Charles L. Scott, MD: Music, Military, and Medicine

There are rare instances for each of us when we meet someone who dramatically changes the course of our lives. For me, this occurred as a third-year resident in Seattle, Washington, in 2008. After hearing Charles Scott lecture at the American Academy of Psychiatry and the Law (AAPL) Forensic Psychiatry Board Review Course, it became clear to me that I had to train with him. Dr. Scott's presentations intrigued me over the three days. I found myself drawn to his lectures, regardless of the subject. He presented on topics including correctional mental health, the death penalty, sexual offenders, juvenile rights, child custody, child abuse, child witness testimony, right to treatment, and psychiatric disability. For each lecture, he masterfully wove together the current medical literature and case law with timely pop culture references. His presentations were as entertaining as they were informative. He presented information with a combination of substance and entertainment that made the topics come alive.

Charles L. Scott, MD

I first met Dr. Scott in person at a reception at the Forensic Review Course. I nervously introduced myself and presented my longstanding interest in forensic psychiatry. In just a few minutes, he elicited my entire educational background through casual conversation. Later that week, I met other faculty members affiliated with the program. From that point forward, I knew that the University of California, Davis (UC-Davis) was where I wanted to train. I was so sure that UC-Davis was the right situation for me that I even considered offering to attend the program for free, if necessary. Fortunately, I did not have to face that decision. Shortly after my interview, Dr. Scott offered me a fellowship position for the next year. The following July, I entered my fellowship with excitement and high expectations. To my surprise, the experience not only met my expectations, it far exceeded them. Although the year was rigorous, I enjoyed every day of it and learned more than I could have ever imagined. He goes to considerable lengths to optimize the experience, including individually tailoring the year for each fellow. He also strives to improve the experience by soliciting feedback. When my classmates and I offered suggestions midyear, he listened attentively and implemented the recommended changes.

I recently learned that Dr. Scott had had an experience similar to my own. In 1994, he was in Philadelphia, Pennsylvania, at the American Psychiatric Association (APA) Annual Meeting. At the meeting, he noticed a large room that was filled with people and decided to investigate. Dr. Resnick stood at the front of the room, lecturing on how to give effective expert testimony. Dr. Scott had never seen anybody present so eloquently. He realized, “within five minutes,” that he wanted to train with Resnick. Slightly over a year later, he began his forensic fellowship with Resnick, himself a renowned educator.¹ Dr. Scott frequently acknowledges the profound impact that Resnick has made on his career.

Once given this opportunity to summarize Dr. Scott's illustrious career, I first had to decide how to proceed. Having completed my forensic training with him, my instinct was to gather extensive collateral information. I began by contacting his mother, Sylvia Scott. She is a delightful woman with an equally charming Southern accent. She lived most of her life in Mississippi, where Dr. Scott was born and raised. She proudly stated, “He's always been determined and always loved knowledge.” Mrs. Scott informed me that she had started him down the right path immediately, by playing classical music while he was in utero. She added that he was able to read newspapers by age three. However, his thirst for knowledge did not always work in his favor. His mother recalled that when he was a child she sometimes had to “fuss at him” for studying under the covers with a flashlight after bedtime.

Mrs. Scott explained that her son always had a magnetic personality and a knack for commanding a room. “The minute he walks into a room, he can entertain,” she said. She marveled that he had received a standing ovation from hundreds after giving a speech at his parents' 50th wedding anniversary. She added, “I thought that was pretty impressive, since all he really talked about was being our son.” She presumed that his abilities would translate into his being an effective educator.

After speaking with Mrs. Scott, I contacted numerous other people. From family members, to long-term colleagues, to former fellows, the response was incredible. His older brother Hal highlighted Dr. Scott's unwavering support for his family. He recalled that several years earlier, he had come down with a life-threatening illness requiring multiple surgical procedures. Hal noted, “He kept me going that entire year that I spent in the hospital, and I don't know if I could have gotten through it without him.” Hal was a young, healthy man who suddenly found himself temporarily incapacitated. Dr. Scott put his forensic work on hold, flew to visit his brother several times, and remained a steady source of support throughout the ordeal.

His younger brother Paul also described Dr. Scott's unwavering commitment to his family. He relished their history of healthful competition, particularly involving board games. When younger, the brothers often battled for “world domination” during intense games of Risk. Dr. Scott recalled that, like many younger siblings, Paul knew just how to get under his older brother's skin. Whenever Dr. Scott took a commanding lead in the game, Paul would declare “total nuclear war” and throw the board across the room, to prevent his older brother from sealing his victory. Even after the heated games of Risk, Paul grew to admire his brother. He indicated, “To say that I looked up to my brother is an understatement. I emulated him and still do in my own way. His fierce and focused determination was a road map for my own success. He showed me that whatever you set your mind to, you could do.” Paul stated that he eventually followed his brother to Emory University, where Dr. Scott had majored in music.

In 1982, while completing his undergraduate studies at Emory, Dr. Scott was the only undergraduate student given the prestigious Robert T. Jones scholarship. The award provided him the opportunity to conclude his studies abroad in Scotland, at the University of St. Andrews. At the conclusion of his year in St. Andrews, he was recognized for his academic excellence in both baroque music history and biochemistry. He was also inducted into Phi Beta Kappa at Emory.

Dr. Scott grew up in humble circumstances. His parents struggled financially at times. Although they were not materially wealthy, his parents always understood the value of education. They sacrificed their own desires for the sake of their children's education. He rarely had new clothes, but was never without a new book. Music was also very important to the family. His older brother was a child prodigy on the piano. He could play beautifully by age three and gave solo recitals by six. As the younger sibling handing out programs to the audience, he came to believe that music represented the way forward in life. He therefore started studying piano. According to Dr. Scott, he had the discipline, but not his brother's talent.

During his college years, he realized that he would never have a career as a solo pianist because he simply wasn't good enough. But, he had a secret dream of becoming a physician, something that had never happened in his family. At the time, he had no concept of how he could possibly finance such an expensive education. He eventually learned that the United States Army offered medical school scholarships in return for years of military service. Whereas music lifted the window toward his undergraduate education, the military opened a door that enabled him to enter medical school.

He returned to Emory for medical school. He graduated cum laude from the Emory University School of Medicine in 1986 and was named a member of the Alpha Omega Alpha Honor Society. He had an experience during medical school that solidified his decision to pursue a career in child and adolescent psychiatry. During a psychiatry clerkship, he was assigned the case of an emotionally fragile eight-year-old boy living in a residential treatment facility. Years earlier, this boy had been cuddling next to his mother in her bed one night when her boyfriend broke into the home. The boyfriend shot and killed the woman while her son begged her not to die and leave him. This young boy had not spoken a word to anybody since the incident.

Dr. Scott was assigned to work with the boy over the course of his psychiatry clerkship. Their interactions primarily involved walking together along the grassy edge of a gentle stream located on the grounds of the facility. While on their first walk together, Dr. Scott found a particularly interesting little rock and gave it to the boy to keep. In the days leading up to the end of the rotation, the boy seemed somewhat indifferent to losing his companion, despite Dr. Scott's attempts to discuss the impending separation. On their last day together, he said his final goodbye to the boy, saddened that despite being able to appreciate the child's pain, he had never actually heard his voice. As he reached the door to leave, he felt a tug on the back of his shirt. As he turned around, he saw the child struggling to pull something out of his tattered pants pocket. As the boy's cupped hands unfolded, Dr. Scott recognized the gift. It was the pale pebble that he had handed the boy the day they first met. While the boy's hand was outstretched to return the only thing he had ever been given, Dr. Scott told him that the rock was his to hold and would be a way for the boy to always remember their times together. For the first time since his mother's death, the boy spoke. “Thank you,” he whispered through his teary eyes.

After excelling in medical school, Dr. Scott pursued a career in psychiatry. He first completed a transitional internship at the Walter Reed Army Center, in Washington, D.C., from 1986 to 1987. During that year, he excelled in all of his rotations, including those on medical and surgical services. One of his surgery attendings gave him the unexpected opportunity to begin a surgical procedure on his own, as an intern. After scrubbing in for the operation, he heard the lead surgeon request over the loud speaker that he go ahead and start without him. Although confident in his abilities, Dr. Scott felt it was important to inform the surgeon that he was not a surgical resident. Once the surgeon learned that his promising protégé was actually a future psychiatrist, he immediately bellowed over the speaker, “Don't do anything. I'll be right there.”

After the transitional internship, Dr. Scott completed his general psychiatry training, also at the Walter Reed Army Center, from 1987 to 1989. He then traveled cross-country to train in child and adolescent psychiatry at the University of California, San Francisco. On the basis of his excellent performance, he was recognized nationally as an Outstanding Military Child Psychiatry Fellow. This award provided him the opportunity to study at the Maudsley Institute, in London, where he learned about Great Britain's approach to providing support services for troubled children in the community.

After completing his child and adolescent fellowship in 1991, he began serving on active duty in the United States Army, where he spent a total of 13 years. Although he became both an officer and a psychiatrist during this period of his life, his main identity was that of an Army officer. “It was an honor to serve my country,” he said. He spent three years stationed at bases throughout Germany. In addition to his clinical duties, he developed and implemented an outpatient child and adolescent psychiatry service for the families of the soldiers stationed in Würzburg, Germany. His initiative significantly broadened the services available to the soldiers' families, particularly their children. By the end of his three years in Germany, he was the acting chief of the Department of Psychiatry in Würzburg. His responsibilities involved organizing and delivering care to a catchment area population of over 100,000 soldiers and their families. After returning stateside in 1994, he worked for one year at the William Beaumont Army Medical Center, in El Paso, Texas. At that facility, he was named chief of the Psychiatry Outpatient Service and chief of the Child and Adolescent Psychiatry Service. He also supervised psychiatry residents from the Texas Tech School of Medicine.

It was during his time in the military that Dr. Scott first interacted with Resnick at the APA Annual Meeting. After leaving the military in 1995, he was offered and accepted a forensic fellowship with Resnick at Case Western University, in Cleveland, Ohio. Resnick marveled at his sense of self-discipline and characterized him as displaying a “mastery of preparation.” Over the course of the fellowship year, Resnick began asking him to help him teach the Case Western law students, a unique assignment for a Fellow. Because Dr. Scott had excelled as a teacher during his fellowship, Resnick asked him to give some lectures for the Forensic Review Course. Dr. Scott first joined the course's faculty in 1996, immediately after his forensic fellowship. His performance evaluations were so stellar that Resnick asked him to take over additional lectures for the course during the coming years.

His co-fellows, Stephen Noffsinger and Madeline Andrew, also reflected fondly on their time at Case Western University with Dr. Scott. Dr. Noffsinger recalled, “He was already well polished with his forensic opinions and abilities.” He further characterized Dr. Scott as “very bright and a very hard worker.” Dr. Andrew stated that, “He definitely led the way.” She added, “Charles made an incredible impact on me, not only as a friend, but as a scholar. He has continued to be an inspiration for me from the moment I met him until today.” Andrew recalled that during their fellowship year, there was an incident involving a very large patient who pinned her against the wall and threatened to assault her. Dr. Scott immediately stepped between them and said, “That's not going to happen!” Andrew described him as “my knight in shining armor.”

After completing his year at Case Western University, Dr. Scott accepted a position as Assistant Professor at Tulane University in 1996. He was appointed the director of the Competency Restoration Unit at Feliciana Forensic Facility, the only maximum-security psychiatric facility in Louisiana. While at Tulane, he was quickly named the co-director of the forensic psychiatry fellowship. During his time with the program, he helped his colleagues achieve Tulane's first-time ACGME (Accreditation Council for Graduate Medical Education) accreditation for their forensic program.

It was during his two years at Tulane that Dr. Scott met his long-time colleague and friend, Barbara McDermott, a child and forensic psychologist. Dr. McDermott fondly recalled sitting on the beach with him in Puerto Rico, during her first AAPL meeting. This was an opportunity to socialize outside of work and helped lead to a wonderful friendship and longstanding collaboration. While in Puerto Rico, Dr. Scott and McDermott also developed plans for several presentations to submit for the upcoming AAPL meeting in Denver, Colorado. Since that time, they have published or presented topics together well over 50 times. McDermott commented that she has always been struck by his tireless work ethic and dedication to completing every task with a smile.

Dr. Scott was awarded the prestigious Association for Academic Psychiatry Junior Faculty Development Award in 1998. He was one of six nationally recognized recipients of the honor. Also in 1998, he relocated and began his current tenure at UC-Davis. He saw UC-Davis as an ideal situation for him to establish a successful forensic fellowship program. By drawing on his experiences from Tulane, he quickly helped the UC-Davis forensic psychiatry fellowship achieve first-time accreditation through the ACGME. Over the years since it gained accreditation, he has continued to expand and develop the program.

McDermott was saddened when Dr. Scott left Tulane, but thrilled when he recruited her for her current position on the faculty at UC-Davis. She said that it has been an honor to work directly with him, witness his professional development, and see first-hand his relentless dedication to his students. Last year, he even took McDermott's postdoctoral student under his wing and treated him as one of his own. She stated, “I can't imagine anyone having a finer teacher. What I myself have learned from him is immeasurable.” McDermott indicated that there were too many anecdotes from the past 15 years of working with Dr. Scott for her to choose just one to share (although his rapping to her at the dinner table after a Tulane function jumped to her mind). McDermott concluded by saying that she truly appreciates Dr. Scott as both a close friend and a colleague.

In addition to directing the forensic fellowship, Dr. Scott has several roles at UC-Davis. He is a Professor of Clinical Psychiatry and chief of the Division of Psychiatry and the Law. He directs the Forensic Psychiatric Consultation Service at Napa State Hospital and provides psychiatric consultation to the Sacramento County Jail. At Napa State Hospital, he supervises the UC-Davis fellows, directly consults in complex cases, and provides regular didactics to the staff psychiatrists and psychologists. Napa State Hospital's appreciation of him is particularly apparent when watching the recruitment video that they distribute to all prospective applicants, in which his presence at the facility is repeatedly highlighted.

While at UC-Davis, he has provided additional education and consultation outside of the Department of Psychiatry. He annually organizes the Napa Forensic Visiting Scholars program, for which he invites two internationally regarded speakers to discuss pertinent topics with the local mental health community. During the peak of school violence, he was retained as the forensic psychiatric consultant to Florida's Hillsborough School District. In one of his more unique endeavors, he worked as a consultant to the National Football League (NFL). In that position, he developed a comprehensive violence risk assessment training and a syllabus for the NFL's substance abuse counselors.

Of course, his most influential responsibility at UC-Davis has been as Training Director of the Forensic Psychiatry Fellowship. In that role, he has affected the lives of many pupils over the years. Through his exceptional work ethic and teaching abilities, he challenges each fellow to maximize his potential. In addition to teaching the material, he imparts his wisdom about being an effective educator. In anticipation of the annual AAPL meeting, he works diligently on a panel along with the fellows. They develop the presentations over several months and rehearse them repeatedly before the AAPL meeting every year. Alumni utilize the skills they learn from this experience for the remainder of their careers.

He is devoted to his training program and strives to provide the best possible education. He challenges his fellows to maximize their abilities. They feel assured that the didactics presented during the year are well researched, current, and accurate. He not only works tirelessly on his own lectures, but he demands excellence from other faculty members as well. Although the fellowship year requires hard work and dedication, those who are up to the challenge become polished forensic psychiatrists. UC-Davis fellows leave with sharpened diagnostic skills, vastly improved writing abilities, and extensive forensic psychiatric knowledge.

During the fellowship year, his fellows are routinely exposed to his fascinating case list. Whenever possible, he allows them to attend his consultations with attorneys, depositions, and trial testimony. Preparing fellows to provide effective expert testimony is another of his primary objectives. One of his best teaching tools is his ability to channel a particularly savvy “Southern attorney” known as Mr. Jones who periodically surfaces to match wits with the fellows. Anybody with the ability to withstand his cross-examination is prepared for just about any future courtroom experience. He draws upon his extensive experience from past testimony to make the questions particularly challenging. His mantra is that he wants each fellow to learn from his own past mistakes.

It becomes apparent during the fellowship year that Dr. Scott's genuine motivation is his love of teaching. As anybody in academics quickly discovers, teaching generally does not reimburse as well as other endeavors. Some high-profile academicians expect trainees to help with their work, as a quid pro quo for teaching. Dr. Scott, however, is selfless. He spends his time carefully scrutinizing the fellows' work product and providing constructive feedback designed to improve their report writing abilities. In fact, he can often be found helping a fellow summarize records in the dank basement of the Napa State Hospital medical records building. He has been nationally recognized for his teaching abilities. In 2005, he was awarded the APA's Irma Bland Award for outstanding and sustained contributions to resident education. In 2008, he was awarded AAPL's Award for Outstanding Teaching in a Forensic Fellowship Program.

Dr. Scott has fostered an impressive network of graduates from the UC-Davis fellowship program. Alumni have gone on to become leaders in academic centers, community psychiatry systems, correctional settings, and the private practice community. The program effectively prepares its graduates for success in diverse settings. Each year, he organizes a dinner at the AAPL meeting for alumni and others affiliated with the program. Always planning ahead, he invites aspiring forensic psychiatrists to attend. This experience exposes them to the collegial environment that exists between the UC-Davis faculty and alumni of the program. The dinners are full of successful professionals whose careers have been molded by him. Former fellows commonly use this arena to recount a favorite “Charles story.” For instance, he once took a fellow along on a high-profile murder case in Miami, Florida. Excited about the case, he fetched his car from the hotel's valet and drove toward the jail while updating the fellow about the case. After an extensive interview with the defendant, they returned to the hotel. Staff from the hotel angrily confronted them upon their return. Apparently, Dr. Scott had driven off in the wrong car. Instead of his own red rental car, he had taken off in one belonging to a honeymooning couple.

While developing this biography, I contacted several of Dr. Scott's former fellows. A few common themes emerged from the responses. Several people commented that even after completing the fellowship, he remains a lifelong mentor. Former fellows routinely contact him with questions about forensic cases or projects. He takes the time to share his wisdom, even years after graduation. Numerous former fellows expressed that the year they spent with him continues to motivate them to this day. Several people also referenced his punctuality and constant attention to details. The only reported instance of his running late for an appointment was when his car literally caught on fire. He took pictures of the car as proof of the excuse for his tardiness. Most important, many former fellows referred to him as the most effective teacher they had encountered throughout their educational histories.

Specific responses that I received from many of Dr. Scott's former fellows highlighted his profound impact on their lives. One individual appreciated his fellowship experience so much that he actually named his son in honor of Dr. Scott. Another former fellow succinctly responded, “I have been blessed with many great mentors, but Charles was the best. He represents the highest standard of excellence.” The other responses were equally glowing.

Dr. Scott's impact on the field of forensic psychiatry has extended well beyond his excellence as the fellowship director at UC-Davis. He has authored over 70 book chapters and articles. He has given over 200 national lectures on a variety of topics, in addition to numerous regional lectures. He is the editor of the Handbook of Correctional Mental Health.² He is also co-editor, along with Elissa Benedek and Peter Ash, of the Principles and Practice of Child and Adolescent Forensic Mental Health.³ Each of these works is considered by many to be the preeminent text on the topic. He also served as chair of the national task force that examined ACGME guidelines for forensic psychiatry training programs.

His contributions to AAPL have been similarly impressive. He was a member of two AAPL task forces that drafted the organization's recommendations for addressing criminal responsibility and trial competency. He has been a member of the Association of Directors of Forensic Psychiatry Fellowships since 1996. He was president of that group from 2006 until 2011. Dr. Scott has served on many AAPL committees over the years, including the Peer Review Committee, the Rappeport Fellow Selection Committee, the Ethics Committee, the Sexual Offenders Committee, and the Program Committee.

Over the past few years, he has accepted even more of a leadership role in AAPL. He was appointed as a councilor from 2002 through 2005. He was Vice-President of AAPL from 2010 to 2011. Along with Christopher R. Thompson, MD, he coordinated the program for the 2011 Annual Meeting in Boston, Massachusetts. In addition to implementing the program for the meeting, they arranged three lunchtime speakers and a mock trial experience. Anybody who has been exposed to this process can appreciate the hard work that goes into those preparations. In 2011, he became the 38th President of AAPL. He will remain in this role until October 2012.

As a practicing forensic psychiatrist, Dr. Scott's reputation in the legal community is impeccable. He has been retained on cases throughout the country, many of which have been high profile. Attorneys frequently contact him based on feedback from colleagues who have worked with him in the past. He is board certified in general psychiatry, child and adolescent psychiatry, forensic psychiatry, and addiction psychiatry. This background has prepared him to be an effective expert in a broad array of cases. However, he does not rest on his impressive credentials. He has a thirst for knowledge that constantly pushes him to seek new information as it surfaces. On more than one occasion, I have seen him incorporate information that he learned from another conference presenter into his own lecture later the same day. He routinely takes writing courses, reads about presenting material effectively, and searches for new techniques to enhance his already masterful abilities as an educator.

His own determination commands excellence from everybody around him. David Spagnolo is a vital member of the UC-Davis Division of Psychiatry and the Law. In addition to managing all of the cases that come through the division, he is also the program coordinator of the forensic psychiatry fellowship. Spagnolo's work ethic, abilities, and organizational skills mirror Dr. Scott's. They work in harmony together. In concert with others, Spagnolo expressed his admiration for Dr. Scott. He commented that working with Dr. Scott pushes him to perform at his highest level. Spagnolo pointed to Dr. Scott's timely sense of humor as the quality that he enjoyed most about working with him. He concluded our conversation by saying, “It is a sincere honor to work for Dr. Scott.”

There are many talented, intelligent forensic psychiatrists throughout the country. What sets Dr. Scott apart in my mind is his ability to remain grounded and maintain his sense of humor at all times. Even the most challenging academic endeavors with him are made enjoyable due to his pleasant demeanor and sharp wit. It is clear that he genuinely enjoys being a forensic psychiatrist. Whereas many people would groan when confronted with three large boxes of records for a new case, he eagerly welcomes a new challenge. He likens himself to a detective, digging through the information in search of the truth. Throughout each new challenge, he maintains his enthusiasm.

For all of his abilities as an educator and forensic psychiatrist, Dr. Scott somehow manages to remain very well rounded. He is an excellent pianist. At the age of 12, he was invited to perform as the solo pianist with his state symphony orchestra, where he performed Mozart's 20th piano concerto in D minor, for an audience of nearly 10,000. He is likewise dedicated to his physical health and is a regular weightlifter. In fact, Arnold Schwarzenegger once had to wait at a Sacramento gym while Dr. Scott completed his bench press reps, perhaps with more vigor than usual. He is also an avid reader and can freely discuss topics ranging from classical literature to “verbal judo.” Les Miserables has been one of his favorite books since childhood. Even at a young age, he enjoyed the rehabilitation and redemption theme of the story.

When trying new things, Dr. Scott does not do anything partway. He recently took up running. Shortly thereafter, he decided to run a marathon. After joining a running group, he began the challenging, 18-week preparation. He read book after book about optimizing his training. His dedication eventually paid off when he completed the Paris Marathon in 2011. He even stopped briefly during the marathon to assist an older woman who had injured herself after a dangerous fall. His brother Hal, who accompanied him to Paris, marveled at his brother's ability to actually enjoy himself while completing the grueling run. After the race, while many other runners were tearfully recovering, Dr. Scott immediately transitioned to planning his post-race champagne celebration with his brother.

At this point, I can only wonder what the future holds for Dr. Scott. Having already accomplished so much, there is assuredly more in store. He is interested in traveling and has visited several intriguing sites. To aid in his travels, he is working on expanding his repertoire of languages. In addition to being fluent in German, he has been learning Spanish, Italian, and French. He is also interested in writing fiction. He has already outlined a crime novel that he plans to complete over the coming years. His history of involvement in unbelievable cases undoubtedly provides enough material to complete an entire series.

When Dr. Scott invited me to join his fellowship program at UC-Davis, he provided me with an opportunity for which I will be forever grateful. He has had a remarkable impact on my life and my career, providing me with incredible mentorship and always motivating me to perform at my highest level. I am honored to have the opportunity to continue working with him on a regular basis. In my own academic career, I will always strive to make a fraction of the difference in others' lives that he has made in mine. I have no doubt that he will continue to motivate and inspire others throughout the remainder of his career.

• © 2012 American Academy of Psychiatry and the Law