Commonwealth v. Piantedosi ( 2017 )


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    SJC-11802
    COMMONWEALTH   vs.   CHRISTOPHER PIANTEDOSI.
    Middlesex.       October 6, 2017. - December 18, 2017.
    Present:    Gants, C.J., Gaziano, Budd, Cypher, & Kafker, JJ.
    Homicide. Mental Impairment. Intoxication. Insanity.
    Evidence, Intoxication, Insanity, Expert opinion. Witness,
    Expert. Constitutional Law, Fair trial. Due Process of
    Law, Fair trial. Fair Trial. Practice, Criminal, Capital
    case, Fair trial, Instructions to jury, Acquittal by reason
    of insanity.
    Indictments found and returned in the Superior Court
    Department on June 7, 2012.
    The cases were tried before Diane M. Kottmyer, J.
    Robert S. Sinsheimer (Lisa A. Parlagreco also present) for
    the defendant.
    Emily K. Walsh, Assistant District Attorney (Nicole L.
    Allain, Assistant District Attorney, also present) for the
    Commonwealth.
    GAZIANO, J.     A jury in the Superior Court found the
    defendant guilty of murder in the first degree in the stabbing
    death of his longtime girl friend, on theories of deliberate
    2
    premeditation and extreme atrocity or cruelty.1   At trial, the
    defendant conceded that he had killed the victim but asserted
    that he lacked criminal responsibility for her death due to his
    involuntary intoxication from having taken prescribed
    antidepressant medications.    In this direct appeal from his
    convictions, the defendant challenges the judge's refusal to
    permit a defense expert to testify on direct examination to
    hearsay statements made by the defendant; the introduction of
    testimony by the Commonwealth's expert concerning what "drove"
    the defendant's behavior; and the judge's failure to instruct
    the jury that the consequences of a verdict of not guilty by
    reason of insanity would include a potential psychiatric
    commitment for life.    In addition, the defendant asks this court
    to exercise its extraordinary authority under G. L. c. 278,
    § 33E, to reduce the verdict to murder in the second degree.
    For the reasons that follow, we affirm the defendant's
    convictions and, after a thorough review of the entire trial
    record, decline to grant relief pursuant to G. L. c. 278, § 33E.
    1.   Background.   We summarize the facts that the jury could
    have found, reserving other details for later discussion of
    particular issues.
    1
    The defendant also was convicted of malicious destruction
    of the victim's personal property. See G. L. c. 266, § 127.
    3
    a.    Commonwealth's case.   The victim and the defendant were
    involved in an eighteen-year relationship and had a daughter,
    Alexa,2 who was a teenager at the time of these events.    The
    victim had a son from another relationship, whom she and the
    defendant were raising as their child.     The four lived as a
    family for approximately six years in an apartment in a three-
    family house then owned by the defendant's parents, and
    thereafter for more than ten years in a rented house in
    Burlington.    In April, 2012, the defendant moved into his
    parents' house, explaining that he needed time and space away
    from the victim.    The victim confided to a friend that she had
    asked the defendant to leave due to his verbal and emotional
    abuse.
    In the early evening of May 3, 2012, the defendant went, as
    scheduled, to the house in Burlington to visit Alexa.     Alexa
    noticed that he was "kind of acting strange."     The defendant
    agreed to buy Alexa dinner, and the victim placed an order for
    takeout food delivery.    While the three were together in the
    living room, the defendant and the victim got into an argument.
    At trial, Alexa was not certain of the topic of the
    disagreement, but recalled that the defendant "started saying
    something and she [was] getting mad.    So they were kind of like
    2
    A pseudonym.
    4
    fighting back and forth."       The defendant instructed Alexa to go
    to her room, and she did so.
    At around 6:30 P.M., Alexa used a tablet computer, which
    she propped up on her window sill, to "video chat" with a
    friend, Ethan.3      Alexa and Ethan were able to see and hear each
    other using this computer program.       While they were talking,
    Alexa thought that she heard the doorbell or a knock on the
    door, and stepped out of her room believing that her takeout
    food delivery had arrived.       Ethan stayed connected to the video
    chat, waiting for Alexa to return.
    Alexa's parents were in the kitchen, arguing.     The victim,
    who appeared distraught, picked up the telephone and threatened
    to call the police.      The defendant snatched the telephone from
    her.       He then removed a small knife from his pants pocket and
    put it down on a living room table.       The victim seized the
    knife, pointed it at the defendant, and implored him to leave
    the house.      She repeatedly said, "Get out.   I'll call the cops.
    You're scaring me."       As the victim cried, the defendant hugged
    Alexa and said, "I love you."       Alexa replied, "Are you trying to
    kill her or something?"
    The defendant went into the kitchen and stood there,
    telling himself, aloud, that he was going to calm down.       He then
    turned abruptly, grabbed a butcher knife from a knife block on
    3
    Also a pseudonym.
    5
    the counter, and chased the victim.    The victim ran into Alexa's
    room in full view of Ethan, who watched from his computer
    screen.
    The victim was holding the bedroom door shut when the
    defendant broke down the door and burst into the room.    The
    force knocked the victim backwards onto the bed.    She screamed,
    "No, Chris, stop.   I love you."   Alexa entered the room shortly
    thereafter and attempted to pull the defendant away from the
    victim by grabbing him around the neck.   The defendant pushed
    her off.
    Through the video chat, Ethan watched the defendant shake
    the victim forcefully and then stab her in the chest while she
    was lying on the bed; Ethan screamed "Stop" into the computer
    microphone, but the defendant did not react.    Alexa was still in
    the room; she told the defendant that she was calling the
    police, grabbed her cellular telephone, and ran from the room.
    Ethan heard the victim say, "Remember," and the defendant
    respond, "No, you got to die.   You got to die."   The defendant
    stabbed the victim repeatedly until she fell off the bed onto
    the floor.
    Alexa ran out of the house, where she encountered the food
    delivery driver, who had just arrived.    Alexa sat in the vehicle
    with the driver and telephoned 911.    Alexa and the driver
    watched as the defendant walked away from the house toward his
    6
    vehicle.    The delivery driver described the defendant as "stone
    face[d]."    When police arrived, within minutes of Alexa's call,
    they found the victim's body on the floor in the space between
    the edge of Alexa's bed and the wall.      The victim had been
    stabbed more than thirty times and the kitchen knife was
    imbedded in her neck.
    The defendant left Burlington and eventually drove to
    western Massachusetts.4    The next day, May 4, 2012, the defendant
    drove his automobile into the parking lot of the State police
    barracks in Weston.     He got out of his vehicle and lay on the
    ground.     A public works employee driving nearby and saw the
    defendant lying in front of his vehicle.      The employee tried to
    rouse him but was unable to do so; the defendant remained
    unresponsive.     The employee went into the barracks and summoned
    police officers to help.    One of the officers, who recognized
    the defendant from a police bulletin and media reports, placed
    him under arrest.     Investigators searched the defendant's
    vehicle and found handwritten notes on the dashboard.      One note
    read, "Unarmed.     Just have to sleep."   Another portion of a note
    recounted the stabbing.
    4
    Burlington police tracked the defendant's cellular
    telephone to a location approximately thirty miles away, at a
    shopping mall in Leominster. Police recovered the defendant's
    bloody clothing and his cellular telephone from a Dumpster
    behind the mall.
    7
    b.   Defendant's case.   After the Commonwealth rested its
    case-in-chief, the defendant presented evidence concerning the
    issue of his criminal responsibility on the day of the homicide.
    The defendant called two witnesses:   his father and Dr. Wade C.
    Meyers, a forensic psychiatrist.   The defendant also introduced
    medical records from his admissions to the Lahey Clinic and Holy
    Family Hospital, records relating to his psychiatric treatment
    at the county jail and Bridgewater State Hospital, and a May 7,
    2012, competency evaluation.
    The defendant's father provided background information
    about the defendant, including describing the defendant's
    "normal" relationship with the victim.   The father also
    testified to the defendant's psychiatric hospitalization a few
    days before the May 3, 2012, incident.   On April 29, 2012, the
    father visited the defendant at the Holy Family Hospital
    emergency room and observed that he was quiet and nontalkative.
    According to medical records, the defendant had been admitted to
    the hospital for self-inflicted injuries to his arms.      He was
    diagnosed with depression and prescribed Prozac (to be taken in
    the morning) and Trazodone (to be taken before bed).
    Upon the defendant's discharge on May 2, 2012, his father
    picked him up from the hospital and drove him to a pharmacy to
    8
    fill his prescriptions.5   The defendant was scheduled to attend
    an outpatient program beginning on May 3, 2012.    He spent the
    afternoon in his room but left to attend classes at a
    professional school that evening; several of the students in his
    class noticed that he seemed tired and unwell.    The next
    morning, the defendant did not come downstairs from his bedroom
    until approximately 11:30 A.M.; he was pale and dehydrated.       The
    defendant left the house shortly thereafter, telling his father
    that he was planning to pick Alexa up at school, because she had
    a half-day off, and take her out for ice cream.
    Meyers evaluated the defendant to determine his mental
    state at the time of the crime.   Based on interviews with the
    defendant, Meyers's review of past psychiatric records,
    neuropsychological testing, and other information, Meyers
    concluded that on May 3, 2012, the defendant did not have the
    capacity to appreciate the wrongfulness of his conduct and was
    not able to conform his conduct to the requirements of the law.
    Meyers opined that the defendant suffered from involuntary
    intoxication from the antidepressants Prozac and Trazodone.       He
    explained that possible side effects of those medications
    included "irritability, rage reactions, hostility, mania,
    5
    After the defendant's arrest, his father counted the
    Prozac and Trazodone pills remaining in the defendant's
    prescription bottles. He testified that there was one pill
    missing from both bottles, which could have indicated that the
    defendant had taken his medications as prescribed.
    9
    insomnia, racing thoughts, a disinhibition of . . . behavior,
    impulsivity and trouble concentrating."        Meyers opined further
    that the defendant suffered from bipolar disorder, and therefore
    that he was more vulnerable to the toxic effects of Prozac and
    Trazodone.   He noted that Prozac and Trazodone contain warnings
    to screen for bipolar disorder because "taking those medications
    has a significant risk of swinging you into a manic episode."
    He stated that people with bipolar disorder who are treated with
    antidepressants generally are also treated with mood stabilizers
    to prevent possible manic episodes.
    In rebuttal, the Commonwealth called Dr. Alison Fife, a
    forensic psychiatrist.        Fife also had interviewed the defendant
    and reviewed the relevant treatment records and police reports.
    She disagreed with the conclusion that the defendant was
    intoxicated by therapeutic doses of Prozac and Trazodone.        She
    also did not agree with Meyers's diagnosis of bipolar disorder.
    Fife testified that a mental disease or defect did not "drive"
    the defendant to kill the victim.       When asked, in her opinion,
    what did "drive" the defendant to do so, she responded that
    feelings of anger, sadness, and rage "drove" the defendant's
    behavior.
    2.   Discussion.     a.    Limitations on direct examination of
    defendant's mental health expert.       The defendant contends that
    he was precluded from presenting a complete defense because the
    10
    judge did not permit the introduction of certain testimony by
    the defendant's medical expert concerning a conversation that
    the expert had had with the defendant during the forensic
    interview.   The defendant argues that the exclusion of these
    statements violated his rights under the due process clause and
    the Sixth Amendment to the United States Constitution.    Because
    the defendant objected, we review to determine whether the
    exclusion of the evidence was error, and if so, whether it was
    prejudicial.   See Commonwealth v. Aviles, 
    461 Mass. 60
    , 67
    (2011).
    In conducting his evaluation of the defendant's mental
    state, Meyers reviewed the defendant's mental health records,
    police reports, and other discovery material; interviewed
    collateral witnesses; and "met with [the defendant] on two
    occasions:   May 2[, 2013,] and July 19[, 2013,] for a total of
    about seven and a half hours."   On direct examination, defense
    counsel asked Meyers about certain statements the defendant had
    made to him during the course of these interviews.   Counsel
    inquired, "Were you able to learn anything from [the defendant]
    concerning his mental health history. . . that was of
    significance to you in forming your opinion?"
    The prosecutor objected to the question because the
    defendant's statements had not been admitted in evidence.      As an
    offer of proof, defense counsel represented that Meyers would
    11
    testify to statements made by the defendant "about experiencing
    manic-like symptoms in the past . . . hyperactivity, increased
    mood, . . . needing to sleep for a couple of days at a time,
    that sort of thing."     Counsel added that he wanted to raise with
    Meyers "some things about [the defendant's] mental health and
    employment histories and . . . the events on May 3."6    After a
    lengthy sidebar conference, the judge ruled that the statements
    made during Meyers's interviews of the defendant were not
    admissible on direct examination.    During the remainder of his
    direct testimony, Meyers testified that the defendant suffered
    from bipolar disorder.    As a basis for this opinion, Meyers
    stated that he had relied upon the defendant's "history from
    different sources and as well my history from him."
    The thrust of the prosecutor's cross-examination was that
    the defendant's prior treatment records did not support a
    6
    After the conclusion of Meyers's testimony, defense
    counsel provided the judge with another offer of proof. Counsel
    represented that Meyers would have testified to the following:
    (1) the defendant's relationship with the victim; (2) the events
    of May 3, 2013, including "that morning when he woke up," "his
    plans with [his] daughter and communications with his daughter
    in the afternoon," and "his activities during the afternoon
    leading up to the time he arrived at [the victim's house]," "the
    events between 5:30 P.M. and approximately 6:45 P.M. -- that is,
    in the kitchen and living room area and the event itself";
    (3) the defendant's employment history, including losing two
    potential jobs in late April, 2012, after having lost his truck
    driving position in March, 2012, that caused "a significant
    amount of stress, anxiety, and depression; and (4) the
    defendant's mental health history including instances of manic
    behavior.
    12
    diagnosis of bipolar disorder.    Pursuing this line of inquiry,
    the prosecutor asked Meyers about records admitted in evidence
    from the Lahey Clinic and Holy Family Hospital, treatment
    records from the Cambridge house of correction and Bridgewater
    State Hospital, and a May 7, 2012, competency evaluation
    conducted by Dr. Jodie Shapiro.    The prosecutor did not
    challenge Meyer's reliance on the defendant's out-of-court
    statements as the basis for his expert opinion that the
    defendant suffered from bipolar disorder.    On redirect
    examination, defense counsel did not ask Meyers any questions
    about statements made by the defendant concerning this subject.
    The question the defendant raises concerns the
    admissibility of testimony by an expert witness, on direct
    examination, concerning facts upon which the expert's opinion is
    based, and that are independently admissible, but that have not
    been introduced in evidence.   See generally Department of Youth
    Servs. v. A Juvenile, 
    398 Mass. 516
    , 531 (1986); Mass. G. Evid.
    § 703 (2017).   Prior to our decision in Department of Youth
    Servs., we followed the traditional rule that an expert's
    opinion had to be "based on either the expert's direct personal
    knowledge, on evidence already in the record or which the
    parties represent will be presented during the course of the
    trial, or on a combination of these sources."    Commonwealth v.
    Barbosa, 
    457 Mass. 773
    , 784 (2010), cert. denied, 
    563 U.S. 990
                                                                          13
    (2011), quoting LaClair v. Silberline Mfg. Co., 
    379 Mass. 21
    , 32
    (1979).      In Department of Youth 
    Servs., supra
    at 531, we
    expanded the permissible bases of expert opinion testimony to
    include "facts or data not in evidence if the facts or data are
    independently admissible and are a permissible basis for an
    7
    expert to consider in formulating an opinion."         See
    Commonwealth v. Chappell, 
    473 Mass. 191
    , 203 (2015), quoting
    Department of Youth 
    Servs., supra
    ; 
    Barbosa, supra
    at 785.
    Although an expert may formulate an opinion based on facts
    or data not admitted in evidence, but that would be admissible
    with the proper witness or foundation, "the expert may not
    testify to the substance or contents of that information on
    direct examination."       Commonwealth v. Chappell, 
    473 Mass. 191
    ,
    203 (2015), quoting Department of Youth 
    Servs., 398 Mass. at 531
    .       The purpose of this limitation on expert witness testimony
    is to prevent the proponent of the opinion from "import[ing]
    inadmissible hearsay into the trial."       Commonwealth v. Goddard,
    
    476 Mass. 443
    , 448 (2017).       See Commonwealth v. Greineder, 464
    7
    In Department of Youth Servs. v. A Juvenile, 
    398 Mass. 516
    , 531 (1986), we decided to take a "modest step" toward
    allowing an expert witness to state his or her basis of opinion,
    and declined to adopt then proposed Mass. R. Evid. 703 (the
    equivalent of Fed. R. Evid. § 703). Under this broader
    evidentiary rule, the proponent of expert opinion testimony is
    permitted to disclose otherwise inadmissible facts or data to
    the jury "if their probative value in helping the jury evaluate
    the opinion substantially outweighs their prejudicial effect."
    Fed. R. Evid. § 703 (2012). See Vassallo v. Baxter Healthcare
    Corp., 
    428 Mass. 1
    , 16 (1998).
    
    14 Mass. 580
    , 583, cert. denied, 
    134 S. Ct. 166
    (2013)
    ("Disallowing direct testimony to the hearsay basis of an expert
    opinion helps prevent the offering party from slipping out-of-
    court statements not properly in evidence in through the 'back
    door'"); Commonwealth v. Nardi, 
    452 Mass. 379
    , 392 (2008)
    (expert witness may not "under the guise of stating the reasons
    for his opinion" testify to inadmissible hearsay).
    We have emphasized that "[t]he thrust of [our] rule is to
    leave inquiry regarding the basis of expert testimony to cross-
    examination" (citation omitted).   
    Barbosa, supra
    .    The opposing
    party then may, as a matter of trial strategy, elicit details of
    the facts or data underlying the expert's opinion.    Commonwealth
    v. Markvart, 
    437 Mass. 331
    , 338 (2002).   If the door is opened
    by the opposing party, on redirect examination, the proponent of
    the evidence then may introduce the details surrounding the
    source of the expert's opinion.8   Chappell, 
    473 Mass. 203-204
    .
    8
    For example, on cross-examination in this case, the
    prosecutor challenged Meyers's assumption that the defendant
    took his medications as prescribed following his release from
    the hospital. Meyers agreed that he did not examine the
    defendant's pill bottles or "have any conversation with anyone
    else [other than defense counsel] about the number of pills"
    missing from those bottles. Thereafter, on redirect
    examination, the judge permitted Meyers to testify to certain
    information he had obtained from the defendant during the
    forensic interview. The judge ruled that the testimony was
    admissible on redirect examination "as a basis of [Meyers's]
    opinion . . . for the fact that it was said and the doctor
    relied on it." Meyers then testified that he learned that the
    defendant felt nauseated and vomited soon after awaking midday
    15
    See Mass. G. Evid. § 705 (2017).     See generally Commonwealth v.
    Garcia, 470 Mass, 24, 36 (2014) (purpose of redirect examination
    is to "explain or rebut adverse testimony or inferences
    developed during cross-examination" [citation omitted]).
    The judge's decision to require compliance with this rule
    of evidence did not violate the defendant's constitutional right
    to present a full defense.     The rule limiting direct examination
    testimony of an expert witness "is a common-law evidentiary rule
    that operates in both civil and criminal cases and applies to
    both sides."9     
    Chappell, 473 Mass. at 204
    .   "A defendant's right
    to present a full defense . . . is not without limits . . . and
    as a general rule, does not entitle him to place before the jury
    evidence normally inadmissible" (quotations and citations
    omitted).   
    Id. Here, Meyers
    testified that he interviewed the
    defendant, and that he diagnosed the defendant with bipolar
    disorder based in part upon learning the defendant's history.
    on May 3, 2012, and that this was evidence that the defendant
    had been compliant with taking his medication as prescribed.
    9
    See Commonwealth v. Johnston, 
    467 Mass. 674
    , 696 (2014)
    (error for Commonwealth's expert psychiatrist to summarize on
    direct examination statements provided by witnesses that
    defendant did not exhibit signs of mental illness during weeks
    and hours before killing); Commonwealth v. Nardi, 
    452 Mass. 379
    ,
    392 (2008) (substitute medical examiner unable to testify to
    hearsay statements recorded in autopsy report); Commonwealth v.
    Jaime, 
    433 Mass. 575
    , 577-578 (2001) (Commonwealth's expert
    should have been precluded from testifying on direct examination
    that witnesses reported that defendant was his normal jovial
    self day before murder).
    16
    The underlying facts, which were not otherwise introduced in
    evidence, were not admissible on direct examination.     See
    
    Barbosa, 457 Mass. at 784
    ; Mass. G. Evid. § 703.
    The defendant argues that the rule established in
    Department of Youth Servs. has been called into question by our
    subsequent decisions in Commonwealth v. Brown, 
    449 Mass. 747
    ,
    768 (2007), and Commonwealth v. Rutkowski, 
    459 Mass. 794
    , 799-
    800 (2011).   These cases, however, do not support the
    proposition that facts not otherwise in evidence are admissible
    on direct examination of an expert witness.    In both cases, we
    held that where a defendant's statements properly have been
    admitted in evidence, an instruction that the statements may be
    considered only as the basis of the expert's opinion is
    warranted.    See 
    Rutkowski, supra
    ; 
    Brown, supra
    .
    Furthermore, we note that the judge's evidentiary ruling
    did not deprive the defendant of the ability to pursue an
    insanity defense.   The defendant was able to introduce testimony
    from his and the Commonwealth's medical experts, his medical
    records from four different facilities, and evidence from his
    competency examination, as well as statements by his father and
    his classmates as to his appearance and activities in the first
    twenty-four hours after he was released from the hospital.     See
    
    Chappell, 473 Mass. at 204
    -205 (noting that defendant was able
    to elicit excluded information by introducing medical records).
    17
    The defendant argues that the statements excluded from evidence
    would have described his conduct on May 3, 2012, and would have
    demonstrated that he had experienced psychiatric symptoms
    suggesting that he was suffering from a manic episode as a
    result of his bipolar disorder.    The transcript indicates that,
    on direct examination, referring to his review of "records" and
    "collateral material," Myers was able to provide a detailed
    description of the events of May 3, 2012.
    In describing the events on the day of the victim's death,
    Meyers testified that, on that day, the defendant made plans to
    take Alexa out for ice cream.     He arrived to pick up Alexa at
    around 5 P.M. and went into the house.     At first, the defendant,
    Alexa, and the victim "were conversing" and "things were fine."
    The victim ordered takeout food for Alexa, and the defendant and
    the victim got into an argument.    The victim attempted to stab
    the defendant; he grabbed the knife from her.    "At some point
    she picked up a knife again.    They went at it. This time . . .
    is in front of his daughter."
    In addition, Myers testified as to the defendant's mental
    health history.   This history included details involving the
    defendant's admission to Holy Family Hospital on April 29, 2012,
    and his subsequent treatment and prescriptions.     In Meyers's
    opinion, the defendant had exhibited symptoms of bipolar
    disorder prior to the May 3, 2012, incident.     Meyers testified
    18
    that the defendant had been struggling with depression, anxiety,
    and irritability for years, "which could be a sign of bipolar";
    that the clinicians at the jail documented "the [defendant's]
    history of prior manic episodes"; Alexa witnessed the
    defendant's wide fluctuation in moods on May 3, 2012, ranging
    from "nice and sweet one moment, then screaming, then psycho and
    then nice again."   Meyers also described the defendant's May 7,
    2012, competency evaluation, at which Shapiro had noted that
    "approximately a week before [the evaluation, the defendant] had
    symptoms of what appeared to be mania.    He had described
    increased hypersexual feelings . . . sleep problems, increased
    energy and that had just been a week before so it sounded like
    the beginnings of a manic episode."
    b.   Admission of Commonwealth's expert witness opinion
    testimony on defendant's motivation.     The defendant argues that
    Fife, the Commonwealth's expert witness, improperly testified
    about what "drove" the defendant to kill the victim.    He
    contends that this testimony was impermissible, first, because
    Fife did not express her opinion in accordance with the standard
    set forth in Commonwealth v. McHoul, 
    352 Mass. 544
    , 546 (1967);
    and second, because Fife's testimony infringed on the jury's
    right to determine the ultimate question of the defendant's
    criminal responsibility.   As there was no objection to Fife's
    testimony, our review is limited to consideration whether there
    19
    was error, and if so, whether it created a substantial
    likelihood of a miscarriage of justice.   Commonwealth v. Wright,
    
    411 Mass. 678
    , 681 (1992), S.C., 
    469 Mass. 447
    (2014).
    During Fife's testimony, the following exchange took place:
    Q.: "Based on your evaluation of the defendant and your
    review of the associated materials in this case, do
    you have an opinion to a reasonable degree of medical
    certainty as to whether mental illness drove this
    defendant to kill [the victim] on May 3, 2102?"
    A.:   "Yes, I have an opinion."
    Q.: "And what's that opinion?"
    A.:   "My opinion is that mental disease did not drive this
    behavior on that day."
    Q.: "And, again, based on your evaluation of the defendant
    and your review of the case materials, do you have an
    opinion to a reasonable degree of medical certainty as
    to whether a mental defect drove this defendant to
    kill [the victim] on May 3rd of 2012?"
    A.:   "Yes, I have an opinion."
    Q.: "And what's your opinion on that?"
    A.:   "My opinion is that there is no mental defect present
    at that time that drove his behavior."
    Q.:   "What in your opinion did drive him to kill her on
    that day?"
    A.:   "In my opinion, this individual, the defendant was
    angry, he was upset, he had feelings of depression,
    sadness mixed with danger [sic], mixed with rage and I
    think that those were the primary feelings that drove
    the behavior on that day."
    We conclude that there was no error in Fife's testimony
    about what drove the defendant's behavior.   A qualified expert
    20
    witness need not phrase his or her opinion in terms of the
    McHoul test.   See Commonwealth v. Amaral, 
    389 Mass. 184
    , 193
    (1983), citing Commonwealth v. Shelley, 
    381 Mass. 340
    , 348 n.4
    (1980), S.C., 
    411 Mass. 692
    (1992); Commonwealth v.
    Gerhartsreiter, 
    82 Mass. 500
    , 509 (2012).   To the contrary,
    "Testimony in purely medical or psychological terms may in many
    instances be preferable; the expert may be best equipped to use
    medical and psychological concepts, and the testimony may not
    fit neatly in legal categories."   Shelley, supra.10
    10
    Defense counsel also questioned Fife on what drove the
    defendant's behavior, albeit in a hypothetical form.
    "Assume that an individual is in the midst of a
    breakup with his girl friend who has never exhibited any
    signs of physical violence towards that girl friend suffers
    from an apparent depressed mood, exhibits suicidal thoughts
    and behaviors, is hospitalized for three days due to that
    depressed mood and suicidal behaviors and thoughts, is
    prescribed Prozac and Trazodone, takes those medications
    for three or four days, exhibits symptoms of nausea and
    vomiting, then goes to his girl friend's home with his
    daughter present with a Chinese food delivery person on the
    way and then stabs her.
    "My question is you as a psychiatrist would it be
    reasonable to suggest that you would have to explore the
    possibility that that conduct was driven by a mental
    disease or defect?
    ". . .
    "Would it be reasonable, Doctor, and would you have to
    explore the possibility that the Prozac and Trazodone drove
    that conduct . . . ?"
    21
    The defendant argues also that, in another portion of her
    testimony, Fife misstated the McHoul standard.    Fife stated that
    she relied on that standard, which she described as follows:
    "[The McHoul standard] states that at the time of the
    crime -- at the time of the crime -- at the time of the
    alleged crime, an individual has to first meet the criteria
    for mental illness, and then it splits from there so that
    if a person meets that criteria [do] they as a result of
    the mental illness either lack the substantial capacity to
    appreciate the wrongfulness, it's sometimes called the
    criminality, but the wrongfulness of their behavior at the
    time of the alleged crime as a result of the mental
    illness, or were they substantially less capable of
    conforming their behavior to the requirements of the law,
    again coming back to because of an active mental illness at
    the time of the crime."
    In an attempt to clarify her testimony, Fife strayed from the
    McHoul formulation and stated:
    "I think of that as the first part of it that whether
    or not there is a mental illness and then the prongs as if
    there's a mental illness because of that illness.
    Sometimes I think of it as but for the illness would the
    crime have happened. You know, so . . ."
    We have cautioned that if an expert witness were to
    reference a legal standard, "[C]ounsel properly would be
    required to ask the expert to cast his opinion in terms of the
    legal standard set out in McHoul."    
    Shelley, 381 Mass. at 348
    n.4.    Fife did not do that; indeed, her statement was both
    incorrect and likely to have confused the jury.    Fife's effort
    to clarify her understanding of the McHoul standard did not,
    however, create a substantial likelihood of a miscarriage of
    justice.    The judge interrupted her midsentence to inform the
    22
    jurors that she would be the one to instruct the jurors "on the
    law that they will apply with respect to the standard" before
    they began deliberating.    In her final charge, the judge
    correctly instructed the jury as follows:
    "Criminal responsibility is a legal term. A person is
    not criminally responsible for his conduct if he has a
    mental disease or defect, and as a result of that mental
    disease or defect lacks substantial capacity either to
    appreciate the criminality or wrongfulness of his conduct
    or to conform his conduct to the requirements of law."
    See Gerhartsreiter, 
    82 Mass. App. Ct. 509-510
    (no error where
    expert witness misstated McHoul standard but judge provided
    proper legal standard).
    Moreover, Fife's testimony concerning what drove the
    defendant's behavior did not usurp the jury's role as the sole
    and exclusive finders of the facts.    An expert witness may not
    offer an opinion as to a defendant's guilt or innocence.
    
    Goddard, 476 Mass. at 446
    .   Commonwealth v. Lodge, 
    431 Mass. 461
    , 467 (2000).   An expert witness is not precluded, however,
    from providing an opinion that reaches or approaches the
    ultimate issue in a case.    See Commonwealth v. Okoro, 
    471 Mass. 51
    , 66 (2015), quoting Commonwealth v. Federico, 
    425 Mass. 844
    ,
    847 (1997); Mass. G. Evid. § 704 (2017).
    In this case, Fife did not offer an opinion that the
    defendant was criminally responsible for the victim's death.
    She was permitted to testify that anger, sadness, and rage, not
    23
    mental illness, motivated his actions.     See Commonwealth v.
    Johnston, 
    467 Mass. 674
    , 699-700 (2014) (no error in expert
    testimony implying that defendant's resentment for victim, not
    mental illness, motivated killing); Commonwealth v. LaFave, 
    407 Mass. 927
    , 934 (1990) (expert allowed to testify on issue of
    motive).    See also Commonwealth v. 
    Goddard, 476 Mass. at 446
    -447
    (expert testimony that defendant's behavior was "planned" and
    "goal-directed" was admissible as relevant to issue of criminal
    responsibility).
    c.     Mutina instruction.11   In her final charge, the judge
    instructed the jury on the consequences of a verdict of not
    guilty by reason of lack of criminal responsibility, as set
    forth in Commonwealth v. Mutina, 
    366 Mass. 810
    , 823 & n.12
    (1975).    The judge instructed as to "what happens to a defendant
    if he is found not guilty by reason of lack of criminal
    responsibility."    At trial, the defendant did not object to this
    formulation of the instruction.     In this appeal, however, the
    defendant argues that the instruction created a substantial
    likelihood of a miscarriage of justice because the judge failed
    adequately to inform the jury of the real possibility that the
    defendant could be committed for life.
    11
    We have considered the additional arguments in the
    defendant's reply brief filed pursuant to Commonwealth v.
    Moffett, 
    383 Mass. 201
    , 207-208 (1981), and conclude that they
    are unavailing.
    24
    In 
    Chappell, 473 Mass. at 205-206
    , we modified the model
    Mutina instruction set forth in our Model Jury Instructions on
    Homicide, effective at the time of the defendant's trial.     The
    provisional instruction set forth in Chappell, supra at 209
    (Appendix), informs the jury that "[t]here is no limit to the
    number of such renewed orders of commitments as long as the
    defendant continues to be mentally ill and dangerous; if these
    conditions do continue, the defendant may remain committed for
    the duration of his [or her] life."    Nonetheless, we concluded
    also that the Mutina instruction as set forth in the 2013 Model
    Jury Instructions on Homicide accurately stated the law, and
    that the judge did not err in giving the then-existing Mutina
    instruction.   
    Id. at 205-206.
    In cases decided after Chappell, we have said that it is
    not error for a judge "like the judge in Chappell . . . [to
    give] the Mutina instruction that, at the time of trial, was the
    governing model jury instruction."    Commonwealth v. Dunn, 
    478 Mass. 125
    , 139 (2017).   See Commonwealth v. Griffin, 
    475 Mass. 848
    , 862 (2016).   The Mutina instruction the judge gave in this
    case, three years before we decided Chappell, was proper and did
    not create a substantial likelihood of a miscarriage of justice.
    d.   Review pursuant to G. L. c. 278, § 33E.   We have
    carefully reviewed the entire record pursuant to our duty under
    G. L. c. 278, § 33E, and we discern no reason to order a new
    25
    trial or to reduce the conviction of murder in the first degree
    to a lesser degree of guilt.
    Judgments affirmed.