United States v. R. Peter Stanham ( 2010 )


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  •                                                                    [DO NOT PUBLISH]
    IN THE UNITED STATES COURT OF APPEALS
    FOR THE ELEVENTH CIRCUIT
    ________________________             FILED
    U.S. COURT OF APPEALS
    No. 07-14097         ELEVENTH CIRCUIT
    OCT 13, 2010
    ________________________
    JOHN LEY
    CLERK
    D. C. Docket No. 03-20951-CR-AJ
    UNITED STATES OF AMERICA,
    Plaintiff-Appellee,
    versus
    ARIADNA PUERTO,
    EDUARDO ORLANSKY,
    HECTOR ORLANSKY,
    Defendants-Appellants.
    ________________________
    Appeals from the United States District Court
    for the Southern District of Florida
    _________________________
    (October 13, 2010)
    ON PETITION FOR REHEARING
    AND REHEARING EN BANC
    Before O’CONNOR,*Associate Justice Retired, CARNES and ANDERSON,
    Circuit Judges.
    __________________
    *Honorable Sandra Day O’Connor, Associate Justice (Retired) of the United States Supreme
    Court, sitting by designation.
    PER CURIAM:
    No Judge in regular active service on the Court having requested that the
    Court be polled on rehearing en banc (Rule 35, Fed.R.App.P.), the Petition for
    Rehearing En Banc is DENIED. Turning to Eduardo’s subsidiary petition for
    panel rehearing, we deny panel rehearing, but acknowledge the need to modify Part
    II.F.1. of the panel opinion, issued on August 12, 2010. In his petition for
    rehearing, Eduardo argues for the first time that the district court and the panel
    opinion inappropriately relied upon the testimony of Dr. Gelblum and Dr. Crown
    that, because neither they nor others examined or tested Eduardo earlier, they could
    not opine with any degree of medical certainty that at the relevant times Eduardo
    lacked the requisite mens rea or lacked the ability to appreciate the nature and
    quality or wrongfulness of his acts. Eduardo’s new argument is that Fed.R.Evid.
    704(b) precludes any expert opinion on such ultimate issues, and that the district
    court and the panel opinion erred in requiring same. Eduardo now argues also that
    the district court and the panel opinion erred in requiring that there should have
    been contemporary mental health examinations or tests. We reject Eduardo’s new
    argument. Neither the district court nor the panel opinion imposed a requirement
    that, to be admissible, a mental health expert must testify as to the ultimate issue, or
    a requirement that there be mental health examinations or tests during the relevant
    2
    time period. Obviously, there is no requirement that there shall have been mental
    health examinations or tests during the relevant time period. We are in full
    agreement with the Fifth Circuit in United States v. Long, 
    562 F.3d 325
     (5th Cir.
    2009), when that court said:
    Obviously, neither Dr. Friedberg nor any other expert examined Long
    during the commission of the crimes, and in any event, would have
    been prevented under Federal Rule of Evidence 704(b) from offering a
    direct assessment of Long’s ability to appreciate the nature, quality,
    and wrongfulness of his acts at the times he committed them. This
    necessitates some degree of inference based on the characteristics of
    Long’s illness at the time that he was examined and Long’s own report
    of his mental state and motivation at the time that he acted.
    
    Id. at 342
     (Italics in original; footnote omitted).
    Rather than imposing a requirement that a mental health expert testify as to
    the ultimate issue, the district court construed the doctors’ candid admissions as
    indicating that there was simply a paucity of evidence to conclude that Eduardo’s
    mental deficiencies existed at the times of the crimes. In other words, there was a
    paucity of evidence for the doctors to opine with any degree of medical certainty
    about the level or degree of Eduardo’s mental deficiencies at the relevant times.
    Thus, the district court found that “neither Dr. Gelblum nor Dr. Crown are able,
    with any degree of medical or scientific certainty, to opine that Mr. Orlansky
    suffered from dementia with significant cognitive loss during the time period.”
    3
    District Court Order, Doc. 625, at 1. We cannot conclude that the district court
    abused its discretion in this regard. Indeed, although the doctors did at some points
    testify (without objection) that they were unable to opine with the requisite medical
    certainty about the ultimate issues, they also repeatedly disavowed any ability to
    opine generally as to Eduardo’s state of mind or the degree of Eduardo’s mental
    deficiencies at the relevant times or the date of onset of any significant cognitive
    loss.*
    The district court’s interpretation of the doctors’ admissions and its
    conclusion that there was a paucity of evidence with respect to Eduardo’s mental
    deficiencies at the relevant times are amply supported in the record. There was no
    history of mental deficiencies. No such complaint had ever been communicated to
    any doctor, or to anyone else, prior to Eduardo’s indictment. In light of the
    admissions of the doctors that their examinations and tests were insufficient, the
    only evidence in any way suggesting mental deficiencies at the relevant times was
    *
    Such testimony is not prohibited testimony on the ultimate issue. As the Fifth
    Circuit in Long said: “Appropriate testimony . . . should ‘describe the characteristics of [the
    defendant’s] mental illnesses and the effect of such illnesses on his ability to appreciate
    wrongdoing.’” 
    Id. at 333
    . In short, appropriate testimony includes testimony about “mental state
    and motivation.” 
    Id. at 334
    . See also United States v. Alexander, 
    805 F.2d 1458
    , 1463 (11th
    Cir. 1986) (in discussing the prohibition on expert testimony on the ultimate issue, Fed.R.Evid.
    704(b), we commented: “Psychiatrists, of course, must be permitted to testify fully about the
    defendant’s diagnosis, mental state and motivation . . . at the time of the alleged act so as to
    permit the jury or judge to reach the ultimate conclusion.”).
    4
    the testimony of Eduardo’s wife and a couple of employees in the business.
    Eduardo’s wife testified vaguely at the Daubert hearing that he had begun to act
    strangely, and that she had noted a decline in his intelligence and memory. An
    employee, Mendez, testified at trial about some ritualistic behaviors and about
    Eduardo’s poor business judgment and trouble understanding financial documents.
    However, Eduardo never adduced pertinent expert testimony as to the significance
    of such testimony. With respect to the two cursory emails from Dr. Gelblum and
    Dr. Crown referring to that testimony, the district court concluded that the emails
    were “conclusory and provided little to no basis for the opinions offered.” After
    exhaustive exploration of, and hearings on, Eduardo’s medical evidence, the
    district court effectively concluded that any opinions of Dr. Gelblum or Dr. Crown
    about Eduardo’s mental state during the relevant time period would be mere
    speculation. We cannot conclude the district court abused its discretion in this
    regard. Accordingly, Eduardo’s petition for panel rehearing is denied. However,
    because certain loose language in the panel opinion might contribute to the
    misinterpretation adopted by Eduardo in his petition for rehearing, we modify Part
    II.F.1. of that opinion (relating to the discussions of the Insanity Defense Reform
    5
    Act (“IDRA”), and relating to Fed.R.Evid. 702 and Daubert v. Merrell Dow
    Pharm., 
    509 U.S. 579
    , 
    113 S. Ct. 2786
     (1993)) to read as follows.**
    II. DISCUSSION
    F. Eduardo’s Mental State
    1.     Eduardo’s challenge to the district court’s exclusion of his experts’
    mental health testimony
    Eduardo sought to introduce evidence about his diminished mental state
    during the relevant time period for three reasons. The first was to support his
    insanity defense under the Insanity Defense Reform Act (“IDRA”), 
    18 U.S.C. § 17
    (2000). Second, he sought to introduce the evidence as a means of challenging the
    Government’s argument that he had the requisite mens rea to commit the charged
    crimes. Third, he sought to introduce evidence of his diminished mental state to
    support his claim that he had been kept in the dark about the fraud and it had been
    orchestrated by lower level management.
    Eduardo submitted a Notice of Insanity Defense and Expert Evidence of
    Mental Condition, which included reports from neuropsychologist Dr. Barry
    Crown and neurologist Dr. Jeffrey Gelblum (Eduardo’s treating neurologist). He
    also included the report from an MRI, which reportedly showed evidence of an old
    **
    All other parts of our opinion issued on August 12, 2010, remain unchanged.
    6
    stroke in his left caudate nucleus and a large, “very old” fluid accumulation in his
    left temporal and temporal frontal region, which probably resulted from a stroke.
    In response, the Government moved to exclude evidence that Eduardo suffered
    from a mental defect, for a Daubert8 hearing, and to exclude the testimony of the
    two doctors. The district court excluded the testimony of the two doctors both
    because it was inadmissible under the IDRA and because it was inadmissible under
    Fed. R. Evid. 702 and Daubert. Eduardo challenges both rulings; we address each
    in turn.
    a. The legal standard under the IDRA
    Under the IDRA, insanity is an affirmative defense that the defendant must
    prove by clear and convincing evidence. 
    18 U.S.C. § 17
    ; United States v. Westcott,
    
    83 F.3d 1354
    , 1357 (11th Cir. 1996). The Act restricted the definition of insanity:
    at the time of the commission of the acts constituting the offense, the
    defendant, as a result of a severe mental disease or defect, was unable
    to appreciate the nature and quality or the wrongfulness of his acts.
    Mental disease or defect does not otherwise constitute a defense.
    
    18 U.S.C. § 17
    (a). Before the Act’s passage, a defendant could also assert a valid
    defense if he was unable to conform his conduct to the requirements of the law.
    United States v. Freeman, 
    804 F.2d. 1574
    , 1576 (11th Cir. 1986). However, as the
    8
    Daubert v. Merrell Dow Pharm., Inc., 
    509 U.S. 579
    , 
    113 S. Ct. 2786
     (1993).
    7
    second sentence of the Act recites, Congress prohibited the use of “‘non-insanity’
    psychiatric evidence that points toward ‘exoneration or mitigation of an offense
    because of a defendant’s supposed psychiatric compulsion or inability or failure to
    engage in normal reflection.’” United States v. Cameron, 
    907 F.2d 1051
    , 1066
    (11th Cir. 1990). “Congress intended to prohibit the presentation of evidence of
    mental disease or defect, short of insanity, to excuse conduct.” Westcott, 
    83 F.3d at 1357-58
    . In passing the IDRA, Congress considered that such prohibited
    evidence would, if allowed to go to the jury, resurrect the former, broader version
    of the insanity defense “in the guise of showing some other affirmative defense,
    such as . . . diminished responsibility . . . and open the door, once again, to
    needlessly confusing psychiatric testimony.” Cameron, 
    907 F.2d at 1066
     (quoting
    S. Rep. No. 98-225, 98th Cong., 2d Sess. 229 (1984), reprinted in 1984
    U.S.C.C.A.N. 3182, 3411) (internal punctuation omitted). However, we have held
    that Congress did not intend to exclude the use of psychiatric evidence that negated
    specific intent. Westcott, 
    83 F.3d at 1358
    ; Cameron, 
    907 F.2d at 1066-67
    .9 We
    examine the testimony of each of the proffered experts in turn.
    9
    The distinction mentioned in the case law between psychiatric evidence that
    negates specific intent, on the one hand, and psychiatric evidence that a defendant does not have
    the capacity to form specific intent, on the other hand, is not relevant in this case. See Westcott,
    
    83 F.3d at 1358
    ; Cameron, 
    907 F.2d at 1066-67
    ; see also United States v. Pohlot, 
    827 F.2d 889
    ,
    903-05 (3d Cir. 1987).
    8
    i. Dr. Jeffrey Gelblum
    Eduardo’s treating neurologist testified at the four-day hearing in November
    2005 about his diagnosis of Eduardo, the etiology of Eduardo’s illness, and his
    opinion about Eduardo’s mental state. He testified that he had diagnosed Eduardo
    in 2004 with progressive vascular dementia based on reports by his family of
    deficits in activities of daily living and an MRI and an electroencephalogram
    (“EEG”), neurological tests that pinpoint the dementia’s causes. The MRI showed
    that a region in Eduardo’s brain’s left hemisphere was cavitated out, meaning that
    the brain tissue had been replaced with fluid. Dr. Gelblum testified that Eduardo
    had significant damage to the left temporal lobe, the left frontal lobe, and the left
    parietal lobe, which suggests interference of brain functioning in a critical part of
    the brain. He explained that the left side of the brain primarily controls right-sided
    body function, as well as comprehension, arithmetic, executive planning, and
    fluency. Memory is also impaired with this type of injury, with short-term memory
    being most prominently affected because it is relegated to the left temporal lobe.
    Dr. Gelblum opined that the damage to Eduardo’s brain was caused by an
    arachnoid cyst and superimposed stroke syndrome. Arachnoid cysts are congenital,
    meaning that the patient was born with the cyst, and Dr. Gelblum explained that
    superimposed stroke syndrome refers to small, “silent” strokes. While the MRI
    9
    could not give an exact date of onset, Dr. Gelblum speculated that the degree of
    whiteout in the brain suggested that the damaged area had been fluid-filled for “six,
    seven, [or] eight years.” But he conceded that because he did not have access to
    previous MRIs, he could not determine if the cyst had been growing or if it had
    been that size since birth; the MRI and the EEG could only provide a snapshot of
    the patient’s current condition.
    At the time that Dr. Gelblum began to treat Eduardo, in May 2004, Dr.
    Gelblum thought that Eduardo was legally insane. However, he testified that there
    is no scientifically valid way for him to ascertain Eduardo’s mental state before that
    time. Additionally, he agreed that talking to family about the patient’s past
    behaviors could not scientifically determine the patient’s mental state in years past.
    When asked if there was any scientifically reliable way of determining if Eduardo
    had the capacity to deceive during the period from 1994 to 2003, Dr. Gelblum
    answered “we don’t have those scans or studies, no.”
    Because Dr. Gelblum testified that he relied upon the reports of family and
    friends to make diagnoses, Eduardo introduced evidence from Eduardo’s wife,
    Jane, and later trial testimony from his former employee, Mendez. Jane Orlansky
    testified that Eduardo had begun to act strangely beginning in 1992 or 1993,
    engaging in what she termed ritualistic behavior. She also noted a decline in his
    10
    intelligence and short term memory. However, she testified that she did not
    recommend to him that he seek any professional or medical help for the strange
    behavior that he began to exhibit. Similarly, Mendez testified to Eduardo’s
    ritualistic behavior. Although Jane Orlansky’s and Mendez’s testimony may have
    suggested that Eduardo was beginning to develop dementia during the time period
    at issue, Dr. Gelblum did not testify that, on the basis of the testimony of Jane and
    Mendez, he could opine with any degree of medical certainty about Eduardo’s state
    of mind at the relevant time period such that a fact-finder could infer that Eduardo
    was unable to appreciate the nature and quality or wrongfulness of his actions
    during the relevant time period.10
    While Dr. Gelblum testified that accounts from family of behavior and
    patient history comprise ninety-five percent of the information required for
    diagnosis, as the district court noted, Dr. Gelblum did not state that he relied on
    those accounts in his letters or reports when he wrote that, at the time of the crimes,
    Eduardo suffered from severe mental defect such that he could not appreciate the
    wrongfulness of his actions. And he affirmatively testified that he could not render
    10
    Furthermore, one of the Government’s experts, Dr. David Fishbain, reviewed
    Eduardo’s business writing, correspondence and notes made from 1996 to 2003 and discerned no
    signs of mental or cognitive deterioration. Additionally, Dr. Fishbain noted that Eduardo made
    no complaints about forgetfulness, anxiety or being upset to his primary care physician until late
    2004, after he was being treated by Dr. Gelblum and after he had been indicted.
    11
    an opinion about Eduardo’s ability or capacity to lie during that period. Although
    he did try to rectify his opinion by testifying that he could rely on family reports to
    make a retroactive diagnosis, he did not testify that he could opine with any degree
    of medical certainty that Eduardo was unable to lie or deceive at the time of the
    crimes.
    ii. Dr. Barry Crown
    Dr. Crown is a neuropsychologist who administered a series of psychological
    tests to Eduardo in order to ascertain the severity of the damage caused by the
    arachnoid cyst and the stroke syndrome identified by the neurologists. His report
    stated that he would testify that at the time of Eduardo’s involvement in the
    criminal acts, Eduardo was suffering from vascular dementia with significant
    cognitive loss. Further, he wrote, Eduardo, “at best, would have been performing
    at a twelve year old level” on his language-based critical thinking and abstract
    problem-solving ability.
    During the hearing, Dr. Crown testified that all of the tests he administered
    to Eduardo only showed Eduardo’s capabilities at the time of the tests’
    administration. When asked specifically if he could testify as to Eduardo’s mental
    condition during the relevant period of the case, he stated that could not provide an
    opinion. He testified that his statement in the report was based on his
    12
    understanding that Eduardo was not in the acute stage of the illness and that his
    illness had been progressing for some time. However, he admitted that he had no
    way to “date stamp it,” and that the rate of decline varies by individual. The
    district court then asked Dr. Crown if he could say “to any degree of medical
    certainty when that significant cognitive loss occurred?” Dr. Crown replied: “No,
    other than Mrs. Orlansky relating to me that she felt that he deteriorated, and that
    there were problems at or about the time of a civil lawsuit that took place well over
    ten to 12, 14 years ago. But that’s the only historical bit of information that I have
    that suggests a point of noticeability.” Finally, when asked if he could state with
    any degree of scientific certainty that Eduardo was insane at any point during the
    ten-year period that the charge embraced, Dr. Crown answered no.
    iii. Analysis
    The district court properly noted that the IDRA allows a defendant to put on
    an affirmative defense that, as a result of a severe mental disease or defect, he was
    unable, at the time of the commission of the acts constituting the offense, to
    appreciate the nature and quality or the wrongfulness of his acts. 
    18 U.S.C. §17
    (a).
    We also noted above that in the IDRA, Congress intended to prohibit the use of
    non-insanity psychiatric evidence that points to exoneration or mitigation of an
    offense, but that Congress did not intend to exclude the use of psychiatric evidence
    13
    that negated specific intent. Westcott, 
    83 F.3d at 1358
    ; Cameron, 
    907 F.2d at 1067
    . However, the IDRA specifically requires that such evidence focus on the
    defendant’s state of mind at the time of the charged offense. See Cameron, 
    907 F.2d at 1067
     (“Evidence offered as psychiatric evidence to negate specific intent is
    admissible, however, when such evidence focuses on the defendant’s specific state
    of mind at the time of the charged offense.”) (internal quotations omitted).
    Eduardo’s problem is that neither Dr. Gelblum nor Dr. Crown could provide
    testimony about what Eduardo’s state of mind was at the time of the charged acts.
    At most, they could speculate that he had begun to decline during that period, but
    they could not opine with any degree of medical certainty about Eduardo’s state of
    mind (or the level or degree of his mental deficiencies) during the relevant time
    period.*** Moreover, because they did not know what his mental state was during
    ***
    In his petition for rehearing, Eduardo argues for the first time that the district court
    erred by insisting that, to be admissible, Dr. Gelblum and Dr. Crown would have to have testified
    to the ultimate issue – i.e., that Eduardo lacked the ability at the relevant time to appreciate the
    nature and quality or wrongfulness of his acts. Eduardo now argues that the district court erred in
    insisting upon testimony on the ultimate issue because such testimony is prohibited by
    Fed.R.Evid. 704(b). Although it is true that the doctors did at some point testify without
    objection that they were unable to opine with any degree of medical certainty as to that ultimate
    issue, they also repeatedly testified to a similar inability to opine generally with respect to
    Eduardo’s mental state at the relevant times (including the timing of significant cognitive loss).
    The district court construed the doctors’ candid admissions as indicating that there was a paucity
    of evidence with respect to Eduardo’s state of mind at the relevant times, such that the two
    doctors could not opine with the requisite medical certainty that Eduardo suffered from dementia
    with significant cognitive loss during the relevant time period. We cannot conclude that the
    district court abused its discretion in this regard.
    14
    the relevant time, they also could not opine with any degree of medical certainty
    with respect to his mens rea during the relevant time period. For this reason, the
    district court held that the IDRA rendered the testimony of the two doctors
    inadmissible.
    The district court (Judge Adalberto Jordan) exhaustively explored this
    evidence and its admissibility. First it held a four-day hearing in November 2005,
    during which it actively questioned the experts and after which it produced two
    well-reasoned and comprehensively analyzed orders excluding the evidence.
    Additionally, the court undertook reconsideration of the decision mid-trial and
    again determined that the evidence could not meet the IDRA’s standards.11 In view
    11
    Eduardo moved again mid-trial seeking reconsideration of the district court’s
    decision to exclude the testimony of the doctors. Eduardo relied on the trial testimony of
    employee and co-conspirator Mendez about Eduardo’s behavior during the relevant time, to wit:
    that some of Eduardo’s business decisions made no sense; that he had trouble understanding
    financial documents; that he had memory problems; and that he engaged in some ritualistic
    behaviors. The FBI statement of another employee also reported ritualistic behaviors, like
    repeatedly putting out his cigarette by pressing it against the bottom of the ashtray for an
    inordinate amount of time. Eduardo did not proffer sworn testimony of either doctor to the effect
    that the new evidence would permit them to testify with any degree of medical certainty as to
    Eduardo’s state of mind as of the relevant time period. However, Eduardo did proffer brief
    emails from the two doctors. The district court concluded that the emails were “conclusory and
    provide little to no basis for the opinions offered.” We have considered the testimony of Mendez
    and the statement of the other employee as well as the emails. We cannot conclude that the
    district court abused its discretion. The emails are conclusory; they fail to explain how the
    actions described would indicate either the timing or the degree of any cognitive impairment.
    Moreover, especially in the absence of expert testimony, we doubt that the behaviors described
    could indicate cognitive impairment to a degree that mens rea would be negated. For example,
    the most significant behaviors – poor business judgment and trouble understanding financial
    documents – would not seem to indicate cognitive impairment to the extent that a person would
    not realize that it is wrong to fabricate accounts receivable in order to mislead one’s lender and
    15
    of the careful and comprehensive consideration by the district court,12 and because
    neither doctor could testify with any degree of medical certainty about Eduardo’s
    state of mind at the relevant times we cannot conclude that the district court abused
    its discretion in excluding the testimony of Dr. Gelblum or Dr. Crown.13
    b. Rule 702 of the Federal Rules of Evidence
    The district court also denied admission of the testimony based on Rule 702
    of the Federal Rules of Evidence, which controls the admission of expert
    testimony. It provides:
    joint venture partner. In any event, in the absence of expert testimony to that effect, we cannot
    conclude that the district court abused its discretion. We also note that after his indictment,
    Eduardo’s own doctors initially opined that Eduardo was competent to stand trial.
    12
    In addition to the hearings the district court held on the evidence of Eduardo’s
    mental state, it held a four-day hearing on the related issue of Eduardo’s competency before trial
    began and ordered both an in-patient evaluation and an independent expert evaluation of
    Eduardo’s competency. Moreover, as discussed below, the court re-examined Eduardo’s
    competency both during the trial and after it, producing detailed analyses of the experts’
    testimony and demonstrating an extensive understanding of Eduardo’s mental condition.
    13
    We noted above in Part II.F.1 that Eduardo sought to introduce the testimony of
    the two doctors for three purposes: first, to support his insanity defense; second, to negate mens
    rea; and third, to support his claim that he had been kept in the dark about the fraud. The district
    court’s opinions, and our own opinion in the text above, specifically address the issue only with
    respect to its use to support the insanity defense, and to negate mens rea. However, the same
    rationale applies with equal force to Eduardo’s attempt to use the evidence to support his claim
    that he had been kept in the dark about the fraud. We can assume arguendo, but we expressly do
    not decide, that the IDRA would not present an absolute bar to the use of psychiatric evidence for
    this third purpose. However, even assuming that, it is clear that the IDRA would require that the
    evidence be focused on defendant’s state of mind at the time of the crime. Because the evidence
    of the two doctors was not thus focused, the district court did not abuse its discretion in
    implicitly holding that the IDRA renders the evidence inadmissible for this third purpose also.
    16
    If scientific, technical, or other specialized knowledge will assist the
    trier of fact to understand the evidence or to determine a fact in issue,
    a witness qualified as an expert by knowledge, skill, experience,
    training, or education, may testify thereto in the form of an opinion or
    otherwise, if (1) the testimony is based upon sufficient facts or data,
    (2) the testimony is the product of reliable principles and methods, and
    (3) the witness has applied the principles and methods reliably to the
    facts of the case.
    The Supreme Court has instructed that Rule 702 compels the district courts to
    perform a critical “gatekeeping” function concerning the admissibility of expert
    scientific evidence. Daubert v. Merrell Dow Pharm., 
    509 U.S. 579
    , 589 n.7, 597,
    
    113 S. Ct. 2786
    , 2795 n.7, 2798 (1993). “This function ‘inherently require[s] the
    trial court to conduct an exacting analysis’ of the foundations of expert opinions to
    ensure they meet the standards for admissibility under Rule 702.” United States v.
    Frazier, 
    387 F.3d 1244
    , 1260 (11th Cir. 2004) (en banc) (quoting McCorvey v.
    Baxter Healthcare Corp., 
    298 F.3d 1253
    , 1257 (11th Cir. 2002)).
    This court employs a three-part inquiry to determine admissibility under
    Rule 702. The trial court must consider whether:
    (1) the expert is qualified to testify competently regarding the matters
    he intends to address; (2) the methodology by which the expert
    reaches his conclusions is sufficiently reliable as determined by the
    sort of inquiry mandated in Daubert; and (3) the testimony assists the
    trier of fact, through the application of scientific, technical, or
    specialized expertise, to understand the evidence or to determine a fact
    in issue.
    17
    Frazier, 
    387 F.3d at 1260
    . Here, the district court denied admissibility of the
    testimony of Doctors Gelblum and Crown based on the second and third prongs of
    the inquiry, reliability and assistance to the trier of fact. While the Court in
    Daubert recognized that “it would be unreasonable to conclude that the subject of
    scientific testimony must be ‘known’ to a certainty,” it held that “in order to qualify
    as ‘scientific knowledge,’ an inference or assertion must be derived by the
    scientific method.” 
    509 U.S. at 590
    , 
    113 S. Ct. at 2795
    . “Proposed testimony must
    be supported by appropriate validation – i.e., ‘good grounds,’ based on what is
    known.” 
    Id.
     Further, assistance to the trier of fact is primarily a question of
    relevance. 
    Id. at 591
    , 
    113 S. Ct. at 2795
    . Therefore, the question is whether the
    evidence will help the jury decide a factual dispute; “Rule 702’s ‘helpfulness’
    standard requires a valid scientific connection to the pertinent inquiry as a
    precondition to admissibility.” 
    Id. at 591-92
    , 
    113 S. Ct. at 2796
    .
    As discussed in reference to the IDRA, there did not exist “‘good grounds,’
    based on what is known.” Neither of the proposed expert witnesses could testify
    with any medical certainty to evidence with respect to Eduardo’s state of mind at
    the relevant times that would allow a reasonable fact-finder to conclude that
    Eduardo was either insane at the time of the offenses or lacked the requisite mens
    18
    rea at the time of the offenses.14 Therefore, the district court’s conclusion that the
    evidence failed both the reliability and assistance to the trier of fact prongs was not
    an abuse of discretion.15
    SO ORDERED.
    14
    The district court also properly rejected, on the basis of Daubert, Eduardo’s third
    rationale for admitting the expert witness testimony about his mental state – to show that he was
    easily influenced by his employees – because of the experts’ inability to testify with any medical
    certainty about his mental state during the relevant time period.
    15
    In light of our decision that the district court did not abuse its discretion in
    excluding the testimony of the two doctors on the basis of the IDRA and Rule 702, we need not
    address the district court’s alternative ground, Fed. R. Evid. 403.
    19