United States v. Buckingham

• Decision Date: 09 December 2020
• Docket Number: Case No.: 2:18-cr-376-RDP-SGC-2
• Parties: UNITED STATES OF AMERICA, v. JOHN LADD BUCKINGHAM, Defendant.
• Court: U.S. District Court — Northern District of Alabama

UNITED STATES OF AMERICA, v. JOHN LADD BUCKINGHAM, Defendant.

Case No.: 2:18-cr-376-RDP-SGC-2

UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF ALABAMA SOUTHERN DIVISION

December 9, 2020

MEMORANDUM OPINION ADOPTING THE MAGISTRATE'S REPORT AND RECOMMENDATION

Before the court is Defendant John Ladd Buckingham's Motion for Order of Competency to Stand Trial (Doc. # 44), Magistrate Judge Ott's Report and Recommendation (i.e., "R&R") (Doc. # 136), and the Government's Objection to Report and Recommendation (Doc. # 140). Defendant is an 87-year-old male suffering from dementia. (Docs. # 57, 70). The court, having considered all the evidence and for the reasons set forth below, finds that Defendant is currently incompetent to stand trial.

I. Procedural History¹

Defendant was indicted to twenty (20) counts for violating the Controlled Substances Act. (Doc. # 1). In Count One, the Government alleges that Defendant, then a licensed physician, conspired to distribute controlled substances "outside the usual course of professional practice and not for a legitimate medical purpose," in violation of 21 U.S.C. §§ 841(a)(1), 841(b)(1)(C), 846. (Id. at ¶¶ 20-41). In Counts Two (2) through Eighteen (18), Defendant is charged with unlawful distribution of controlled substances, in violation of 21 U.S.C. §§ 841(a)(1), 841(b)(1)(C), and 18 U.S.C. § 2. (Id. at¶¶ 42-44). Count Nineteen (19) charges that he unlawfully maintained a drug-involved premises, in violation of 21 U.S.C. § 856(a)(1). (Id. at ¶¶ 45-46). And, Count Twenty (20) alleges that he conspired with others to launder money, in violation of 18 U.S.C. § 1956(h). (Id. at ¶¶ 47-58). These types of conspiracies and activities are related to what are colloquially known as "pill mills." The Government alleges that these criminal activities occurred during the period from January 1, 2012 through December 31, 2015. (Doc. # 136 at 1).

After being indicted to the charges, Defendant pleaded not guilty and entered an insanity defense pursuant to Federal Rule of Criminal Procedure 12.2. (Docs. # 44, 46, 104). Defendant requested a hearing so that the court can determine whether he was competent to stand trial. (Docs. # 46, 104). Defendant's counsel supported the position that Defendant is incompetent to stand trial with Dr. H. Randall Griffith's forensic neuropsychological evaluation. (Doc. # 57). In response, the Government moved for a psychiatric evaluation of Defendant (Doc. #49). Defendant then reversed course and moved to withdraw his insanity defense and request for a competency hearing, which the government opposed. (Docs. # 56, 59). He also moved to dismiss the charges against him under Federal Rule of Criminal Procedure 48. (Doc. # 104).

Following this crossfire of motions, the court ordered an independent psychiatric evaluation of Defendant. (Doc. # 62). The court ordered Defendant to meet with Dr. Rocksheng Zhong for at least two psychiatric evaluation sessions so that Dr. Zhong could opine on Defendant's condition. (Id.; Docs. # 57, 126-2). The court further encouraged those who frequently interact with Defendant to meet with Dr. Zhong. (Doc. # 62). Dr. Zhong has now filed his evaluation. (Doc. # 70).

II. Expert Reports, the Competency Hearing, and the Government's Objections

At this stage, the court has before it a well-developed record of Defendant's mental health and Judge Ott's R&R. In reviewing the R&R (Doc. # 136) and the Government's Objections to the R&R (Doc. # 140), the court has evaluated the following evidence.

A. Dr. Griffith's Report

On February 28, 2019, Dr. H. Randall Griffith, a board-certified clinical neuropsychologist, submitted a neuropsychological evaluation of Defendant to the court. (Doc. # 57). Dr. Griffith's conclusion is that "Dr. Buckingham lacks sufficient present ability to assist in his defense by consulting counsel with reasonable degree of rational understanding of the facts and legal proceedings against him." (Id. at 9).

Dr. Griffith's evaluation was anything but conclusory. Rather, his conclusions are supported by an in-depth analysis of Defendant's condition. In conducting his evaluation, Dr. Griffith reviewed Defendant's health records and personal information, interviewed Defendant's family members, reviewed Defendant's correspondence, and interviewed Defendant. (Id. at 1). He also administered several psychological tests to measure Defendant's cognitive functioning. (Id. at 6). The tests show that some of Defendant's cognitive abilities are impaired while others remain proficient. (Id. at 8). Specifically, Defendant's "attention, expressive language, visual skills, delayed memory, and executive function" are all impaired while his "immediate memory and abstraction" are "intact." (Id.).

Based on all the information available to Dr. Griffith, especially the psychological test results, which showed that Defendant's "overall cognitive severity" was "moderately impaired" based on his age and estimated "premorbid functioning," he opined that Defendant suffered from a "Major Neurocognitive Disorder" (i.e., dementia). (Id. at 6-7). He also concluded that Defendant's cognitive deficiencies were not the result of malingering or any other disorder. (Id. at 8).

Dr. Griffith found that Defendant's condition leaves him unable to perform important tasks to assist counsel in his defense. This is so, according to Dr. Griffith, because Defendant is "highlydistractible and unable to consistently maintain train of thought, [has] severe memory loss, particularly after an intervening time period, and [has] impairments in divided attention and mental flexibility, which would render him unable to hold information in consciousness and be able to rationally make decisions regarding such information." (Id. at 9-10).

B. Dr. Zhong's Report

Upon the Government's request, the court ordered an evaluation of Defendant. (Doc. # 62). Dr. Rocksheng Zhong, a forensic psychiatrist, evaluated Defendant and filed a report containing his findings. (Docs. # 70). Dr. Zhong evaluated Defendant for six and one-half hours on two separate occasions. (Id. at 1). Dr. Zhong also reviewed Dr. Griffith's report, the tests conducted by Dr. Griffith, Defendant's medical records, and questioned Defendant's daughter, attorney, and primary Psychiatrist. (Id. at 1-2). In is his opinion (and his opinion is consistent with that of Dr. Griffith), Defendant suffers from dementia (Id. at 12). Dr. Zhong also agrees with Dr. Griffith that Defendant's dementia renders him unable to assist his counsel in adequately preparing for his defense. (Id. at 11-12).

Dr. Zhong explained why Defendant's dementia causes him to be incompetent to stand trial. His conclusion, based on his interview, is that "[Defendant] did not demonstrate an understanding of the charges against him, though [he] did demonstrate an understanding of general court procedures and personnel." (Id. at 9). Defendant was able to discuss the role of the judge, the jury, the prosecution, "courtroom decorum," and the difference between proceeding to trial and pleading guilty in abstract terms. (Id. at 10). Similarly, Defendant was able to discuss the types of crimes he is charged with in the abstract. (Id. at 9). But, when discussing his proceedings, Defendant struggled to engage with Dr. Zhong. For example, he was unable to explain how the crime of conspiracy to distribute a controlled substance applied to the conduct the Government alleges. (Id.). Defendant was also unable to recall the allegations in the Indictment for the conspiracy to commit money laundering charge. (Id.).

During the second evaluation period, Dr. Zhong reports that he observed the following:

I attempted to educate [Defendant] about the allegations listed in the indictment. Despite extensive and repeated efforts to provide information about the charges, [Defendant's] deficits persisted. On review, following over two hours of discussion concerning his legal situation, he said, "The number 15 sticks in mind, but you said there were more [charges] than that...[I am accused of] writing prescriptions for narcotics that I shouldn't have...I don't remember the legal term...You said something about maintaining a business or something to do with that, but I don't know the name of it...There was Conspiracy but I don't remember what the conspiracy was about." Regarding the associated penalties, he said, "A whole lot of years in jail." He said incorrectly that his potential fines totaled "75 million dollars."

. . . .

[Defendant] did not demonstrate the ability to assist in his defense. He was not able to engage in a rational discussion of his legal situation, and he did not exhibit the ability to work effectively with his defense attorney.

[Defendant's] memory impairments prevented him from participating in a meaningful dialogue about his case. He had difficulty retaining and assimilating information pertaining to his legal situation. Without an understanding of his charges, he could not go on to discuss legal strategy, evaluate aspects of his case, or explain the rationale behind his conclusions. At times, [Defendant] could have superficial discussions about legal matters, based on his general knowledge about courts. He could also, in the moment, discuss a particular item for which he had just been provided information. However, when asked to combine multiple pieces of data over a sustained period or when questioned about the specifics of his case, he often replied, "I don't know."

. . . .

[Defendant]'s cognitive impairments likewise interfered with his ability to assist properly in his defense. Without foundational knowledge about his charges, [Defendant] would be unable to follow testimony for contradictions and errors, bring relevant information to his attorney's attention, testify and be cross-examined, understand instructions and advice, and make rational and informed decisions about the handling of his case. [Defendant] had some insight about his deficits, and both he an

...