UNITED STATES, Appellee
v.
Jermain J. BEST, Private
No. 00-0679
Crim. App. No. 9701222
Argued
Decided
CRAWFORD, J., delivered the opinion of the
Court, in
which GIERKE, C.J., and EFFRON and ERDMANN, JJ., joined. BAKER,
J., filed
a separate opinion, concurring in the result.
Counsel
For Appellant: Captain Eric D. Noble (argued); Colonel Mark Cremin, Lieutenant Colonel Mark Tellitocci, and Major Allyson G. Lambert (on brief).
For Appellee: Captain Edward E. Wiggers (argued); Colonel Steven T. Salata, Lieutenant Colonel Margaret B. Baines, Lieutenant Colonel Mark L. Johnson, and Major Natalie A. Kolb (on brief).
Military Judge: Peter E. Brownback III
THIS OPINION IS SUBJECT TO REVISION BEFORE
FINAL
PUBLICATION.
Judge CRAWFORD delivered the opinion of the Court.
Contrary to his pleas, Appellant was
convicted by a general court-martial of officer and enlisted members of
unpremeditated murder, assault with infliction of grievous bodily harm,
and
carrying a concealed weapon, in violation of Articles 118, 128, and
134,
Uniform Code of Military Justice (UCMJ) , 10 U.S.C. §§ 918, 928, 934
(2000). The convening authority approved the sentence of twenty
years of
confinement, forfeiture of all pay and allowances, reduction to E-1,
and a
dishonorable discharge. The United States Army Court of Criminal
Appeals
affirmed the findings and sentence. United
States v.
Best, No. ARMY 9701222 (A. Ct. Crim. App. Mar. 8, 2000)
[hereinafter
Best I]. After Appellant raised issues of mental
competence and
responsibility for the first time before this Court, we returned the
record to
the Army Judge Advocate General on
(1)
Was there an actual conflict of interest [involving Drs. Galloway and
Kirubakaran] sufficient to undermine the reliability of the sanity
board’s
findings?
(2) Was appellant aware of the potential conflict of interest at the
time of
the sanity board?
(3) If so, did appellant have an opportunity to raise the issue?
(4) Did appellant waive [any] conflict of interest?
That, if the court concludes that there was a conflict of interest that
was not
waived and further concludes that the findings of the sanity board are
not
reliable because of a conflict of interest, the court will order
another sanity
board; and
That, after resolving the above issues, the court will determine
whether
appellant has the mental capacity to understand and to conduct or
cooperate
intelligently in the appellate proceedings. If so, the court will
determine whether the evidence regarding appellant’s mental
responsibility at
the time of the offenses warrants setting aside the findings and
sentence.
United States v. Best, 56 M.J. 251 (C.A.A.F.
2001) (order
setting aside decision of Court of Criminal Appeals in Best I
and
returning record for further fact-finding) (citation omitted).After
reviewing
the findings of the hearing convened pursuant to United States v.
DuBay,
17 C.M.A. 147, 37 C.M.R. 411 (1967), the court below again affirmed the
findings and sentence. United States v. Best, 59 M.J. 886
(A. Ct.
Crim. App. 2004)[hereinafter Best II].
On
WHETHER THE UNITED STATES ARMY COURT OF CRIMINAL APPEALS ERRED IN HOLDING THAT THERE WAS NO ACTUAL CONFLICT OF INTEREST INVOLVING MEMBERS ON APPELLANT’S SANITY BOARD SUFFICIENT TO UNDERMINE THE RELIABILITY OF THE SANITY BOARD’S FINDINGS.
We conclude for the reasons set forth below, the court did not err.
FACTS
We accept the factual determinations of the court below, which we include here for clarity:
At about
After appellant hit SPC Brown, several of the people near them attempted to restrain appellant. Appellant departed that area of the club and took off his easily recognizable, red and white stripe shirt and placed it under his white t-shirt. Shortly thereafter, appellant and SPC Fowlkes departed the club and waited for SPC Wright near the club entrance. A few minutes later, SPC Wright joined them and stated “a guy inside the club [] told three patrons to follow [appellant] and see where he was going, and hold him until they got out there[.]” Appellant asked to see SPC Fowlkes’ “buck knife.” Specialist Fowlkes gave it to him and appellant placed it in his pocket.
Appellant, SPC Fowlkes, and SPC Wright then proceeded toward SPC Wright’s automobile. Private First Class (PFC) Little, SPC Bos, and SPC Woods caught up with appellant and his friends. Private First Class Little grabbed appellant by the arm, turned him around, and said, “[Y]ou need to come back with us. You just busted a dude in the face and you need to come back with us, the MPs are on their way.” Appellant pulled away from PFC Little and said, “You need to back off me. Just get away,” and walked across the street to SPC Wright’s car. Appellant stated that he just wanted to leave. Private First Class Little again approached appellant and told him “[C]ome back; you got to be a man and live up to what you did.” Private First Class Little pushed appellant back a couple of feet and appellant came back at him. They started wrestling and punching. Private First Class Little dropped to his knees and said “Oh, you got to use a knife.” Appellant replied, “[Y]eah, mother[******].” Specialist Bos then came toward appellant. As SPC Bos did so, he put his hand behind his back and pretended to be holding a knife. Specialist Bos stated the following to appellant: “Oh, you gotta use a knife. I’m gonna show you a knife.” Appellant turned and ran to SPC Wright’s car and departed with his friends.
Lieutenant Colonel Marzouk, a forensic pathologist, testified that he conducted an autopsy on PFC Little’s body. Private First Class Little was stabbed a total of twelve times -– in the heart, left lung, left arm, left armpit, and forearm. The fatal stab wound was to the left axilla, armpit, which lacerated a major vein and artery. Private First Class Little died as a result of blood loss.
Best I, slip op. at 3-5.
Similarly,
we
accept the additional factual determinations of the lower court in its
On or
about 30
September 1997, appellant arrived at the USDB [United States
Disciplinary
Barracks],
Sometime in the spring or summer of 1999,
appellant
began “speaking in tongues” and, infrequently, fell into trances.
Appellant expressed a belief that he “would be delivered from
confinement
and received into heaven on the evening of the new millennium.”
Appellant’s conduct was not disruptive until his belief was not
confirmed
and the millennium passed.
In January 2000, appellant was on the
“blotter” for
two separate incidents of disobedience and he began “speaking in
tongues” more
frequently. Appellant’s case provider requested an assessment of
appellant to
determine whether appellant was suffering from some type of psychosis
or a
religious calling. Doctor Ellen Galloway3 was directed to assess
appellant to
determine the cause of his disruptive behavior. Before she met
appellant,
Dr. Galloway: 1) discussed his status with the head chaplain and three
mental
health technicians; 2) reviewed his mental health records; 3) reviewed
the
battery of psychological tests administered to him during the reception
process;4
and 4) researched “speaking in tongues” on an Assemblies of God web
page.
On
On
The personality disorder would have been sub-clinical in nature and exacerbated by his confinement. This would have been intensified further when his expectation of deliverance was not realized. The rigidity inherent in personality disorders would explain why he persists with his behavior despite starting to experience adverse consequences. The malingering would explain why his behavior does not follow the pattern that [the head chaplain] stated he would have expected from an individual who speaks in tongues. It would also explain his refusal to cooperate with any form of assessment . . . .
Doctor
Galloway recommended, at that time, that any further disruptive or
disobedient
behavior should be treated as a custody and
control
issue rather than a mental health or religious issue. She stated
that all
inmates, regardless of their mental status, are expected to comply with
the
USDB regulations, but that a psychological issue could result in
mitigating
punitive action. Doctor Galloway even suggested that she be
called as a
witness at any board to explain the mental health circumstances.
By
Doctor Kirubakaran immediately met with
appellant in
his cell. Appellant refused to look at Dr. Kirubakaran, did not
respond
to any of his instructions, kept his face covered with a blanket,
constantly
talked to himself, and rocked his body. Because Dr. Kirubakaran was
unable to
fully assess appellant’s mental or physical
condition,
he recommended appellant be sent to the nearest emergency room for a
complete
examination. Later, Dr. Kirubakaran diagnosed appellant with a
“psychotic
disorder [not otherwise specified] and concerns about catatonia.”
He had
appellant admitted to the psychiatric services section of the
Leavenworth
Veterans Administration (VA) Hospital.
The VA hospital staff initially determined
that
appellant was depressed and was, perhaps, “playing games” with them.
The
VA put appellant on anti-psychotic and mood stabilizing drugs.
Appellant
seemed aware of his surroundings because he shook his head “no” when
asked
about taking his medication and allowed the nursing staff to take his
vital
signs and blood. Between 5 and
By
On
On
In early May 2000, Drs. Mallory and Frederick
started
appellant on an involuntary, non-consensual medication regimen because
they
considered appellant gravely disabled and without it, at risk of death.
They
began medicating appellant with very large doses of extremely powerful
anti-psychotic drugs. Even with the medication, it took appellant
approximately one month to respond to staff interactions in any
consistent
fashion. On
Doctor Frederick advised Dr. Galloway that he
thought
it would be in appellant’s best interest to continue his treatment at
the
Appellant
continued his treatment at the
_______________
3 Doctor Galloway, Chief of the Mental Health Division at
the
Directorate of Treatment Programs at the USDB, is a Doctor of
Psychology.
At the time of the DuBay
hearing, Dr. Galloway had held her
position for
approximately two years as an active duty officer, captain, and for
approximately one and one-half years as a civilian.
4 Doctor Galloway determined these test
results were
invalid because of appellant’s “need to present himself in an
unrealistically
socially desirable light. He was unwilling to admit to even minor
flaws
which are considered within normal limits.”
5 Doctor Kirubakaran, the psychiatry medical officer for
Community
Mental Health, which is part of the Munson Health Center on Fort
Leavenworth,
is board certified in Psychiatry, and is a consulting psychiatrist for
the
USDB. At the time of the DuBay hearing, Dr. Kirubakaran
had been a
psychiatrist for thirty-three years.
6 Because the military does not have
adequate
facilities to provide long-term, inpatient psychiatric treatment for
its
prisoners, those prisoners requiring such treatment are typically
transferred
to the custody of the Federal Bureau of Prisons under the provisions of
Article
58(a), UCMJ. Before a prisoner can be involuntarily transferred
from a
prison to a psychiatric treatment facility, he is entitled to certain
procedural safeguards, including notice, counsel, and a hearing before
an
independent decision-maker. Vitek v. Jones,
445
59 M.J. 888-91 (footnotes in original).
DISCUSSION
Appellant argues that R.C.M. 706 contains an implicit, per se prohibition of membership on a so-called “sanity board” by any physician or psychologist who has previously “diagnosed and/or treated” the subject of that board. In the alternative, we are urged to conclude that the results of the board convened under R.C.M. 706 to examine Appellant are fatally unreliable because of an actual or apparent conflict of interest on behalf of one or more members of that board.
At
the outset, we
decline the Government’s invitation to view both the question of
whether a
conflict of interest existed and the effect of any such conflict as
questions
solely of fact, and thus limit our review to a determination of whether
the
Army Court of Criminal Appeals abused its discretion in denying
relief.
While there are factual questions in issue, the lower court’s
interpretation of
R.C.M. 706 and assessment of the reliability of trial proceedings are
matters
of law that we review de novo, not only because the lower court’s
decision
constitutes the recognition and formulation of legal standards, but
because
“the reasoning upon which it is based shows it to be a matter of
law.”
A. NATURE OF AN R.C.M. 706 BOARD IN THE POST-TRIAL ARENA
A
sanity board is
a creature not of statute, but of executive order and long-standing
military
practice, dating to at least 1917. See Captain Charles E.
Trant, The
American Military Insanity Defense: A Moral, Philosophical, and
Legal
Dilemma, 99 Mil. L. Rev. 1, 66 n.349 (1983).
Referring to sanity inquiries based on the Manual for
Courts-Martial,
Nonetheless,
we
have frequently recognized the important protections afforded by R.C.M.
706 and
its predecessors to servicemembers facing the court-martial
process. We
have emphasized the responsibility of the convening authority and the
military
judge to order a sanity board when required, as well as the duty of all
participants in the process to bring to the attention of the convening
authority or military judge any condition or behavior that may
reasonably call
into question the mental responsibility or competence of an
accused.
Although post-trial R.C.M. 706 boards are not expressly sanctioned by the rule (or by its predecessors, MCM (1951 ed.), para. 121, and MCM (1969 ed.), para. 121), this Court has historically addressed issues associated with such boards:
In the Uniform Code of Military Justice, sanity is mentioned directly only with respect to trial proceedings, and not at all in connection with post-trial review. See Articles 51 and 52, 50 USC §§ 626 and 627. Paragraph 121 of the 1951 Manual is entitled “Inquiry before Trial” -- and therefore, on its face, would appear to be inapplicable to mental disease first appearing during the appellate process, and not present either at the time of the crime or that of the trial. However, this same Manual division is referenced in paragraph 124, which is concerned with the post-trial action of the convening, or of higher, authority. This mention we construe to be directed to insuring that, in a proper case, the convening authority will direct the convention of a medical board of inquiry -- as provided in paragraph 121 -- for the purpose of answering three questions concerning the accused’s mental condition. The first two of these have to do with mental responsibility for the crime; the third concerns mental capacity and is phrased as follows: “Does the accused possess sufficient mental capacity to understand the nature of the proceedings against him and intelligently to conduct or cooperate in his defense (120c)?”
Further, “when not
restrained by the 2-year limitation of Article 73, [UCMJ, 10 U.S.C. §
873] we
have given preferential treatment to the question of mental
responsibility when
raised for the first time on appeal.”
It is true that, historically, sanity has occupied a special status in military law. However, to prevail on appeal an accused must convince an appellate court that a “different verdict might reasonably result” if the trier of fact had evidence of a lack of mental responsibility that was not available for consideration at trial.
B. QUALIFICATION AND DISQUALIFICATION OF SANITY BOARD MEMBERS
1. Federal Civilian References
Although applicable only by analogy, we note that 18 U.S.C. § 4247(b)(2000), provides, in part:
A psychiatric or psychological examination ordered pursuant to this chapter shall be conducted by a licensed or certified psychiatrist or psychologist, or, if the court finds it appropriate, by more than one such examiner. Each examiner shall be designated by the court, except that if the examination is ordered under section 4245 [commitment of those already imprisoned] or 4246 [commitment of prisoners due for release], upon the request of the defendant an additional examiner may be selected by the defendant . . . Unless impracticable, the psychiatric or psychological examination shall be conducted in the suitable facility closest to the court.
Neither this section nor Federal Rule of Criminal Procedure 12.2, on the same subject, precludes examination of a defendant by a psychotherapist who has previously assessed, examined, diagnosed, or treated that defendant. In fact, by allowing the defendant to pick his own additional examiner in certain situations, the statute appears to invite participation in the process by a treating psychotherapist, though not in the specific context of a pretrial sanity inquiry.
Few cases in the federal circuits have examined conflicts of interest involving psychotherapists, and none has considered the precise question of whether a psychotherapist who has entered even a limited practitioner-patient relationship should be excluded from participation in future, unbiased evaluations of that patient. Even so, we are aided by the logic of the Third and Seventh Circuits on related topics.
Addressing whether a treating physician should be allowed to testify as an expert witness for the patient he had treated, the Third Circuit said:
Opinions
by physicians who have neither examined nor treated a patient “have
less
probative force, as a general matter, then they would have if they had
treated
or examined him.” Wier ex rel. Wier v.
Heckler,
734 F.2d 955, 963 (3d Cir. 1984). In the context
of social
security disability cases, in fact, we afford greater weight to a
treating
physician’s opinion. See Dorf v. Bowen, 794 F.2d
896 (3d
Cir. 1986); Brewster v. Heckler, 786 F.2d 581 (3d Cir. 1986).
“The
rationale for giving greater weight to a treating physician’s opinion
is that
he is employed to cure and has a greater opportunity to know and
observe his
patient. . . .” Sprague v. Bowen, 812
F.2d 1226,
1230 (9th Cir. 1987).
Holbrook v. Lykes Bros. S.S. Co., Inc., 80 F.3d 777, 782-783 (3d Cir. 1996).
In Silagy v. Peters, when invited to find a due process violation in the alleged incompetence of one or more of the psychiatrists appointed to examine that appellant, the Seventh Circuit observed:
[W]e
would be reluctant to open up
this type of [Ake v. Oklahoma, 470 U.S. 68 (1985)] claim to a
battle of
the experts in a “competence” review. Every aspect of a criminal
case
which involves the testimony of experts could conceivably be subject to
such a
review -- a never[-]ending process.
In this case,
as the district court noted, three experienced, board-certified,
independent
practicing psychiatrists were appointed to examine the Petitioner.
Each
psychiatrist conducted a thorough examination and submitted his
diagnosis to
the court . . . Without regard to their ultimate diagnoses,
we believe that this meets the requirements set forth in Ake.
A
conclusion to the contrary would require this court and other federal
courts to
engage in a form of “psychiatric medical malpractice” review as
part-and-parcel
of its collateral review of state court judgments. The ultimate
result
would be a never-ending battle of psychiatrists appointed as experts
for the
sole purpose of discrediting a prior psychiatrist’s diagnosis. We
do not
believe this was the intent of the Court in Ake when it held
that
indigent defendants who raise a defense of insanity are entitled to
psychiatric
assistance in the preparation of their defense.
Accordingly, we
reject Petitioner’s fourteenth amendment due process claim concerning
the competence
of the psychiatrists at his trial.
905 F.2d 986, 1012-13 (7th Cir. 1990).
While the Seventh Circuit specifically noted that each of these psychiatrists was “independent” –- the quality Appellant claims is missing in his case –- we believe that reference was to the right to an expert independent of the prosecution established by Ake: “In the cases, ‘independent’ as opposed to ‘neutral’ means that the expert must be additional to, and separate from, court-appointed experts or experts engaged by the prosecution.” Orbe v. True, 233 F. Supp. 2d 749, 776 (E.D. Va. 2002) (discussing a mental health expert in a capital case).
2. Military References
The UCMJ specifies numerous qualifications for participants in the military justice process. Congress has established statutory qualifications for convening authorities (Articles 22, 23, 24, UCMJ, 10 U.S.C. §§ 822, 823, 824 (2000)), court members (Article 25, UCMJ, 10 U.S.C. § 825 (2000)), military judges (Article 26, UCMJ, 10 U.S.C. § 826 (2000)), trial and defense counsel (Article 27, UCMJ, 10 U.S.C. § 827 (2000)), and investigating officers (Article 32, UCMJ, 10 U.S.C. § 832 (2000)). Congress provided for court reporters and interpreters (Article 28, UCMJ, 10 U.S.C. § 828 (2000)) but left their qualifications to the service secretaries.
Likewise, pursuant to his authority under Article 36, UCMJ, 10 U.S.C. § 836 (2000), the President has promulgated the Manual for Courts-Martial establishing or embellishing qualifications for convening authorities, court members, military judges, counsel, court reporters, bailiffs, interpreters, escorts, clerks, and guards. See generally R.C.M., ch. V.
R.C.M. 706 establishes requirements for sanity boards, including membership qualifications:
By whom conducted. When a mental examination is ordered under subsection (b) of this rule, the matter shall be referred to a board consisting of one or more persons. Each member of the board shall be either a physician or a clinical psychologist. Normally, at least one member of the board shall be either a psychiatrist or a clinical psychologist. The board shall report as to the mental capacity or mental responsibility or both of the accused.
R.C.M. 706(c)(1).
R.C.M.
706 does not address professional conflicts of interest for sanity
board members. Both the discussion and the drafter’s analysis are
silent
on the issue. Neither the 1951 Manual for Courts-Martial,
nor the
May 1953 edition of the Department of the Army’s Technical Manual (TM)
8-240, Psychiatry
in Military Law, addressed conflicts of interest for sanity board
members
or prohibited appointment to such boards of mental health practitioners
who may
have previously diagnosed or treated an accused.1 However, in 1961, this
Court
noted, without comment, the appointment of a treating psychiatrist to a
“competency board” (predecessor of the R.C.M. 706 board) pursuant to a
local requirement
that the doctor “personally responsible” for the accused be a member of
the
board. Erb, 12 C.M.A. at 529,
31 C.M.R. at 115. In
fact, in Erb, the accused’s psychiatrist was appointed as a
member of
the second competency board, notwithstanding his participation in the
first
board as the psychiatrist who “presented the case to the board.” Erb,
12 C.M.A. at 529, 31 C.M.R. 115. This
second
board found that Sergeant Erb was a chronic schizophrenic, but could
distinguish right from wrong and had an impaired ability to form the
specific
intent for “homicide.”
Responding to one appellant’s broad challenge to the neutrality of military psychotherapists appointed to sanity boards, this Court said:
[i]n
the many records that have
passed through this Court, we have observed
no
tendency on the part of military psychiatrists to favor either the
prosecution
or the defense. We are satisfied that their determinations are
impartial
and that they seek not to uncover evidence for the Government but truly
to
determine the mental condition of the accused. . . . Military
psychiatrists are
paid by the Government, but so are defense counsel.
We are certain that neither group shirks its professional
responsibilities because they are employees of the
402, 405 (1973).
In
The next question is whether the requirements of RCM 706 (Change 3)
have been
met. RCM 706(c)(1) provides that an
inquiry into
mental capacity or mental responsibility “shall be referred to a board
consisting of one or more persons. Each member of the board shall
be
either a physician or a clinical psychologist.”
We hold that the requirements of RCM 706(c)(1) have been met in appellant’s case. A
board
consisting of a single psychiatrist would have satisfied the rule.
Furthermore, even assuming arguendo that CPT Coleman had not
received his
Ph.D. degree at the time he participated in the board, there is nothing
in the
rule requiring that a “clinical psychologist” possess a Ph.D. The
record
before us reflects that CPT Coleman was a trained psychologist, was
credentialed by Army medical authorities as a clinical psychologist,
and was
assigned to duties as a clinical psychologist. RCM 706 was
amended in
1986 to parallel prevailing federal practice of allowing use of
clinical
psychologists in mental status evaluations. Drafters’ Analysis of RCM
706(c)(1), Manual, supra at A21-36 (Change
3). Unlike 18
USC § 4247(b), RCM 706(c)(1) does not
specify that the
psychiatrist or psychologist performing the evaluation be “licensed or
certified.” Nevertheless, in the absence of evidence to the
contrary, the
fact that CPT Coleman was credentialed by military medical authorities
to
perform duties as a clinical psychologist raises a presumption that he
was
qualified to do so. See United
States v.
Masusock, 1 U.S.C.M.A. 32, 35, 1 C.M.R. 32, 35 (1951) (“presumption
of
regularity in the conduct of governmental affairs”). That
presumption has not been rebutted in this case.
41 M.J. 213, 241 (C.A.A.F. 1994).
3. Medical and Analogous References
Although there are no readily applicable ethical guidelines for psychiatrists,2 the American Psychological Association’s (APA) Ethical Principles of Psychologists and Code of Conduct, which became effective in 1992, contains at least two applicable standards:
1.17 Multiple Relationships.
(a) . . . Psychologists must always be sensitive to the potential
harmful
effects of other contacts on their work and on those persons with whom
they
deal. A psychologist refrains from entering into or promising
another
personal, scientific, professional, financial, or other relationship
with such
persons if it appears likely that such a relationship reasonably might
impair the
psychologist’s objectivity or otherwise interfere with the
psychologist’s
effectively performing his or her functions as a psychologist, or might
harm or
exploit the other party.
(b) Likewise, whenever feasible, a psychologist refrains from taking on professional or scientific obligations when pre-existing relationships would create a risk of such harm.
(c) If a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist attempts to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code.
. . . .
7.02 Forensic Assessments.
(b) . . . psychologists provide written or oral forensic reports or testimony of the psychological characteristics of an individual only after they have conducted an examination of the individual adequate to support their statements or conclusions.
Both Drs. Galloway and Kirubakaran testified that they were aware of these guidelines, had considered them, and had concluded that no conflict of interest existed. No case law, commentary, or analysis is available to enlighten our consideration of their conclusions.
While not in force at the time of Appellant’s sanity board, the 2003 revision of the APA ethical standard for multiple relationships is enlightening:
3.05 Multiple relationships.
(a) A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person . . . . A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist’s objectivity, competence, or effective-ness in performing his or her function as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.
Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.
. . . .
3.06 Conflict of Interest.
Psychologists refrain from taking on a professional role when personal, scientific, professional, legal, financial, or other interests or relationships could reasonably be expected to 1) impair their objectivity, competence, or effectiveness in performing their function as psychologists or 2) expose the person or organization with whom the professional relationship exists to harm or exploitation.
APA Ethical Principles of Psychologists and Code of Conduct §§ 3.05, 3.06 (2003).
Neither the Office of Government Ethics’ Standards of Ethical Conduct for Employees of the Executive Branch, 5 C.F.R. pt. 2635 (2005), nor the Department of Defense supplement thereto, provides any directly pertinent provision, as the conflict of interest rules therein are primarily aimed at financial or employment conflicts.
Finally, we note that this case does not require us to decide whether, or in what circumstances, a practitioner who receives a privileged communication under M.R.E. 513 may be ineligible to serve as a member of a board appointed under R.C.M. 706.
C. TEST FOR EVALUATION OF POTENTIAL CONFLICTS
Because we are neither a legislative nor executive body, and because even an expansive interpretation of R.C.M. 706 does not suggest such an intent by the drafters, we decline to read that rule so as to contain a per se exclusion from participation in examining boards of practitioners who have either treated or diagnosed the subject of such a board.
After reviewing historical practice, our own precedent, and the legal reasoning of the court below, we agree that “an actual conflict of interest exists if a psychotherapist’s prior participation materially limits his or her ability to objectively participate in and evaluate the subject of an R.C.M. 706 sanity board.” Best II, 59 M.J. at 892.
D. APPLYING THE NEW TEST
1. Dr. Galloway’s prior involvement
As
Chief, Mental
Health Division, USDB, Dr. Galloway was directed in January 2000 to
assess
Appellant to determine whether he was suffering from a psychosis and to
determine the cause of his disruptive behavior. When Dr. Galloway
attempted to interview Appellant, he resisted and then declined, saying
that
God was taking care of him and he needed no mental treatment. Best
II,
59 M.J. at 889. Dr. Galloway then
reported to
the commandant that she was unable to “determine the driving force
behind
Appellant’s behavior,” and posited a combination of personality
disorders and
malingering as the most likely causes. She further recommended
that
Appellant’s disruptions be treated as misconduct rather than medical
issues.
Q. You talked about the questions that the board had prior to it’s [sic] meeting. Did you know the answers to those questions before the board met on the 21st of March?
A.
I knew that
Q. No, no, just testify from your recollection.
A.
Okay. Okay, from my
recollection, sir, I had
Q. So the short answer is you didn’t know before the board met?
A. No.
Q. You didn’t know the answers to the questions?
A. Well, except that I did know their opinion on the diagnostic piece. I didn’t know the rest at all.
Q. And you knew theirs disagreed with yours?
A. Right.
Q. Okay, now after the board met though, and after you –- I take it you were able to answer the four questions, as a member of the board, and your answer as to the diagnosis agreed with that of Springfield, did it not, after the board?
A. Um-hum. In essence, sir, they were right and I was wrong.
Q. I see.
A. Or at least my earlier one was wrong.
Q.
And you said it was your
responsibility to reach a diagnosis. How exactly do you do that
at this
board? How did you reach the diagnosis that agreed with
A. The same way you reach a diagnosis of anybody. You ask them a whole lot of questions, because I know what symptoms are associated with what illnesses.
2. Dr. Kirubakaran’s prior involvement
When
called by Dr.
Galloway, Dr. Kirubakaran (the psychiatry medical officer at the
CONCLUSION
Adopting and applying the test formulated by the court below, we conclude that even if there exists some evidence of conflict, that evidence is insufficient to comprise an “actual conflict of interest.” There was no material limitation of either Dr. Galloway’s or Dr. Kirubakaran’s ability to participate objectively in the board or evaluate Appellant. Although there are conflict of interest rules for psychologists and commentary to the ethical guidelines for the practice of forensic psychiatry suggesting that psychiatrists “should generally avoid agreeing to be an expert witness or to perform evaluations of their patients for legal purposes,” American Academy of Psychiatry and the Law Ethical Guidelines for the Practice of Forensic Psychiatry (adopted 1987, revised 1995), those conflict rules do not apply to these facts. As Dr. Galloway put it, at least through the time of Appellant’s sanity board, both Dr. Galloway and Dr. Kirubakaran were each wearing only “one hat.” Neither was Appellant’s psychotherapist. Neither did more than a brief assessment, followed in some cases by referral to those who could diagnose Appellant and offer him treatment. Consequently, there is no reason to question whether the board’s membership complied with R.C.M. 706 or question the reliability of the trial results.
The decision of the United States Army Court of Criminal Appeals is affirmed.
1 Subsequent editions of these
references
are similarly silent.
2 See 3
Jay Ziskin
& David Faust, Coping with Psychiatric and Psychological
Testimony
17 (5th ed. 1995). See
also
BAKER, Judge (concurring in the result):
Dr.
Galloway and
Dr. Kirubakaran assessed Appellant’s mental condition while Appellant
was an
inmate at the Disciplinary Barracks,
The question on appeal is whether Dr. Galloway or Dr.Kirubakaran had a conflict of interest that should have disqualified them from serving on Appellant’s R.C.M. 706 board. Put into factual context, in light of their prior assessments, which did not identify the severity of Appellant’s condition, were they capable of impartially serving on Appellant’s board without in some manner trying to validate or justify their prior judgments regarding Appellant?
Like
this Court,
the Court of Criminal Appeals found this to be a question of first
impression. The lower court analogized to both the American
Psychological
Association’s Code of Conduct (applicable to psychologists) and the
American
Medical Association’s Principles of Medical Ethics (applicable to
psychiatrists), as well as the conflict of interest standard for legal
counsel
articulated by the Supreme Court in Mickens v. Taylor, 535 U.S.
162, 172
n.5 (2002), to develop its standard for psychotherapist conflict of
interest
review. The Court of Criminal Appeals “conclude[d] that an actual
conflict of interest exists if a psychotherapist’s prior participation
materially limits his or her ability to objectively participate in and
evaluate
the subject of an R.C.M. 706 sanity board.”
While
I agree with
the majority’s conclusion that Dr. Galloway and Dr. Kirubakaran did not
bear a
disqualifying conflict in this case, I believe the question presented
finds its
root in constitutional due process. The Fifth and Fourteenth
Amendments
of the U.S. Constitution restrain government from depriving any person
of life,
liberty, or property without due process of law, and “protect[] the
individual
against the arbitrary action of government.” Kentucky Dep’t
of Corrections
v. Thompson, 490
Under R.C.M. 706, once a mental examination is ordered, the matter shall be submitted to a sanity board charged to report on the mental responsibility or capacity of the accused. The rule includes specific, discretion-narrowing directives for both the order authorizing the board and for the conduct of the board itself. R.C.M. 706(c). While Appellant may have had no independent constitutional right to an R.C.M. 706 board, once such a board was ordered, its evaluation must have been conducted in a manner consistent with the requirements of procedural due process. See Wainwright, 477 U.S. at 428-29; see also Diaz v. Judge Advocate General of the Navy, 59 M.J. 34, 38 (C.A.A.F. 2003) (where statute has created appellate process as integral part of criminal justice system, procedures used in deciding appeal must comport with demands of due process and equal protection).
Such
due process
includes the right to a fair and impartial adjudicator. Concrete Pipe & Prods. v. Constr.
Laborers
Pension Trust, 508 U.S. 602, 617 (1993) (“That officers acting in a
judicial or quasi-judicial capacity are disqualified by their interest
in the
controversy to be decided is, of course, the general rule.”) (quoting Tumey v. Ohio, 273
I believe the facts as applied against this standard indicate that both were capable of impartial judgment. Among other things, Dr. Galloway acknowledged under direct examination and cross-examination that she was incorrect in her initial assessment of Appellant. Further, she demonstrated a willingness to reassess her judgment and to do so without apparent defensiveness or protection of her prior judgment. As judges are asked on occasion to reconsider their judgments on appeal, based on perceived errors in law or fact, See, e.g., C.A.A.F. R. 31, I do not believe doctors as professionals are inherently incapable of doing the same absent a showing of actual conflict. In the context of the liberty interest associated with this particular R.C.M. 706 board, there was added protection in that the integrity and impartiality of the doctors’ evaluation was subject to the crucible of cross-examination.
This would appear to leave Appellant in the position of arguing for a per se disqualification where an assessing psychotherapist subsequently serves on a R.C.M. 706 board. However, such a position is not required as a matter of statutory law or constitutional due process, where as here, Appellant has had the opportunity to test for impartiality. Moreover, in the military context, there may be good operational reasons why an assessing or treating physician may also be required to serve on an R.C.M. 706 board.
That being said, while the Government may be satisfied that a doctor can appropriately function as both a treating physician and subsequent board member in specific situations, that does not mean that a treating physician should always do so. The Government might choose as a prudential matter to eliminate any possible appearance of a conflict of interest, and related litigation, by affirmatively selecting qualified R.C.M. 706 board members with no prior connection to the subject of the review. Such an approach is consistent with the admonition in both the psychologists’ Code of Conduct and the psychiatrists’ Principles of Medial Ethics, which disfavor, and in some cases bar, a treating psychotherapist’s performance of multiple roles.
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