Monday, February 11, 2008

Competency hearing exposes clinical feud

Competency to stand trial: Flip of the coin?

Whether a defendant is found incompetent to stand trial is based mainly on "luck of the draw," that is, which psychologist or psychiatrist happens to be assigned by the court.

That's the controversial thesis of law professor Michael Perlin, who's written an excellent book on competency that's due out this spring. As evidence, Perlin cites a study in which forensic evaluators split almost evenly in their opinions about a hypothetical vignette. Perlin lambasts the current system as a "fraudulent" one in which the courts abrogate their decision-making responsibilities to "imperial experts" who decide competency based largely on idiosyncratic approaches and moral stances.

While many might argue with this rather extreme position, proponents could point to the unfolding murder trial of Thomas Shane O'Hagan as a perfect example.

O'Hagan allegedly stabbed his girlfriend to death while she was taking a shower and then put her body in a small plastic box.

In the 3 ½ years since then, the Pierce County (Washington) Superior Court has issued nine orders for competency evaluation and treatment. But the experts can't seem to agree on whether he is competent to stand trial.

"First doctors said he was competent to stand trial and could understand what was going on and help his attorneys defend him. Then they said they weren't sure. Then they said he wasn't competent anymore," according to news coverage a year ago.

The saga has grown to farcical proportions, with a dispute between opposing experts spilling into court and forcing the judge to remove herself from the case.

In an unusual twist, two opposing experts, one a psychologist and the other a psychiatrist, both work for the same state hospital that has repeatedly evaluated and treated O'Hagan.

Psychologist Barry Ward, who has evaluated O'Hagan at least three times, testified at a hearing last September that the defendant was not competent to stand trial. Psychiatrist William Ritchie took the opposite position.

Further muddying the issue, the judge invited a third doctor from Western State Hospital who was observing the proceedings, psychiatrist Margaret Dean, into her chambers to view some artwork. Ward, the psychologist who testified that O'Hagan was incompetent, emailed attorneys and told them that Dean was a member of O'Hagan's hospital treatment team, something the judge says she didn't realize when she issued her invitation. When Dean found out about Ward's email, she called the judge to complain.

Thrust into the middle of this feud among clinicians, Superior Court Judge Beverly Grant Ward was forced to remove herself from the case. The state hospital, meanwhile, is reportedly conducting an internal review.

Washington is among a decreasing number of states with a centralized competency evaluation system in which defendants are evaluated while hospitalized in state facilities. O'Hagan's attorneys are now arguing that their client cannot receive an unbiased evaluation at the hospital, and so should be evaluated at a "nonstate-run facility."

Of course, if Professor Perlin's controversial thesis is correct, a change of setting won't make any difference: Luck of the draw will still decide whether O'Hagan is found competent or incompetent to stand trial.

Sources:

Morris, G.H., Haroun, A.M., & Naimark, D. (2004). Health Law in the Criminal Justice System Symposium: Competency To Stand Trial on Trial. Houston Journal of Health Law and Policy, Vol. 4, p. 193

Perlin, M.L. (2004). Health Law in the Criminal Justice System Symposium: "Everything's a Little Upside Down, As a Matter of Fact the Wheels Have Stopped": The Fraudulence of the Incompetency Evaluation Process. Houston Journal of Health Law and Policy, Vol. 4, p. 239

Lynn, Adam, “Feud makes a mess of murder case," News Tribune (Tacoma, Washington), Feb. 10, 2008

Hucks, Karen, “Judge keeps suspect on drugs for disorder; Attorneys argue whether a man charged with killing his girlfriend must continue to take anti-psychotic drugs. A judge says yes,” News Tribune, May 27, 2006

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