State v. Cone
| Decision Date | 24 August 1999 |
| Citation | 3 S.W.3d 833 |
| Parties | (Mo.App. W.D. 1999) Sate of Missouri, Respondent v. William D. Cone, Appellant WD55518 0 |
| Court | Missouri Court of Appeals |
Appeal From: Circuit Court of Lafayette County, Hon. Robert H. Revenhill
Counsel for Appellant: Joseph Hadigan
Counsel for Respondent: David Cosgrove
Opinion Summary: Psychiatrist William D. Cone appeals from a jury determination finding him guilty of six counts of first degree sexual assault, section 566.040, and 13 counts of first degree deviate sexual assault, section 566.070, as a result of sexual relations with two of his patients.
Division holds: (1) There was sufficient evidence for the jurors to conclude that the victims were unable to understand that their conduct was sexual in nature and they were mentally incapacitated under the definition contained in section 556.061(13).
(2) The state's experts' testimony, regarding the credibility of the victims' statements, was permissible in order to allow the experts to establish a basis for their diagnosis and opinions. The trial court did not abuse its discretion in admitting such testimony.
William D. Cone, a psychiatrist, was found guilty by a jury in Lafayette County Circuit Court, of six counts of first degree sexual assault, section 566.040, RSMo 1986, and 13 counts of first degree deviate sexual assault, section 566.070, RSMo 1986, as a result of sexual relations with two of his patients. The court sentenced him to 19 consecutive terms of seven years each. He appeals from these convictions, claiming that the evidence was insufficient to prove that the victims were "mentally incapacitated," and that the trial court erred in allowing the state to present expert testimony that the victims were credible.
The defendant began practicing psychiatry in West Plains, Missouri, in 1979. Rebecca and Jean were his patients.1 The defendant practiced until 1994 when, at 70 years old, he lost his license as a direct result of the facts recited herein. Subsequently, in January 1997, the defendant was charged by information with sexually assaulting Jean, and encouraging another person to do so on one occasion, and sexually assaulting Rebecca, both between November 1993 and January 1994.2 At trial, the defendant did not dispute that he engaged in sexual relations with both women. His contention at trial and on appeal was that the women were not "mentally incapacitated," as required for a conviction under section 566.040 and section 566.070. With respect to this issue, the state presented the testimony of three experts, the two victims and several other witnesses. The defendant also testified. The evidence, which supports the verdicts, is as follows.
Rebecca first sought psychiatric treatment when she was 12 years old for problems related to a troubled childhood. In the Fall of 1993, Rebecca was involuntarily hospitalized by the defendant. She had been receiving treatment from the defendant since 1988, when she was 26 years old. He diagnosed her with bi-polar disorder, mixed type, borderline personality disorder, and substance abuse, primarily from her overuse of prescription medications. The hospital records showed that the defendant considered Rebecca's judgment so impaired that she could not make the decision to leave against medical advice. She was discharged from the hospital on September 26, 1993. The defendant's discharge notes stated that Rebecca had "poor judgment" and that her prognosis was "guarded." She was discharged with Prozac, Trazodone, Buspar, and Vistaril. It was a little over a month later that the defendant commenced having a sexual relationship with her.
Following this hospitalization, the defendant encouraged Rebecca to become more trusting by discussing sexual fantasies. The defendant's "treatment" progressed from discussion of sexual fantasies to actual sexual contact. The defendant's discussions about sex were timed to tragic past events in Rebecca's life that caused her to be distraught and upset. It was during this time that the defendant started his "reparenting" therapy as a prelude to their sexual relationship.3 In late 1993, the defendant told her that her condition was worsening and convinced her that if they had sex, it would help her treatment because she needed the nurturing she never received from her mother. The defendant gave her two pills and then they engaged in sexual intercourse and oral sex at his office. She testified that "[e]very time I saw him [after the initial sexual encounter] I had to give him oral sex" as part of the "nurturing process." She further testified that she did not enjoy the sexual contact, but believed it to be a part of her treatment. The sexual contact continued for approximately three months, until she got "high enough and drunk enough" to tell her family. On one previous occasion, while being forcibly medicated and restrained, Rebecca attempted to reveal the sexual aspects of her therapy. The defendant told her if she told anyone about the sexual aspect of her therapy, that he would have her involuntarily committed to a state mental hospital. She then tried to commit suicide.
Rebecca's psychiatric treatment with the defendant was very stormy. She was frequently angry and depressed, was using a variety of drugs and alcohol, and was often restrained, forcibly medicated and involuntarily hospitalized when she would not cooperate. She was involuntarily committed "several" times while under the care of the defendant.
During the treatment, the defendant prescribed Prozac, Trazodene and Klonopin for Rebecca. The defendant would only provide her with medication (, samples of Xanax) when she had "done a good job."4 On one occasion, the defendant showed Rebecca a gun that he kept in his office for "unruly patients." She took the incident as an implied threat and it frightened her because she considered herself to have been unruly. She testified that the defendant was her psychiatrist, but she also "trusted him as a father figure."
Dr. Stephen Jarvis, a board certified psychiatrist, was assigned by the Department of Mental Health to evaluate the defendant's patients. Dr. Jarvis reviewed the extensive medical records of both women, and the defendant's treatment notes. He then spent approximately two hours interviewing each victim. At trial, he testified as to the reasons why sexual relations between physicians and their patients are prohibited and to the concept of transference in which psychiatric patients have inaccurate preconceptions regarding their doctor's intelligence, wisdom and ability to heal.
Dr. Jarvis testified as to Rebecca's family background, lengthy mental health history and diagnosis, and the treatment she received from the defendant. In order to assess Rebecca for malingering, Dr. Jarvis had to determine whether her story was internally consistent, whether it made sense from one part of the story to the other, whether it fit the facts available from outside sources, and if what she was telling him fit the nature of her illness. He testified, over objection, that it was part of his diagnosis to determine whether what Rebecca and Jean were telling him during his evaluation interviews was true, and to determine if their perceptions were distorted. Based on these criteria, he testified that he could rely on her statements to him as truthful. In his mental status examination, Dr. Jarvis testified that, due to Rebecca's mental condition, her dependant relationship on the defendant, and her addiction to prescription drugs, she would be extremely fearful of having her therapist and her medication taken away from her. In this context, he stated that Rebecca had the emotional age of a small child with respect to her relationship with the defendant, and that her intellectual capacities would be irrelevant in such a relationship. Dr. Jarvis considered Rebecca very depressed and anxious. He described her as "very, very fragile and shaken."
He concluded, within a reasonable degree of medical certainty, that Rebecca was not able to appreciate the nature of her sexual conduct with the defendant because of her mental illness and her belief that the conduct was part of her treatment. Additionally, he opined that she was unable to express her unwillingness to act because of her illness, as well as her dependence on the defendant and the prescription medication he was providing her.
Dr. Richard Scott, a psychologist and certified forensic examiner, also evaluated Rebecca. He reviewed her medical records and conducted a three-hour interview. Dr. Scott is employed by the Missouri Department of Mental Health as the Program Director for the Forensic Evaluation Program. During the interview, he described Rebecca as very, very nervous, she had a tremor in her hands, her voice quivered, and she was very, very anxious. He diagnosed her as having a personality disorder with dependant features, a severe bi-polar disorder, post-traumatic stress disorder related to her history of rapes, and Benzodiazepine dependence. He believed that Rebecca was suffering from these disorders at the time she was sexually abused by the defendant.
Dr. Scott explained how Rebecca's dependent personality, coupled with her long-term transference with the defendant, worked together to prevent her from understanding the nature of her conduct. He testified that transference in a patient-therapist relationship can be manipulated to push a person into having sex, even if they did not want to, as with Rebecca, in the form of the "reparenting" therapy. He testified:
[W]hen he started saying what you need is this form of treatment, and gives her a theoretical rationale of sorts for that treatment, she is going to believe it. So, for example, he reportedly said that she had been weaned from breast-feeding too early and that in order to address that conflict that came from being weaned too early, she...
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