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Tuesday, August 22, 2006

Do You Solemnly Swear?

A member of our clinical team did an assessment of an inmate two years ago, whose diagnosis was Major Depression. A year latter, apparently after using PCP and marijuana, he he got in a morning dispute, shot one man to death and injured another. By noon he was in a second dispute, killing another man and injuring the man's brother. By afternoon, he had killed another man and injured another. By the time the police caught up with him, he had terrorized two more people with an empty gun, the fact of which they were unaware. He was reported as shouting "I am the devil" as he was shooting. He was charged with 3 murders and 4 attempted murders, and in CA, the circumstance of multiple-murders qualifies you for the death penalty. He refused to allow his attorney to raise the issues of drug use or his psychiatric history. He was convicted after 4 hours of jury deliberation. The sentencing phase began today, and my colleague was subpoenaed by the defense for this coming Monday, as it attempts to convince a jury to spare his life. In my mind, this is a clinician's nightmare.

As I read the clinical note, it basically described a man who had been in jail a majority of the past 20 years, apparently had a difficult time on the streets, and reported that he occasionally, purposely, committed a crime in order to "get a roof over my head." While he reported feeling "a little depressed," he was taking medication which he indicated as "helpful." There was no evidence of frank delusion, thought disorder, psychosis, anxiety, or cyclical pattern of depression; in other words, he met the diagnosis for Major Depressive Disorder. He was diagnosed as Antisocial Personality Disorder - and I am usually cautious with this diagnosis, in that some who are "difficult" forensic patients are given this diagnosis without a corroborating psychiatric & criminal history. But in this case, the suggestive criminal history was present.

In hindsight he made two comments, that my colleague quoted in the note, that are suggestive. When asked if had thoughts of harming or killing anyone, he denied them. I have had numerous patients tell me sarcastically, "I'm in a maximum security prison; I have them [thoughts] every day." But do you have a plan? This patient stated, "I have gotten mad enough where I could have killed someone." When asked of his future plans he said, "When you have nothing, you have nothing to lose." In and of themselves, these two comments are certainly not predictive, but they are undoubtedly open to interpretation. My colleague is being asked to provide context to these comments.

A small group of us sat around this afternoon discussing this situation. As you might expect, my colleague is anxious. I suspect that too many movies and too much Law and Order has her believing she will be "torn apart" by an attorney. Factually, she did not diagnose or provide him with any form of treatment. Apart from her case note, she vaguely recalls this patient and her single interaction with him. We "Googled" the case to get the details, of which we are now intimately familiar. We don't belong in court. We work in a forensic environment, but we are not forensic experts.

I have been thinking this evening that if a defense team (and I suspect an underfunded court-appointed defense team) feels compelled to utilize the testimony and single-page case note of a one-time interaction with a truly peripheral clinician to aid in a Death Penalty defense, "justice" is an extraordinarily loose concept. In fact, I find it too pitiful to imagine.


Blogger Sarebear said...

On a completely unrelated note, Foo, you were in my dreams the other night, as a distant, clinical, detached observer.

I'm starting to dream about blog people.

That's better than dreaming about bog-people, isn't it? Less frightening . . .

First it was Dr. Deb, then it was a dream that I had that acholigernic thingie that NeoNurse talks about, and now you.

Okay, who's next? Pluto? Arf!

August 23, 2006 10:01 AM  
Blogger ClinkShrink said...

Hey Foo, yes I can imagine the group discomfort associated with this case. Unfortunately, we do sometimes end up in court (recall Andrea Yates and the jail psychiatrist). In this case your colleague wasn't there as an expert (expressing an opinion, drawing conclusions from observations) but rather as a fact witness. There's pretty much no way to avoid involvement as a fact witness except to be very very careful about what you document. You won't get called if you're useless to both sides.

I'm guessing your colleague got called because the sentencing guidelines may have 'future dangerousness' as an aggravating circumstance for the death penalty. Working in a system where killers continue to kill inside the walls, you could probably guess where I stand on that issue.

August 23, 2006 4:22 PM  

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