United States v. Joel Steinger

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[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________
Nos. 14-14081; 14-14088
Non-Argument Calendar
________________________
D.C. Docket Nos. 1:12-cr-20123-RNS-1; 1:08-cr-21158-RNS-1
UNITED STATES OF AMERICA,
Plaintiff-Appellee,
versus
JOEL STEINGER,
a.k.a. Joel Steiner,
Defendant-Appellant.
________________________
Appeals from the United States District Court
for the Southern District of Florida
________________________
(December 11, 2015)
Before HULL, MARTIN and ANDERSON, Circuit Judges.
PER CURIAM:
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Joel Steinger is serving a total 240-month sentence after pleading guilty to 2
counts of conspiracy to commit mail and wire fraud, in violation of 18 U.S.C.
§ 1349. Steinger’s convictions arose from two separate cases, but we have
consolidated his appeals because they raise the same issues concerning Steinger’s
competence to plead guilty. After careful review, we affirm.
I. BACKGROUND
A. 2008 and 2012 Indictments
In 2008, Steinger was charged with conspiracy to commit mail and wire
fraud, in violation of § 1349; substantive mail and wire fraud, in violation of 18
U.S.C. §§ 2, 1341, and 1343; and conspiracy to commit money laundering, in
violation of 18 U.S.C. § 1956(h), all in connection with a scheme to fraudulently
sell interests in third parties’ life insurance policies (hereinafter, the “2008 case”).
In 2012, while Steinger was out on bond awaiting trial, he was indicted in a
separate action for conspiracy to commit mail and wire fraud and substantive mail
and wire fraud, based on his participation in a scheme to fraudulently obtain health
insurance (hereinafter, the “2012 case”).
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In December 2012, after holding multiple status conferences, the district
court presiding over Steinger’s 2008 case sua sponte scheduled a competency
hearing and ordered mental and physical competency evaluations of Steinger. 1
Barb. 2013 Competency Evaluation Report
On May 3, 2013, the district court received a forensic evaluation of Steinger
under seal. Psychiatrist Ralph Newman, M.D., and psychologist Adeirdre Stribling
Riley, Ph.D., authored the report describing Steinger’s mental and physical
condition. They stated that Steinger was 63 years old and suffered from spinal
stenosis, myeloradiculopathy, chronic obstructive pulmonary disease, which
required oxygen, benign prostatic hypertrophy, gastro-esophageal reflux disease,
polyps on the gallbladder, sleep apnea, insomnia, obesity, and incontinence, and
had masses on his parotid glands and needed a catheter to urinate.
Between 1994 and 2009, Steinger had three surgeries for his spinal stenosis.
While awaiting trial, Steinger was housed at Larkin Community Hospital
(“Larkin”), where physicians recommended that he be evaluated for further
surgical intervention. Steinger, however, refused to have any operation at Larkin,
and requested instead that he be transferred to the University of Miami Hospital
(“UMH”) for the recommended evaluation.
1
Steinger raised competency concerns in his 2012 case. The parties ultimately agreed
that the results of the competency hearing in the 2008 case would be binding on both cases.
Consequently, all of the proceedings relevant to Steinger’s competency and the appeals before us
occurred in the 2008 case.
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Steinger relied on a battery of drugs to control his pain. He used a fentanyl
patch and took venlafaxine, ozcarbazepine, ibuprofen, acetaminophen, methadone,
and morphine. He also took Ativan for anxiety, in addition to other miscellaneous
medications for his gastrointestinal and prostate ailments. Steinger rated his pain
as ten out of ten.
As to Steinger’s mental health, Dr. Newman and Dr. Stribling Riley
concluded:
[A]lert and oriented to person, place, time, and situation. His memory
is intact for immediate, recent, and remote recall to include details of
the alleged offense . . . . Thought processes are well-organized
without a thought disorder. He denies delusions or hallucinations. He
is somatically preoccupied with his pain and discomfort, which
appears to be genuine, although pain is subjective.
They noted that Steinger was “more depressed than the average person” but “less
depressed than the average pain patient.” His anxiety was average when compared
to the general community but “considerably below average for pain patients.”
Overall, the doctor examiners determined that Steigner was competent to
stand trial. They opined that Steigner did not suffer from a severe mental disease
or defect, and that he understood the charges against him and the possible penalties
and benefits associated with pleading guilty. Steinger could assist counsel in his
defense, and his medication regimen did not impede his ability to do so or to
understand the proceedings. Finally, the doctors documented some malingering,
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noting that Steigner sought to “portray himself with a severe physical disability
which would limit his ability to participate in . . . legal activities.”
C. May 2013 Competency Hearing
After receiving the report, the district court held a competency hearing on
May 29, 2013. Dr. Newman testified that: (1) there was “no doubt in [his] mind”
that Steinger had the mental competency to undergo trial and assist in his defense;
(2) Steinger’s medications were “not particularly cognitively impairing” in their
current doses; and (3) pain is subjective and can be easily exaggerated, and it was
suspicious if a person claiming extreme pain refused a surgery that could provide
relief.
Dr. Stribling Riley testified that Steinger was competent to stand trial.
Steinger was on medication when she examined him and he was still able to
complete 1 hour and 15 minutes’ worth of psychological tests and give coherent
and rational responses to the questions. Dr. Stribling Riley observed that it was
“remarkable, given the length of testing, that there were no complaints of pain or
observable signs of pain.” She waited about 15 minutes after he took his
medication to begin the tests because she was concerned that he could be distracted
by his pain or temporarily sedated by the medication. She observed that Steinger
had the wherewithal to be aware of his pain and request medication when he
needed it.
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Steinger addressed the district court and stated that he was in such pain that
he screamed and cried all the time. He said it was “common sense” that morphine
affected his ability to concentrate and that, without the morphine, he was in such
pain that he could not focus. Steinger explained that “[t]his all could be solved” if
he received a spinal surgery at a hospital that was better equipped to handle the
risky procedure and subsequent physical therapy than Larkin. He suggested UMH,
and explained that he had previously declined the operation because he did not
have faith in his Larkin doctors’ abilities.
The district court found that Steinger was competent to stand trial. It
determined that he did not have a serious mental disease or defect and that his
medication was not affecting his ability to assist his attorneys. The district court
stated that it would continue to monitor Steinger’s health and medication regimen
during the months leading up to trial.
D. September 2013 Status Conference
On September 9, 2013, the district court conducted a status conference, in
which Steinger spoke at length about his health and requested a continuance. He
stated that his medical condition had changed rapidly over the intervening months
and he could not stand the pain any longer. He was past taking morphine and now
required heavier drugs, which still did not give him relief. Steinger described
himself as “a walking dope man” and said that he did not “even know what’s going
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on half the time.” Steinger’s counsel also stated that Steinger was preoccupied by
his health during attorney-client interviews. Counsel requested a continuance
because Steinger had a surgical consult scheduled at UMH and the surgery could
alleviate Steinger’s pain. The district court severed Steinger’s case from his co-
conspirators’ cases and ordered a continuance.
E. December 2013 Status Conference
The parties met for another status conference on December 19, 2013. UMH
personnel related to the district court that Steinger had a surgical consult on
September 19, 2013, and the neurosurgeon scheduled Steinger’s surgery for the
next day. Steinger, however, refused the surgery on September 20, and refused the
surgery on two more occasions. Eventually, UMH discharged Steinger because the
surgery was not going to occur. Steinger’s surgeon stated that the procedure would
likely have a worse outcome now that Steinger delayed it.
Steinger testified that he refused to have surgery on September 20 because
he had not met the surgeon and no one had explained the procedure to him or told
him about the rehabilitation process. He denied refusing the surgery on the second
date that it was scheduled. Steinger stated that, on that occasion, he simply wanted
to speak to the surgeon about arrangements for his rehabilitation before consenting
to the procedure. After the second attempted surgery, Steinger learned for the first
time that he needed work on multiple areas of his spine. He was surprised to hear
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that. He also learned that pre-surgical testing revealed that he had suffered a heart
attack at an unknown time. He returned to Larkin to make arrangements and think
things over in light of the new information, and his pain continued to worsen.
Steinger told the district court that he still wanted the surgery but only if
satisfactory arrangements for his rehabilitation could be made. Steinger’s treating
physician at Larkin testified that, despite the pain since his return from UMH,
Steinger had a good memory and was “with it 100 percent.” The district court
scheduled the trial to begin in April 2014 regardless of whether Steinger had the
operation.
F. March 2014 Plea
But in March 2014, Steinger accepted a plea agreement for both cases. At
the consolidated change-of-plea hearing, Steinger testified that he was taking
Dilaudid for his back pain, which was stronger than morphine. He also took
OxyContin and Ativan prior to the hearing. The district court asked him whether
he could think clearly and understand what was happening, and Steinger replied
that he could.
Steinger then signed the plea agreement and stated that he understood the
factual proffer, terms, conditions, maximum statutory sentence, the method in
which his sentence would be calculated under the Sentencing Guidelines, and the
rights that he was giving up by pleading guilty. No one had coerced him into
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entering the plea or made any promises. Steinger explained that he had talked with
his attorney about his case and his decision to plead guilty. Finally, the district
court discussed Steinger’s sentence appeal waiver and Steinger did not express any
misunderstandings or concerns.
The district court accepted Steinger’s guilty plea and determined that he was
“fully competent and capable of entering an informed plea.” The court stated that,
due to Steinger’s health issues, it had paid particular attention to his answers and
“condition” in reaching this conclusion.
G. August 2014 Sentencing
At a consolidated sentencing hearing that August, the district court
sentenced Steinger to concurrent 239-month sentences in both the 2008 and 2012
cases, and imposed a consecutive 1-month sentence under 18 U.S.C. § 3147
because Steinger committed the 2012 offense while he was on bond from the 2008
offense. Steinger now appeals his convictions.
II. GUILTY PLEA AND APPEAL WAIVER
A. Legal Principles
Because Steinger did not object to the district court’s determination that he
was competent to enter a guilty plea, our review is for plain error only. 2 United
States v. Rodriguez, 751 F.3d 1244, 1251 (11th Cir.), cert. denied, 135 S. Ct. 310
2
A defendant’s sentence appeal waiver cannot bar his claim that he was incompetent to
plead guilty. United States v. Wingo, 789 F.3d 1226, 1234 n.8 (11th Cir. 2015).
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(2014). “To establish plain error, a defendant must show that there is (1) error,
(2) that is plain, and (3) affects substantial rights.” Id. (quotations omitted). In
addition, in the context of guilty pleas, the defendant must show that, but for the
error, there was a reasonable probability that he would not have entered the plea.
Id. at 1252.
Defendants have a fundamental right under the Due Process Clause not to be
convicted while incompetent. United States v. Wingo, 789 F.3d 1226, 1235 (11th
Cir. 2015). Thus, a defendant’s guilty plea, and any corresponding waiver of his
appellate rights, is not valid if the defendant was incompetent at the time of the
plea. See id. A defendant is competent to enter a guilty plea only when he “has
sufficient present ability to consult with his lawyer with a reasonable degree of
rational understanding and has a rational as well as factual understanding of the
proceedings against him.” Rodriguez, 751 F.3d at 1252 (quotation marks omitted).
Federal Rule of Criminal Procedure 11 safeguards a defendant’s right not to
plead guilty while incompetent by requiring the district court to “conduct an
inquiry into whether the defendant makes a knowing and voluntary guilty plea.”
United States v. Hernandez-Fraire, 208 F.3d 945, 949 (11th Cir. 2000). The court
must address three core concerns: (1) whether the plea is free from coercion;
(2) whether the defendant understands the nature of the charges; and (3) whether
the defendant knows and understands the consequences of his plea. Id.
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A similar inquiry is required in order for a sentence appeal waiver to be
enforceable. The record must make clear that the defendant “understood the full
significance of the waiver,” or that “the district court specifically questioned the
defendant about the waiver” during the plea colloquy. United States v. Johnson,
541 F.3d 1064, 1066 (11th Cir. 2008).
B. Discussion
The record evidence establishes that the district court did not err, plainly or
otherwise, by accepting Steinger’s guilty plea. In May 2013, about ten months
before Steigner pled guilty, two mental health professionals evaluated him and
agreed that he could understand the charges against him and participate in his own
defense. They concluded that Steinger’s medications did not impede his cognitive
abilities and he was competent to stand trial.
Specifically, the medical experts found that Steinger was alert and oriented
and was able to give coherent responses to questions. Accordingly, at this
juncture, there was no evidence that Steinger was incompetent. See Rodriguez,
751 F.3d at 1252.
While Steinger contends that his health deteriorated between May 2013 and
March 2014, causing him to become incompetent, the record does not support his
contention. Steinger spoke at two status conferences before pleading guilty in
March 2014, and he provided lucid and pointed commentary about his health on
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each occasion. He also presented seemingly rational reasons for delaying his
spinal surgery at UMH; although, based on Dr. Newman’s and Dr. Stribling
Riley’s suggestion that Steinger was malingering, it was reasonable to believe that
he was delaying the surgery to manipulate his legal proceedings. Furthermore,
while it appears that Steinger began taking stronger pain medications at some time
before the December 2013 status conference, there was no indication that Steinger
was unable to focus during the proceedings, and his treating physician testified that
he was “with it 100 percent.”
Similarly, at the change-of-plea hearing in March 2014, Steinger acted
appropriately and stated that he was thinking clearly, could understand what was
happening, and understood his plea agreement and the factual proffer. There is no
doubt that Steinger suffered from serious physical health conditions and was taking
a number of medications to control his pain, but Steinger’s own admissions and
behavior throughout his two cases showed that his cognitive abilities remained
intact. At the worst, Steinger was distracted and anxious because of his health
conditions and 26-month hospitalization, but there was no indication that he failed
to appreciate the proceedings against him or assist his attorneys in preparing a
defense. See id. Rather, the record of the proceedings showed that Steinger
consistently was alert, articulate, and attentive to the factual basis of the
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proceedings and had the ability to consult with his counsel. 3 See id. Therefore, the
district court did not err by determining that Steinger was competent to enter a
guilty plea.
Finally, to the extent that Steinger seeks to invalidate his guilty plea or
sentence appeal waiver for reasons other than his competency, his arguments fail.
At the change-of-plea hearing, the district court confirmed that Steinger understood
the nature of the charges against him and the consequences of pleading guilty. See
Fed. R. Crim. P. 11; Hernandez-Fraire, 208 F.3d at 949. Steinger further agreed
that no one coerced him into entering his plea. See Fed. R. Crim. P. 11;
Hernandez-Fraire, 208 F.3d at 949. Likewise, the district court questioned
Steinger about the provisions of the sentence appeal waiver and Steinger did not
express any misunderstandings. See Johnson, 541 F.3d at 1066. Steinger’s plea
agreement and sentence appeal waiver are both valid and enforceable.
III. SECOND COMPETENCY HEARING
A. Legal Principles
Whether a defendant is competent is an ongoing inquiry, and the defendant
must be competent at all stages of trial. Drope v. Missouri, 420 U.S. 162, 181, 95
3
We also note that Steinger’s attorney, who had been attentive to Steinger’s physical and
mental health needs throughout the two cases, did not raise concerns about Steinger’s
competency at the change-of-plea hearing. While this is not dispositive, it is further evidence
that Steinger’s competency was not in doubt. See Watts v. Singletary, 87 F.3d 1282, 1288 (11th
Cir. 1996).
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S. Ct. 896, 908 (1975). Pursuant to 18 U.S.C. § 4241(a), when there is “reasonable
cause to believe that the defendant may presently be [incompetent],” the district
court must order a competency hearing sua sponte. 18 U.S.C. § 4241(a). The
“reasonable cause” standard is satisfied when there is a “bona fide doubt regarding
the defendant’s competence.” See Wingo, 789 F.3d at 1236 (quotation marks
omitted).
This Court has identified three factors to consider when determining whether
there was a bona fide doubt about the defendant’s competence: “(1) evidence of the
defendant’s irrational behavior; (2) the defendant’s demeanor at trial; and (3) prior
medical opinion regarding the defendant’s competence to stand trial.” Id.
(quotation marks omitted). The district court “must consider the aggregate of
evidence pertaining to all three prongs and not evaluate each prong in a vacuum.”
Id.
While we normally review issues not raised below for plain error, the abuse-
of-discretion standard always applies when reviewing a district court’s failure to
sua sponte order a competency hearing. See id. at 1234, 1236 (reviewing a
§ 4241(a) claim for abuse of discretion despite the fact that no objection was made
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in the district court); United States v. Williams, 468 F.2d 819, 820 (5th Cir. 1972)
(applying the same standard). 4
B. Discussion
The district court did not abuse its discretion by determining that Steinger
was competent to plead guilty without ordering a second competency evaluation.
Each medical professional who evaluated Steinger concluded that he was
competent to stand trial. See Wingo, 789 F.3d at 1236. Furthermore, while
Steinger was often agitated and angry during hearings and status conferences, he
was attentive to the proceedings, provided meaningful responses to questions, and,
during the change-of-plea hearing, explicitly indicated that he was thinking clearly
and could understand the significance of his guilty plea. See id. While Steinger
now contends that his decision to cancel his spinal surgery was irrational, the
record shows that Steinger had concerns about rushing the procedure and receiving
inadequate physical therapy. These concerns, and any desire to avoid trial,
however, were understandable under the circumstances and did not evidence
irrationality. See id.
As Steinger was alert, articulate, and rational during his two cases, and did
not have any prior medical diagnoses suggesting he was incompetent, there was no
4
This Court has adopted as binding precedent all decisions of the former Fifth Circuit
handed down before October 1, 1981. Bonner v. City of Prichard, 661 F.2d 1206, 1209 (11th
Cir. 1981) (en banc).
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bona fide doubt about his ability to understand the proceedings and participate in
his defense. See id. Accordingly, the district court did not abuse its discretion by
failing to order a second competency hearing sua sponte. See 18 U.S.C. § 4241(a);
Wingo, 789 F.3d at 1236.
In light of all the foregoing, we affirm Steinger’s two convictions.
AFFIRMED.
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