State v. Cantrell

• Decision Date: 05 March 2008
• Docket Number: No. 30,250.,30,250.
• Citation: 2008 NMSC 016,179 P.3d 1214
• Parties: STATE of New Mexico, Plaintiff-Appellee, v. Dawna CANTRELL, Defendant-Appellant.
• Court: New Mexico Supreme Court

179 P.3d 1214

2008 NMSC 016

STATE of New Mexico, Plaintiff-Appellee, v. Dawna CANTRELL, Defendant-Appellant.

No. 30,250.

Supreme Court of New Mexico.

March 5, 2008.

John Bigelow, Chief Public Defender, Michael L. Rosenfield, Assistant Public Defender, Albuquerque, NM, for Appellant.

Gary King, Attorney General, Joel Jacobsen, Assistant Attorney General, Albuquerque, NM, for Appellee.

OPINION

MAES, Justice.

{1} In this appeal we determine whether ordering Defendant to submit to involuntary antipsychotic drug treatment for the sole purpose of establishing Defendant's competency to stand trial violates Defendant's due process rights. Following the United States Supreme Court's four-part test in Sell v. United States, 539 U.S. 166, 123 S.Ct. 2174, 156 L.Ed.2d 197 (2003), we conclude that Defendant's due process rights were not violated, and we affirm the trial court's order.

FACTUAL AND PROCEDURAL BACKGROUND

{2} On October 1, 2003, the Grant County Sheriff's Office received information that Defendant, Dawna Cantrell, killed her husband, Gentry Cantrell, by stabbing him with a knife; that she did so in self-defense; and that the knife was in a drawer in Defendant's van. Defendant was arrested and charged with an open count of murder and two counts of tampering with evidence.

{3} Based on an evaluation by Defendant's expert, Dr. Eric Westfried, defense counsel raised the question of Defendant's competency to stand trial. Defendant's pre-trial motion requested a neuropsychological evaluation to determine Defendant's competency to stand trial and to stay the proceedings pending a competency hearing. The court granted the motion and permitted both Defendant's expert and the State's expert, Dr. Edward Seigel, to evaluate Defendant.

{4} The experts found that Defendant suffers from a persecutory delusional disorder that causes her to believe that there is a conspiracy against her. While finding that Defendant's delusion is confined to Grant County and the perceived conspiratorial influence of two individuals, the experts determined that her delusion can become aggravated to include other persons and circumstances. The experts concluded that this delusional disorder makes it difficult for Defendant to assist her attorney in her defense. As a result of these findings, the parties stipulated that Defendant understood the nature and significance of the criminal proceedings against her and had a factual understanding of the criminal charges, meeting the first two criteria for trial competency. See UJI 14-5104 NMRA. The parties also stipulated that because Defendant was unable to assist her counsel in her defense, she was legally incompetent to stand trial under the third criterion for trial competency.

{5} Finding Defendant incompetent to stand trial, the court ordered Defendant to submit to a dangerousness evaluation. Dr. Siegel conducted the evaluation and issued a report in which he concluded that Defendant was not considered a dangerous person. Also in that report, Dr. Siegel commented on Defendant's competency to stand trial. Dr. Siegel noted that Defendant's mood and cognition were clearer and more controlled than during his previous evaluation of her. Dr. Siegel ascribed this improvement to Defendant's medication, which she had not been taking at the time of the previous evaluation. According to Dr. Siegel, Defendant seemed competent in a normal setting, but he believed that her anxiety would likely increase during courtroom proceedings, which would heighten her delusion. Dr. Siegel concluded that treatment with antipsychotic medication would strengthen Defendant's "psychological defenses" and establish her competency to stand trial.

{6} In response to Dr. Siegel's report, the trial court appointed a new forensic evaluator, Dr. Gerald Fredman, to re-evaluate Defendant's competency to stand trial. Dr. Fredman evaluated and interviewed Defendant and reviewed several records, including Dr. Westfried's and Dr. Siegel's evaluations. In his report, Dr. Fredman stated, "within a reasonable degree of medical certainty that [Defendant] understands the nature and significance of the proceedings against her," but she would have difficulty assisting her attorney with her defense due to the nature of her delusion. However, it was Dr. Fredman's opinion that Defendant would be able to assist her attorney if she were treated with antipsychotic medication.

{7} Predicated on Dr. Fredman's report, the State filed a motion asking the court to order Defendant to submit to a psychiatric examination for the purpose of prescribing antipsychotic medication and treating Defendant to trial competency. At the hearing on this motion, the court heard contrary testimony from two experts, Dr. Fredman, who testified for the State, and Dr. Westfried, who testified for Defendant.

{8} Dr. Fredman testified that he based his expert opinion on his evaluation of Defendant and on his personal experience as a psychiatrist. Dr. Fredman is a licensed psychiatrist with a sub-speciality in forensic psychiatry who has several board certifications from both psychiatry and forensic psychiatry boards. Dr. Fredman has been qualified to testify as an expert in competency matters hundreds of times. Although Dr. Fredman has extensive experience, he is neither a researcher nor an author in the field of forensic psychiatry. Dr. Fredman has been in private practice for almost thirty years and estimated he has fifty to seventy-five patients. Over the course of his career, Dr. Fredman has treated ten patients who suffered from a delusional disorder.

{9} Dr. Fredman's testimony was the basis for the court's finding that Defendant could be successfully treated to competency with antipsychotic medication. Dr. Fredman testified that Defendant would benefit from a combination of therapy and antipsychotic medication.¹ Dr. Fredman stated that it was "more likely then [sic] not" that this treatment would restore Defendant's competency to stand trial. Dr. Fredman based this conclusion on his own experience in treating patients suffering from delusional disorders. Dr. Fredman testified that over half of those patients responded favorably to treatment by showing a significant reduction in the level of their delusional symptoms.

{10} Dr. Fredman also testified concerning the medications' potential side effects that might disable defendant during trial. Dr. Fredman testified that "it's more likely then [sic] not" that such side effects would not occur with Defendant. However, Dr. Fredman advised the need for a medical assessment prior to initiating treatment, including a consultation with a cardiologist.

{11} Defendant's expert, Dr. Westfried, offered testimony based on clinical and research knowledge. Dr. Westfried is an experienced forensic psychologist whose practice exclusively consists of forensic psychology. Dr. Westfried testified that he is one of four board-certified forensic psychologists in New Mexico, and one of four hundred in the United States. As explained by Dr. Westfried, forensic psychology addresses issues of the law with research and clinical evaluations. His experience includes over one thousand forensic evaluations since 1995.

{12} Dr. Westfried's analysis was largely based on his interpretation of Defendant's thought process relating to treatment with antipsychotic medications. Dr. Westfried described Defendant as having a "tight" thought process, meaning that she could relate events in a logical, comprehensible order. Dr. Westfried explained that atypical antipsychotic medications (the type Dr. Fredman recommended for treating Defendant) are used to treat schizophrenia because they tighten the thought process by "diminish[ing] the frequency and severity of the looseness of associations." Dr. Westfried believed that antipsychotic medications would not improve Defendant's delusional symptoms because her thought process is not "loose."

{13} Dr. Westfried also countered Dr. Fredman's assertions by explaining that there is a lack of scientific literature addressing the effects of antipsychotics on delusional disorders in the context of competency to stand trial. He stated that there was no literature indicating that the medications Dr. Fredman recommended would have any effect on a patient suffering from a delusional disorder. Dr. Westfried expressed concern that a person suffering from a delusional disorder could be made competent to stand trial through treatment with antipsychotic medications when there is no research addressing that specific question.

{14} Relying on the United States Supreme Court's analysis in Sell, the trial court granted the State's motion. Sell articulates due process guidelines for ordering a defendant to submit to involuntary drug treatment for the purpose of achieving competency to stand trial. In this case, the trial court's order was tailored to the Sell factors:

THE COURT FINDS CLEAR AND CONVINCING EVIDENCE THAT:

. . . .

5) There is an important governmental interest in bringing the defendant to trial;

6) Administration of antipsychotic medication will substantially render the defendant competent to stand trial and is substantially unlikely to have side effects which will interfere significantly with the defendant's ability to assist counsel in conducting a defense;

7) The Defendant has participated in out-patient therapy for over a year and this or any other alternative, less intrusive treatments are unlikely to achieve substantially the same results;

8) Administration of antipsychotic medication is medically appropriate and in the patient's best medical interest in light of her medical condition.

See Sell, 539 U.S. at 180-81, 123 S.Ct. 2174. The trial court ordered Defendant to submit to a psychiatric evaluation for the purposes of selecting antipsychotic medication and monitoring Defendant's treatment with the medication. The court also ordered Defendant to take the medication as prescribed, if...