State v. Eager.

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Electronically Filed
Supreme Court
SCWC-14-0001079
30-JUN-2017
08:04 AM
IN THE SUPREME COURT OF THE STATE OF HAWAI#I
---o0o---
STATE OF HAWAI#I, Respondent/Plaintiff-Appellee,
vs.
SAMUEL EAGER, Petitioner/Defendant-Appellant.
SCWC-14-0001079
CERTIORARI TO THE INTERMEDIATE COURT OF APPEALS
(CAAP-14-0001079; CR. NO. 13-1-0145)
JUNE 30, 2017
RECKTENWALD, C.J., NAKAYAMA, McKENNA, POLLACK, AND WILSON, JJ.
OPINION OF THE COURT BY RECKTENWALD, C.J.
This case requires us to consider whether a defendant’s
failure to take prescription medication can constitute self-
induced intoxication under Hawai#i Revised Statutes (HRS) § 702-
230, which precludes the defendant from relying on the defense of
lack of penal responsibility due to a physical or mental disease,
disorder, or defect. We hold that it does not, and that the
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defense is therefore available in the circumstances presented
here.
Defendant Samuel Eager was charged with assault in the
second degree after attacking a stranger at a bus stop, and a
bench trial was held in the Circuit Court of the First Circuit
(circuit court).1 Eager presented the defense of lack of penal
responsibility as a result of disease, disorder, or defect,
arguing that he was experiencing a psychotic episode at the time
of the attack. The State did not dispute Eager’s psychosis, but
argued that he should nonetheless be held criminally responsible
because his psychosis stemmed from his failure to take prescribed
medication and from marijuana use. The circuit court found Eager
guilty, concluding that “any disease, disorder, or defect the
Defendant may have been suffering from at the time of the assault
was self-induced and the product of the Defendant’s refusal to
take his prescribed medication and his use of marijuana.” The
court sentenced Eager to five years’ incarceration.
On appeal to the Intermediate Court of Appeals (ICA),
Eager argued that (1) he was deprived of a fair trial because one
expert witness, Dr. Wagner, improperly bolstered the opinion of
another expert witness, Dr. Jacobs, and (2) the circuit court
abused its discretion in sentencing Eager to five years’
imprisonment because there were strong mitigating factors, making
1
The Honorable Randal K.O. Lee presided.
2
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probation a more appropriate sentence. The ICA rejected Eager’s
arguments and affirmed the circuit court’s judgment of
conviction. Eager now raises the same arguments on certiorari
review here.
We agree with the ICA’s reasoning regarding Eager’s
first point of error. We need not consider Eager’s arguments
regarding his sentence, as we recognize plain error in the
circuit court’s holding that Eager’s psychotic behavior was the
result of self-induced intoxication. HRS § 702-230(5) (1993)
defines “self-induced intoxication” as “intoxication caused by
substances which the defendant knowingly introduces into the
defendant’s body, the tendency of which to cause intoxication the
defendant knows or ought to know.” Accordingly, the circuit
court’s holding that Eager’s failure to take his medication
caused his psychotic behavior is inconsistent with the plain
language of the statute, which requires the introduction of
substances into the body. Thus, the circuit court’s conviction
of Eager was in error.
We therefore vacate the ICA’s judgment on appeal and
the circuit court’s judgment of conviction, and remand for
further proceedings consistent with this opinion.
I. Background
A. Circuit Court Proceedings
On February 1, 2013, the State charged Eager with one
count of assault in the second degree in violation of HRS
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§ 707-711(1)(b)2 for recklessly causing substantial bodily injury
to then-79-year-old Hua Zhao Liang (Liang), and subject to
sentencing under HRS § 706-660.23.
Eager filed a “Motion for H.R.S. § 704-404[4]
Examination” to determine his fitness to proceed to trial and
2
HRS § 707-711(1)(b) (Supp. 2011) provides: “A person commits the
offense of assault in the second degree if . . . [t]he person recklessly
causes serious bodily injury to another[.]” Assault in the second degree is a
class C felony.
3
HRS § 706-660.2 (1993) provides, in relevant part:
Notwithstanding section 706-669, a person who, in the
course of committing or attempting to commit a felony,
causes the death or inflicts serious or substantial
bodily injury upon a person who is:
(1) Sixty years of age or older;
. . .
and such disability is known or reasonably should be
known to the defendant, shall, if not subjected to an
extended term of imprisonment pursuant to section 706-
662, be sentenced to a mandatory minimum term of
imprisonment without possibility of parole as follows:
. . .
(4) For a class C felony--one year, eight
months.
4
HRS § 704-404 (Supp. 2008) provides in relevant part:
(1) Whenever the defendant has filed a notice of
intention to rely on the defense of physical or mental
disease, disorder, or defect excluding responsibility,
or there is reason to doubt the defendant’s fitness to
proceed, or reason to believe that the physical or
mental disease, disorder, or defect of the defendant
will or has become an issue in the case, the court may
immediately suspend all further proceedings in the
prosecution.
(2) Upon suspension of further proceedings in
the prosecution, the court shall appoint three
qualified examiners in felony cases . . . to examine
and report upon the physical and mental condition of
the defendant. In felony cases the court shall
appoint at least one psychiatrist and at least one
licensed psychologist. The third member may be a
psychiatrist, licensed psychologist, or qualified
physician[.]
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whether he would be held penally responsible for his conduct.
The circuit court appointed a three-member panel of examiners:
Dr. Leonard Jacobs, Dr. Duke Wagner, and Dr. Olaf Gitter.
Each doctor submitted a report to the court. The
doctors all determined that Eager was fit to proceed, but
differed with regard to penal responsibility. Dr. Jacobs and Dr.
Wagner concluded that Eager’s cognitive and volitional capacities
were not substantially impaired at the time of the alleged
assault. Dr. Gitter concluded that Eager’s capacities were
substantially impaired due to an “acute manic episode.”
The court issued a “Judicial Determination of Fitness
to Proceed and Order,” finding that Eager was fit to stand trial.
Eager waived his right to a jury, and his case
proceeded to a bench trial. Liang testified that on January 29,
2013, he got off the bus and was walking to the food bank when
“on the left side of me suddenly someone hit me on my head and
then I fainted.” He testified that he lost consciousness and did
not see the person who hit him. An ambulance took Liang to
Queen’s Medical Center (Queen’s), where he received eighteen
stitches. A passerby testified that on the morning of
January 29, 2013, she saw Eager stomping on the head of an
elderly man laying motionless on the ground, leading her to call
911 in response. A “Stipulation as to Testimony” was filed in
open court, which indicated that Liang’s injuries included a
major laceration of the skin on his forehead, a facial bone
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fracture, and a serious concussion.
The State’s witnesses also included two Honolulu Police
Department officers who interacted with Eager following his
arrest several hours after the attack, and the detective who
investigated the incident. The arresting officer testified that
Eager was “compliant” and attentive at the time of arrest.
Dr. Gitter, an expert in clinical psychology, testified
for the defense that he reviewed Eager’s medical records from
Queen’s, where he was treated on January 8-10 and 26-27, 2013,
and O#ahu Community Correctional Center (OCCC), where he was
examined following the alleged assault.
Dr. Gitter testified that the Queen’s and OCCC records
showed that Eager exhibited signs of mental illness, including an
acute manic episode, auditory and visual hallucinations, and
bipolar disorder. Dr. Gitter also stated that on Eager’s January
26-27 visit to Queen’s, “drug testing showed that he tested
positive for marijuana only.”
When questioned about Eager’s marijuana use, Dr. Gitter
testified that “cannibus [sic] psychotic disorder” exists, but
that he “seriously doubt[ed]” that marijuana triggered Eager’s
acute manic episode.
The defense then asked Dr. Gitter about Eager’s mental
state at the time of the incident, and Dr. Gitter answered that
“he was suffering from a bipolar disorder mix type of depressive
and manic features and that it was so severe that he was also
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psychotic at the time.” When asked if he thought Eager was
penally responsible for the assault, Dr. Gitter opined that
Eager’s cognitive and volitional capacities were “substantially
impaired by an exacerbation of his mental disorder.”
On cross-examination, Dr. Gitter testified that
although he could not say what exactly triggered Eager’s manic
episode at the time of the incident,
my opinion is that he still was suffering just two
days after having been discharged from Queen’s Medical
Center. He had not been given any medication that
typically would have been given to deal with the
psychosis. He was only given, I believe Ambien, which
is a sleep medication. And, the way he described the
assault to me was that he was clearly psychotic asking
the gentleman whether he believed in Jesus and then
assaulting him to drive out the demons. Plus, two
days later when he was at OCCC again he was noted to
be manic and psychotic.
The court asked Dr. Gitter if marijuana could
indirectly trigger a psychotic episode by altering Eager’s
perception of reality, to which Dr. Gitter replied, “it could.”
When the court asked Dr. Gitter if Eager was psychotic from the
time he was discharged from Queen’s until he was admitted to
OCCC, Dr. Gitter said yes.
The State presented two rebuttal witnesses, Dr. Jacobs
and Dr. Wagner, who also examined Eager at OCCC prior to trial.
Dr. Jacobs, an expert in psychiatry, opined that
Eager’s judgment was impaired due to a combination of self-
induced prescription drug withdrawal and marijuana use. Dr.
Jacobs diagnosed Eager with “a personality disorder and somatic
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symptom disorder with predominant pain persistent and severe.”5
Dr. Jacobs testified that Eager was prescribed the sleep aid
Ambien, the anti-inflammatory medication Meloxicam, and the
painkiller Percocet. Dr. Jacobs also testified that Eager
reported that he had “not taken any of his drugs, except
marijuana, for three days” prior to the incident. Dr. Jacobs
opined that ceasing to take Ambien would cause “severe insomnia,
agitation, and feeling very uncomfortable,” and that stopping
Percocet, an opiate, “can cause severe problems with withdrawal.”
Dr. Jacobs testified that Eager “did not have any
psychosis at the time I interviewed him” and, according to the
Queen’s reports and Eager himself, he was not intoxicated but
rather “probably suffering from withdrawal symptoms” at the time
of the assault.6 Dr. Jacobs further testified that despite his
personality disorder, Eager “knows right from wrong.”
On cross-examination, Dr. Jacobs agreed that, at the
time of the incident, Eager’s psychotic episode rendered him
incapable of appreciating the wrongfulness of his actions.
The State then called Dr. Wagner, an expert in
5
Dr. Jacobs testified that, according to Eager’s medical records,
previous doctors “gave [Eager] a diagnosis of cannabis withdrawal, opiate
withdrawal, sedative hypnotic anxiolytic withdrawal, cannabis use disorder
severe, opiate use disorder severe, sedative hypnotic anxiolytic disorder
moderate, substance medication induced psychotic disorder with delusions
versus a substance withdrawal delirium.”
6
When asked if there was any indication that Eager was addicted to
his prescription medications, Dr. Jacobs opined that he was “addicted to all
of them.”
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psychology, who testified that his “diagnostic impressions at the
time of the alleged offense” were “post-traumatic stress disorder
and cannabis abuse versus dependence.” The State asked Dr.
Wagner about the possible effects of marijuana use:
[Deputy Prosecuting Attorney]: [A]s a psychologist
were you able to say whether or not the intake of a
type of cannabis, for instance, marijuana, could that
lead to psychosis?
[Dr. Wagner]: Well, I think the literature indicates
that there is that possibility, yes. That has
happened, I believe, in instances with many different
types of illicit drugs, we found that to be true. And
I think marijuana, although not maybe as frequently
as, let’s say, other drugs, like crystal
methamphetamine, but still, I think there’s been an
indication that that has happened.
Dr. Wagner described Eager’s account of the incident as
follows:
[Eager] was walking along the sidewalk, and he
evidently asked the male individual, from what he
reported to me, whether or not he believed in Jesus,
and the individual replied, No, and laughed and said
something else. Then he got angry, and he grabbed the
individual, threw him down, started kicking him.
Dr. Wagner opined, “to me [there] is not enough
evidence to indicate that he is suffering from severe psychotic
symptoms and a psychotic disorder such that he doesn’t know that
it’s inappropriate to hit someone or pull someone to the ground
and -- and can’t control his behavior.”
The State asked Dr. Wagner several questions about Dr.
Jacobs’ report, two of which the circuit court disallowed because
the State appeared to be “asking Dr. Wagner to testify as to the
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credibility of another witness.”7 The court permitted questions
regarding whether Dr. Jacobs’ report changed Dr. Wagner’s
opinion, and Dr. Wagner answered that Dr. Jacobs’ report
“provides additional information about the use of prescribed
medication,” but “doesn’t change the final opinion as far as
penal responsibility.”
The court asked Dr. Wagner whether “the cannabis abuse
or dependence [would] heighten [Eager’s] sensitivity to post-
traumatic stress disorder.” Dr. Wagner said that he thought the
cannabis was an “additive factor,” but he did not know the extent
that “it pushed him over the edge here in this situation.”
Eager elected not to testify.
In its closing argument, the State explained that it
did not dispute that Eager was psychotic at the time of the
incident, but rather argued that the psychosis was self-induced.
The State noted that Dr. Wagner testified that marijuana could
cause psychosis, and Dr. Jacobs “also built on this viewpoint.”
The State also noted that Dr. Jacobs had testified that
“withdrawals of opiates can also cause psychosis.” Thus, because
Eager’s behavior was due to “the withdrawal of his pills and the
usage of the marijuana,” Eager was criminally responsible.
7
Specifically, the circuit court disallowed the following
questions: “Now, based on your expertise and your knowledge in your sphere,
how did you take away, you know, with Dr. Jacobs’ opinion?”; and, “Now, would
you agree with [Dr. Jacobs’] expert opinion? Is it consistent, I guess,
consistent in your examining this defendant in this case?”
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The defense’s closing argument focused on Dr. Gitter’s
testimony, noting that Dr. Gitter had considered marijuana-
induced psychosis and “outright rejected it.” Defense counsel
further stated that “we dispute the fact that it could have been
marijuana that induced the psychosis, [but] even if that were
true that would fall into the realm of pathological intoxication
and would still result in a defense.”
The circuit court found Eager guilty of assault in the
second degree.8
The circuit court filed its “Findings of Fact,
Conclusions of Law, and Order,” in which it made the following
conclusions regarding Eager’s mental state:
18. Section 702-230 HRS further defines
“Self-induced intoxication” as “. . . intoxication
caused by substances which the defendant knowingly
introduces into the defendant’s body, the tendency of
which to cause intoxication the defendant knows or
ought to know . . .”
. . . .
20. As applied, the Hawaii Supreme Court has
held that, “. . . mental disability excusing criminal
responsibility must be the product of circumstances
beyond the control of the defendant . . .
[s]elf-induced intoxication is not such a disability.”
See State v. Freitas, 62 Haw. 17, 20, 608 P.2d 408,
410 (1980).
. . . .
28. The issue at hand is whether, at the time
8
The court found that there was insufficient evidence that Eager
knew that Liang was at least 60 years old, and thus was not eligible for the
mandatory minimum sentence under HRS § 706-660.2.
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of the offense, the Defendant was suffering from a
mental disease, disorder, or defect that was the
product of circumstances beyond the control of the
defendant.
. . . .
30. [T]he evidence in this case is clear that
prior to the incident in question, the Defendant was
not taking his prescribed medication and was smoking
marijuana.
. . . .
32. The Court further finds and concludes that
any disease, disorder or defect the Defendant may have
been suffering at the time of the assault was self
induced and the product of the Defendant’s refusal to
take his prescribed medication and his use of
marijuana.
33. Although Doctor Gitter testified and opined
that the marijuana may not have been the cause of the
Defendant’s psychotic behavior, the Court finds and
concludes that the evidence presented at trial
supports the opinions and conclusion of Doctor Jacobs
and Doctor Wagner who concluded that the Defendant’s
capacity to appreciate the wrongfulness of his conduct
or conform his conduct to the requirements of the law
was not substantially impaired as a result of a mental
or physical disease, disorder or defect.
. . . .
37. Given the Defendant’s history of behavior
leading up to and after the assault of Mr. Liang, the
Court can only find and conclude that the Defendant’s
psychotic and delusional behavior resulted from his
refusal to take his medication and knowingly smoke
marijuana.
38. Therefore, the Court finds and concludes
that on January 29, 2013, the Defendant’s psychotic
and delusional behavior was as a result of the
Defendant’s decision not to take his prescribed
medication, the subsequent withdrawal from prescribed
medication, and knowingly smoking marijuana.
39. The Court further finds and concludes that
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on January 29, 2013, the Defendant was not suffering
from a mental or physical disease, disorder, or defect
that substantially impaired his ability to appreciate
the wrongfulness of his conduct or conform his conduct
to the requirements of the law.
The circuit court thus sentenced Eager to five years’
incarceration and ordered him to pay restitution.
B. ICA Proceedings
On appeal to the ICA, Eager raised two points of error.
First, Eager asserted that he was deprived of a fair trial
because Dr. Wagner considered the opinion of Dr. Jacobs, which
improperly bolstered Dr. Jacobs’ credibility.
Second, Eager argued that the circuit court abused its
discretion when it sentenced him to five years’ imprisonment
because there were strong mitigating factors present to sentence
him to probation. Eager argued that probation would have been
appropriate because he showed remorse for his actions and would
benefit from mental health treatment.
The ICA found both of Eager’s arguments to be without
merit. First, the ICA determined that “Dr. Wagner testified
about whether Dr. Jacobs’ report changed Dr. Wagner’s opinion; he
did not provide any impermissible testimony on the subject of Dr.
Jacobs’ credibility.” Second, the ICA concluded that the circuit
court did not abuse its discretion in sentencing Eager to five
years’ imprisonment instead of probation, noting that the court
“emphasized the nature and circumstances of Eager’s offense, his
prior criminal history, and the danger he posed to the
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community.” The ICA thus affirmed the circuit court, and
judgment on appeal was filed on August 2, 2016.
II. Standards of Review
A. Admissibility of Opinion Evidence
“In Hawaii, admission of opinion evidence is a matter
within the discretion of the trial court, and only an abuse of
that discretion can result in reversal.” State v. Tucker, 10
Haw. App. 73, 89, 861 P.2d 37, 46 (1993) (citation omitted).
“However, when there can only be one correct answer to the
admissibility question, or when reviewing questions of relevance
under Hawai#i Rules of Evidence (HRE) Rules 401 and 402, [the
appellate] court applies the right/wrong standard of review.”
Kealoha v. County of Hawai#i, 74 Haw. 308, 319, 844 P.2d 670, 676
(1993).
B. Conclusions of Law
This court reviews the trial court’s conclusions of law
[COLs] de novo. Bhakta v. Cnty. of Maui, 109 Hawai#i 198, 208,
124 P.3d 943, 953 (2005) (citation omitted).
III. Discussion
In his application for writ of certiorari, Eager
repeats his arguments asserted at the ICA and presents the
following questions:
(1) [Whether] Petitioner was deprived of a fair trial
because Dr. Wagner “considered the expert opinion of
Dr. Jacobs in his opinions,” which, Petitioner argues,
improperly bolstered Dr. Jacob’s testimony, and
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(2) [Whether] [t]he trial court abused its discretion
in sentencing Petitioner to five years’ imprisonment
because there were strong mitigating factors to
withhold a prison sentence and instead sentence
Petitioner to probation.
We conclude that the ICA correctly determined that Dr.
Wagner’s testimony did not improperly bolster Dr. Jacobs’
opinion.
However, the circuit court plainly erred in improperly
characterizing Eager’s failure to take his medication as self-
induced intoxication, thus negating his incapacity defense.
Accordingly, we vacate the circuit court’s judgment and remand
this case for further proceedings consistent with this opinion.9
A. Dr. Wagner’s Testimony
Eager asserts that he was deprived of a fair trial
because Dr. Wagner bolstered Dr. Jacobs’ expert opinion by
commenting on it. Eager appears to suggest10 that Dr. Wagner’s
testimony was improper because HRS § 704-404(3) provides that,
during the examination process to determine a defendant’s fitness
to stand trial, the experts are required to “render diagnoses and
opinions upon the physical and mental condition of the defendant
independently from the other examiners.” (Emphasis added.)
9
Since we are remanding for further proceedings consistent with
this opinion, we do not address Eager’s argument that the circuit court abused
its discretion in sentencing him.
10
As noted by the ICA, “Eager’s argument makes no attempt to connect
the facts of the case to the law he presents, which means that we may
‘disregard [the] particular contention [because he] makes no discernible
argument in support of that position.’” (Quoting Kakinami v. Kakinami, 127
Hawai#i 126, 144 n.16, 276 P.3d 695, 713 n.16 (2012).)
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However, HRS § 704-404(4)(f) (Supp. 2008)11 provided that
“[a]fter all reports are submitted to the court, examiners may
confer without restriction.” Accordingly, Eager’s citation to
HRS § 704-404 is inapposite.
The Hawai#i Rules of Evidence (HRE) allow experts to
testify within their area of expertise in order to assist the
trier of fact. See HRE Rule 702 (1992). While experts may not
testify as to the credibility of other witnesses, expert
testimony nevertheless has the potential to indirectly bolster or
refute the credibility of another witness. State v. Batangan, 71
Haw. 522, 558, 799 P.2d 48, 52 (1990). However, this fact by
itself does not render such testimony inadmissible. Id. In
those cases, “[t]he pertinent consideration is whether the expert
testimony will assist the [trier of fact] without unduly
prejudicing the defendant.” Id.Dr. Wagner testified that he and Dr. Jacobs had
different focuses in writing their reports, which is consistent
with the fact that Dr. Wagner is a psychologist and Dr. Jacobs is
a psychiatrist. Additionally, Dr. Wagner never opined on Dr.
Jacobs’ truthfulness or his skills as a psychiatrist. Further,
the court did not allow Dr. Wagner to testify regarding whether
he agreed with Dr. Jacobs’ report or thought it was accurate.
Dr. Wagner’s testimony is therefore distinguishable
11
HRS § 704-404(4)(f) (Supp. 2008) has since been recodified as
§ 704-404(5)(d) (Supp. 2016).
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from prior cases in which we held that a witness improperly
bolstered another witness’s testimony. See State v. Calara, 132
Hawai#i 391, 400-01, 322 P.3d 931, 940-41 (2014) (finding
inadmissible a police detective’s testimony that probable cause
was established to arrest the defendant); State v. Ryan, 112
Hawai#i 136, 141, 144 P.3d 584, 589 (2006) (finding inadmissible
police officers’ testimony that they did have any reason not to
believe the complaining witness); State v. Morris, 72 Haw. 527,
528-29, 825 P.2d 1051, 1052 (1992) (finding inadmissible an
expert’s testimony that clearly implied that he believed the
complaining witness); Batangan, 71 Haw. at 562, 799 P.2d at 54(same). Accordingly, the circuit court did not err in allowing
Dr. Wagner’s testimony, as it did not improperly bolster the
testimony of Dr. Jacobs.
B. Self-Induced Intoxication
Although Eager’s argument that Dr. Wagner improperly
bolstered the testimony of Dr. Jacobs is without merit, we
exercise plain error review with regard to the circuit court’s
application of HRS § 702-230. “[W]here plain error has been
committed and substantial rights have been affected thereby, the
error may be noticed even though it was not brought to the
attention of the trial court.” State v. Miller, 122 Hawai#i 92,
117, 223 P.3d 157, 182 (2010) (brackets and emphasis omitted)
(quoting State v. Kaiama, 81 Hawai#i 15, 25, 911 P.2d 735, 745
(1996)); see also Hawai#i Rules of Penal Procedure Rule 52(b)
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(1977).
The circuit court appears to have impermissibly
considered Eager’s failure to take his medication as a basis for
his self-induced intoxication:
37. Given the Defendant’s history of behavior
leading up to and after the assault of Mr. Liang, the
Court can only find and conclude that the Defendant’s
psychotic and delusional behavior resulted from his
refusal to take his medication and knowingly smoke
marijuana.
38. Therefore, the Court finds and concludes
that on January 29, 2013, the Defendant’s psychotic
and delusional behavior was as a result of the
Defendant’s decision not to take his prescribed
medication, the subsequent withdrawal from prescribed
medication, and knowingly smoking marijuana.
(Emphasis added.)
HRS § 704-400 (1993) provides:
A person is not responsible, under this Code, for
conduct if at the time of the conduct as a result of
physical or mental disease, disorder, or defect the
person lacks substantial capacity either to appreciate
the wrongfulness of the person’s conduct or to conform
the person’s conduct to the requirements of law.
HRS § 702-230 (1993) provides that self-induced
intoxication is not a defense under HRS § 704-400:
(1) Self-induced intoxication is prohibited as a
defense to any offense, except as specifically
provided in this section.
(2) Evidence of the nonself-induced or pathological
intoxication of the defendant shall be admissible to
prove or negative the conduct alleged or the state of
mind sufficient to establish an element of the
offense. Evidence of self-induced intoxication of the
defendant is admissible to prove or negative conduct
or to prove state of mind sufficient to establish an
element of an offense. Evidence of self-induced
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intoxication of the defendant is not admissible to
negative the state of mind sufficient to establish an
element of the offense.
(3) Intoxication does not, in itself, constitute a
physical or mental disease, disorder, or defect within
the meaning of section 704-400.
(4) Intoxication which (a) is not self-induced or (b)
is pathological is a defense if by reason of such
intoxication the defendant at the time of the
defendant’s conduct lacks substantial capacity either
to appreciate its wrongfulness or to conform the
defendant’s conduct to the requirements of law.
(5) In this section:
(a) “Intoxication” means a disturbance of mental or
physical capacities resulting from the introduction of
substances into the body;
(b) “Self-induced intoxication” means intoxication
caused by substances which the defendant knowingly
introduces into the defendant’s body, the tendency of
which to cause intoxication the defendant knows or
ought to know, unless the defendant introduces them
pursuant to medical advice or under such circumstances
as would afford a defense to a charge of a penal
offense;
(c) “Pathological intoxication” means intoxication
grossly excessive in degree, given the amount of the
intoxicant, to which the defendant does not know the
defendant is susceptible and which results from a
physical abnormality of the defendant.
(Emphases added.)
This court has stated that the purpose of HRS § 702-230
“is to prevent defendants who willingly become intoxicated and
then commit crimes from using self-induced intoxication as a
defense.” State v. Souza, 72 Haw. 246, 248, 813 P.2d 1384, 1386
(1991). Accordingly, self-induced intoxication that is not
pathological should not be considered a substantial factor in
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determining legal competency because it is not a mental disease,
disorder, or defect. See HRS § 702-230 (3).
In convicting Eager, the circuit court determined that
“any disease, disorder or defect the Defendant may have been
suffering at the time of the assault was self induced and the
product of the Defendant’s refusal to take his prescribed
medication and his use of marijuana.” In other words, the court
appears to have determined that Eager did not have a defense
under HRS § 704-400 because his behavior was self-induced under
HRS § 702-230.
The circuit court’s analysis does not comport with the
plain language of HRS § 702-230. Self-induced intoxication
requires a defendant to have “knowingly introduce[d]” a substance
into his or her body. See HRS § 702-230(5)(b). However, the
circuit court found Eager criminally culpable for failing to take
his prescribed medication. This conclusion was in error, as
failing to take medication cannot be characterized as
“introducing” a substance into his body.
The State concedes that Eager’s “failure to take his
prescribed medication does not equate to ‘the introduction of
substances into the body’” per HRS § 702-230(5). Nonetheless, it
argues that this failure “was a volitional act on his part and
should not absolve him of penal responsibility.” In other words,
the State argues that even though Eager was psychotic at the time
of the incident, he should be held responsible because his
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psychosis stemmed from the “volitional act” of not taking
medication. This argument is without merit. The State’s
contention that such a “volitional act” can give rise to penal
responsibility has no basis in HRS § 702-230. See HRS § 702-
230(5)(b) (“‘Self-induced intoxication’ means intoxication caused
by substances which the defendant knowingly introduces into the
defendant’s body[.]”) (emphasis added). Moreover, the State
provides no other authority in support of its argument that a
defendant can be held criminally responsible for acts committed
while psychotic if the psychosis stems from a “volitional act”
resulting in the non-introduction of substances into the human
body, and we are aware of none.
The reasoning of Commonwealth v. Shin, 16 N.E.3d 1122(Mass. App. Ct. 2014), provides additional support for the
outcome we reach here. In Shin, the defendant, who had been
diagnosed with schizophrenia, was charged with indecent assault
and battery. See id. at 1123-24. At a bench trial, his primary
defense was “lack of criminal responsibility” based on his mental
illness and his inability to conform his conduct to the law. See
id. at 1124-25. The trial court found the defendant guilty,
determining that he “knew that if he didn’t take his medication
he was likely to commit further crimes and went ahead anyway and
stopped taking his medication.” Id. at 1126 (internal quotation
marks omitted).
The Appeals Court of Massachusetts held that the trial
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court erred by “inquiring [into] whether the defendant’s lack of
criminal responsibility was caused by his failure to take
prescribed medications.” Id. at 1128. The court distinguished
prior cases which considered whether a defendant was criminally
responsible for conduct resulting from the voluntary consumption
of drugs or alcohol:
Obviously, here, the question is not whether the
defendant knowingly and voluntarily consumed alcohol
or drugs that exacerbated his inability to understand
the wrongfulness of his behavior or undermined his
capacity to conform his behavior to the requirements
of the law, but whether his failure to take prescribed
medication had those effects. It is not at all clear
that the situations are analogous; mentally ill people
fail to take prescribed medication for a myriad of
reasons, including, for example, side effects that may
be otherwise dangerous to their health. . . . In
addition, some people are unable to obtain the
appropriate medication because of lack of money or
access to medical care, or problems with necessary
paperwork such as may have occurred in this case. A
decision not to take a prescribed medicine, though it
may be ill-advised, is different in kind from a
decision to ingest alcohol or drugs that are not
prescribed. In addition, some medications work better
than others, or take time to become effective, and the
difficulty of discerning when, exactly, someone
stopped taking medication and what his mental state
was at that time would be challenging at best.
Id. at 1128-29.
Unlike cases in which the ingestion of drugs or alcohol
caused the criminal behavior, the court observed, “[the
defendant’s] mental illness is not caused by his failure to take
medication, even though the medication might alleviate it
somewhat or even entirely.” Id. at 1128 (emphasis in original).
Thus, the court determined that “[t]he appropriate analysis was
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simply whether, at the time of the incident, the defendant was
criminally responsible.”12 Id.
As the Shin court similarly concluded, the failure to
take medication may not be considered in determining the defense
of lack of penal responsibility due to a mental disease,
disorder, or defect. In this case, the circuit court based its
finding that Eager was criminally responsible on Eager’s having
smoked marijuana as well as his “decision not to take his
prescribed medication.” The circuit court did not distinguish
the effects of marijuana use from ceasing to take prescription
medication, and thus we do not know whether the circuit court
would have concluded that Eager’s marijuana use, standing alone,
could support a finding of criminal responsibility due to self-
induced intoxication. Moreover, when a defendant both a)
knowingly ingests an intoxicating substance, the tendency of
which to cause intoxication the defendant knows or ought to know,
and b) experiences mental disease, disorder, or defect, the trier
of fact must determine whether the mental disturbance would
excuse the defendant’s criminal conduct absent the influence of
the intoxicant. See Freitas, 62 Haw. at 21, 608 P.2d at 411(“[I]t was obligatory upon the trial court to disregard whatever
incapacitating effects were attributable to the defendant’s
12
Since the trial court did not determine whether the defendant
lacked the requisite capacity at the time of the crime due to a mental disease
or defect, the court concluded that the defendant was entitled to a new trial.
See Shin, 16 N.E.3d at 1128.
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voluntary ingestion of alcohol in determining whether, at the
time of the conduct charged, the accused was suffering from a
disability that would excuse his criminal conduct.”) (citing
United States v. Burnim, 576 F.2d 236 (9th Cir. 1978)).
Because the circuit court failed to make the necessary
findings, we must remand for further proceedings consistent with
this opinion.
IV. Conclusion
Dr. Wagner’s testimony did not improperly bolster Dr.
Jacobs’ opinion. However, the circuit court erred in its
determination that Eager was criminally responsible based on his
failure take prescription medication. Thus, we vacate the ICA’s
August 2, 2016 judgment on appeal and the circuit court’s
June 30, 2014 judgment of conviction, and remand to the circuit
court for further proceedings consistent with this opinion.
Shawn A. Luiz /s/ Mark E. Recktenwald
for petitioner
/s/ Paula A. Nakayama
Loren J. Thomas
for respondent /s/ Sabrina S. McKenna
/s/ Richard W. Pollack
/s/ Michael D. Wilson
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