LANDMARK CASES C-D

Question 1

Canterbury v. Spence (DC COA 1972) FOTC

Answer 1

• Canterbury 19M (minor) w/ back pain who had laminectomy by Dr. Spence, neurosurgeon
• Mother told about/consented, but that it was no more dangerous than any operation
• Paraplegia & incontinence
• Canterbury said not informed of 1% risk of paraplegia
  (- Also that operation negligently and nursing care following inadequate, not real testimony on this issue)
• Spence testified that not good medical practice to inform paraplegia, bc dissuade pts from needed surgery
• Trial court found in favor of Spence

Question 2

Canterbury v. Spence (DC COA 1972) H

Answer 2

H: Reversed and remanded: changed physician’s obligation to disclose risks from “reasonable medical practitioner” rule to “materiality of the information standard.”

Question 3

Canterbury v. Spence (DC COA 1972) R (Basic, Info, Causal, BOP, Expert)

Answer 3

• Every pt right to self-determination, which shapes boundaries of duty to reveal. Can only be made if sufficient info. So pt’s need determines physician disclosure.
• Info must include inherent/potential risks of tx, alternatives to tx, and likely result w/ non-tx
• Causal connection necessary for successful malpractice, exists only when disclosure of risks would have resulted in decision against it. OBJECTIVE REASONABLE PERSON TEST
• BOP falls on plaintiff, but burden of proving privilege NOT to disclose (therapeutic exception) falls on doc
• Experts unnecessary to show materiality of risk, so unlike “reasonable medical practitioner” standard, no experts needed

Question 4

Canterbury v. Spence (DC COA 1972) 2 Exceptions

Answer 4

1. Emergency: Unconscious/harm from failure to treat is imminent and outweighs any harm from proposed tx. Attempt to obtain consent, but otherwise proceed.
2. Therapeutic exception: risk disclosure such a threat of detriment to pt (emotionally distraught on this disclosure) as to preclude rational decision, and becomes unfeasible or contraindicated. Disclosure to close relative for consent may be only alternative

Question 5

Clark v. Arizona (SCOTUS 2006) FOTC

Answer 5

• Clarked charged w/ 1st degree murder of LEO
• Pled NGRI 2/2 undisputed paranoid schizophrenia
• AZ statute said BOP on defense by CACE that 2/2 mental ds/defect did not know criminal act was wrong
• Defense provided expert & lay evidence that Clark thought aliens trying to kill him, some impersonating gov’t agents, only way to stop was w/ bullets
• Prosecution showed Clark enticed LEO to stop vehicle, knew it was LEO, and shot him
• Trial judge found Clark guilty & sentenced to life
• Clark appealed on whether exclusion of nature/quality from NGRI constitutional, as well as exclusion of MI for mens rea purposes

Question 6

Clark v. Arizona (SCOTUS 2006) 2 Issues

Answer 6

Clark appealed on 2 Due Process Grounds:
1. Constitutionality of 1993 AZ changed to modified M’Naghten which removed “whether knew nature and quality” & instead was only on wrongfulness
2. Whether prior AZ SC decision prohibiting defendant from introducing MI evidence to rebut requisite criminal intent violated due process

Question 7

Clark v. Arizona (SCOTUS 2006) H (2) & R (3)

Answer 7

H: Due process doesn’t prohibit AZ’s use of insanity for only right and wrong, nor AZ’s right to preclude MH testimony on mens rea
R:
- No constitutional minimum re: insanity rule, up to states
- Wrongfulness sort of envelopes nature/quality of act, bc if didn’t know that, wouldn’t know wrong
- Re: precluding MH testimony re: mens rea, expert testimony not settled scientific issue and may confuse jury by complicating huge # of cases, so AZ fine to do it

Question 8

Clark v. Arizona (SCOTUS 2006) 3 New Categories of Evidence w/ Potential Bearing on Mens Rea (& AZ Point)

Answer 8

1. Observation Evidence - what def did/said, also expert testimony on tendency to think/behavioral characteristics (lay & expert)
2. Mental Disease Evidence - only expert, opinion testimony that suffered from mental ds
3. Capacity Evidence - opinions abotu def’s capacity for cognition and moral judgment and to form requisite mens rea
   - AZ disallowed (2) and (3)

Question 9

Clark v. Arizona (SCOTUS 2006) Dissent

Answer 9

New tripartite model of evidence w/r/t MI makes no sense “to divorce the observation evidence from the explanation that makes it comprehensible.”

Question 10

Clites v. State of Iowa (IA COA 1982) FOTC

Answer 10

• Clites MR, hospitalized at IA state hospital since 11
• Frequent antipsychotics for aggression, developed TD
• Father filed claim against state for negligent use of drugs
• Trial court found defendants failed to provide reasonable medical care
• Defendants appealed, alleging trial court used incorrect standard of care

Question 11

Clites v. State of Iowa (IA COA 1982) H and R (2 Gen, 4 Specific Acts, and Constitutional)

Answer 11

H: Upheld, including 385k award (future medical expenses) and 375k past/future pain/suffering
R:
- Not sufficient evidence of aggression/abuse
- Use more as convenience for staff than therapeutic programs
- Failed to adequately monitor, arrange drug holidays, stop when TD signs started, request consultation from specialist
- Found 1st A gave right to refuse meds in non-emergency and required institution obtain informed consent, never obtained

Question 12

3 Cases Cited in Clites v. State of Iowa (IA COA 1982)

Answer 12

Youngberg
Rennie
Rogers
(RTRM)

Question 13

Colorado v. Connelly (SCOTUS 1986) FOTC

Answer 13

• Connelly approached DEN PO & confessed murder
• Officer Miranda’d, Connelly said understood but wanted to confess
• Detailed & gave exact location
• Next day visibly disoriented w/ PD & sent to state psych hospital for eval
• Eval w/ Metzner: following “voice of God” saying confess or suicide
• Trial court ruled these statements were involuntary, despite no coercion from police
• & found mental state vitiated attempted waiver of R to counsel and privilege of self-incrimination, and violated Due Process

Question 14

Colorado v. Connelly (SCOTUS 1986) H & R (BOP and Const.)

Answer 14

H: Reversed – coercive police activity necessary for confession not to be voluntary and violate Due Process
R:
- State only has to prove Miranda waiver by POTE
- Sole concern of 5th A is government coercion, when not present, no violation there or w/ Due Process

Question 15

Colorado v. Connelly (SCOTUS 1986) Dissent (2)

Answer 15

• Use of MI’s involuntary confession antithetical to fundamental fairness in Due Process
• Confessions given such weight that everything else in criminal process superfluous, so way more open to abuse

Question 16

Custodial Confession (& Case)

Answer 16

• Miranda rights apply whenever a reasonable person would believe that he is not free to leave (not just at police station)
• Colorado v. Connelly (SCOTUS 1986)

Question 17

Cooper v. Oklahoma (SCOTUS 1996) FOTC & Issue

Answer 17

• Cooper charged w/ brutal killing of 86M during burglary
• Competency Q raised 5x during trial
• Judge expressed uncertainty re: competency, but stated def had not carried BOP by CACE (OK standard)
• Cooper conv/sentenced to death
• Upheld by COA
• Appealed SCOTUS
  Issue: Does the 14th A Due Process Clause allow state to require defendant to prove incompetence by CACE standard?

Question 18

Cooper v. Oklahoma (SCOTUS 1996) H & R (2)

Answer 18

H: Reversed/remanded, violates SUBSTANTIVE Due Process 14th A. Max standard for def should be BOP on them by POTE
R:
- CACE allows state to try person who is more likely than not incompetent, which violates fundamental fairness of every other right during trial
- BOP: reasonable to be on defendant bc of risk of malingering, but not such high bar

Question 19

Cooper v. Oklahoma (SCOTUS 1996) Other Case Noted

Answer 19

Said in agreement w/ Addington v. Texas (1979) (Due Process requires CACE for invol commitment), bc that rule protected fundamental liberty interest, while this ruling safeguards right not to be required to stand trial while incompetent

Question 20

Daubert v. Merrell Dow Pharmaceuticals (SCOTUS 1993) FOTC

Answer 20

• 2 minors born w/ severe birth defects, parents sued Merrell Dow saying caused by Bendectin exposure
• Federal Distr Co granted MD’s req for summary judgment 2/2 well-credentialed expert affidavit citing extensive literature of safety of maternal Bendectin
• Plaintiffs proffered 8 experts w/ testimony of Bendectin birth defects of animal studies, chemical structure, reanalysis of other studies
• Distr Co excluded plaintiff experts bc didn’t meet “general acceptance” (Frye) standard
• COA affirmed
• Plaintiffs appealed SCOTUS

Question 21

Daubert v. Merrell Dow Pharmaceuticals (SCOTUS 1993) H & R (Comparison of the 2, Gen Reasoning, and other Protection)

Answer 21

H: Fed. Rules of Evidence, NOT Frye, provide standard of admitting expert scientific evidence in federal trial
R: Frye Test: “must be sufficiently established to have gained general acceptance in the particular field”
Fed RoE 702: “If scientific, technical, other specialized knowledge will assist…witness qualified as expert by knowledge, skill, xp, training, or education may testify”
- Rule 702 placed appropriate limits on admissibility via reliability standard, that judge makes preliminary assessment that testimony rests on reliable foundation and is relevant
- Cross-ex, contrary evidence, and instruction on BOP, rather than wholesale exclusion, is best way to challenge the evidence

Question 22

Daubert v. Merrell Dow Pharmaceuticals (SCOTUS 1993) 5 Factors for Judge to Consider

Answer 22

1. Whether the theory or technique in question can be (and has been) tested
2. Whether it has been subjected to peer review and publication
3. Its known or potential error rate
4. The existence and maintenance of standards controlling its operation
5. Whether it has attracted widespread acceptance in the relevant scientific community (Frye test)

Question 23

Daubert v. Merrell Dow Pharmaceuticals (SCOTUS 1993) in Soft Sciences

Answer 23

• Most courts have not applied to soft sciences such as violence risk and NGRI

Question 24

Daubert and Kumho:

Answer 24

• Kumho extended Daubert to “skill or experience-based evidence”

Question 25

DeShaney v. Winnebago County DSS (SCOTUS 1989) FOTC

Answer 25

• Child DeShaney lived with father after divorce
• Severe beatings w/ severe permanent brain damage
• Winnebago County DSS received complaints of abuse, took steps to protect, but didn’t remove from father’s custody
• Child/mother sued under 42 USC Section 1983, alleging DSS deprived of liberty interest in bodily integrity, and 14th A Due Process by failing to protect against father’s violence
• Dist Co granted summary judgment for DSS, and COA affirmed
• Appealed SCOTUS

Question 26

DeShaney v. Winnebago County DSS (SCOTUS 1989) H & R (2 & Add’l Consideration)

Answer 26

• 14th A based on limiting state’s power to act, not requiring to protect life/liberty/property against private actions
• Rejected “special relationship” contention about affirmative DTP. “Special relationships” exist when state has imposed limitations on the individual or placed in the predicament (such as providing medical care to prisoners (Estelle v. Gamble 1976) or safety to institutionalized (Youngberg v. Romeo 1982)), but didn’t create/worsen DeShaney’s predicament
• Possible that tort exists bc voluntarily undertook protecting Josh w/ protection and then was not adequate, but 14th A doesn’t xform every tort committed by state employee into a constitutional violation

Question 27

DeShaney v. Winnebago County DSS (SCOTUS 1989) Dissent

Answer 27

Bc state undertook protection to point that private sources don’t intervene, state should have responsibility for that protection

Question 28

Dillon v. Legg (CA SC 1968) FOTC & Issue

Answer 28

• Erin Dillon struck/killed by driver Legg. Mother brought wrongful death suit for damages for deceased daughter, emotional injuries sustained by another daughter, and emotional injuries for self from witnessing
• Legg moved for summary judgment, trial court denied w/r/t surviving daughter, bc up for jury to decided Zone of Danger, did grant for mother bc beyond Zone of Danger
• Plaintiff appealed to SCOTUS
  Issue: Can individual who sustains emotional injuries from another’s negligence recover damages despite no physical impact herself and not w/in Zone of Danger?

Question 29

Dillon v. Legg (CA SC 1968) H & R

Answer 29

H: Duty to avoid conduct which might foreseeably harm another can extend to another beyond ZoD so long as emotional injuries reasonably foreseeable
R: “Duty” was introduced in 19th C to limit liability, but really should be about “foreseeability,” as mother’s emotional injury was reasonably foreseeable from Legg’s act

Question 30

Dillon v. Legg (CA SC 1968) 3 Components of Reasonably Foreseeable

Answer 30

1. Injured party must be located near the scene of accident
2. Must experience a direct emotional injury from accident by actually witnessing it
3. Must be closely related to the victim

Question 31

Dillon v. Legg (CA SC 1968) 2 Arguments Rejected

Answer 31

1. Concern about fraudulent claims bc recovery in isolated fraudulent cases shouldn’t deprive an entire class of meritorious claims
2. Concern about inability to fix definitions for recovery for future cases (rejected by providing new critical issue of reasonably foreseeable)

Question 32

Doe v. Roe (NY SC 1977) FOTC

Answer 32

• Doe, former pt (pnym), brought action against psychiatrist Roe (pnym) & Roe’s husband alleging unlawfully invaded privacy by publishing book (8 yrs later) w/ verbatim/extensive pt’s thoughts, feelings, emotions, fantasies, and biographies
• Plaintiff sued for injunction to stop book and damages

Question 33

Doe v. Roe (NY County SC 1977) H (2) & R (3)

Answer 33

H:
- Held injunction and $20k compensatory
- Rejected punitive damages bc “defendants’ actions were not willful, malicious, or wanton,” as required by law, but “merely stupid”
R:
- Cited ethics codes, Hippocratic, and licensing revocations for betrayal of professional secrets, as well as noting that psych in general could only work in an atmosphere of unusual trust
- Tort doesn’t necessarily need to have a name, just importance of infliction of harm w/o legal justification
- Confidentiality not absolute, but “curiosity of medical profession” doesn’t supersede

Question 34

Doe v. Roe (NY SC 1977) Other Case Quoted for Importance

Answer 34

Lifschutz

Question 35

2 Violations of Privacy and Which One in Doe v. Roe (NY SC 1977)

Answer 35

Unreasonable intrusion and unreasonable publicity

Question 36

Durham v. U.S. (DC COA 1954) FOTC

Answer 36

• Durham convicted of housebreaking by Distr Co. Only defense NGRI
• Long hx of psych hospitalizations
• Extensive psych testimony, judge rejected saying didn’t think established defendant of unsound mind on date/couldn’t contradict presumption of insanity
• Durham appealed on who had BOP

Question 37

Durham v. U.S. (DC COA 1954) H & Basic R, but also Other Main Point

Answer 37

• Overturned, bc once defense provides burden of production (evidence of insanity introduced), burden of persuasion falls on prosecution BARD
• Bazelon created his new test: “An accused is not criminally responsible if his unlawful act was the product of mental disease or defect.”

Question 38

Durham v. U.S. (DC COA 1954) Test Reasoning (3)

Answer 38

• Rejected McNaughten bc didn’t take into account psych realities and new knowledge, based on one sx so not generalizable
• Rejected irresistible impulse test bc no recognition to MI characterized by brooding/reflection
• Basically said new scientific knowledge from modern psych recognized more integrated personality from which “reason” can’t be isolated out, basically said this was natural scientific progression

Question 39

Durham v. U.S. (DC COA 1954) Historical Ramifications (3)

Answer 39

• Abandoned in 1972 for American Law Institute (ALI) / Moral Penal Code (MPC) due to undue influence by experts
• Hinckley found NGRI under this standard (bc burden of persuasion BARD fell on prosecution)
• Insanity Defense Reform Act (IDRA) in 1984 set standard for federal trials to place BOP for NGRI on defendant by CACE

Question 40

Dusky v. United States (SCOTUS 1960) FOTC

Answer 40

• Dusky charged (w/ 2 juvenile codefs) w/ abducting 15F, xporting across state lines, rape/attempted rape
• Atty raised both CST and NGRI
• Dusky hosp for 4 months at federal medical center for exam
• Dx Schizophrenic Reaction, chronic, w/ visual hallx and c/b alcoholism
• Later report stated unable to properly understand/adequately assist
• Another report said basic understanding, but unable to assist due to suspicions, confusion, inability to interpret reality
• Trial court said was competent
• Convicted, affirmed by COA
• Appealed SCOTUS

Question 41

Dusky v. United States (SCOTUS 1960) H & R

Answer 41

H: Reversed, said proper CST test is “whether the accused has sufficient present ability to consult with his lawyer with a reasonable degree of rational understanding and whether he has rational as well as factual understanding of the proceedings against him.”
- Minimal actual reasoning provided

Question 42

Dusky v. United States (SCOTUS 1960) Historical Effects (2)

Answer 42

• Most widely used standard, but “rational understanding” often omitted; not followed exactly bc interpreting federal statute instead of constitutional requirement
• Superseded by IDRA 1984: “present mental ds or defect renders the defendant unable to understand the nature and consequences of the proceedings against him or to assist in his defense.”