Randall depo Flashcards
(315 cards)
1
Q
Are there different specialties other than clinical and forensic?
A
There are human factors (more psychology and engineering). There’s neuropsychology, clinical psychology, aspects of clinical psychology, forensic psychology.
2
Q
What does “clinical” mean?
A
Clinical means treatment of a behavioral health issue.
3
Q
What does “forensic” in forensic psychology mean?
A
Forensic refers to the forum, the forensicist. Forensic psychology is the intersection of a legal issue and a field of study, in this case behavioral health. Specifically there can be civil, family law and probate, or criminal proceedings where you have an intersection of a psychological issue and behavioral health.
4
Q
What would you call an 18-207 report?
A
A forensic mental health assessment per 18-207. MSO
5
Q
When did you first start doing FMHAs?
A
In the 1990s in Ohio
6
Q
What kind of assessments did you do when you first started conducting FMHAs?
A
They varied. E.g., (1) criminal assessments for competence to stand trial; (2) family law assessments [child custody, psyc evals]; (3) some for assessments for NGRI.
7
Q
When did you move to Texas?
A
Gradually moved in 2010 and relocated by 2011.
8
Q
Why did you move to Texas?
A
(1) chronic sinusitis due to proximity to the Great Lakes; drier atmosphere in Texas; (2) have a son who lives in Austin; (3) winter weather is warmer in Texas
9
Q
Who coined the term “forensic mental health assessment?”
A
Kirk Heilbrun
10
Q
What is an FMHA?
A
It’s an assessment of a person’s mental condition and defect.
11
Q
Why did Mr. Heilbrun coin this term?
A
Standardize terminology in a field that was highly specialized and very localized in the 70s, 80s and 90s.
12
Q
When you started doing FMHAs, were there guidelines on how to write them?
A
Yes there were guidelines. They were codified “to some extent.”
13
Q
When you started writing FMHAs, what guidelines did you follow initially?
A
[For criminal work] - there were guidelines from experts like Thomas Grisso, Melton. SGFP and APA ethical standards.
14
Q
When did the APA provide standards? Different standards for different evals including psych assessment and evaluation, specialty guidelines fp, record keeping etc
A
EPP 1990 SGFP 1991
15
Q
Is there an updated edition of the standards and guidelines that you follow today?
A
There are multiple standards and guidelines that I follow and yes they have been revised. SGFP 2013. Record keeping 2007. EPPCC 2017.
16
Q
Can you name the standards and guidelines?
A
There are numerous standards and guidelines from at least 7 different organization. What are you interested in.
17
Q
What guidelines do you follow specifically for criminal cases?
A
(1) Both the APA ethical standards for professional practice 2017 and the standards and guidelines for forensic psychology 2013 would be primary.
(2) With testing issues, there is a nod to forensic use in the American Educational Research Association 2014 guidelines.
(3) For psychosexual evals, the Association for the Treatment of Sexual Abusers (ATSA) 2014 guidelines.
(4) For assessing abuse allegations with children, the 2017 American Professional Society on the Abuse of Children has guidelines.
18
Q
Are those guidelines followed by forensic practitioners that are writing FMHAs as a community?
A
Yes, for those who are in the know.
19
Q
Based on your discription, is dissimulation an important part of an FMHA?
A
Yes
20
Q
What kinds of tools do you use to figure out the presence of dissimulation?
A
It depends on the issue. SVT, PVT, and dissim built into a test
21
Q
What kind of issues could there be?
A
Performance and symptom issues are the primary distinctions.
22
Q
What are “performance issues?”
A
What level of effort is a person putting forth to do a test or participate in an evaluation.
23
Q
Examples of performance issues
A
Being lackadaisical, disengaged, not putting in a lot of effort.
24
Q
How do those types of performance issues impact the test or evaluation?
A
It could cast them in an unfavorable light - negative impression management - through poorer test performance due to poor effort
25
Can you define "symptom?"
Symptoms would be to assess the likelihood that the presentation of my symptoms are indeed accurate and not overstated or understated.
26
What is Saint Elizabeth's in Washington?
Teaching hospital of forensic psychology for years. They have a well-known forensic unit.
27
When you look at these guidelines, do they tell you how you should conduct a FMHA?
To some extent, they tell you steps that you must or should take. But, they do not provide the process for how to do a particular specific evaluation or assessment.
28
Example of this?
The guidelines will inform you that you need to tell the litigant that their conversation, depending on who retained me, is or is not confidential, that they do not have to participate ... etc. This is notification.
29
When you're doing these criminal FMHAs, what is the goal of writing that assessment.
The goal is to address a psycholegal issue.
30
Were you retained to answer a question in this case?
Yes. D mental condition and defect.
31
Were you appointed in this case?
No.
32
Were you retained in this case?
Yes.
33
When were you retained?
Approximately 11-12-18.
34
Where do you start with gathering information about the person that you're going to evaluate?
Psycholegal issue, discovery, meet litigant
35
Did you request all the discovery in this case?
Yes.
36
Were you provided with everything that you requested?
How would I know?
37
Do you feel you had enough information in this case? To come to your opinion?
Yes.
38
In your report there was a list of information, correct?
No. There was a list of records.
39
Is Exhibit 1 a true and accurate depiction of your report that you prepared in this case?
It is.
40
Starting on page 77, that is the beginning of the records that you reviewed for this case?
Yes
41
So that's all the information that you reviewed in writing this report?
Records plus discovery provided that may not have been listed and other incidental research
42
(no question - a continuation from card 44)
We have an assistant who prepares the appendix, and given the voluminous nature and the way the documents are frequently embedded in discovery, I would warrant that she does a good job, but I'm not going to say it's perfect because what you and I might consider to be a document that should be listed may simply be embedded in a discovery dump.
43
When you first met with the defendant in this case, you said it was on what date?
11-16-2018
44
What other dates did you meet the D
11-16-18, 4-17-19, 8-26-19, 8-27-19, 8-28-19, 11-21-19, 1-28-20, 2-13-20, 6-17-20, 7-13-22 TOTAL 10 for 29.90 hours $52,666.93
45
So when you first met with him on the 11-16-18, how did that meeting go? Where was it?
Recall CCU conference. Chalenging due to his mental condition.
46
Who was in that meeting?
Me, Mr. Diaz, Mr. Scou, Ms. Enterkine
47
How long did the meeting last?
2 hours
48
When writing this report, is the diagnosis important?
Depends on the status or the nature of the psycholegal question, and it depends on the jursidiction.
49
What about for this case?
Is a dx important? I would say not necessarily at all. There's divergent views on the use of a diagnosis for a mental state exam.
50
Why do you put a dx in your FMHA?
Primary reason: in this state, for many psycholegal issues a dx is required. So a 19-2522 or an 18-211, they require a dx. For an 18-207, there is no such requirement.
51
What is functional behavior?
This is how a person acts (functional abilities) and behaves in real life.
52
Is that definition you have for functional behavior a clinical definition?
What does "clinical definition" mean?
53
Is there a clinical definition for functional behavior?
Clinical - DSM-5. But why clinical? Forensic is target.
54
Do you follow Grisso & Heilbruns approach?
Yes. I'm not diagnostically driven.
55
Grisso and Heilbrun are people you are familiar with in doing these criminal FMHAs?
Yes.
56
You say you're not diagnosis driven.
Correct.
57
It appears you still diagnose people while doing these FMHAs?
Depending on the jurisdiction and nature of the assessment.
58
What states do you practice in?
I'm licensed in Oregon, Idaho, Florida, Texas, and interjurisdictional practice in about 34 other states
59
So you're practicing in Texas starting in 2011 and then you move up to Idaho when?
Established a parttime dwelling in Idaho around 2015
60
Are you still practicing in Texas?
Yes
61
Just forensic work in Texas?
Yes.
62
Where are you testifying in the past 6 months?
(checks database) CR26
63
For that testimony, is that all related to criminal FMHAs?
No
64
Just since June. What's the percentage of criminal testimony versus we'll say other testimony, civil, family?
CR26
65
What kind of cases?
All kinds. A handful of civil. Initially more family law and now it's more criminal. 23 CR 4 CV 21 FL
66
Can you give me a percentage?
47% criminal.
67
**How many are the 18-207?
Table 4-22 **
Thru 7-18 18-211s; 8 18-207s; 51 19-2522s; and 2 coerced confession reports.
68
Let me strike that question. I can ask a better one. What would the situation be where you wouldn't generate a report after conducting a FMHA?
Situation?
69
When you use "odd behavior" in your report, do you have a definition for what odd behavior is?
Odd is probably a very general description. Unusual behavior. Have to see the report for context.
70
So when you use "odd behavior" in a report, is that a clinical term?
Define "clinical terms." (If expert term, then yes in MSE or DSM-5 and other treatises)
71
Is there a definition in the forensic psychology community for "odd behavior," or is that your term?
There is not one definition that is definitive. The term is used in the forensic community.
72
You did provide a diagnosis in this report, right?
Yes
73
Where is your diagnosis in your report?
Schizophrenia paranoid type pg 65
74
Do you use either of these in helping diagnose a patient with a particular mental disease or defect?
I do.
75
What's the difference?
ICD-11, and the International Classification of Disease in general, has been the diagnostic language and coding used by the international community. The Diagnostic and Statistical Manual by the American Psychiatric Association, the DSM, had been used to define mental disorders. So there's a DSM-2, 3, 4, and now 5.
76
So you say schizophrenia is a spectrum.
Yes.
77
Diagnoses .... So we have these different diagnoses, and along the spectrum is this schizoaffective disorder.
Yes.
78
Now, which diagnostic criteria -- actually, can you explain what diagnostic criteria means?
In the DSM-5 for any diagnosis they have what are specifically called criteria. You have to meet one, two, three, or two of one in a certain time period and so forth. So that's diagnostic criteria per the DSM-5.
79
Which of the DSM-5's diagnostic criteria did you rule in in this case?
I believed and ruled in that he had major depressive disorder, and ruled in and believed that he had schizoaffective disorder with where I believe he was functioning with likely schizophrenia.
80
When you consulted DSM-5, what are their criteria for diagnosing schizophrenia?
Do you literally want me to go through the criteria per the DSM-5?
81
Sure
Okay.
82
Unless you know it off the top of your head.
I prefer to go back to the source document. That way, if I, for some reason, have a hiccup and miss one minor point, it won't come back to greet me later.
83
(continuing schizophrenia criteria)
Schizophrenia, diagnostic criteria they have A through F. So criteria A: Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3). And then they have five manifestations: (1) delusions; (2) hallucinations; (3) disorganzed speech, namly, for example, frequent derailment or incoherence; (4) grossly disorganized or catatonic behavior; and (5) negative symptoms, for example, diminished emotional expression or avolition.
84
(continuing schizophrenia criteria)
B: For a significant portion of the time since the onset of the disturbance, level of functioning in one or more major areas, such as work, interpersonal relations, or self-care, is markedly below the level achieved prior to the onset (or when the onset is in childhood or adolescence, there is failure to achieve expected level of interpersonal, academic or occupational functioning).
85
(continuing schizophrenia criteria)
C: Continuous signs of the disturbance persist for at least 6 months. This 6-month period must include at least 1 month of symptoms ( or less if successfully treated) that meet Criterion A (active-phase symptoms) and may include periods of prodromal or residual symptoms. During these prodromal or residual periods, the signs of the distrubance may be manifested by only negative symptoms or by two or more symptoms listed in Criterion A present in an attenuated form, for example, odd beliefs, unusual perceptual experiences.
86
(continuing schizophrenia criteria)
D: The schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either (1) no major depressive or manic episodes have occurred during active-phase symptoms, or (2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
87
(continuing schizophrenia criteria)
E: The disturbance is not attributable to the physiological effects of a substance, for example, a drug of abuse, a medication, or another medical condition.
F: If there is a history of autism spectrum disorder or a communication disorder or childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms of schizophrenia, are also present for at least 1 month (or less if successfully treated).
88
(continuing schizophrenia criteria)
Then it goes on to "Specify if." So to continue: "The following course specifiers are only to be used after a 1-year duration of the disorder and if they are not in contradiction to the diagnostic course criteria."
"First episode, currently in acute episode: First manifestation of the disorder meeting the defining diagnostic symptom and time criteria. An acute episode is a time period in which the symptom criteria are fulfilled."
"First episode, currently in partial remission: Partial remission is a period of time during which an improvement after a previous episode is maintained and in which the defining criteria of the disorder are only partialy fulfilled."
"First episode, currently in full remission: Full remission is a period of time after a previous episode during which no disorder-specific symptoms are present."
89
(continuing schizophrenia criteria)
"Multiple episodes, currently in acute episode: Multiple episodes may be determined after a minimum of two episodes (... after a first episode, a remission and a minimum of one relapse).
"Multiple episodes, currently in partial remission."
"Multiple episodes, currently in full remission."
"Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining for the majority of the illness course, with subthreshold symptom periods being very brief relative to the overall course."
90
(continuing schizophrenia criteria)
And then "Unspecified."
"Specify if: With catatonia (refer to the criteria for catatonia associated with another mental disorder, pages 119-120 for definition).
"Coding note: Use additional code 293.89 (F06.1) catatonia associated with schizophrenia to indicate the presence of teh comorbid catatonia."
"Specify current severity: Severity is reated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (See Clinician-Rated Dimensions of Psychosis Symptom Severity in the chapter 'Assessment Measures')."
"Note" Diagnosis of schizophrenia can be made without using this severity specifier."
91
Now, in diagnosing schizoaffective disorder, what's the diagnostic criteria listed?
Schizoaffective disorder diagnostic criteria:
"A: An uninterrupted period of illness during which there is a major mood episode (major depressive or manic) concurrent with criterion A of schizophrenia. Note: The major depressive episode must include Criterion A1: Depressed mood."
"B: Delusions or hallucinations for two or more weeks in teh absence of a major mood episode (depressive or manic) during the lifetime duration of the illness."
"C: Symptoms that meet criteria for a major mood episode are present for the majority of the total duration of the active and residual portions of the illness."
"D: The disturbance is not attributable to the effects of a substance (for example, a drug of abuse, a medication) or another medical condition."
92
(continuing schizoaffective criteria)
"Specify whether: 295.70 (F25.0) bipolar type. This subtype applies if the manic episode is part of the presentation. Major depressive episodes may also occur."
"295.70 (F25.1) depressive type. This subtype applies if only major depressive episodes are part of the presentation."
"Specify if: With catatonia (refer to the criteria for catatonia associated with another mental disorder, pages 119-120 for definition)."
"Coding note: Use additional code 293-89 (F06.1) catatonia associated with schizoaffective disorder to indicate the presence of the comorbid catatonia."
93
(continuing schizoaffective criteria)
"Specify if: The following course specifiers are only to be used after a 1-year duration of the disorder and if they are not in contradiction to the diagnostic course criteria."
"First episode, currently in acute episode: First manifestation of the disorder meeting the defining diagnostic symptom and time criteria. An acute episode is a time period in which the symptom criteria are fulfilled."
"First episode, currently in partial remission: Partial remission is a time period during which an improvement after a previous episode is maintained and inw hich the defining criteria of the disorder are only partially fulfilled."
"First episode, currently in full remission: The full remission is a period of time after a previous episode during which no disorder-specific symptoms are present."
94
(continuing schizoaffective criteria)
"Multiple episodes, currently in acute episode: Multiple episodes may be determined after a minimum of two episodes (for example, after a first episode, a remission and a minimum of one relapse).
"Multiple episodes, currently in partial remission."
"Multiple episodes, currently in full remission."
"Continuous: Symptoms fulfilling the diagnostic symptom criteria of the disorder are remaining for the majority of the illness course, with subthreshold symptom periods being very brief relative to the overall course."
95
(continuing schizoaffective criteria)
"Specify current severity: Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (See Clinician-Rated Dimensions of Psychosis Symptom Severity in teh chapter 'Assessment Measures')."
"Note: Diagnosis of schizoaffective disorder can be made without using this severity specifier."
"Note: For additional information on development and course age-related factors, risk and prognostic factors, environmental risk factors, culture-related diagnostic issues, and gender-related diagnostic issues. (See the corresponding sectins in schizophrenia bipolar I and II disorders and major depressive disorders in their respective chapters.)"
96
When you diagnosed the defendant in this case, Mr. Diaz, what diagnostic criteria of schizophrenia disorder did you rule in?
REPHRASE TO SCHIZ
97
So if I hear you correctly, you weren't able to rule any of the criteria out?
Given the nature of the evaluation, and the acknowledgement that this is retrospective, and we're relying on multiple sources of information, that is my best opinion on the diagnosis that would fit.
98
So you weren't able to rule anything out?
Given what I just said, that's correct.
99
Under diagnostic criteria A for schizoaffective disorder, it relates back to criterion A of schizophrenia. Is that a correct statement?
That's correct.
100
So when you looked at criterion A of schizophrenia, what were you able to rule in?
There are delusions, hallucinations, there is disorganized speech, there is disorganized motor activity, and there is negative symptoms. So I think without any doubt from what I saw, there were delusions and there was avolition in terms of negative symptoms. There is some evidence there was some psychomotor disorganization in terms of just lack of drive. But the first two are what I primariliy relied upon.
101
Which ones were you able to rule out?
ANSWER
102
Which ones did you not give weight to?
ANSWER
103
What negative symptoms did you rule in?
Avolition
104
Were there any negative symptoms that you ruled out?
Again, you're making it black and white, ruling it in and ruling it out. So I would not agree that I'm ruling it out. I am just not ruling it in as a substantial foundational piece.
105
What negative symptoms did you not weigh as a foundational piece?
ANSWER
106
What are the differences?
In a schizoaffective disorder you have the major mood component and you have some less rigorous criteria in terms of the remaining criteria for schizophrenia. Like the time, for example, would be one of those.
107
What are the similarities of schizophrenia and schizoaffective disorder?
You're meeting at least the criterion A of schizophrenia, which would be the presence of delusions, hallucinations, psychomotor disturbance, disorganized speech, and negative symptoms.
108
So in your profession are those two different diagnoses?
Yes
109
Speaking specifically to schizoaffective disorder, is that a spectrum as well?
It's in the spectrum of schizophrenia. The initial heading for this whole diagnostic category is schizophrenia spectrum and related disorders.
110
Do you have a spectrum of severity when it comes to schizoaffective disorder?
Yes
111
So the labels attached to describing the rating of the disorder go mild to severe?
Yes
112
Did you do a differential diagnosis in your diagnosis of schizophrenia
Yes
113
When you did that differential diagnosis, what other conditions were you able to rule out?
ANSWER
114
You did do a differential diagnosis in thise case?
Yes
115
Were you able to rule out other mental conditions?
Yes
116
What were they?
SEE DSM RULE OUTS
117
Did you, after your assistant compiled this list for the report, did you check that list?
No
118
Did you read the list to make sure everything was there?
No IMPORTANT?
119
Well, do you want to take a look at your report and see if there is anything missing in those records?
If you want me to take the rest of the morning and compare what she has and try to find it in the discovery I have, I'll be glad to do it. It's up to you.
120
Is there anything you would have liked to have seen in addition to the records you reviewed?
Since I don't have an exhaustive list of available records, I have no basis to say there were records I would have liked to have seen.
121
Would you consider your report complete at this time?
Yes, it's complete until and unless I have further information that warrants a supplement.
122
So your opinions and conclusions, they haven't changed as of today?
Correct.
123
Do you feel that you have enough information to adequately assess Mr. Randall's thought process?
I do.
124
When you came to Idaho, what codes did you consult?
What codes?
125
When you came to Idaho, what code sections did you consult?
Relevant sections of the criminal code, IRFLP, civil rules of procedure and other codes as necessary.
126
So you said criminal responsibility. You have in your CV issues mitigating criminal responsibility. Can you tell me what that means?
Mitigating is a factor that would argue for or against a person's criminal responsibility. So there's different factors that are either for or against.
127
Is that before sentencing or after sentencing?
Criminal responsibility?
128
When you say "issues mitigating criminal responsibility."
Could be either but typically before sentencing.
129
When you interviewed him in these cases, can you tell me how that interview was, how those interviews were conducted? And let me qualify that with face-to-face, a video, I know they've got video calls, they've got through the glass.
It's face-to-face.
130
How did you have these transcribed?
Rev or Scribie
131
When you get these transcriptions back, do you review them for accuracy?
Yes
132
So when you're writing your report, you're relying on these transcripts for statements Mr. Randall made?
Yes
133
Did you find any inaccuracies in the quotes?
Some spelling and place names
134
So there wasn't any significant errors in any of the transcripts?
Not regarding content
135
So there could be pieces of that interview that weren't recorded.
Yes.
136
Do you always audio record your interviews?
Not always
137
Why?
I want to have my record be accurate.
138
When you have him the MMPI-2 on that day, can you describe what that test is?
MMPI-2 is a personality test that's oriented towards determining psychopathology in a person. It is a true/false measure, it has 567 questions. It meets the Daubert standard and is the most widely used measure of personality or psychopathology in the world. It is the second edition of that test. And is one of a handful of tests that has great reliability and strength for forensic studies.
139
When you say "Daubert standard," what do you mean?
1. Whether the theory or technique can and has been tested;
2. Whether it has been subjected to peer review and publication;
3. The theory or technique's known or potential rate of error; (reliability, validity, reference/norm groups etc.)
4. Whether there are standards controlling its operation; and (Pearson qualifications)
5. Whether the theory or technique enjoys general acceptance within the relevant scientific community (Adoption rates)
140
When giving the MMPI-2, is there training that is required before giving it?
Yes.
141
Can you describe that training?
Training in the test itself and testing in general. (Pearson qualifications: Tests with a C qualification require a high level of expertise in test interpretation, and can be purchased by individuals with:
A doctorate degree in psychology, education, or a closely related field with formal training in the ethical administration, scoring, and interpretation of clinical assessments related to the intended use of the assessment.
OR
Licensure or certification to practice in your state in a field related to the purchase.
OR
Certification by or full active membership in a professional organization (such as APA, NASP, NAN, INS) that requires training and experience in the relevant area of assessment.
142
Have you had training in the MMPI-2?
I have. My minor in graduate school was in evaluation and measurement, test and measurement. I was trained in the MMPI-2 by John Graham, who is one of the four leading experts in the MMPI-2 in the country.
143
When was that training?
1972 - 1975 with CE since
144
When?
It's in my CV.
145
With these tests, tell me if I'm getting this wrong, there is administering the test, there is scoring the test, and then there is interpreting the test?
Decision to use a test, test selection for a specific litigant, administration, scoring, hypotheses, interpretation.
146
I believe so. Thank you.
Do you need to be trained on interpreting the MMPI-2?
Yes.
147
Who trained you?
Multiple people. John Graham on MMPI-2, Carl Auria and Spies on tests and measurement, various CE including Roger Greene.
148
Are you board certified?
I'm board eligible, and I've been board eligible for years.
149
So this supervision by Anita Voss, when did that occur?
In the early 2000s. It took place over several years.
150
Can you describe what her supervision involved?
Sure. We would talk about different cases I was working on, and some of those were criminal responsibilities, some were competence, some were risk assessment, some adolescents, some adults, some were immigration, that was one of her areas that she specialized in, some were psychosexual issues.
151
That he would fill out.
Do you need training to administer the PAI?
Yes.
152
Can you describe that?
Well, it's similar in that certainly you would understand the construct of the test, you'd understand the purpose of the test, you'd know there is forensic research or research regarding forensic use in various forensic settings. There would be a protocol on how you would go about introducing the test, providing instructions to the test taker, answering their questions, and so on. Yes, there's training in doing that.
153
Did you do that with Mr. Randall?
Yes.
154
Do you need training to interpet the PAI?
Yes.
155
What type of training?
It would be similar to the MMPI, training in evalutation of measurements, personality testing, the information in the test manual and related learned treatises about how to interpret it, what it means, knowledge of the statistics involved in the scales and their elevations, knowledge in the different use of adjectives that people use to describe scales.
156
Did you receive training on the PAI?
Yes. It's embedded in some of the continuing education. But on the PAI, much like any newer instrument, there are training videos with the test publisher, which is PAR.
157
When you say "learned treatises," are you referring to what you call relevant literature in the last page of your report?
Yes
158
Would you characterize these Relevant Literature publications gold standard?
No idea what that standard is
159
Can you explain what Supervised Clinical Experience involves, what it encompasses I should say.
Sure. The Clinical Psychology Practicum was a program funded by the National Institute of Mental Health, run through the psychology department at Michigan State. Art Siegel and one of his graduate assistants were supervisors, and they held weekly trainings in clinical psychology and they also supervised placement in different settings for clinical experiences.
160
What's the difference between your Supervised Clinical Experience and your supervised forensic experience?
So clinical experience is oriented towards clinical treatment of emotional problems; forensic supervision is oriented towards providing additional oversight and insight in training for forensic issues. They are different. So they're just different focuses of psychology.
161
So when you received the supervised forensic experience with I believe Anita Boss, what years did that go between? When did it start and when did it end?
12-2005 through 2-2007
162
Do you have experience that was supervised before that?
I don't know about before. I told you I also had a supervisory relationship with David Martindale in family law.
163
So for the criminal component of your forensic supervisory experience, that started in December of 2005?
That relationship started. I'd taken prior CEs and so forth and so on on forensic cases. But as far as a supervisory relationship that I initiated, that is when I initiated with her.
164
So I'll start with the M-FAST, does that require training in order to administer to a defendant?
Yes.
165
Have you received training in administering the M-FAST?
Training on the M-FAST would consist of my securing the test materials, reading the test materials, and following the procedure I just laid out in terms of learning what to do and how to administer it.
166
So if I understand correctly for the M-FAST, there's no independent class you need to take in order to be able to administer it?
No
167
I guess we might as well with the MMSE, does it require training? What training does the MMSE require?
Reading the materials, understanding the nature of the test, and having some simple practice in administering the test according to its instructions.
168
For the RBANS, what training is required to administer the test?
The RBANS is a test that you really have to practice the administration and look at the materials that are available and that's what I did.
169
But when I think of practicing to get competence in administering a test, I think of taking like a class, having critiques. Is taht the same way that you would learn how to do the RBANS?
Not necessarily. I use electronic test suites. So PAR has many of their tests available electronically for administration using their software called PARiConnect. Pearson, which is a major provider of testing, also has test suites with Q-global, Q Local, and Q-interactive. Training videos and practice administration.
170
So when you administer these tests, are they electronic or paper formats?
Both
171
Let's start with the M-FAST.
Read to D using paper and pencil
172
So when I think of data, tell me if I'm wrong, I'm thinking of there's a question presented and an answer given. Is that the form that this data is originally in?
Yes
173
So are these index scores for these five different parts -- I'm going to call them parts.
They're just index scores. They're just indexes.
174
-- do these come from an interaction between you and the defendant?
Yes.
175
Do you ever video record interactions with people for FMHA evaluations?
At times, yes.
176
How come?
Well, it depends on the setting and purpose of the FMHA.
177
I mean, the ultimate question is, we have these index scores but we have no idea how you got to these scores.
The Index scores are based on raw scores from multiple subtests.
178
When you specifically interview either a third-party contact or the defendant in this case, do you take notes? Do you write notes down?
No. The answer is no because it's memorialized in the transcript.
179
You also said there was some materials that the defense told you not to give as part of that.
Correct.
180
Can you identify what those materials are?
CONFER with defense
181
Did any of those emails give you relevant information that you relied upon in this 18-207 report?
No.
182
I know we've talked a little bit about your ongoing investigating in this report, or in this case. How much longer do you think it's going to take you to review the additional discovery that was turned over to you by the defense?
I really don't have a good idea. Latest date of discovery in my report is 7-24-2019 (Around 2290's)
183
Do you know what -- I'm going to call them Bates-stamped numbers -- you've received up to?
The PD has warranted that I have complete discovery at this time. My files are broken into subfies so tracking the Bates stamp would be time consuming.
184
Have you not been able to look at the additional discovery they've given you?
Having gotten it last week and having everything else transpire, no.
185
Can you at least document if and when you meet with Mr. Diaz?
[Mr. Smith: I don't think you can direct our expert what to do.]
186
You can answer the question.
I routinely document any and all contact with people.
187
Would you be willing to prepare a report on that if you found it consequential to the 18-207?
If I found any information that I thought was probative and the PD agreed. My task is to try to provide the best information that I can to the trier of fact.
188
Essentially that is what you've done in your opinions in this case, is you've been able to give your best effort on assisting them in the 18-207 report.
With the information I have available, yes.
189
So if you are going to update your report, do you have a deadline for when you would do that?
No, I don't.
190
How many of these criminal FMHAs have you done where you've diagnosed a defendant with schizoaffective disorder?
I have no idea. I can tell you that it is not an uncommon diagnosis for me when someone has a serious mental illness. So schizoaffective and schizophrenia are probably in the top three diagnoses that I would encounter for a defendant or an inmate with a serious mental illness.
191
July 2018 of 6 for 18-211, 8 for 18-207, 51 for 19-2522, and 2 for coerced confession
July of 2018, approximately.
192
How many of those have you diagnosed the person, the defendant, with schizophrenia or schizoaffective disorder?
DK or document frequency of dx
193
Would you be able to give me a percentage?
No.
194
Do you have one off the top of your head percentage-wise?
No.
195
How many cases would you say here in Idaho you have been asked to evaluate a criminal defendant and not generate a report?
Maybe 15% of the time.
196
When we talk about generally people with schizoaffective disorder, are they able to I guess make decisions?
Sure.
197
Are there any decisions that someone with schizoaffective disorder can't make?
I don'tknow how to answer your question because I'm certain we can come up with scenarios where a person who is severely mentally ill was unable to make a decision. But people who are severely mentally ill make decisions every day; they make decisions about what to eat, they make decisions about what they're going to do, including sleeping in their bunk. So it's not like they're a vegetable, unless they are catatonic and vegetative in sort of the worst of the worst kinds of situations.
198
Do you people with schizoaffective disorder, do they know the difference between right and wrong?
It depends.
199
On what?
It depends on the severity of their mental illness. It depends on the nature of what it is we're talking about is right and wrong. Again, there's no hard and fast answer.
There are circumstances where somebody certainly could know the difference between right and wrong on day 1 and on day 7 not for a specific issue. There are circumstances where a person can know the difference between right and wrong on a particular issue every day of the year, but if you change the issue they don't. Again, this becomes extremely specific to the functional behavior in the context of the person that we're talking about.
200
So just because somebody has schizoaffective disorder doesn't mean they don'tknow the difference between right and wrong.
Doesn't necessarily know... It depends.
201
When you've been doing these 18-207 evaluations here in Idaho, have you ever found a defendant that can appreciate the wrongfulness of their conduct?
Yes.
202
Can you give me an example?
Not offhand.
203
So you write a report when somebody doesn't appreciate the wrongfulness of their conduct in 18-207?
Possibly. The ALI standard in 19-2523 says: The capacity of the defendant to appreciate the wrongfulness of his conduct or to conform his conduct to the requirements of law at the time of the offense charged. You could have a matter where a D can't conform his conduct to the requirements of law. (Psychosis, command hallucinations)
204
So when you write "lacking culpability," what do you mean?
[Mr. Smith: Object to the form; calls for a legal conclusion.]
My concept of culpability would be a lack of a sense of wrongfulness.
205
When you write that "either they lack capacity for the criminality/wrongfulness or conform his conduct," which one is it?
Okay. He lacks substantial capacity either to appreciate the criminality or the wrongfulness of his conduct or to conform his conduct to the requirements of law. I am saying both.
206
Would you be able to provide us with a list of the cases that you either testified in or wrote an 18-207 report for here in Idaho?
Yes if you agree to pay for my time to research. No otherwise.
207
Have you testified in Idaho regarding an 18-207 report that you've written?
CR 26.
208
When you're doing these reports, the FMHAs, what side are you doing the evaluations for in a criminal matter?
Neither side. I'm not an advocate for the defense and I'm not an advocate for the prosecution.
209
Who are you being retained by in this case?
The defense.
210
Have you ever been retained by the State in a criminal case in Idaho?
No.
211
Have you ever testified on behalf of the State of Idaho in a criminal trial?
No.
212
In Idaho, have you ever done any evaluation for the state?
No.
213
How much are you being paid for testimony?
Well, I'm not paid for testimony; I'm paid for my time.
214
How much are you being paid for your time testifying?
$325 an hour.
215
How much are you being paid for your time in evaluating Mr. Diaz?
$52,000 to date for time and other expenses.
216
Are those times differentiated? Do you have a different rate for evaluation or tesing versus an interview?
No.
217
So when you're doing your evaluations, it's all one standard rate?
Yes.
218
How many hours have you spent on Mr. Diaz' case to date?
Approximately 194.65
219
Does Dr. Nancy normally help you with your criminal FMHAs?
Yes.
220
Has she done any sort of specialized forensic training?
Yes.
221
When?
She's had forensic training over the years in the same venues that I have. So the question that you're asking is so broad I don't have a way to even begin to answer it.
222
Would you consider yourself an expert in pharmaceutical effects of prescribed medication?
I'm knowledgeable about psychotropic medication effects but not a pharmacologist.
223
Have you ever written reports or papers or articles on the pharmaceutical effects of medications?
No.
224
Have you ever testified in court on pharmaceutical effects of prescribed medications?
I have in some cases.
225
What cases?
Don't notate cases for this type of information. (Phosphatydelethanol, etg and routine psychotropics)
226
Is there any particular ones that you enjoy reading or find interesting?
I think the psychology, law, and public policy from the APA is always interesting. Family law review from AFCC has been interesting. Sexual abuse from ATSA has been interesting. Some hit and miss with the "Monitor" from the APA, from the American psychologists from APA. I look at the newsletters from AIDD, I look at the newsletters monthly from GIFR, I look at the newsletters from APLS. The reading runs in streaks, depending on the cases that I'm having to deal with.
227
So you try to familiarize yourself with literature that's relevant to a particular issue you're dealing with in one of these FMHA's?
Yes.
228
So are these FMHAs peer reviewed?
Yes - Dr. Nancy
229
Do you consult with anybody when writing one of these reports pursuant to these assessments?
Sometimes.
230
This is one, I don't like asking this question but I feel like I have to: Have you been subject to any professional discipline?
No.
231
Does the defendant know in this case the difference between right and wrong?
Well, you'd have to refer to a time period for that knowledge.
232
How about did you split it up in time periods when you evaluated it?
I think I did show in my report that there was clearly some knowledge of right and wrong in some time preceding the alleged offense.
233
What time?
ANSWER
234
Do you anticipate testifying in this case?
Yes.
235
Wednesday, the first day of the deposition, you called yourself a practitioner. What did you mean by that?
Well, I described it at the time, I'm not a theoretician, I'm not a college professor working in a classroom. A practitioner practices the art, if you will.
So in practicing forensic psychology, I do court-appointed evaluations, I do attorney-retained evaluations, I'm retained by attorneys to consult on cases, criminal, civil, and in family and probate law. I don't have as a career goal to write articles. I have done some limited continuing legal education, I have supervised people in training for forensic tasks, I provided continuing education for various organizations over the years. But that is not a primary focus of what I do day to day.
236
So when you say what you do day to day, that would mean these FMHAs, that's your practice.
Well, you're kind of defining again a niche of it. Consulting doesn't mean I'm doing a FMHA. Evaluating somebody and generating a report, the report is the FMHA, the report is that document. As we talked about Wednesday, there are times where I don't generate a report at all. So the scope of the practice covers various tasks, as I think I ust described.
237
So your practice at this point isn't treating patients, it's forensic work.
Correct. Treating patients would be considered clinical, and forensic is the psycholegal issue being evaluated or consulted with.
238
Can you tell me, is there a difference between a mental disease and a mental defect?
A mental disease typically would be a diagnosable mental disorder such as you would find in the DSM-5 or the ICD-10-CM. It would not include typically a personality disorder.
A mental defect would be an intellectual disability, whether it's a traumatic brain injury, lower functioning autism, lower functioning. It would include people that could have Alzheimer's or dementia.
239
Thank you for clarifying that.
What is a psychotic thought process?
Psychotic thought process would go back to defining the behavior in the schizophrenia spectrum.
240
Can you tell me what psychotic thought process the defendant had in the time preceding the alleged attack.
ANSWER
241
So what psychotic process did he have after he attacked?
AFTER
242
Have you ever been retained to testify for the prosecution in any state?
No
243
So I'm trying to understand how when you go to interview somebody in jail after you've been retained to complete an 18-207 FMHA, do you have a game plan for what you want to-- I apologize for the sport reference, but do you have like a game plan for what you want to accomplish during that specific interview?
Yes.
244
How do you come up with that game plan for various 18-207 evaluation interviews?
Knowledge, training, experience.
245
So for every interview, if I heard you correctly, you have a basic game plan of what you want to do for that interview.
Yes.
246
It seems to me, correct me if I'm wrong, that some of these interviews are focused on background information like what has happened in the defendant's past, 20, 30 years ago.
Yes. I'm always seeking to get history and background in any evaluation, unless it's impossible to get because of lack of cooperation of a defendant particularly. But yes, that's an initial piece of any evaluation. When it occurs, again, depends on the nature of the evaluation. There's been evaluations where I have not started with that.
247
When you're asking those types of questions, are you like analyzing the answers? Are you trying to assess anything?
Well, I'm always doing some observation or assessment in the process. So if a person is oriented, alert, paying attention, speaking in what we call sort of a normal way with normal prosody, then there's nothing unusual. It would be this persons is in the room and I'm talking to a person who's oriented well today.
But in other situations you can have a person that does things such as derail or have tangential thoughts or is actively hallucinating or having ideas of reference or talking really slow (demonstrating). When you have those kinds of behavioral indications in the observation that I'm doing, that generates other hypotheses about what I may need to do as the interview of this person progresses.
248
Ideas of reference, can you tell me that is, ideas of reference?
REWRITE That woman over there is looking at me. She's making fun of me as we're talking and I don't like it right now. So somebody is referring, I'm thinking they're referring to me. That's an idea of reference.
You have thoughts where a person could be thought insertion. I'm being told I shouldn't talk to you right now. I have talked to defendants where they would say, I think you're an alien. You have thought withdrawal. I'd tell you but it's being taken out of my mind against my will right now.
You have derailment. I know we're talking about Mr. Randall but how about those Cubs? So we just kind of went way over there to some subject that makes no difference.
249
There is one that started with like a tan- --
Tangential.
250
Tangential. What is that?
Tangential would be to just talk about things that are irrelevant.
251
So it sounds like the questions where you're talking about the historical background of a defendant, that does help you assess different factors for your FMHA?
It does.
252
It sounds like with some of this stuff it helps you test their ability to recall memories when you talk about the history, the background.
Yes.
253
When you say "TBI," do you mean traumatic brain injury?
I do.
254
I want to talk to you a little bit about your testing. I know that we've talked a lot about it already, kind of your training and experience in the different tests that you've done. Are there tests that you didn't perform in this case that other forensic psychology professionals use to evaluate an 18-207 issue?
The best answer I could give you is I don't think so. Obviously, practitioners will have their own tool kit.
255
Then you mentioned earlier the R-CRAS.
It's a criminal responsibility assessment tool by Rogers. The R-CRAS is more of a checklist, if you will. He's saying in his R-CRAS form if you're going to assess for criminal responsibility, I think you ought to look at these factors.
256
You're an agent of the defense counsel?
No (Randle) Yes Diaz per next card.
257
Well, under Idaho Criminal Rule 16(b)(9), Unredacted Digital Media under subsection (i) "Defense counsel, including agents of defense counsel, may review the unredacted digital media and discuss the contents of the recording with the defendant but must not share the unredacted digital media in any manner with the defendant without prior consent of the prosecuting attorney or an order of the court."
Yes in terms of the criminal rule and the definition of agent: a person who acts for or represents another. I acted for the PD to assess Mr. Diaz.
258
Were you doing 18-207 reports in Idaho before 2018?
Yes
259
If you need to look at this document to check my counting here, but I count 14 different case numbers.
Yes.
260
How many of these cases did you end up testifying in?
One. Bailey Hammer
261
So in these 14 cases, did you ever find that somebody was able to appreciate the wrongfulness of their conduct?
I would have to review each case to answer your question.
262
What would keep you from telling us that?
I've been retained by the attorney, and being retained by the attorney I'm under their work product for confidentiality.
263
Was the defendant taking any psychotic medications when you met with him during these interviews?
He was not at the first interview and was thereafter.
264
Did you review any jail records to confirm or deny if he was taking psychotic medications?
Yes
265
Did you ever speak with the defendant outside of the ten interviews you conducted in this case?
No.
266
You reviewed Dr. Sombke's reports in this case; correct?
I did.
267
Did you agree with it?
I don't really have a basis to agree or disagree with it. He saw him at a different date, and he saw him for a different purpose. The only thought I had in looking at it was that some of his observations were consistent with what I had found.
268
Was there anything in Dr. Sombke's reports or materials that you had a reason to disagree with?
I don't have a reason to agree or disagree with anything. He did the evaluation; I wasn't there.
269
When you're doing these interviews with the defendant, and specifically the five interviews in this case, what were the reasons, if any, for pausing the audio recordings?
I would generally pause a recording, if somebody was getting up and trying to get the attention of one of the deputies for some reason, if I was going to have to get some materials that's going to take a period of time to pull them out, haul them out, if I'm trying to fix a problem with the iPads, or if there is a conversation that's really extracurricular and irrelevant, that's there for rapport building or some such, or pausing a recording if there's operator error in using the recorder.
270
Does that mean you're unsure as to whether or not you recorded all of the evaluations in this case?
Well, I didn't record all of the evaluations, period, because, for example, when there was testing done, I don't record that.
271
So when you retrieved those three tests that you listed out from Mr. Randall, did he indicate to you whether he had any difficulty or confusion completing the test to you whether he had any difficulty or confusion completing the test?
I asked him, he said he did not.
272
In your experience conducting these FMHAs, do some people exaggerate their symptoms?
Yes.
273
How do you determine that?
Well, there's different methods. There are tools that are used. The M-FAST, for example, is a screening tool for symptom exaggeration. That would be one piece. VIP for performance effort. You have validity scales on the MMPI-2 and the PAI that also would be sources of information. Inconsistent, fabulous statements by an individual.
274
Is fibromyalgia a psychiatric illness?
Depends which decade you want to talk about. If you wanted to talk back in the '70s and '80s and the '90s, and you had a person come in with fibromyalgia or one of its earlier diagnostic terms, in the mental health world people would look at each other and go, Yeah, chronically anxious, this is all in their head, and so forth. There was a prior diagnostic term called CFIDS, C-F-I-D-S, and it was related by many in the field to be a psychosomatic disorder reflecting a lot of anxiety. In general often you would find that people had a lot of anxiety.
275
When you talked about the RBANS yesterday, you said that the responses that Mr. Randall gave on the iPad that he had, those responses would go to Pearson's server.
Correct.
276
Do you have access to the data on Pearson's servers for the RBANS?
Define "data" for me and I can answer your questions.
277
His responses.
Item-level responses, how did he respond to A, B, C?
278
Yes.
I have, to the extent they have item-level responses saved and accessible to me, yes. Those item-level responses are controlled by them and I have a button, if you will, that says item-level responses and then I would see how he responded to different items.
279
You can let me know if there is a concern on your part for the ethical reasons of providing us underlying data from your tests.
Issue is test data vs test item content (copyrighted)
280
So would it be fair to say that Pearson in interpreting those responses and giving us these scores is relying upon your recording of the defendant's responses?
It depends on the test. Some items are direct responses of the examinee. Some are my scores on a task.
281
I thought you had said earlier that when you input the data, they spit out these results. They also -- sorry for the phrasing "spit out" -- but they also give you a narrative that you said that you disregard.
No, I don't think I said narrative. I said they give you other information that I don't use clinically.
282
What's that information?
It depends on the test.
283
Excuse my ignorance, but how do you interpret -- so if you could explain this very elementary for me, how do you interpret the M-FAST test?
ANSWER
284
For the M-FAST, and I'm going to go through all of these tests with you, how do you interpret what you've been given as scores?
Well, it's a screening measure. And so it's screening for malingered symptomology. Or to put it differently, if a person is -- say, we have a group of people that are seriously mentally ill, and we assess them for the characteristics that go with a seriously mentally ill person, we would find that a person who actively hallucinates may have a span of XYZ characteristics.
Somebody who is malingering the seriousness of the mental illness may then present with more symptoms than the observed real live actual patients who are hallucinating. So that would be viewed as malingering because they are confabulating, they are providing an unusually high number of unusual symptoms that we don't see in a truly schizophrenic person.
So it's screening because alternatively, if we really have a very, very disturbed person who may not be well managed, or maybe they're managed the best they can be, we still could see really, really unusual symptoms that go beyond the typical seriously mentally ill person.
Make sense so far?
285
I'm following.
So here we have a cutoff score of 6. They have different types of symptoms that they're looking at on the scale as reported versus observed.
286
Okay.
So we have reported versus observed. So we're going to look at what did they report as symptoms and what do I observe relative to their report. They had extreme symptomatology, extreme symptoms that would be highly unusual in a sample of seriously mentally ill people. Rare combinations, so we would have rare combinations of symptoms that would be very unusual in a seriously mentally ill sample. Unusual hallucinations, unusual symptom course, negative image, suggestibility, and then a total score.
So they're sampling different areas that people commonly, if they're going to malinger or feign would endorse. This is tied, to some extent, to the SIRS-2. And the use of this, if it shows a person with a score cutoff below 6, the use of this is it's a data point to help the evaluator determine, is there a likelihood that they are malingering their symptomatology. You might get a score below the cutoff, and they might still think for various other reasons in context and in talking to them, I don't think they're being credible about the seriousness of their symptoms.
287
So it's my understanding the PAI is just, is it a one-trick pony or does it have two different areas that you're looking at?
The PAI is a personality test that has clinical usage as well as forensic use. So it is not one trick; it is just the test. The test results are going to be consistent. I'll clarify. The output of the test will be consistent no matter what the forum is. But by research we would know that the test results for people who are in a correctional setting, if you have a sample to tell you that, will be different than the test results for people who have no emotional problems and never been seen clinically versus people that have been seen clinically for certain kinds of problems.
So the -CS means that with the advent of them having a correction sample, I can get results that show me the norms for a clinical population for the basic population of the test, the community population, and norms for a correction sample. Because on different scales there's a difference.
And the normal sample they use you might find that a score -- I'm making this up -- but a score of 60 would be considered moderately high. In a correction sample a score of 60 might actually be low or normal because so many people are in jail or prison for drug use.
288
How do you interpret the PAI-CS?
ANSWER
289
Yes.
So with T-scores 50's your average and a standard deviation is 10. Are you familiar with a standard deviation?
290
Same with that blue dot or that blue line?
The blue line on the test is called the sky line, and the sky line means that this score cannot go higher than this. It can't go higher than this typically. This is just saying this is really where it's done.
291
Do you ever look at the report narrative?
After I'm done I'll glance at it. I'll glance at it because I've looked at Morey's handbook, and I've come up with my findings. I'll glance at this and go like, Am I way out in left field on something I didn't
know about. Because they use an algorithm to generate this, and I haven't got a clue what it is, but they're not going to tell me.
But one thing that you'll see here is, they talk about a moderately elevated SCZ or schizophrenia
score; socially awkward, introverted, cognitive slippage, moderately elevated PAR, paranoia, indicates a level of interpersonal sensitivity, suspicious tendencies, so forth and so on. It's just kind of a
double check again of what I've concluded and what I've written.
292
Have you ever changed an 18-207 report in the past after submitting it and having it filed?
No, I have not.
293
Have you ever changed any criminal FMHA evaluation in the past after submitting it?
No.
294
Correct me if I'm wrong, bizarre is a term that's used in the DSM-5; correct?
It is, correct.
295
When it's used in the DSM-5, it's describing delusions; is that right?
CHECK Typically, yes.
296
Is there a distinction between bizarre delusions and non-bizarre delusions?
CHECK Yes. For simplicity sake, let me just pull up the DSM-5 and I'll give you an example.
297
When you get there can you give me a page number?
On page 87 it states, under the paragraph of Delusions, or the heading Delusions, second paragraph: "Delusions are deemed bizarre if they are clearly
implausible and not understandable to same culture 1 peers, and do not derive from ordinary life experiences.
An example of a bizarre delusion is a belief that an outside force has removed his or her internal organs. An example of a non-bizarre delusion is a belief that
one is under surveillance by the police despite a lack of convincing evidence."
298
Is it the same for these ideations, are there bizarre ideations and non-bizarre ideations?
CHECK Ideation is just really talking about a person's thinking. So I think we're kissing cousins unless there's a different context.
299
Is there a distinction between a delusion and a strongly held belief?
Yes.
300
What's the difference?
Well, strongly held belief is simply that. Delusion would be belief that no one else believes in despite evidence to the contrary.
301
So when you use the term "bizarre" to describe ideations, you're not using that word with any clinical or forensic significance in defining it, just the ordinary definition.
Of course there is a clinical/forensic significance.
302
When you write "psychotic thought process," are you referring to a mental disease or a mental defect?
A psychotic thought process would be a mental disease.
303
In this case, did the Defendant have a severe mental disease?
Yes.
304
What is that?
Schizophrenia.
305
Did he have severe mental defect?
No - WAIS-IV IQ 74 Borderline
306
Why is the Defendant's mental disease severe?
Diaz - note severity level by dx
307
What percent of the population is affected by schizophrenia?
DSM-5. 0.3 to 0.7% simplistic answer
308
What's the prevalence of schizoaffective disorder?
Estimated to be three-tenths of a percent, about one-third as common as schizophrenia.
309
So is the inability to appreciate the nature and quality or wrongfulness the same as lacking substantial capacity to appreciate criminality, wrongfulness of their conduct or conform their conduct to the requirements of the law? To sum that up, are those the same or different things?
I think they're really intending to be the same. The language of ALI would be lacks substantial capacity to understand the wrongfulness of the act and to conform to the requirements of law. So inability, it sounds like a binary term, that would not be the intention. The intention would be the capacity term of ALI.
310
Have you testified in criminal cases regarding a defendant's ability to appreciate the wrongfulness of his or her conduct?
Yes. ID Hammer, OR, OH
311
Was there anything to suggest that the defendant thought he was attacking an alien instead of a human?
Yes. Thought everyone was an alien (3 eyed reptilians, grays, third eye aliens). Attacked because believed they would attack and kill him - so needed to attack first. He is a reincarnated Samurai. Attacked because trying to protect a Japanese princess that is being sexually abused with forced oral sex. Shape shifters. Take over a human body.
312
In this case did you find any evidence contrary to your diagnosis?
No
313
Did you find any evidence contrary to your opinions?
No.
314
Have you ever written report where you opined that someone with a serious mental disease or defect was able to appreciate the wrongfulness of their conduct in a criminal case?
Yes regarding the finding. No to writing a report. The NGRI pleas were dropped.
315
Have you ever testified that someone with a serious mental disease or defect was able to appreciate the wrongfulness of their conduct in a criminal case?
Not in testimony. Yes in reports to attorney.
