United States v. MacDonald , 2014 CAAF LEXIS 868 ( 2014 )

UNITED STATES, Appellee
v.
George D. B. MACDONALD, Private First Class
U.S. Army, Appellant
No. 14-0001
Crim. App. No. 20091118
United States Court of Appeals for the Armed Forces
Argued May 13, 2014
Decided August 27, 2014
BAKER, C.J., delivered the opinion of the Court, in which
ERDMANN, STUCKY, RYAN, and OHLSON, JJ., joined.
Counsel
For Appellant: William E. Cassara, Esq. (argued); Lieutenant
Colonel Jonathan F. Potter and Captain Robert H. Meek III (on
brief); Captain Brandon H. Iriye.
For Appellee: Captain Daniel M. Goldberg (argued); Colonel John
P. Carrell, Lieutenant Colonel James L. Varley, and Major
Catherine L. Brantley (on brief); Major Robert Rodrigues.
Military Judge: James L. Pohl
THIS OPINION IS SUBJECT TO REVISION BEFORE FINAL PUBLICATION.
United States v. MacDonald, No. 14-0001/AR
Chief Judge BAKER delivered the opinion of the Court.
A panel of members sitting as a general court-martial
convicted Appellant, contrary to his pleas, of one specification
of resisting apprehension in violation of Article 95, Uniform
Code of Military Justice (UCMJ), one specification of
premeditated murder in violation of Article 118, UCMJ, and two
specifications of assault in violation of Article 128, UCMJ. 10
U.S.C. §§ 895, 918, 928 (2012). Appellant was sentenced to a
reprimand, reduction to E-1, forfeiture of all pay and
allowances, confinement for life without the eligibility of
parole, and a dishonorable discharge. The convening authority
approved the adjudged sentence. Appellant then appealed to the
United States Army Court of Criminal Appeals (CCA), which
focused on two issues: (1) whether the military judge erred in
quashing Appellant’s subpoena request to Pfizer, Inc. (Pfizer)
for additional data; and (2) whether the military judge abused
his discretion in denying Appellant an instruction on
involuntary intoxication. On July 3, 2013, the CCA held that
the military judge erred in failing to enforce the subpoena, but
the error was harmless beyond a reasonable doubt. United States
v. MacDonald, No. ARMY 20091118, 2013 CCA LEXIS 548, at *25,
2013 WL 3376714, at *9 (A. Ct. Crim. App. July 3, 2013)
(unpublished). The CCA also concluded the military judge abused
his discretion in refusing to issue the involuntary intoxication
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instruction but the error was harmless beyond a reasonable
doubt. Id. at *25-*26, 2013 WL 3376714, at *9. On this basis,
the CCA determined that the findings and sentence were correct
in law and fact, and affirmed. Id. at *32, 2013 WL 3376714, at
*10.
On September 3, 2013, Appellant appealed to this Court.
United States v. MacDonald, 73 M.J. 40 (C.A.A.F. 2013). We
granted review of two issues:
I. WHETHER THE ARMY COURT OF CRIMINAL APPEALS ERRED
IN DETERMINING THAT THE MILITARY JUDGE’S ERROR IN
QUASHING A SUBPOENA ISSUED TO PFIZER, INC., TO
PRODUCE RELEVANT AND NECESSARY DOCUMENTS
REGARDING CLINICAL TRIALS, ADVERSE EVENT REPORTS,
AND POST-MARKET SURVEILLANCE OF THE DRUG
VARENICLINE WAS HARMLESS BEYOND A REASONABLE
DOUBT.
II. WHETHER THE MILITARY JUDGE ABUSED HIS DISCRETION
IN DENYING A DEFENSE REQUESTED INSTRUCTION ON
INVOLUNTARY INTOXICATION, AND ERRED IN FAILING TO
INSTRUCT THE MEMBERS ON THE EFFECT OF
INTOXICATION ON APPELLANT’S ABILITY TO FORM
SPECIFIC INTENT AND PREMEDITATION.
United States v. MacDonald, 73 M.J. 238 (C.A.A.F. 2014) (order
granting review). Because we decide Issue II in Appellant’s
favor and reverse, we need not reach Issue I.
SUMMARY
The ultimate questions in resolving the second issue in
this case are whether Appellant’s ingestion of varenicline
(popularly known as and hereinafter referred to as Chantix)
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United States v. MacDonald, No. 14-0001/AR
should have resulted in an involuntary intoxication instruction
and, if so, whether a mental responsibility instruction
otherwise rendered the absence of such an instruction harmless
beyond a reasonable doubt.
The CCA determined that the military judge erred in failing
to give an instruction on involuntary intoxication despite the
technically imprecise instruction proffered by the defense. In
the words of the CCA, “[t]he evidence presented at trial raised
the involuntary intoxication defense.” MacDonald, 2013 CCA
LEXIS 548, at *26, 2013 WL 3376714, at *8. “The proposed
instruction was essentially correct . . . .” Id. at *27, 2013
WL 3376714, at *9. And, “[t]he judge effectively denied the
existence of an involuntary intoxication defense.” Id. at *21,
2013 WL 3376714, at *7. Because Appellant put on “some
evidence” that “reasonably raised” the defense of involuntary
intoxication in the form of evidence of ingestion as well as
expert testimony regarding the potential side effects of
Chantix, we hold that the military judge had a sua sponte duty
to instruct on the defense of involuntary intoxication and
therefore agree with the CCA’s ultimate determination that the
military judge erred in failing to give a separate and distinct
involuntary intoxication instruction.
Therefore, the key question is whether this instructional
error was harmless beyond a reasonable doubt. The CCA concluded
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United States v. MacDonald, No. 14-0001/AR
that the error was harmless because the military judge’s
instruction on mental responsibility otherwise covered the
defense of involuntary intoxication. Further, “[e]ven if the
requested instruction were given, it is clear beyond a
reasonable doubt that the panel would have found appellant
guilty of the offenses charged in this case. . . . Appellant
cannot escape the overwhelming evidence of his mental
responsibility for the offenses he committed.” Id. at *29, 2013
WL 3376714, at *9. Similarly, with respect to the military
judge’s sua sponte duty, the CCA determined that “even if such
an instruction were rendered, a rational panel would have found
appellant guilty of premeditated murder, as well as the other
offenses charged, in light of the overwhelming evidence that
appellant was fully able to form the intent necessary to be held
criminally liable.” Id. at *29, 2013 WL 3376714, at *9. We
disagree.
The defense of lack of mental responsibility requires
demonstration that the accused suffered from a mental disease or
defect and that as a result he was unable to appreciate the
nature and quality or wrongfulness of his act. Article 50a,
UCMJ, 10 U.S.C. § 850a (2012). In turn, the defense of
involuntary intoxication “require[s] a finding that there has
been involuntary ingestion of an intoxicant” and that the
accused was “unable to appreciate the nature and quality or
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United States v. MacDonald, No. 14-0001/AR
wrongfulness of his acts.” United States v. F.D.L., 836 F.2d
1113, 1117 (8th Cir. 1988). As the CCA explained:
the defense of involuntary intoxication is similar to
that of lack of mental responsibility in that the
defense must prove by clear and convincing evidence
that he did not appreciate the nature and quality or
wrongfulness of his acts, but different in that he
need not prove that he suffered a severe mental
disease or defect, but rather that he was intoxicated
by some substance that results in what amounts to
legal insanity.
MacDonald, 2013 CCA LEXIS 548, at *26, 2013 WL 3376714, at *8
(emphasis added).
Without an involuntary intoxication instruction, it is
possible that the members may have concluded that they could not
acquit Appellant without first finding a mental disease or
defect. It is similarly possible that the members did not
consider, as a separate matter, whether involuntary intoxication
may have prevented Appellant from appreciating the nature and
quality or wrongfulness of his act. Further, we cannot be
confident beyond a reasonable doubt, as the CCA was, that the
members would have concluded Appellant appreciated the
wrongfulness of his actions if they had been properly instructed
on involuntary intoxication with respect to Chantix.
Consideration of such evidence was and is in the first instance
the responsibility of the trier of fact.
As a result, we are not confident the error did not
contribute to the verdict in this case.
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BACKGROUND
The Events Leading Up to May 18, 2008
At the time of his arrest, Appellant was nineteen years old
and had been in the service for approximately a year. Prior to
enlisting, Appellant was an active member of his community and
led various volunteering and mentoring projects as an Eagle
Scout. Upon turning eighteen, both Appellant and his twin
brother enlisted in the United States Army. After successfully
completing Infantry Training and the Airborne Course, they were
both selected for an appointment to the United States Military
Academy Preparatory School (USMAPS), class of 2009.
During the pendency of his matriculation to USMAPS,
Appellant was assigned to the supply room at Delta Company, Fort
Benning, Georgia. Multiple coworkers described him as a
peaceful person. On April 18, 2008, a week shy of his
nineteenth birthday, Appellant visited the Martin Army Community
Hospital to seek help in quitting smoking. According to the
medical record, he sought medical help because he had smoked up
to a half pack of cigarettes daily for the past three years.
During the visit, the Army doctor prescribed Chantix to
Appellant as a smoking cessation drug. On May 18, 2008, one
month after the Army doctor prescribed Chantix, Appellant
fatally attacked Private (PVT) Bulmer while he was sleeping,
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United States v. MacDonald, No. 14-0001/AR
stabbing him to death. Prior to this attack, Appellant did not
know nor had he ever interacted with PVT Bulmer.
At the time of Appellant’s attack, PVT Bulmer was a twenty-
three-year-old recruit who had been in training for three days.
PVT Bulmer was recovering from surgery he underwent prior to his
arrival at Fort Benning. Because of this, PVT Bulmer had been
excused by his drill sergeant from drill and ceremony training
that day and was instructed to wait in the shade next to the
barracks. Undetected, PVT Bulmer slipped away and went to sleep
in his rack.
Meanwhile, Appellant was in his room reading a book and
waiting to do laundry. For some days, however, according to his
statement, Appellant had been experiencing “new and strange
thoughts” including a “person [was] telling me . . . dangerous
things that arent [sic] me.” These included violent thoughts of
killing someone. In fact, the night before the attack,
Appellant had asked his girlfriend whether she would still love
him if he killed someone.
Appellant eventually left his room to do laundry and
without thinking he placed a small, black, double-edged knife
into his pocket that he used to cut string. He headed toward
the closest laundry facility, which was in the same bay as PVT
Bulmer. Along the way, Appellant happened upon a sleeping PVT
Bulmer. According to his confession, something “snapped” and he
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went “crazy,” attacking PVT Bulmer with the knife in his pocket.
Appellant first stabbed PVT Bulmer in the neck, intending it to
be a fatal blow. PVT Bulmer awakened mid-attack and tried to
ward off the blows. His resulting screams and pleas for help
drew the attention of nearby trainees. Two soldiers saw the
assault through a window. When they realized one man was
attacking another, they entered PVT Bulmer’s room and
intervened. Lashing out at one of the soldiers who tried to
stop the attack, Appellant fled to his room, covered in PVT
Bulmer’s blood. There, Appellant showered, placed all the
bloody clothes into a backpack, and hastily left his room
wearing civilian clothes. Although the soldiers’ intervention
had stopped Appellant’s assault, PVT Bulmer had already suffered
more than fifty knife wounds that would ultimately prove fatal.
By the time Appellant left his room, a general alert had
been issued to apprehend the man who attacked PVT Bulmer. A
noncommissioned officer (NCO) patrolling the periphery of Fort
Benning found Appellant walking along the tree line away from
the scene of the crime. When questioned by the NCO, Appellant
said he was going to buy a new pair of sneakers on post.
Suspecting something was amiss, the NCO questioned Appellant
further at which point Appellant attempted to flee. The NCO
chased him and physically subdued him until military police
arrived and apprehended Appellant.
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United States v. MacDonald, No. 14-0001/AR
Taken into custody, Appellant waived his right to remain
silent and admitted he had stabbed PVT Bulmer. In a handwritten
statement, he described an internal struggle and that he “was
someone else, something was wrong” and that he “want[ed] help.”
Appellant also acknowledged that he “didn’t even know the guy
[PVT Bulmer], didnt [sic] think about it before-hand . . . .
[w]as telling myself ‘NO’ . . . [this] wasn’t me.” “I fought
myself with the idea,” he continued, stating that, “I guess I
thought I was supposed to kill this man.” Appellant wrote that
“I was someone else, something was wrong . . . . I want help.”
When asked why he stabbed PVT Bulmer, Appellant replied by
writing “Insanity, temp.” because “this is not who I am, I went
crazy for a while, I should have seen the signs, was hurting, I
snapped Im [sic] so sorry.” He also admitted that he felt
“stretched thin” due to his extended stay as a private at Fort
Benning and complained of abuse by drill instructors. Appellant
ended his confession by writing “Im [sic] very sorry, dont [sic]
know what happened to me. Sorry.”
The Escalation of Chantix Warnings
Chantix was approved by the Food and Drug Administration
(FDA) in May 2006, at which point the most common side effects
listed in the labeling were nausea, changes in dreaming,
constipation, gas, and vomiting. Dep’t of Health & Human
Servs., FDA, NDA 021928, Chantix, at 25 (May 2006) (Chantix
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United States v. MacDonald, No. 14-0001/AR
approval label), available at
http://www.accessdata.fda.gov/drugsatfda_docs/nda/2006/021928_s0
00_Chantix_PrntLbl.pdf (last visited Aug. 27, 2014). However,
over the course of the next two years, the nature and scope of
the warnings rapidly escalated. By November 2007, the FDA
issued an update noting that “suicidal thoughts and aggressive
and erratic behavior” were reported in patients taking Chantix.
Dep’t of Health & Human Servs., FDA, Early Commc’n About an
Ongoing Safety Rev. of Varenicline (marketed as Chantix) (Nov.
20, 2007), available at
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformat
ionforPatientsandProviders/DrugSafetyInformationforHeathcareProf
essionals/ucm070765.htm (last visited Aug. 27, 2014). The
update revealed that “many cases reflect new-onset of depressed
mood, suicidal ideation, and changes in emotion and behavior
within days to weeks of initiating Chantix treatment.” Id.Three months later, in February 2008, the FDA issued an Alert to
“highlight important revisions to the WARNINGS and PRECAUTIONS
sections of the full prescribing information . . . regarding
serious neuropsychiatric symptoms” associated with Chantix.
Dep’t of Health & Human Servs., FDA, Info. for Healthcare
Prof’ls: Varenicline (marketed as Chantix) (Feb. 1, 2008),
available at
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformat
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United States v. MacDonald, No. 14-0001/AR
ionforPatientsandProviders/ucm124818.htm (last visited Aug. 27,
2014). Specifically, the Alert acknowledged that since the FDA
issued their November 2007 communication, “it appears
increasingly likely that there is an association between Chantix
and serious neuropsychiatric symptoms.” Id. The Alert listed
the symptoms as “changes in behavior, agitation, depressed mood,
suicidal ideation, and attempted and completed suicide.” Id.The February Alert also stated that while most symptoms
“developed during . . . treatment,” for others “symptoms
developed following withdrawal of Chantix therapy.” Id.On May 16, 2008, two days before Appellant killed PVT
Bulmer, the FDA issued a Public Health Advisory, the third
warning in less than six months. Dep’t of Health & Human
Servs., FDA, Pub. Health Advisory: Important Info. on Chantix
(varenicline) (May 16, 2008), available at
http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformat
ionforPatientsandProviders/DrugSafetyInformationforHeathcareProf
essionals/PublicHealthAdvisories/ucm051136.htm (last visited
Aug. 27, 2014). This time the Alert urged patients to stop
taking Chantix and to call their doctor right away if they, or
their family or caregiver, noticed “agitation, depressed mood,
or changes in behavior that are not typical for you, or if you
have suicidal thoughts or actions.” Id. The Advisory stated
that “Chantix may cause worsening of a current psychiatric
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United States v. MacDonald, No. 14-0001/AR
illness . . . and may cause an old psychiatric illness to
reoccur.” Id. The Advisory also stated that patients may
experience “vivid, unusual, or strange dreams.” Id.By July 2009, the FDA issued a Black Box warning -- the
strongest FDA warning level before a drug is pulled from the
market. Dep’t of Health & Human Servs., FDA, Chantix, at 1
(July 2009) (updated Chantix safety label), available at
http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/021928s
012s013lbl.pdf (last visited Aug. 27, 2014). This Black Box
warning stated:
All patients being treated with CHANTIX should be
observed for neuropsychiatric symptoms including
changes in behavior, hostility, agitation, depressed
mood, and suicide-related events, including ideation,
behavior, and attempted suicide. These symptoms, as
well as worsening of pre-existing psychiatric illness
and completed suicide have been reported in some
patients attempting to quit smoking while taking
CHANTIX in the post-marketing experience.
Id. (emphasis added). In addition to the Black Box warning,
this update included the following information under the
WARNINGS section:
Serious neuropsychiatric symptoms have been reported in
patients being treated with CHANTIX (See Boxed Warning,
PRECAUTIONS/Information for patients, and ADVERSE
REACTIONS/Post-Marketing Experience). These post-marketing
reports have included changes in mood (including depression
and mania), psychosis, hallucinations, paranoia, delusions,
homicidal ideation, hostility, agitation, anxiety, and
panic, as well as suicidal ideation, suicide attempt, and
completed suicide.
Id. at 9 (second emphasis added).
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Similar warnings were also included in the section titled
“Information for Patients” under PRECAUTIONS. For example, one
of the bullets in this section noted that “some patients have
experienced . . . psychosis, hallucinations, paranoia,
delusions, homicidal ideation, aggression, anxiety, and panic.”
Id. at 13 (emphasis added). Likewise, in the “Post-Marketing
Experience” section under ADVERSE REACTIONS, one of the
paragraphs noted “[t]he following adverse events have been
reported during post-approval use of CHANTIX . . . [t]here have
been reports of . . . homicidal ideation, aggression, hostility,
anxiety, and panic.” Id. at 17 (emphasis added).
Appellant’s Defense Theory at Trial
Appellant argued that use of the smoking cessation drug
Chantix was a key factor in his violent, homicidal outburst
leading to the tragic death of PVT Bulmer. This defense theory
was premised on showing Appellant had Chantix in his system and,
given this, that Chantix was a factor in Appellant’s fatal
stabbing of PVT Bulmer.
1. Presence of Chantix in Appellant’s System
On May 19, 2008 -- a day after the fatal stabbing --
Appellant voluntarily supplied a sample of blood and urine.
This was later tested by the Armed Forces Institute of Pathology
(AFIP) but came back negative for Chantix. From Appellant’s
perspective, however, the reliability of the AFIP tests was
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United States v. MacDonald, No. 14-0001/AR
questionable, particularly because AFIP did not have the
stability studies necessary for testing pursuant to the correct
toxicological standards. Appellant argued that a drug “degrades
in urine or blood over time depending on the manner in which it
is stored,” and the results can be affected by tolerance levels
of the testing equipment.
Subsequently, Appellant had his previously collected sample
of urine independently tested for the presence of Chantix at NMS
Labs -- a private laboratory -- in June 2009, over a year after
the death of PVT Bulmer. In contrast to the earlier AFIP test,
this time the laboratory had the stability studies from Pfizer.
The NMS results reported positive for Chantix. Although
questions were raised by both sides about whether the test
accurately represented the actual concentration of Chantix in
Appellant’s system at the time of the incident -- due to the
uncertainty regarding the conditions under which the sample was
stored and transported, as well as the potential impact on the
test result given the passage of time -- the parties proceeded
at trial on the basis that there was Chantix in Appellant’s
system at the time of the incident, as noted in the stipulation
of fact.
Based on this positive test, Appellant made a motion for
the military judge to reconsider the quashing of an earlier
subpoena requesting data from Pfizer regarding Chantix and its
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United States v. MacDonald, No. 14-0001/AR
potentially harmful effects. Appellant requested this
reconsideration for several reasons; namely, the positive test
result demonstrated the presence of Chantix in Appellant’s
system at the time of the incident, a new and more severe
warning about Chantix had been issued, and the Rules for Courts-
Martial (R.C.M.) 706 board had not considered the potential of
Chantix influencing Appellant.1
However, the military judge denied this motion. In doing
so, the military judge concluded that “‘[i]t doesn’t make any
difference as far as [he could] see whether [Appellant’s mental
condition was] caused by Chantix or not caused by Chantix.
Chantix is an explanation.’” MacDonald, 2013 CCA LEXIS 548, at
*13, 2013 WL 3376714, at *4. He continued that:
the court does not believe that the new evidence or
that anything has changed since its last ruling. The
court still believes the proper standard is R.C.M. 703
because this is a court order to a third party, and
therefore the defense motion for a reconsideration of
its ruling of 24 June is hereby denied.
Id. at *13-*14, 2013 WL 3376714, at *4.
2. Neuropsychiatric Symptoms Associated with Chantix and
the Involuntary Intoxication Instruction
During trial, Appellant provided evidence that Chantix was
subject to a number of escalating FDA warnings about its
1
Appellant also argued that Dr. Lupcho -- the psychologist that
did the R.C.M. 706 evaluation -- “[n]ever factored into any of
her analysis whether or not there was a pharmaceutical or
pharmacological basis for the actions of Private MacDonald.”
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potential side effects. A defense expert in forensic
psychiatry, Dr. Glenmullen, provided testimony on the effects of
Chantix on the brain’s neurochemistry. Specifically, Dr.
Glenmullen described that the level of dopamine in the brain
affects a person’s behavior and “probably has one of the most
profound effects on human emotion and behavior.” Increases in
dopamine can cause one to “feel more agitated, irritable,
anxious, sleepless; keep turning it up and up you can get manic;
keep turning it up and up you can get psychotic.” Dr.
Glenmullen elaborated that because Chantix effectively causes an
increase of dopamine in the brain, it can be correlated with
behavioral changes. Further, though the side effects of
increased dopamine vary, some of the more severe side effects
are more likely when there are underlying mental health issues
in the patient.
To that end, Dr. Glenmullen conducted an assessment of
Appellant and interviewed his friends and family members,
concluding that Appellant suffered from three diagnoses of
untreated psychiatric conditions. Specifically, Appellant had a
“schizoid personality disorder which was kind of his reaction to
his childhood,” as well as a “history of long term mild
depression” and “psychosis . . . [that included] auditory
hallucinations.” These conditions predated Appellant’s
treatment with Chantix. Specialist Harrison -- who intervened
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during the stabbing of PVT Bulmer -- testified that Appellant
was acting “completely crazy,” “[l]ike he was possessed.”
Another expert, Dr. Pancholi, also testified that based on her
assessment, Appellant previously suffered from psychotic
disorder, schizoid personality disorder, and dysthymic disorder.
On this basis, she said she would not have prescribed Chantix to
a person with these underlying psychiatric issues. In addition,
another defense expert -- Thomas Moore -- testified that due to
the serious psychiatric side effects of Chantix, a number of
defense and civil agencies had banned the use of this drug. For
example, the Department of Defense banned the use of this drug
for missile crews and aircraft personnel. Similarly, the
Federal Aviation Administration restricted the use of Chantix by
all pilots and air controllers and the Department of
Transportation banned its use by people driving trucks.
During trial, Appellant argued that he was under the
influence of Chantix both before and during the fatal stabbing
of PVT Bulmer. To that end, Appellant requested an instruction
on involuntary intoxication, which he argued could be a complete
defense to the charges or, in the alternative, could negate the
element of premeditation and intent.2 Specifically, Appellant
requested the following instruction:
2
The question this Court is asked to address is whether
Appellant was entitled to an involuntary intoxication
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United States v. MacDonald, No. 14-0001/AR
To invoke the defense of involuntary intoxication, the
defendant must produce sufficient evidence to raise a
reasonable doubt as to the voluntariness of his
intoxication. Involuntary intoxication results from
fraud, trickery or duress of another, accident or
mistake on defendant’s part, pathological condition,
or ignorance as to the effects of prescribed
medication and is a complete defense where the
defendant is so intoxicated that he is unable to
distinguish between right and wrong, the same standard
as applied in an insanity defense. Salahdin v.
Gibson, 275 F.3d 1211.
In support, Appellant relied on his experts’ testimony.
Specifically, Dr. Glenmullen testified that at the time of the
incident, Appellant had “substance intoxication” where the
substance was Chantix which “essentially catapult[ed] him into
the equivalent of an acute psychotic break in a schizophrenic.”
During the four weeks Appellant took Chantix, Dr. Glenmullen
noted that Appellant became more “paranoid” and “thought that
people were out to get him,” eventually developing “homicidal
thoughts” during the fourth week of taking Chantix. Dr.
Glenmullen further testified that Appellant’s preexisting
neuropsychiatric condition was exacerbated by Chantix and
because of a Chantix-induced psychosis, he would not have been
able to possess the conscious intent to kill. Moreover, Dr.
instruction, not whether he was entitled to the instruction
requested by Appellant which, admittedly, was flawed but not
fatally so. Because we hold that the military judge had a sua
sponte duty to instruct on involuntary intoxication we do not
reach the issue of whether the military judge should have
instructed despite the technically imprecise instruction
proffered by Appellant.
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Glenmullen specifically referenced “substance intoxication” and
testified on cross-examination that involuntary intoxication
occurs when an individual takes a prescription drug without
correct warnings and is thereby not responsible for his
behavior. In fact, when Appellant raised this issue of the
escalating Chantix warnings at trial, he noted that these facts
went toward the issue of involuntary intoxication and mental
responsibility generally.
Of note, the Government also offered an instruction on
involuntary intoxication, albeit using different language.
However, the military judge declined to give this instruction or
an alternative involuntary intoxication instruction on the basis
that his mental responsibility instruction was sufficient.
During this exchange, the military judge elaborated:
MJ: Got it. But that’s not a correct statement of
the law. It says here, it says where the
defendant is so intoxicated [he] is unable to
distinguish between right from wrong the same
standard is applied in an insanity defense.
Don’t you need a mental disease -- a serious
mental disease or defect causing the accused not
to appreciate the wrongfulness of his act or the
quality of his act?
DC: Sir, that’s what I got out of the case, the
federal case.
MJ: I understand that, but I’m talking about under
military law that’s passed by Congress does not
it require a superior --
DC: But I found no military case law to support this
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instruction, sir. But that said, that doesn’t
mean the instruction shouldn’t be given.
MJ: No, I agree. I agree that we can look at other
courts for guidance in a particular area. But
Congress is legislator in this area and in my
view we’re bound by the congressional act, and
therefore I will give the mental responsibility
instruction I discussed earlier, but not that
particular one.
Accordingly, the military judge did not provide an
involuntary intoxication instruction. Ultimately, Appellant was
convicted of all charges and sentenced to a reprimand, reduction
to E-1, total forfeitures, confinement to life without the
eligibility of parole, and a dishonorable discharge. The
convening authority approved the sentence as adjudged. Though
the CCA determined that the military judge erred in failing to
issue the involuntary intoxication instruction, the CCA also
held this error to be harmless beyond a reasonable doubt.
Appellant then appealed to this Court.
STANDARD OF REVIEW
The adequacy of a military judge’s instructions is reviewed
de novo. United States v. Dearing, 63 M.J. 478, 482 (C.A.A.F.
2006). “The military judge bears the primary responsibility for
ensuring that mandatory instructions . . . are given and given
accurately.” United States v. Miller, 58 M.J. 266, 270
(C.A.A.F. 2003); see also R.C.M. 920(a).
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If an affirmative defense is reasonably raised by the
evidence, the military judge has a sua sponte duty to instruct
the members on that defense. United States v. Davis, 53 M.J.
202, 205 (C.A.A.F. 2000). A defense is reasonably raised when
“some evidence, without regard to its source or credibility, has
been admitted upon which members might rely if they chose.”
United States v. Stanley, 71 M.J. 60, 61 (C.A.A.F. 2012)
(internal quotation marks and citations omitted); United States
v. Watford, 32 M.J. 176, 178 (C.M.A. 1991) (noting a defense is
reasonably raised when there is “some evidence” to which the
panel members “might attach credence”). Any doubt regarding
whether an affirmative defense instruction is in order should be
resolved in favor of the accused. Davis, 53 M.J. at 205.
“Where an instructional error raises constitutional
implications, this Court has traditionally tested the error for
prejudice using a “‘harmless beyond a reasonable doubt’
standard.” United States v. Davis, 73 M.J. 268, 271 (C.A.A.F.
2014) (quoting United States v. Wolford, 62 M.J. 418, 420
(C.A.A.F. 2006)). The test for determining if the
constitutional error is harmless is “whether it appears ‘beyond
a reasonable doubt that the error complained of did not
contribute to the verdict obtained.’” United States v.
McDonald, 57 M.J. 18, 20 (C.A.A.F. 2002) (quoting Chapman v.
California, 386 U.S. 18, 24 (1967)). “Whether the error is
22
United States v. MacDonald, No. 14-0001/AR
harmless beyond a reasonable doubt is a question of law that we
review de novo.” United States v. Simmons, 59 M.J. 485, 489
(C.A.A.F. 2004).
ANALYSIS
The threshold questions presented are whether the military
judge should have instructed on involuntary intoxication and
whether there was prejudice in the absence of this instruction.
Involuntary intoxication is an affirmative defense under
the UCMJ.3 Although not expressly listed as an affirmative
defense under R.C.M. 916, not all affirmative defenses are
listed. See Davis, 73 M.J. at 272 n.5 (C.A.A.F. 2014)
(“Although, R.C.M. 916 does not expressly list defense of
property as a special defense, this Court and its predecessor
have long recognized defense of property as an available defense
in the military justice system.”). R.C.M. 916 states that the
term “defenses” includes “any special defense which, although
not denying that the accused committed the objective acts
constituting the offense charged, denies, wholly or partially,
criminal responsibility for those acts.” By its own terms,
R.C.M. 916 provides an illustrative rather than an exhaustive
3
The Rules for Courts–Martial suggest that the terms “special
defense” and “affirmative defense” are interchangeable. R.C.M.
916(a) Discussion; see also Davis, 73 M.J. at 271 n.3. In this
case, it is more accurate to use the term “affirmative defense”
because the accused bears the burden of showing it by clear and
convincing evidence.
23
United States v. MacDonald, No. 14-0001/AR
list of defenses. Further, a number of courts -- including this
Court -- recognize involuntary intoxication as an affirmative
defense. See, e.g., United States v. Hensler, 44 M.J. 184, 187-
88 (C.A.A.F. 1996); United States v. Craig, 3 C.M.R. 304, 311
(A.B.R. 1952) (“The general rule that involuntary intoxication
excuses an accused from criminal responsibility applies where
one involuntarily becomes drunk by being compelled to drink
against his will, or through another’s fraud or stratagem, or by
taking liquor prescribed by a physician.”); see also Waller v.
Tucker, No. 11-21841-CIV-JORDAN, 2011 U.S. Dist. LEXIS 156455,
at *40-*44, 2011 WL 9350129, at *14-*15 (S.D. Fla. Dec. 12,
2011); Lucherini v. State, 932 So. 2d 521 (Fla. Dist. Ct. App.
2006); People v. Garcia, 113 P.3d 775 (Colo. 2005); Colon v.
State, 568 S.E.2d 811 (Ga. Ct. App. 2002); see generally Phillip
E. Hassman, Annotation, When Intoxication Deemed Involuntary So
as to Constitute a Def. to Crim. Charge, 73 A.L.R.3d 195 (1976);
2 Crim. Prac. Manual § 40:2 (2014). In Hensler, this Court
recognized involuntary intoxication as an affirmative defense
and the Government has not challenged that legal conclusion at
trial or on appeal. Rather, the Government challenge has been
to the scope of the defense and its factual applicability in
this case.
Here, the CCA determined Appellant provided some evidence
at trial that reasonably raised the defense of involuntary
24
United States v. MacDonald, No. 14-0001/AR
intoxication and the military judge erred in not providing a
corresponding instruction. The CCA did not analyze whether
involuntary intoxication was an affirmative defense, but
summarily concluded:
As to whether the military judge had a sua sponte
duty to address involuntary intoxication as it related
to the questions of intent and premeditation, we also
find that even if such an instruction were rendered, a
rational panel would have found appellant guilty of
premeditated murder, as well as the other offenses
charged, in light of the overwhelming evidence that
appellant was fully able to form the intent necessary
to be held criminally liable.
MacDonald, 2013 CCA LEXIS 548, at *29, 2013 WL 3376714, at *9.
We hold that the military judge had a sua sponte
responsibility to instruct. However, unlike the CCA, we are not
confident the absence of an involuntary intoxication instruction
did not contribute to the verdict. In determining that the
instructional error was harmless beyond a reasonable doubt, the
CCA relied on two related conclusions. First, “[t]he ultimate
issue to be decided by the panel relative to each [defense] is
sufficiently equivalent to ensure the reliability of the
convictions in this case.” Id. at *29, 2013 WL 3376714, at *9.
Second, “even if such an instruction were rendered, a rational
panel would have found appellant guilty of premeditated murder,
as well as the other offenses charged, in light of the
overwhelming evidence that appellant was fully able to form the
25
United States v. MacDonald, No. 14-0001/AR
intent necessary to be held criminally liable.” Id. at *29,
2013 WL 3376714, at *9. We address each argument in turn.
The military judge instructed the members on mental
responsibility as well as partial mental responsibility, which
covered whether or not Appellant was suffering from a mental
disease or defect at the time of the crime. In doing so, the
military judge relied on Article 50a, UCMJ:
It is an affirmative defense in a trial by court-
martial that, at the time of the commission of the
acts constituting the offense, the accused, as a
result of a severe mental disease or defect, was
unable to appreciate the nature and quality or the
wrongfulness of the acts. Mental disease or defect
does not otherwise constitute a defense.
The accused has the burden of proving the defense of
lack of mental responsibility by clear and convincing
evidence.
Article 50a(a)-(b), UCMJ; see also 18 U.S.C. § 17; United States
v. Martin, 56 M.J. 97, 103 (C.A.A.F. 2001). Specifically, the
military judge’s instructions read:
If you determine that, at the time of the offenses,
the accused was suffering from a severe mental disease
or defect, then you must decide whether, as a result
of that severe mental disease or defect, the accused
was unable to appreciate the nature and quality or
wrongfulness of his conduct.
If the accused was able to appreciate the nature and
quality and the wrongfulness of his conduct, he is
criminally responsible; and this is so regardless of
whether the accused was then suffering from a severe
mental disease or defect.
On the other hand, if the accused had a delusion of
such a nature that he was unable to appreciate the
nature and quality or wrongfulness of his acts, the
26
United States v. MacDonald, No. 14-0001/AR
accused cannot be held criminally responsible for his
acts, provided such a delusion resulted from a severe
mental disease or defect.
To summarize, you must first determine whether the
accused, at the time of these offenses, suffered from
a severe mental disease or defect. If you are
convinced by clear and convincing evidence that the
accused did suffer from a severe mental disease or
defect, then you must further consider whether he was
unable to appreciate the nature and quality or the
wrongfulness of his conduct. If you are convinced
that the accused suffered from a severe mental disease
or defect, and you are also convinced by clear and
convincing evidence that he was unable to appreciate
the nature and quality or wrongfulness of his conduct,
then you must find the accused not guilty only by
reason of lack of mental responsibility. On the other
hand, you may not acquit the accused on the ground of
lack of mental responsibility, absent the accused
suffering from a severe mental disease or defect, or
if you believe that he was able to appreciate the
nature and quality and wrongfulness of his conduct.
The military judge also gave an instruction on partial
mental responsibility, in which he stated that “[i]n determining
this issue you must consider all relevant facts and
circumstances and the evidence presented on the issue of lack of
mental responsibility.” He also noted that members should
consider, “in connection with all the relevant facts and
circumstances, evidence tending to show that the accused may
have been suffering from a mental disease, defect, condition or
disorder of such consequence and degree as to deprive him of the
ability to entertain these states of mind.” The military judge
reinforced his instruction by asking the members to “remember
that the defense of lack of mental responsibility, that is,
27
United States v. MacDonald, No. 14-0001/AR
insanity, and evidence that the accused may have lacked the
required state of mind are separate defenses although the same
evidence may be considered with respect to both.” However, as
the CCA noted, the “judge’s failure to provide the [involuntary
intoxication] instruction was aggravated by his failure to even
mention Chantix as relevant to the panel’s consideration of the
defense of lack of mental responsibility and on the question of
intent and seriously impaired the defense presentation.”
MacDonald, 2013 CCA LEXIS 548, at *28, 2013 WL 3376714, at *9.
Because both parties rely on this Court’s Hensler decision
in support of their argument that involuntary intoxication is
either distinct from or subsumed within the defense of mental
responsibility, we address it in detail here. And, in fairness
to the military judge and the parties, the case can be read to
support either proposition. 44 M.J. at 187. Therefore, it is
important to distinguish the differences between Hensler and the
present case.
In Hensler, the appellant raised a defense of involuntary
intoxication against charges of conduct unbecoming an officer
and fraternization. At trial, the appellant argued she lacked
mental responsibility because of “a confluence of her drugs, her
personality traits, her depression, and the introduction of
alcohol.” Id. at 187 (internal quotation marks omitted). “The
military judge provided the members the traditional instruction
28
United States v. MacDonald, No. 14-0001/AR
on the insanity defense,” instructing “them that they could
presume the accused to be sane unless they were persuaded by
clear and convincing evidence that she suffered from a severe
mental disease or defect and that, as a result of her severe
mental disease or defect, she was unable to appreciate the
nature and quality or wrongfulness” of her actions. United
States v. Hensler, 40 M.J. 892, 895-96 (N.M.C.M.R. 1994), aff’d,
44 M.J. 184 (C.A.A.F. 1996). The military judge referenced the
term “involuntary intoxication” with respect to the issue of
whether the appellant “knew that she was fraternizing with
enlisted personnel.” Hensler, 44 M.J. at 187. He further
instructed the members that “alcoholism and chemical dependency
is recognized by the medical profession as a disease involving a
compulsion towards intoxication.” Id. (internal quotation marks
omitted).
Following conviction by a general court-martial, Hensler
appealed on the basis that this instruction was not sufficient
for a defense of involuntary intoxication. On review, this
Court affirmed, noting three essential factors. First, the
instructions were adequately, although not perfectly, tailored
to the evidence. Second, the military judge instructed the
members that alcoholism and chemical dependency are a disease.
And finally, the government did not dispute the appellant’s
contention that the combination of psychological problems, job-
29
United States v. MacDonald, No. 14-0001/AR
related stress, over-medication, loss of liver function, and
alcohol consumption could cause a lack of mental responsibility.
Id. at 188.
In the present action, like Hensler, the Government did not
dispute the possibility of involuntary intoxication by Chantix
as it even offered its own set of instructions on involuntary
intoxication. However, unlike Hensler, the military judge’s
instructions were not sufficiently tailored nor did the military
judge refer to “involuntary intoxication” or the potential
effects of Chantix in the given instructions.
Further, this Court stated in Hensler that “[i]nvoluntary
intoxication is treated like legal insanity. It is defined in
terms of lack of mental responsibility.” Id. at 188 (citing
F.D.L., 836 F.2d at 1116-17 (“[T]he mental state of an
involuntarily intoxicated defendant is measured by the test of
legal insanity.”)). It is based on this language that the
Government argues that the test of involuntary intoxication is
essentially the same as mental responsibility. If this is an
accurate statement of law, then clearly the instructions for
involuntary intoxication for mental responsibility would be
substantially the same and any error in failing to give an
involuntary intoxication instruction would be harmless.
The underlying authority on which Hensler is based, namely
United States v. F.D.L., however, is more nuanced than the
30
United States v. MacDonald, No. 14-0001/AR
segment quoted in Hensler suggests. 836 F.2d at 1117 (citing 73
A.L.R.3d 203–04 (1976)). In that case, the Eighth Circuit held
that involuntary intoxication “cases all require a finding that
there has been involuntary ingestion of an intoxicant, usually
through trickery, and that the defendant was unable to
appreciate the nature and quality or wrongfulness of his acts.”
F.D.L., 836 F.2d at 1117. Thus, F.D.L. articulates a two-part
test for involuntary intoxication. First, that there was an
involuntary ingestion of an intoxicant. And second, due to this
ingestion, defendant was unable to appreciate the nature and
quality or wrongfulness of his acts. This is substantially
distinct from a mental responsibility test requiring
demonstration of a mental disease or defect and the inability to
appreciate the nature and quality or wrongfulness of conduct.
To conflate these two defenses is not logical. If the test for
involuntary intoxication required a showing of a mental disease
or defect in addition to the two-part F.D.L. test, this would
essentially be a mental responsibility defense and there would
be no reason to utilize an involuntary intoxication defense.
Based on the foregoing, we conclude there was not sufficient
overlap between an instruction of involuntary intoxication and
the given instruction of mental responsibility.
On the first part of the test, neither party disputes that
Appellant ingested a medically prescribed drug. We previously
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United States v. MacDonald, No. 14-0001/AR
held that intoxication is involuntary when an accused is unaware
of the effect of a drug or substance on him. See, e.g.,
Hensler, 44 M.J. at 188 (concluding that “the defense was not
raised as to the remaining five episodes because appellant was
on notice that she reacted inappropriately to consumption of
alcohol”). Here, the Government argues that MacDonald’s
intoxication was not “involuntary” because he should have been
aware of the effects of Chantix.4 However, no compelling
evidence was presented that Appellant was on notice at the time
of the incident that Chantix could cause serious
neuropsychiatric symptoms -- the Black Box warning was not
published until a year after PVT Bulmer’s death -- or that he
might suffer unanticipated side effects from Chantix.
With respect to the second part of the test, Appellant’s
expert witness, Dr. Glenmullen, testified that to be “under the
influence of a drug” meant that “a drug is affecting you . . . .
[y]ou can, in some instances, be under the influences of a drug
in ways that alters your behavior beyond your control.”
(Emphasis added.) Moreover, Appellant’s expert witnesses
diagnosed Appellant as suffering from preexisting mental
conditions and believed Appellant suffered a short-lived,
psychotic episode at the time of the stabbing which rendered him
4
The defense also requested an instruction on “evidence negating
[a] voluntary act.” The military judge declined to give such an
instruction and the issue was not appealed to this Court.
32
United States v. MacDonald, No. 14-0001/AR
unable to appreciate the wrongfulness of his conduct. For
example, defense expert Dr. Pancholi testified that at the time
of PVT Bulmer’s stabbing, Appellant was psychotic. She further
explained, “[b]asically psychosis is when an individual has a
break in their perception of realities. So they lose contact
with reality and so the onset of psychosis is gradual.” She
also noted that “it’s not an on/off switch,” but rather a
“progression where you’re slowly losing contact with reality and
then when you’re coming out of a psychotic episode it’s a
similar progression to where you can return back to having
contact with reality over a period of time.” Similarly, Dr.
Glenmullen concluded that Appellant was psychotic at the time of
PVT Bulmer’s stabbing and that psychiatric conditions or drugs
can cause psychosis. He noted that Appellant’s psychosis was a
combination of “underlying schizoid personality disorder and
psychotic disorder[, and] auditory hallucinations,” such that he
was the “last person in the world you’d want to give Chantix to
. . . the affect of the Chantix is the combination.” Dr.
Glenmullen further testified that Appellant was unable to form
the conscious intent to kill “because of the psychosis,” and
that Appellant was suffering from a severe mental disease or
defect at the time of the incident which was a “Chantix induced
psychosis.” In addition, several witnesses testified to
Appellant’s disposition during the commission of the crime,
33
United States v. MacDonald, No. 14-0001/AR
including one who stated Appellant was “[a]cting completely
crazy like he was possessed or something.”
Given that a defense of involuntary intoxication is
substantially different from a defense of mental responsibility,
because it includes a distinct threshold prong, we are unable to
conclude it was harmless beyond a reasonable doubt not to
instruct the members on this separate defense. Several experts
provided “some evidence” that Chantix affected Appellant’s
ability to appreciate the nature and quality or wrongfulness of
his acts. There was also “some evidence” from Pfizer and the
FDA, including the rapidly escalating warnings that culminated
in a Black Box warning, that Chantix could have dramatic adverse
effects on some patients.
Moreover, we cannot and do not know whether the members may
have determined that Appellant did not suffer from a serious
mental disease or defect at the time of the murder and declined
to consider the second prong of the mental responsibility
defense. Further, if involuntary intoxication was not a
complete defense it could have been a partial defense by
negating an element in specific intent or premeditation. As
such, the members were not told that involuntary intoxication
itself or in combination with Appellant’s other conditions could
impact his ability to appreciate the nature and quality of
wrongfulness of his act. As a result, we are left with
34
United States v. MacDonald, No. 14-0001/AR
reasonable doubt as to whether the absence of an instruction
contributed to the verdict.
The Government argued that the evidence of Appellant’s
ability to form the necessary intent was so overwhelming that
Appellant could not be prejudiced by any error. In doing so,
the Government cites Appellant’s actions prior to and
immediately following the murder of PVT Bulmer as evidencing a
state of mind that is rational and reflective of a person
cognizant of the nature and quality of his actions. For
example, Appellant telephoned his girlfriend the evening before
the murder and asked whether she would “still love me if I
killed someone.” Appellant also acknowledged the “idea of
violently killing someone, wasnt [sic] always, wasnt [sic] much
at all, only a little, however, I was more willing ‘to do’
whatever I thought about doing because I was so streched [sic]
thin.” The Government also argues that Appellant acted in a
rational manner when he armed himself with a double-edge knife
en route to the laundry room and had the “presence of mind to
stalk a sleeping victim inside a barracks where he would not be
recognized and when no witnesses were present.” Moreover, after
the attack, Appellant fled the scene, showered, and attempted to
escape from the base.
There are two reasons why this evidence is not so
overwhelming as to render the instruction harmless beyond a
35
United States v. MacDonald, No. 14-0001/AR
reasonable doubt. First, although the evidence that the
Government cites could be viewed as compelling evidence that
Appellant was mentally responsible for his actions, it does not
account for the defense expert testimony that the Chantix may
have affected Appellant’s mental state and capacity at the time
of the incident such that he was “under the influence” of
Chantix. In a related manner, some if not all of the evidence
that the Government cites could support an involuntary
intoxication defense as well as refute it. For example,
Appellant’s statements to his girlfriend could manifest
premeditated intent, or they could manifest the sort of
uncontrolled “homicidal ideation” Appellant argues Chantix may
induce. That leads to the second reason we are not ultimately
persuaded that the evidence was sufficiently overwhelming on the
question of intent to negate any error. Where the evidence can
support multiple arguments, the accused is entitled to have the
trier of fact, in this case the members, and not an appellate
court, hear and test the credibility of the evidence based on
proper instructions.
In sum, the instructions for involuntary intoxication were
not substantially the same as those given for mental
responsibility, and the Government did not meet its burden to
demonstrate that failure to properly instruct was harmless
beyond a reasonable doubt.
36
United States v. MacDonald, No. 14-0001/AR
CONCLUSION
We conclude that the military judge erred in failing to
issue a separate instruction on involuntary intoxication and
that contrary to the CCA’s conclusion the error was not harmless
beyond a reasonable doubt.
Accordingly, the decision of the United States Army Court
of Criminal Appeals is reversed. The findings and sentence are
set aside. The record of trial is returned to the Judge
Advocate General. A rehearing is authorized.
37