Background:

Determining a defendant’s competency to stand trial is a critical task that can significantly impact the judicial process. This case study explores a scenario of a 26-year-old Mexican American female defendant, referred to here as “Jane Doe,” who was initially deemed incompetent to stand trial due to apparent cognitive impairments. A request for a second opinion was made to our office. Our second-opinion evaluation revealed that Jane was malingering, ultimately leading to a finding of her having the capacity to know and understand the charges against her and the capacity to work with her attorney. 

 

Case Details:

Jane Doe was charged with homicide, a serious offense that carries significant legal consequences. During the initial court proceedings, her defense attorney raised concerns about her mental state, suggesting that she was unable to comprehend the nature of the charges against her or participate adequately in her defense. The defense attorney stated that Jane had difficulties recalling events at the time of the alleged offense and could not tell her anything about what she would have been doing at that time or where she could have been living. The defense attorney also said that when she visited Jane at the jail, that Jane did not know who she was, and the attorney had to remind her several times that she was Jane’s attorney. Consequently, the court ordered a competency evaluation under California Penal Code 1368. 

 

Jane’s history included: 

  • Jane’s first language was Spanish and Spanish was the language spoken at home. However, she went to school in the U.S. since kindergarten and prefers English. 
  • Jane graduated high school without problems (no special education, etc.) and did not need English as Second Language (ESL) classes. 
  • Jane has no psychiatric treatment history.
  • Jane was the driver in car accident 10 years ago where she endured whip lash and hit her head on the steering wheel. She was found not fault. 
  •  Jane’s CT scan from the accident 10 years ago was negative for any signs of bleeding, swelling, or fractures. The ventricles, sulci, and gyri would appear normal, with no evidence of hematomas or contusions. There was no loss of consciousness. 
  • Jane’s doctor noted that she had problems concentrating, recalling details of the accident, and maintaining attention the day of the accident. It was also noted she was overwhelmed and anxious. Her initial diagnosis was a mild traumatic brain injury (mTBI). She was discharged six hours later, and the hospital note indicated she was oriented but had periodic moderately painful headaches, able to take care of her activities of daily living (ADL’s) and had a minor headache.  
  • Jail records revealed that Jane cares for her ADL’s, participates in group activities in jail, and talks to her family regularly on the phone. She had a few complaints of headaches, but no medication was requested or received. 

 

California Penal Code 1368:

Purpose: CA PC 1368 mandates that if the court or any party involved in the case expresses doubt about the defendant’s competency, the court must suspend the proceedings and order a psychiatric evaluation. This code section ensures that the process for evaluating and addressing competency concerns is followed. Focus: CA PC 1368 outlines the procedures for determining a defendant’s mental competency to stand trial. According to this statute, if a doubt arises regarding a defendant’s mental competence, the court is required to suspend criminal proceedings and order a psychiatric evaluation. The code specifies that a defendant is considered competent if they have the ability to understand the nature of the criminal proceedings and can assist their attorney in mounting a defense. If the court finds the defendant incompetent, they may be committed to a state hospital or another treatment facility until they are deemed competent.

 

California Penal Code 1367 

Purpose: CA PC 1367 provides the criteria that must be met for a defendant to be considered competent or incompetent to stand trial. Focus: CA PC 1367 addresses the issue of a defendant’s mental competency to stand trial. Specifically, it establishes the legal standard for determining whether a defendant is competent. According to PC 1367, a defendant is considered mentally incompetent if, as a result of a mental disorder, mental defect, or developmental disability, they are unable to understand the nature of the criminal proceedings or assist their attorney in the conduct of a defense in a rational manner.  This statute is foundational in ensuring that defendants have the mental capacity to participate in their defense, which is a fundamental right in the legal system. If there is a doubt about a defendant’s competency, the court is required to suspend the proceedings and conduct a hearing to determine competency, often leading to evaluations by forensic psychologists and psychiatrists. If found incompetent, the defendant may be committed to a treatment facility until they are restored to competency.

 

Initial Evaluation:

The first psychological evaluation was reviewed. It revealed that the first evaluator spent 24 minutes conducting a clinical forensic interview with Jane, where Jane typically responded to questions with “I don’t know” or “I don’t remember” responses. She told the first evaluator her memory has been poor since her car accident 10 years ago. The evaluator administered intellectual and memory measures. Jane’s full-scale IQ came out to 73 and her performance on auditory, visual, immediate, and delayed memory tasks revealed similar scores between 41 and 75. No records beyond the hospital records were requested.  The initial report indicated that Jane exhibited signs of severe depression, anxiety, and cognitive deficits. She reported memory lapses, confusion, and an inability to concentrate, which the evaluator interpreted as genuine symptoms of a mental health and major neurocognitive disorder due to her car accident. Based on these findings, Jane was found incompetent and referred for remediation treatment.  

 

Reevaluation:

After several months of treatment, Jane’s symptoms showed minimal improvement, prompting a reevaluation. During this assessment, inconsistencies in Jane’s presentation began to surface. Her reported symptoms fluctuated significantly, and she demonstrated a surprisingly detailed understanding of legal procedures when questioned indirectly.

We employed several standardized tests designed to assess for response style, including malingering, such as the Structured Interview of Reported Symptoms (SIRS) and the Test of Memory Malingering (TOMM). We also administered the Minnesota Multiphasic Personality Inventory-, Third Edition (MMPI-3) and the Test of Non-Verbal Intelligence (TONI). Jane’s performance on these assessments suggested intentional exaggeration of symptoms. Additionally, collateral information from her personal life as indicated by her family through interviews and jail records contradicted her claims of severe cognitive impairment.

 

Findings and Conclusion:

We concluded that Jane was malingering, likely to avoid the legal consequences of her actions. Her behavior was consistent with an attempt to feign cognitive deficits to delay or evade her trial. Our report highlighted:

  • Jane’s intact cognitive abilities as evidenced by her having graduated high school, having no problems at the jail, taking care of her own ADLs, and the inconsistencies between her self-report of symptoms, clinical presentation, and information found in the records. 
  • For the majority of individuals, mild head injuries do not result in long-term cognitive or neurological deficits. Most people return to their baseline level of functioning without significant issues.
  • How factors such as age, previous head injuries (or lack thereof), and the presence of pre-existing conditions can influence recovery time. 
  • Research on how most individuals with mild head injuries recover fully within a few weeks to a few months.
  • Research on the brain’s natural healing processes, along with rest and gradual return to normal activities can facilitate recovery.
  • Finally, how Jane’s intact abilities lent way to her capacity to understand the legal proceedings and assist in her defense.

Based on this comprehensive evaluation, along with a third expert’s evaluation with similar opinions, the court reversed its initial decision, finding Jane competent to stand trial under California Penal Code 1368. 

 

Implications for Forensic Psychology Practice:

This case underscores the importance of thorough assessments, including the use of multiple performance and symptom validity measures and forensic assessment instruments as part of the evaluation. It highlights the need for forensic psychologists to assess for signs of malingering in forensic evaluations like competency to stand trial and to utilize appropriate assessment tools to differentiate between genuine mental health and cognitive deficits and feigned symptoms. By doing ensures more reliable information is provided to the court so that they can make the best decision possible.