Restrictions on Sell Hearing References in an Insanity Defense Trial Do Not Violate Sixth Amendment
In State v. Gregory, 912 S.E.2d 357 (N.C. 2025), the Supreme Court of North Carolina affirmed the court of appeals’s denial of an appeal by a man sentenced to life imprisonment for a series of violent crimes. In a per curiam decision, the court upheld a prior ruling that the trial court did not violate the defendant’s Sixth Amendment right to confront witnesses when it barred defense counsel, during an insanity defense trial, from referencing the context of the state’s expert psychiatrist’s prior testimony at a Sell hearing. A dissenting justice wrote the opinion that is summarized here.
Facts of the Case
Mr. Kendrick Keyanti Gregory was convicted of a series of violent crimes stemming from events in 2015, including the first-degree murder and armed robbery of a pawn shop owner, the rape and kidnapping of a 15-year-old girl, the shooting and robbery of another individual, two additional assaults, another robbery, and possession of a firearm by a felon.
Soon after his arrest, Mr. Gregory was committed to Central Regional Hospital for an evaluation of his competence to stand trial. He was found incompetent to proceed and committed for restoration. In 2020, the state moved to forcibly medicate him to restore competence. At his Sell hearing on involuntary administration of medication, Dr. Nicole Wolfe, a forensic psychiatrist at Central Regional Hospital, testified about Mr. Gregory’s psychotic illness. She had evaluated him on multiple occasions between 2017 and 2020.
Dr. Wolfe testified that she did “not believe that [Mr. Gregory] would regain capacity without antipsychotic medication” (Gregory, p 358). In her view, Mr. Gregory’s psychosis was unlikely to improve without treatment, and he was therefore at risk of suicide and aggression. Before the Sell hearing concluded, Mr. Gregory resumed medication voluntarily, and he was found competent to stand trial shortly thereafter.
Mr. Gregory’s criminal trial began in 2021. The main question at trial was whether Mr. Gregory’s untreated mental disorder prevented him from understanding the nature and quality of his actions at the time of his criminal offenses. One of the state’s witnesses was Dr. Wolfe, who provided a “different picture of Mr. Gregory” than she had presented at the Sell hearing (Gregory, p 359). Dr. Wolfe now noted inconsistencies in his symptom presentation and suspected malingering. She now expressed that Mr. Gregory endorses “symptoms when it serves him” (Gregory, p 359). Dr. Wolfe concluded that Mr. Gregory’s mental illness did not prevent him from understanding the nature and quality or wrongfulness of his actions at the time of the 2015 crimes.
During cross-examination, defense counsel asked Dr. Wolfe about her previous findings that Mr. Gregory was not competent to stand trial and attempted to reference her testimony at the Sell hearing. The prosecution objected, and the court sustained the objection, barring any mention of forced medication or the Sell hearing, citing N.C. Rule of Evidence 403, which permits exclusion of relevant evidence “if its probative value is substantially outweighed by the danger of unfair prejudice, confusion of the issues, or misleading the jury, or by considerations of undue delay, waste of time, or needless presentation of cumulative evidence” (N.C. Gen. Stat. § 8C-1, R. 403 (2020)). Although the defense was able to question Dr. Wolfe about her testimony at the Sell hearing, including her statements about medication being necessary to restore Mr. Gregory’s competency and about discrepancies with prior reports, they were unable to contextualize these statements as occurring during an involuntary medication hearing. After deliberating for two days, the jury found Mr. Gregory guilty on all charges. Mr. Gregory appealed.
The Court of Appeals of North Carolina affirmed Mr. Gregory’s convictions (State v. Gregory, 291 N.C. App. 617 (N.C. Ct. App. 2023)). Per the records from the appellate court, Mr. Gregory had argued that the trial court had abused its discretion by limiting cross-examination of Dr. Wolfe, specifically regarding the Sell hearing and her statements about the need for forced medication, thereby undermining their challenge to her insanity opinion. The court, citing Delaware v. Fensterer, 474 U.S. 15 (1985) and Delaware v. Van Arsdall, 475 U.S. 673 (1986), emphasized that the Sixth Amendment’s Confrontation Clause guarantees only the opportunity for effective cross-examination and that trial courts may impose reasonable limits based on concerns such as harassment, prejudice, confusion of the problems, or marginal relevance. The court further found that any Confrontation Clause error was harmless because the defense was permitted to question Dr. Wolfe about her Sell hearing testimony and the evolution of her diagnostic opinions. The court concluded that the jury had sufficient context regarding Mr. Gregory’s mental state, including his unmedicated status at the time of the offenses and the clinical necessity of treatment, and that excluding direct references to the Sell hearing or forced medication did not impair the defense in challenging Dr. Wolfe’s credibility or suggesting bias. Following this decision, Mr. Gregory petitioned the Supreme Court of North Carolina for review.
Ruling and Reasoning
The Supreme Court of North Carolina affirmed the court of appeals’s decision in a per curiam opinion, without publishing an opinion detailing its reasoning. The entirety of the Gregory 2025 published opinion is that of the dissent.
Dissent
Justice Riggs wrote an opinion, joined by Justice Earls, stating that the trial court improperly limited Mr. Gregory’s cross-examination of Dr. Wolfe, thereby affecting the only contested issue at trial: his state of mind at the time of the crimes. Citing State v. Legette, 231 S.E.2d 896 (N.C. 1977), the dissent emphasized that even partial restrictions on cross-examination can violate the Confrontation Clause of the Sixth Amendment.
The dissent noted that Dr. Wolfe was the sole expert to testify that Mr. Gregory was legally sane and that the excluded material was “highly probative” of her credibility. It highlighted inconsistencies in Dr. Wolfe’s characterization of symptoms during her testimony at the Sell hearing, where she did not mention malingering, and her trial testimony, where she testified that Mr. Gregory was “manipulative” and “feign[ing] symptoms.” Without the context that her Sell hearing testimony supported the state’s effort to forcibly medicate Mr. Gregory, the dissent argued, the jury lacked crucial information in assessing whether the change in Dr. Wolfe’s opinion reflected bias because of her role as the state’s expert.
The dissent further criticized the trial court’s reliance on N.C. Rule of Evidence 403, noting that the court failed to articulate why the probative value of the Sell hearing’s purpose was substantially outweighed by any risk of prejudice. It emphasized that, when the state invokes a legal mechanism such as forced medication, this fact cannot be withheld from the jury because it may be “emotionally troubling.” Concluding that the limitation on cross-examination impaired the defense’s ability to challenge Dr. Wolfe’s credibility, the dissent asserted that Mr. Gregory’s Sixth Amendment rights were violated, particularly given the jury’s prolonged deliberations and apparent difficulty reaching a verdict.
Discussion
State v. Gregory demonstrates the broad discretion courts maintain in limiting cross-examination of expert witnesses, even on matters related to credibility. For forensic psychiatrists, this case underscores the delicate balance expert witnesses must strike in striving for objectivity, allowing their opinions to change when presented with new evidence while also combating concerns about bias.
The forensic psychiatrist must first consider carefully whether performing multiple evaluations for different parties presents a conflict of interest. If an expert conducts multiple evaluations in the same case, it is important to anticipate how earlier opinions, such as those given during a Sell hearing, may be perceived during subsequent legal proceedings. As evident in Gregory, where Dr. Wolfe conducted evaluations for competency, involuntary medication, and criminal responsibility, the defense may challenge shifts in expert opinion as evidence of partiality. Even if, as in this case, such context is not allowed to be fully discussed, forensic psychiatrists should clearly document the basis for any changes in opinion, especially if their opinions appear to align with their retaining party.
Gregory is instructive for forensic psychiatrists regarding the potential uses of their reports and testimony. Ensuring that expert opinions remain objective, internally consistent, and narrowly focused on the referral question is crucial not only for credibility in the trial court but also for the full life of the case, including possible appeals. Forensic psychiatrists should be mindful that their language, emphasis, and conclusions may be viewed through different legal lenses long after the evaluation is complete.
- © 2026 American Academy of Psychiatry and the Law
