Psychiatry, the law and the death penalty

Although death penalty decisions are always controversial, the case of convicted serial murderer Michael B. Ross has proven to be one of the most complex legal battles seen in Connecticut in recent years. Ross, who was found guilty of murdering six young women in the early 1980s, was sentenced to death 18 years ago. Since then, a series of appeals, hearings and overturned decisions has involved not only the courts but also two of Yale’s forensic psychiatrists. Howard V. Zonana, M.D., professor of psychiatry, interviewed Ross before his 1987 trial, and Michael A. Norko, M.D., associate clinical professor of psychiatry, evaluated Ross in 1995, in 2004 and again in March when Ross attempted to waive his right to appeal. Norko found no evidence that Ross suffered from “death row syndrome” or that he was incompetent to waive his right to appeal. Ross was executed on Friday, May 13.

The Ross case is one of about 1,000 consultations for court cases both local and national that the Law and Psychiatry Division at the School of Medicine tackles each year. What began in 1973 as an elective for residents examining the interface between law and psychiatry has grown into a division of five units and 23 staff members that offers a one-year fellowship in forensic psychiatry, as well as courses for psychiatric residents.

“Forensic psychiatry is defined as the use of psychiatric expertise to aid in the resolution of legal problems, and it also deals with patients in settings like prisons, where there are special needs that have to be accounted for,” explained Zonana, who directs the division.

That definition brings forensic psychiatrists into the courtroom as well as the clinic. They consult on everything from insanity defenses to the termination of parental rights. As part of their training, law and psychiatry fellows rotate through various settings: they work with law students in the Jerome N. Frank Legal Services Organization, they see the victim’s perspective through postings with the state’s attorney and they may work in the federal public defender’s office or at the Connecticut Juvenile Training School run by the Department of Children and Families.

The division also contracts with the state of Connecticut to evaluate the competency of defendants in the New Haven region to stand trial—almost 200 cases a year. Under close faculty supervision, residents conduct evaluations, write reports and testify in court.

“We try to get them to approach each case from an objective, critical viewpoint, which may be different from the objective in clinical work, where you’re trying to establish a rapport with the patient,” said Norko. “In forensic psychiatry that’s not necessarily the goal, because the outcome of your evaluation may or may not be helpful to the person.”

On a broader scale, the division frequently examines legal issues such as a statute on the competency of juveniles to stand trial or the legal regulation of psychiatry. “Psychiatry is the most legally regulated subspecialty in medicine because of the fact that we can detain people against their will,” explained Zonana. The division also created a jail diversion project in 1995 that places a clinician in the court to assess defendants charged with drug-related misdemeanors and develop treatment plans as alternatives to incarceration. Thanks to the success of the project, the Connecticut legislature has since expanded it to all lower criminal state courts.

“It’s a very diverse program, which I think is probably one of our biggest strengths,” said Norko, who is the division’s deputy training director. “The other is that we make a conscious effort to present more than one viewpoint about how forensic psychiatry should be done.”