and testimony from either Dr. Fisher or Dr. Ball (Brown’s other treating physician) regarding Brown’s physical ability to withstand a trial.
Most of the testimony concerning the Springfield examination came from non-treating doctors who specialized in fields unrelated to Brown’s principal medical problems — the latter including diabetes, hypertension, heart disease, lung disease and the many adverse side effects of Brown’s daily medications. Of the four individuals cited in the majority opinion, three had largely unrelated specialities, and their testimony was generally confined to those specialities: psychologist D’Andrea testified about Brown’s immediate memory and emotional stability; psychiatrist Butts and neurosurgeon Albaeck testified regarding the possibility of organic brain damage. Dr. Lieberwitz, an osteopath, did testify about Brown’s hypertension, but merely described Brown’s blood pressure in August 1985; he did not consider the anticipated impact of a long and stressful trial, except to the extent that he acknowledged that emotional stress can result in paroxysmal elevations in pressure.
To my mind, the Springfield report considered alone provides scant support for the conclusion that Brown could physically withstand the stress of a trial. But even if the report is considered to support that conclusion, the most important limitation of both the report and accompanying medical testimony is the fact that the conclusions expressed therein were necessarily valid only as of the time of the Springfield evaluation — August 1985. Both the doctors and the district court conceded as much. This caveat, obvious as it may be, is of critical significance in this case, because the evidence about Brown’s physical condition subsequent to August 1985 shows that he was not physically fit to stand trial.8
The January 1986 testimony from Brown’s two principal treating physicians indicated that Brown’s medical condition had worsened over the last several months, and would continue its downward trend. Brown’s hospitalization in late October 1985 resulted from a serious decline in his heart function which was only partially alleviated by installation of a pacemaker. The government presented no evidence to counter the post-August 1985 testimony and reports from Brown’s physicians, and conceded at oral argument that Brown’s condition had deteriorated since the time of the Springfield exam.
Evidence presented by Brown, from his treating physicians, for the time period after August 1985, showed the following:
*995* he currently suffers from diabetes, hypertension, anxiety, depression, chronic obstructive and restrictive pulmonary disease, peptic ulcer, arteriosclerotic cardiovascular disease and congestive heart failure, and gout
* his blood pressure and blood sugar are in poor control, despite compliance with his medication regime — a condition that is exacerbated by stress
* the stress and demands of trial could pose serious, life-threatening risks to Brown, including the very real possibilities of stroke, cardiac decomposition, or death
* a combination of effects from his illnesses and his numerous medications (necessary to keep him alive) significantly impair Brown’s ability to concentrate, remember, and stay awake.
Moreover, the government sent Brown to see a cardiologist, Dr. Usher, in April 1985. This doctor concluded that, because Brown’s blood pressure was not adequately controlled at the time, “it would be a risk to his health to proceed with trial proceedings.” Dr. Usher believed that the problem was remediable, and indicated that trial would be safe if Brown’s pressure were adequately controlled. However, the reports available immediately prior to the June 2, 1986 hearing show that Brown’s physicians had found his blood pressure and sugar to be in poor control, despite compliance with his medication and diet regimes.
To me, it is clear that the prospect of trial posed a substantial danger to the defendant’s life or health.9 Moreover, the combined debilitating effect of his health problems and accompanying medications would have greatly interfered with Brown’s ability to comprehend trial proceedings and effectively assist his counsel in his defense.10
The district court apparently accepted the post-August 1985 evidence from Brown’s physicians; it made clear its belief that Brown’s condition had indeed deteriorated, and would continue to worsen. As the court observed during the January 1986 hearing,
[Brown is] never going to be off the medication. The medical evidence indicates the oxygen to his lungs is not going to get better. His cardiovascular disease is going to deteriorate. As the doctors have testified to, the man is never going to get better.11
*996A few pages later in the January 1986 transcript, the court conceded to defense counsel that
[t]he one thing you can’t address and what troubles this court is medically, he’s never going to be any better. In fact, his condition is going to progressively deteriorate, and he’s in a better condition to stand trial in January, 1986 than he would be in June of 1986.12
Any uncertainty regarding the district court’s position is eliminated by examining its ruling at the May 1986 hearing. The court rejected the claims that Brown was either “mentally incompetent ... [or] physically impaired from assisting counsel in the preparation of the trial or in proceeding to trial in the matter.” Yet the court unambiguously expressed its recognition of Brown’s deteriorating physical health:
... I don't have any doubt — I have never had any doubt that Mr. Brown has a series of serious medical conditions____ the consensus of the doctors was that his condition would never improve, that it would probably get progressively worse.
Indeed, the court could hardly conclude otherwise, since the government conceded that it had no evidence to refute the post-August 1985 medical assessments rendered by Brown’s treating physicians.
From this premise, the court concluded that Brown must be tried immediately:
[I]n view of [Brown’s] physical condition, in view of the likelihood that it will continue to deteriorate, I think that in his interest and the interest of justice that this defendant will have to be tried as soon as possible.
The court had expressed a similar legal conclusion at the January proceeding: “If he’s never going to get any better — if he’s as well now as he’s ever going to be, doesn’t that mitigate in favor of proceeding to trial?”13 It impliedly assumed that a trial was inevitable, and that the only question was one of timing. The district court does not appear to have considered the possibility that, if going to trial posed a severe health risk to Brown, due process might forever prevent him from being tried.
The second ground asserted by the majority for affirming the district court’s decision is the district court’s own observations of Brown. Reliance on this factor is particularly ironic since one of Brown’s protestations on appeal, which the majority fails to address, is that the district court erred in denying Brown’s November 1, 1985 motion for continuance of the competency hearing because of his inability to attend.14 The district court was thus deprived of those critical first-hand impressions which it had obtained from observation of Brown at earlier pretrial proceedings. This deprivation takes on added importance in light of Brown’s claim that his condition had deteriorated considerably during the months following his August 1985 evaluation at the Springfield Center. Indeed, Brown’s absence from the November 1 hearing, due to his recent hospitalization, was itself additional evidence of that deterioration of which Brown complained.
I therefore conclude that the district court’s denial of the continuance is not sustainable on the basis of its observations of Brown.
III.
In light of the uncontradicted evidence of Brown’s physical condition subsequent to *997the Springfield examination, I can only conclude that the district court erred in denying Brown’s motion for a continuance on grounds of ill health.15 Since I think that this issue was properly preserved by Brown’s conditional plea of guilty, I would reverse the judgment of conviction entered on the conditional plea, and remand the case for further proceedings. Unless the government can show a marked improvement in Brown’s health at a reasonably foreseeable future date so that he can be retried, the prosecution should be quashed.

. The full text of F.R.Crim.P. 11(a)(2) provides:
(2) Conditional Pleas. With the approval of the court and the consent of the government, a defendant may enter a conditional plea of guilty or nolo contendere, reserving in writing the right, on appeal from the judgment, to review of the adverse determination of any specified pretrial motion. If the defendant prevails on appeal, he shall be allowed to withdraw his plea.

. The cases cited by the government predate the 1983 Amendment, and hold only that uncondi*993tional guilty pleas usually constitute a waiver of nonjurisdictional defects.

. The majority notes that the Springfield examination was not limited strictly to Brown’s mental status. It is true that, while Brown was at the Medical Center, a series of physical tests was also conducted. However, the results of those tests had no bearing on the report that was being prepared for the court, nor did they include any prediction of the likely consequences of a trial on Brown’s physical well-being.
The sole basis for Brown’s commitment to the Springfield Center, and thus for the Center’s report to the court, was to obtain an assessment of his mental competency to stand trial, as authorized by 18 U.S.C. § 4241. Accordingly, the court’s ruling after the November 1 "competency hearing” found nothing more than that defendant was “competent,” i.e., had the requisite "mental capacity” to stand trial. Indeed, Dr. Lieberwitz, the individual cited by the majority as responsible for preparing the report of Brown’s physical examination, made clear that he was simply monitoring Brown’s health while Brown was confined at the Center, and that the physical exam was not a part of the necessary evaluation that was being conducted. Dr. Lieberwitz described his report as designed primarily to assist Brown’s physicians upon Brown's return home.

. The majority claims that this principle is applicable only to cases involving disability benefits — cases in which the courts have manifested concern for agency independence and objectivity, and a desire to circumscribe the discretion of agencies and AUs. While this concern un*994doubtedly motivates many judicial decisions in the social security context, it has little relevance to the principle cited here. That principle, according special weight to medical assessments rendered by treating physicians, is explicitly justified by the practical recognition that "an expert judgment based on a continuing observation of the patient’s condition over a prolonged period of time” is likely to prove more accurate and reliable than a judgment based on an isolated examination or a simple review of medical records. Mitchell, 699 F.2d at 187. See also Martin v. Secretary of Dept. of Health, Ed. & Welf., 492 F.2d 905, 907-09 (4 Cir.1974).

. Contrary to the majority’s suggestion, I am not arguing that the Springfield report must be disregarded altogether. Its significance, however, is drastically reduced in light of the fact that all medical evidence subsequent to the August 1985 examination demonstrates a marked deterioration in Brown's physical condition.

. The majority notes that other appellate courts have upheld denials of continuances in more egregious circumstances. The cases cited in support of that proposition, however, are distinguishable. In Bernstein v. Travia, 495 F.2d 1180 (2 Cir.1974), the district court found that the defendant would receive scant benefit from a continuance; he "would suffer a great deal of anxiety, in any event, so long as his wife remained on trial.” Id. at 1182. Moreover, the government had already put on its "lengthy case,” id., thus elevating its stake in completing the trial above that which exists in the present case. In United States v. Costello, 760 F.2d 1123 (11 Cir.1985), the defendant made no claim that his participation in the proceeding would pose a risk to his health, but rather only that he was not emotionally or physically up to it, after his suicide attempt earlier that day. Moreover, the proceeding was not a trial but only a sentencing hearing, for which prolonged concentration was not required, and which would not subject him to extended periods of stress and fatigue.

. The district court’s willingness to try to accommodate Brown’s medical needs is surely commendable. However, that does little to mitigate the stress and fatigue inherent in any trial on the charges pending against Brown. The fact that Brown’s blood pressure and sugar, for example, remain uncontrolled despite compliance with his doctor’s orders suggests that there is not much that can be achieved by taking breaks in the trial or adjourning earlier than usual. Indeed, such measures, while possibly helping to reduce daily fatigue, would simultaneously prolong the trial and its attendant stressful impact.

. The majority isolates a paragraph in the January 1986 transcript in which the district court pointed to evidence that ostensibly contradicted the reports of Brown’s physicians. That paragraph, however, was a response to defense counsel’s claim that, apart from Brown’s physical ability to survive a trial, he was unable effectively "to participate in his defense____ [and that there was] nothing else [in the record] to contradict that.” The court’s response focussed solely on this competency issue, noting that Brown had previously demonstrated some ability to consult and communicate with his attorneys. There is no indication of any evidence contradicting the assessment of Brown’s physical ability to tolerate the stress of a trial. Indeed, immediately prior to the exchange just described, the court made the statement quoted in the text, supra.

. Although the court then pointed to some evidence indicating that Brown may have exaggerated problems concerning his memory and attention span, these problems related solely to his capacity to “assist ... adequately in his own defense," and not to his physical ability to survive a trial.

. The majority correctly observes that this quotation from the January 1986 hearing is premised on the district court’s assumption, arguendo, of the ftcts as portrayed by defense counsel. This observation hardly undercuts my position, since the sole purpose of including the quotation is to expose the district court’s erroneous view of the law. That the court did accept the reports and testimony of Brown’s physicians regarding his deteriorating physical condition is amply demonstrated, supra.

. Although Brown had initially waived his presence at the hearing, his attorney filed a withdrawal of that waiver prior to the hearing on November 1.

. The majority characterizes this dissent as “eager" to discredit the Springfield evaluation. Far from it, for I take no comfort in the belief that Brown’s plea of guilty was induced by a fear of the health consequences that would have accompanied a decision to stand trial.