Reliability of Sleep Parasomnia and the Trustworthiness of Patient Self-Reporting

Facts of the Case

On May 15, 2006, a Tennessee grand jury returned a five-count indictment against Adrian Leroy Scott for alleged criminal sexual contact between Mr. Scott and his stepdaughter (who at the time was a minor). Mr. Scott was charged with three counts of sexual battery by an authority figure in violation of Tenn. Code Ann. § 39-13-527 (2006) and two counts of rape in violation of Tenn. Code Ann. § 39-13-503 (2006). Mr. Scott intended to call an expert witness in his defense and provided the state with a report from Dr. J. Brevard Haynes, the Medical Director of the St. Thomas Health Services Center for Sleep. Dr. Haynes opined that “sexual behavior in sleep parasomnia [was] the explanation for [Mr. Scott's] touching of his step-daughter.” The state filed a pretrial motion to exclude the testimony. Following a hearing, the trial court entered an order excluding Dr. Haynes' testimony on two grounds. First, the trial court concluded that “intent is not an element of either offense. Therefore, the information which the defendant [sought] to admit through Dr. Haynes as an explanation of the alleged conduct [did] not aid the jury in an understanding of the offense” (Scott, p 400). Second, the trial court ruled, without elaboration or explanation, that the “methodology and principles underlying the scientific evidence [were] not sufficiently trustworthy and reliable to be presented to the trier of fact” (Scott, p 400). Mr. Scott filed an appeal to the court of criminal appeals, which denied his application. Thereafter, Mr. Scott filed an application under Tenn. R. App. P. 11, and the Tennessee Supreme Court granted Mr. Scott's application for permission to appeal.

On appeal, Mr. Scott argued that the trial court erred by excluding Dr. Haynes' testimony. Specifically, Mr. Scott argued that Dr. Haynes' opinion regarding sleep parasomnia was based on reliable scientific methodologies and principles.

Ruling and Reasoning

The Tennessee Supreme Court ruled that the trial court erred by concluding that Dr. Haynes' testimony was not sufficiently reliable or trustworthy to substantially assist the trier of fact.

The supreme court discussed the factors that determine the admissibility of expert witness testimony, opining that a trial court “must assure itself that the [expert's] opinions are based on relevant scientific methods, processes, and data, and not upon an expert's mere speculation” (McDaniel v. CSX Transp., Inc., 955 S.W.2d 257, 265 (Tenn. 1997)). The court's reliability analysis employed four general inter-related components: assessment of professional qualification; analytical cohesion (i.e., basis for the expert's opinion); methodological reliability; and foundational reliability (i.e., reliability of the expert's testimony and opinion).

The court focused its analysis on the fourth component, the expert's foundational reliability, using a two-step approach. First, it assessed the expert's field by focusing on the reliability of the studies, articles, and data that compose the field and provide the foundation for the expert's testimony. Second, the court analyzed the reliability of the underlying facts on which the expert's opinion is predicated—in this case, Mr. Scott's self-report to Dr. Haynes.

The court found merit in the field of sleep medicine and that a diagnosis of sexual behavior as sleep parasomnia had been generally accepted within the field of sleep science. Further, the court stated: The underlying research relied upon by Dr. Haynes [was] built on a medical and psychological foundation, and its methodologies [were] consistent with this foundation. Expert sleep disorder testimony is not entirely novel; such testimony has been found by other courts to warrant admission as expert testimony [Scott, p 408].

In this case, the state challenged Mr. Scott's self-reporting of his own conduct, arguing that because the facts relied on by Dr. Haynes were self-reported by and in the self-interest of a criminal defendant, they were inherently lacking in trustworthiness. The court rejected the state's argument and noted that Dr. Haynes' analysis went beyond Mr. Scott's self-reporting. Dr. Haynes indicated that reliance on self-reporting was critical to diagnosis and evaluation, and the court concluded that self-reported facts could be relied on by sleep science experts in reaching a diagnosis.

Discussion

The United Stated Supreme Court set standards for the admissibility of expert witness testimony in several cases. In Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993), the Supreme Court ruled that judges should consider the following factors to establish the validity of a scientific methodology: whether the theory or technique can be and has been tested; whether it has been subjected to peer review and publication; the known or potential error rate; whether there are standards available and maintained that govern the operation of the method; and whether it has been generally accepted by a relevant scientific community. In Kumho Tire Co. v. Carmichael, 526 U.S. 137 (1999), the Court expanded the Daubert standard to include nonscientist experts who have expertise based on “technical” and “other specialized” knowledge. In General Electric Co. v. Joiner, 522 U.S. 136 (1997), the Court held that the appropriate standard for reviewing a district court's decision to admit or exclude scientific evidence is an “abuse of discretion” standard.

This case presents an interesting discussion and analysis of the admissibility of expert witness testimony that includes patient self-reporting. The Tennessee Supreme Court found that Dr. Haynes was an expert in his field, given his extensive professional qualifications and experience in sleep medicine. The court found that the record on appeal did not show a wide gap between Dr. Haynes' conclusions and the data on which he based his conclusions. Dr. Haynes interviewed Mr. Scott, performed a physical examination, conducted polysomnography followed by multiple sleep latency tests, listened to taped interviews conducted by police detectives interviewing Mr. Scott, and extensively reviewed medical literature on the subject of sexual behavior in sleep parasomnia. Dr. Haynes testified that his diagnosis of Mr. Scott was reached on a basis that was normal for such diagnoses in his field. The state objected to Dr. Haynes' reliance on Mr. Scott's self-reporting. However, the court found that Dr. Haynes' methodology was consistent with the accepted practices of physicians who treat and make such diagnoses. Considering the factors outlined in Daubert, this court found that sleep parasomnia was an established field of medicine that had been subject to peer review and was generally accepted in the scientific community.

In this case, the court ruled that expert testimony based on self-reporting did not render it inadmissible under Daubert. Rather, the degree to which the expert's opinion was based on the defendant's self-reporting affected the weight given to the opinion. The court suggested that any prejudice that might result from self-reporting can be addressed by cross-examination. Through cross-examination, the trier of fact can determine whether there is a basis for excluding an expert's opinion due to the lack of an adequately trustworthy foundation. In other words, the degree of reliance on patient self-reporting influences the weight given to the testimony, rather than its overall admissibility.

This case is relevant to mental health professionals because mental health expert testimony often relies heavily on patient self-reporting. This court declined to accept the state's argument that a rule should be established that would effectively bar expert testimony based on self-reported statements. By rejecting the state's argument, this court protected the important role of self-reporting in mental health expert examinations.