Use of Data From Competency Restoration

Facts of the Case

Mr. Estes was committed to Lake's Crossing Center for Mentally Disordered Offenders under the Nevada Division of Mental Health and Development Services. This commitment was for his restoration of competency after preliminary findings of not competent to stand trial. The district court eventually found Mr. Estes competent based on Lake's Crossing staff evaluations. He pleaded not guilty by reason of insanity, and the case proceeded to a jury trial. There was no expert testimony on behalf of the defendant. Mr. Estes himself testified to his insanity. He admitted to most of the alleged charges in court but maintained that his mental illness and lithium toxicity from treatment of his bipolar disorder caused him to commit the assault.

The state called Elizabeth Neighbors, PhD, forensic psychologist; Hale Henson, MD, psychiatrist; and A. J. Coronella, LCSW, to provide rebuttal testimony to Mr. Estes' claim of insanity. These clinicians had evaluated or treated Mr. Estes while he was committed at Lake's Crossing for restoration of his competency to stand trial. Dr. Neighbors testified that his psychological testing showed occasional malingering, adding that he was never observed to be psychotic or to seem incompetent by her or other members of the treatment team. Dr. Henson opined that Mr. Estes did not suffer from lithium toxicity when he was their patient and that his desire to be medicated seemed to derive from a wish to prove that he had a mental illness.

Both the psychiatrist and the psychologist testified to a reasonable degree of medical certainty that under the M'Naughten standard Mr. Estes knew right from wrong. They stated also that he had no mental condition that would have impaired his judgment at the time of the crime. They based their testimony on police reports and statements to the police made by Mr. Estes and B.C. and not from a direct assessment of his mental status at the time of the crime.

Ms. Coronella's evidence suggested malingering. Mr. Estes had stated when on the witness stand that he had divorced his wife due to his mental illness. Ms. Coronella testified that in an interview with her, Mr. Estes had stated that he and his wife divorced because of his wife's affair with Mr. Estes' brother. Ms. Coronella also testified that Mr. Estes had expressed an interest in preparing for an insanity defense while he was attending her “legal process” class during his restoration of competency.

The jury convicted Mr. Estes. He was sentenced to 40 years' imprisonment and ordered to register as a sex offender after his release. Mr. Estes appealed this decision to the Supreme Court of Nevada. Most significantly, among other claims, he challenged the admissibility of the mental health professionals' testimony.

Ruling

The Supreme Court of Nevada affirmed most of the judgments of the district court, while dismissing and remanding a few counts on legal technicalities. In its substantial holding, the court opined unanimously that the use of information from Mr. Estes' competency restoration was permissible in rebuttal of his insanity defense.

Reasoning

The most significant issue raised by the appellant is the admissibility of evidence that was gathered from a court‐ordered commitment for restoration of competency. Mr. Estes claimed violation of his due process and Fifth Amendment rights in allowing testimony from Lake's Crossing staff to rebut his insanity defense. Noting that these objections had not been raised at the trial court, the Supreme Court of Nevada assessed his claim under a “plain error review,” a review that examines whether any clear or plain error by the trial court affected Mr. Estes' substantial rights.

In clarifying the jurisprudence and establishing the framework for analyzing the appellant's claim, the Nevada Supreme Court referenced Buchanan v. Kentucky, 483 U.S. 402 (1987). In that decision, the U.S. Supreme Court held that the prosecution's use of psychiatric evaluation did not violate the Fifth Amendment, when limited to the purpose of rebutting the petitioner's claim of extreme emotional disturbance and the defendant had requested the evaluation and had relied on part of that evaluation. In Estes, the Nevada Supreme Court further referenced DePasquale v. State, 803 P.2d 218 (Nev. 1990), in which it had relied on Buchanan in noting that the Fifth Amendment was not implicated by the limited use of psychiatric examination to rebut an insanity defense.

The Nevada Supreme Court concluded that: [A] defendant is generally entitled to protection from admission of un‐Mirandized incriminating statements made to health care professionals in the context of a court‐ordered evaluation or examination. But, if the defendant seeks to introduce the evaluation or portions of it in support of a defense implicating his or her mental state, the prosecution may also rely upon the evaluation for the limited purpose of rebuttal [Estes, p 1121].

The court then examined the testimony provided by the Lake's Crossing staff using this framework.

With respect to the testimony of Drs. Neighbors and Henson, Mr. Estes claimed that their testimony should not have been allowed based on: (1) Esquivel v. State, 617 P.2d 587 (Nev. 1980), in which a conviction was reversed due to the state's use of the defendant's statement made during a court‐ordered mental examination to impeach his denial of charges, and (2) Winiarz v. State, 752 P.2d 761 (Nev. 1988), in which a psychiatrist who had performed a competency‐to‐stand‐trial evaluation testified that the defendant was “lying,” “faking,” and a “cold‐blooded” murderer. The court in Winiarz ruled that the testimony was highly prejudicial, went to the ultimate issue in the case, and was beyond permissible expert testimony. The Nevada Supreme Court made the distinction that, in both of these cases, the defendants had not placed “their sanity at issue.” The Court held that the testimony of Drs. Neighbors and Henson was permissible, as it did not relay any incriminating statements related to the crime that Mr. Estes was charged with and that it was “primarily related to their general observations of his mental state” (Estes, p 1122).

With regard to the testimony of Ms. Coronella, the Court determined that her testimony was admissible also. It determined that the statements were not directly incriminating or obtained through interrogation and held: “this testimony violates neither the Fifth nor the Fourteenth Amendments because Estes placed his sanity in issue and because the testimony does not describe any statements by Estes regarding the underlying crimes” (Estes, p 1121).

The Nevada Supreme Court made a distinction between those portions of the court‐ordered psychiatric evaluation that were inadmissible because they contained “defendant's statements that directly relate to culpability for the crimes charged,” (unless the defendant waived his Fifth Amendment rights) and the other portions of the evaluation that are admissible “to rebut an insanity defense” (Estes, p 1123). It concluded that Mr. Estes' rights were not violated.

Discussion

An evaluation of competency to stand trial is a central part of protecting a defendant from an unfair trial. The process safeguards the rights to effective counsel, to present evidence, and to confront witnesses, as guaranteed by the Sixth Amendment. Detailed investigation of the ability of the defendant to understand the legal proceedings and to assist counsel in his or her defense are central to this process.

It is generally understood that competency evaluation and restoration records are not used to establish guilt or to help in sentencing (Melton GB, Petrila J, Poythress NG, et al.: Psychological Evaluations for the Courts: A Handbook for Mental Health Professionals and Lawyers. 3rd ed. New York: The Guilford Press, 2007). In line with this understanding, no Miranda warnings are given to the defendant before the evaluation or during the restoration of competency. The rather weak warning about the nonconfidential nature of this evaluation is often ineffective. Perhaps for this reason, psychiatrists frequently omit material that is self‐incriminatory and peripheral from their reports.

In the case of Mr. Estes, this competency evaluation and restoration process became central to his insanity defense. Mr. Estes, the patient who is also the forensic evaluee, is likely to assume that his treatment team is acting in his best therapeutic interest, and this may have led him to disregard any nonconfidentiality warnings he may have received about the nature and scope of his restoration evaluation and treatment.

This case is troubling, as it does not address this conflict of ethics and the resultant ineffectiveness of any nonconfidentiality warning that Mr. Estes may have received. Instead, this case tries to parse out direct incriminating statements relating to his crime from statements that merely speak to his sanity, with the court disallowing the former while allowing the latter. Should defendants now be warned that information gathered from a competency evaluation or restoration may be used for other purposes? One effective way to avoid this situation would be to limit strictly the information gathered from competency evaluations and restoration processes to the question of competency alone. The state‐of‐mind evaluation, for the explicit purpose of an insanity defense, should be an independent forensic assessment by a nontreating forensic psychiatrist or psychologist. Such an approach would be one way to preserve the distinction between forensic assessments and therapeutic assessments.