TO THE INTERMEDIATE COURT OF APPEALS (CAAP-14-0001079; CR.
A. Luiz for petitioner.
J. Thomas for respondent.
RECKTENWALD, C.J., NAKAYAMA, McKENNA, POLLACK, AND WILSON,
case requires us to consider whether a defendant's
failure to take prescription medication can constitute
self-induced intoxication under Hawai'i Revised Statutes
(HRS) § 702-230, which precludes the defendant from
relying on the defense of lack of penal responsibility due to
a physical or mental disease, disorder, or defect. We hold
that it does not, and that the defense is therefore available
in the circumstances presented here.
Samuel Eager was charged with assault in the second degree
after attacking a stranger at a bus stop, and a bench trial
was held in the Circuit Court of the First Circuit (circuit
court). Eager presented the defense of lack of
penal responsibility as a result of disease, disorder, or
defect, arguing that he was experiencing a psychotic episode
at the time of the attack. The State did not dispute
Eager's psychosis, but argued that he should nonetheless
be held criminally responsible because his psychosis stemmed
from his failure to take prescribed medication and from
marijuana use. The circuit court found Eager guilty,
concluding that "any disease, disorder, or defect the
Defendant may have been suffering from at the time of the
assault was self-induced and the product of the
Defendant's refusal to take his prescribed medication and
his use of marijuana." The court sentenced Eager to five
appeal to the Intermediate Court of Appeals (ICA), Eager
argued that (1) he was deprived of a fair trial because one
expert witness, Dr. Wagner, improperly bolstered the opinion
of another expert witness, Dr. Jacobs, and (2) the circuit
court abused its discretion in sentencing Eager to five
years' imprisonment because there were strong mitigating
factors, making probation a more appropriate sentence. The
ICA rejected Eager's arguments and affirmed the circuit
court's judgment of conviction. Eager now raises the same
arguments on certiorari review here.
agree with the ICA's reasoning regarding Eager's
first point of error. We need not consider Eager's
arguments regarding his sentence, as we recognize plain error
in the circuit court's holding that Eager's psychotic
behavior was the result of self-induced intoxication. HRS
§ 702-230(5) (1993) defines "self-induced
intoxication" as "intoxication caused by substances
which the defendant knowingly introduces into the
defendant's body, the tendency of which to cause
intoxication the defendant knows or ought to know."
Accordingly, the circuit court's holding that Eager's
failure to take his medication caused his psychotic
behavior is inconsistent with the plain language of the
statute, which requires the introduction of
substances into the body. Thus, the circuit court's
conviction of Eager was in error.
therefore vacate the ICA's judgment on appeal and the
circuit court's judgment of conviction, and remand for
further proceedings consistent with this opinion.
Circuit Court Proceedings
February 1, 2013, the State charged Eager with one count of
assault in the second degree in violation of HRS §
707-711(1)(b) for recklessly causing substantial bodily
injury to then-79-year-old Hua Zhao Liang (Liang), and
subject to sentencing under HRS §
filed a "Motion for H.R.S. § 704-404Examination"
to determine his fitness to proceed to trial and whether he
would be held penally responsible for his conduct. The
circuit court appointed a three-member panel of examiners:
Dr. Leonard Jacobs, Dr. Duke Wagner, and Dr. Olaf Gitter.
doctor submitted a report to the court. The doctors all
determined that Eager was fit to proceed, but differed with
regard to penal responsibility. Dr. Jacobs and Dr. Wagner
concluded that Eager's cognitive and volitional
capacities were not substantially impaired at the time of the
alleged assault. Dr. Gitter concluded that Eager's
capacities were substantially impaired due to an "acute
court issued a "Judicial Determination of Fitness to
Proceed and Order, " finding that Eager was fit to stand
waived his right to a jury, and his case proceeded to a bench
trial. Liang testified that on January 29, 2013, he got off
the bus and was walking to the food bank when "on the
left side of me suddenly someone hit me on my head and then I
fainted." He testified that he lost consciousness and
did not see the person who hit him. An ambulance took Liang
to Queen's Medical Center (Queen's), where he
received eighteen stitches. A passerby testified that on the
morning of January 29, 2013, she saw Eager stomping on the
head of an elderly man laying motionless on the ground,
leading her to call 911 in response. A "Stipulation as
to Testimony" was filed in open court, which indicated
that Liang's injuries included a major laceration of the
skin on his forehead, a facial bone fracture, and a serious
State's witnesses also included two Honolulu Police
Department officers who interacted with Eager following his
arrest several hours after the attack, and the detective who
investigated the incident. The arresting officer testified
that Eager was "compliant" and attentive at the
time of arrest.
Gitter, an expert in clinical psychology, testified for the
defense that he reviewed Eager's medical records from
Queen's, where he was treated on January 8-10 and 26-27,
2013, and O'ahu Community Correctional Center (OCCC),
where he was examined following the alleged assault.
Gitter testified that the Queen's and OCCC records showed
that Eager exhibited signs of mental illness, including an
acute manic episode, auditory and visual hallucinations, and
bipolar disorder. Dr. Gitter also stated that on Eager's
January 26-27 visit to Queen's, "drug testing showed
that he tested positive for marijuana only."
questioned about Eager's marijuana use, Dr. Gitter
testified that "cannibus [sic] psychotic disorder"
exists, but that he "seriously doubt[ed]" that
marijuana triggered Eager's acute manic episode.
defense then asked Dr. Gitter about Eager's mental state
at the time of the incident, and Dr. Gitter answered that
"he was suffering from a bipolar disorder mix type of
depressive and manic features and that it was so severe that
he was also psychotic at the time." When asked if he
thought Eager was penally responsible for the assault, Dr.
Gitter opined that Eager's cognitive and volitional
capacities were "substantially impaired by an
exacerbation of his mental disorder."
cross-examination, Dr. Gitter testified that although he
could not say what exactly triggered Eager's manic
episode at the time of the incident,
my opinion is that he still was suffering just two days after
having been discharged from Queen's Medical Center. He
had not been given any medication that typically would have
been given to deal with the psychosis. He was only given, I
believe Ambien, which is a sleep medication. And, the way he
described the assault to me was that he was clearly psychotic
asking the gentleman whether he believed in Jesus and then
assaulting him to drive out the demons. Plus, two days later
when he was at OCCC again he was noted to be manic and
court asked Dr. Gitter if marijuana could indirectly trigger
a psychotic episode by altering Eager's perception of
reality, to which Dr. Gitter replied, "it could."
When the court asked Dr. Gitter if Eager was psychotic from
the time he was discharged from Queen's until he was
admitted to OCCC, Dr. Gitter said yes.
State presented two rebuttal witnesses, Dr. Jacobs and Dr.
Wagner, who also examined Eager at OCCC prior to trial.
Jacobs, an expert in psychiatry, opined that Eager's
judgment was impaired due to a combination of self-induced
prescription drug withdrawal and marijuana use. Dr. Jacobs
diagnosed Eager with "a personality disorder and somatic
symptom disorder with predominant pain persistent and
severe."Dr. Jacobs testified that Eager was
prescribed the sleep aid Ambien, the anti-inflammatory
medication Meloxicam, and the painkiller Percocet. Dr. Jacobs
also testified that Eager reported that he had "not
taken any of his drugs, except marijuana, for three
days" prior to the incident. Dr. Jacobs opined that
ceasing to take Ambien would cause "severe insomnia,
agitation, and feeling very uncomfortable, " and that
stopping Percocet, an opiate, "can cause severe problems
Jacobs testified that Eager "did not have any psychosis
at the time I interviewed him" and, according to the
Queen's reports and Eager himself, he was not intoxicated
but rather "probably suffering from withdrawal
symptoms" at the time of the assault. Dr. Jacobs
further testified that despite his personality disorder,
Eager "knows right from wrong."
cross-examination, Dr. Jacobs agreed that, at the time of the
incident, Eager's psychotic episode rendered him
incapable of appreciating the wrongfulness of his actions.
State then called Dr. Wagner, an expert in psychology, who
testified that his "diagnostic impressions at the time
of the alleged offense" were "post-traumatic stress
disorder and cannabis abuse versus dependence." The
State asked Dr. Wagner about the possible effects of
[Deputy Prosecuting Attorney]: [A]s a psychologist were you
able to say whether or not the intake of a type of cannabis,
for instance, marijuana, could that lead to psychosis?
[Dr. Wagner]: Well, I think the literature indicates that
there is that possibility, yes. That has happened, I believe,
in instances with many different types of illicit drugs, we
found that to be true. And I think marijuana, although not
maybe as frequently as, let's say, other drugs, like
crystal methamphetamine, but still, I think there's been
an indication that that has happened.
Wagner described Eager's account of the incident as
[Eager] was walking along the sidewalk, and he evidently
asked the male individual, from what he reported to me,
whether or not he believed in Jesus, and the individual
replied, No, and laughed and said something else. Then he got
angry, and he grabbed the individual, threw him down, started
Wagner opined, "to me [there] is not enough evidence to
indicate that he is suffering from severe psychotic symptoms
and a psychotic disorder such that he doesn't know that
it's inappropriate to hit someone or pull someone to the
ground and -- and can't control his behavior."
State asked Dr. Wagner several questions about Dr.
Jacobs' report, two of which the circuit court disallowed
because the State appeared to be "asking Dr. Wagner to
testify as to the credibility of another
witness." The court permitted questions regarding
whether Dr. Jacobs' report changed Dr. Wagner's
opinion, and Dr. Wagner answered that Dr. Jacobs' report
"provides additional information about the use of
prescribed medication, " but "doesn't change
the final opinion as far as penal responsibility."
court asked Dr. Wagner whether "the cannabis abuse or
dependence [would] heighten [Eager's] sensitivity to
post-traumatic stress disorder." Dr. Wagner said that he
thought the cannabis was an "additive factor, " but
he did not know the extent that "it ...