psychiatric review

8/6/2019 Psychiatric Review

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M.E*[CAj.{Hffi

Name:Birth Datc:Age:Examination:

Tlre Univeniry of Kansas

PSYCHIATilCEVATUATIO{GuyM.NeighbcirsJanuary 2,195951yearsMay25, ZO11

CaseRevercnce: 'TheUriitedStates s.GuyM. Neighbors

AttorneyDateof Report

District f KansasNo.2 07-CR-20O7{M; No.2 07-20124{MJPO;No.2 08-CR-20105{M-JOMr.GaryHartluty 22,2O17

Background:GuyM. Neighborsschargedwith a numberofviolationsncluding bstruction f ustkr,

conspiracyo manufacture arijuana,possessing]ntentionallymanufactured arfuana,and being nunlawful serof conttolled ubstancesn possesslonf a fireann.Mr. Nelghbors' ondwas evokednMay,20@,andhe s currently eldat the Ccjnectionsorporationf Americaacility n Leavenurcrth,Kansas^ ehason repeated ccasionsequestedhe dismlssalf hisdefense ttorneys, eenassignednewCounsel,ndproduced volumeof petitions nd ilingsnhisownhand. Hepersistsn he viewthat hisprosecutlons mproper, asmadepublicaccusationsf professionalandersonalmproprietyon he partof law enforcement ndgovernment ttorneys, ndcontinueso argue hat the Court achjurlsdiction,he mentalhehlthprofessionalsvaluating im ack ppropriateicensure, ndso orth.

Becausef the natureof hisobjections ndhisseemlngnability or unwillingness)o take headvlce f attorneyt Mr. Neighbors asbeenpreviouslv valuated y rnentalhealthexperts n severaloccaslons. xaminatlonsavebeendirected, s hispresent ne, o determinewhetherGuyM.Neighborsuffunsfrom mentaldisease r defectwhich educes iscapacityo appreciatehe natureof thecharges galnst im,understandhe impact f a guilty indingandassistn hisown defense.MaterialsReJiewed:

Inpreparationor my examination f Mr. Neighborsand eparateoncurrent nterview f hisspouse),reviewed large uantityof materialduringhe course f this evaluation; ewlygeneratedmaterials erealso eceived nd revlewed, nd astly, requested reviewand diagnosticinterpretation f a previouslyompleted atteryof psychologicalestingu/hichhadoriginally eengenerated yDr. MarilynA Hutchinson, h-D.n 2008.This eview ndanterpretation asperformed


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byDr.elbertPole, h.D.cf.below).His eportsattachedsanappendixo myevaluation.ess-TomFleFrefring6Ft-FtrC-a-eivbdft.m-otheiEne-uitaers.The ollowing sa list of materials have eceivedandreviewed:

U.S-RenewedMotion o Revoke efendant's ondor, In heAlternative,Motlon or MentalExaminationndForShowCauseHearingDocument 55DetentfonOrderDocurnent 75U.5-Motion o Revoke ond Document 5,84Order Document 18U.5.SecondMotion o RevokeBond Docurment28U5. RenewedMotion o Revoke ondDocumentI42U.S.SecondMotion o Revoke ondClerKsCourtroomMinute Sheet Gerrral DocumentiiZExhibit to Document65Defendant'sMotion for hls ExpertWitness o lntervienrDefendants uyartdCarrieNelgiborsOrder Atrthorizlrg nterviewsof DefendantsGW andGnieNeighborsy DeftnseExpertLettef and nitial emailfrorn GaryHaft,Attomeyrequestingassistance ith the caseBackgroundnformation etailon Mr. & Mrs.Neighbors,.e..residence,amily,education,inances, tc^Letter romGaryHart e: U.S. s.GuyM. NeEhbors, e$sterNo.11520-031 letterdated5l L3lLtto the BoP'sFederalMedicalCenter,Butner,NCU.S.Department f tustice-Federal edicalCenterRecordsHutchinso & Associates AFFIDAVIT,icensedpsycholo istReport f Cornpetencyvaluation GuyM. NeighborsForensic valuation, uy M. Neighbors y DavidE.Morrow,Ph.D.,Forensic sychologistLawrence oliceDept.,Review f CCA hone allsmadeby GuyM.NeighborsExhibitsromCarrie's ompetency earingDestruction f constitutional ights or the YellowHouseStoreCorporationOwners YellowPagesletter from GaryHart o Mr. Madason eighbors

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EmailromGaryHartwith elative'snforrnationAuthorizationor Releasef ProtectedHealthnforrnation, uyM.NelghborsMedicalRecordsor GuyM. NeighborsSumrnary f Search f ResidenceocatingMarijuana4rou/'Operation nd"Stolen"PropertyAffidavit urSearchWarrantof Business Residence

. ServedAffidavit or Residence earch0< > J Admbsions yGuyNe[hbors-t212/O5

LabResults f itemsseized t Gq/s homeLabResults f THC

L, e> .) Canie'sAllegedStatement o Inforrnant e: Gqy'sMariluana sePhotos f Guy,Carrie nd heirchlldrenKBILabReportReporting fftcernterviewwith CarrieNeighborsOnenoteof information e:GuyNeighborcGuy's taternento PollceRe.porting fficer nterviewof Guy

Li Os J Guyacknowhdgedtemspurchasedouldbe hot"Lies Guy "let hl skids ow nbringing orne tolentemd'

Exarnplef WhyGuybelieves .D.Officers osing sFBIAgentsAffidavit or DNA amplesrom GuyandCarrieKB ILabReportGuy'semail"Yellow ouseowners acedrug,gunallegations"apparentduplicates f Exhibit throughDOC 65Transcript f MotionHearingDocument 57Transcript f Hearing Dr.Lucking's eportDocument 84

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Transcript f Hearing Dr. Luc*ing's estimonyDocument 85 7l78l2O1OTranscriptfCornpetencyearing ocument68 tzlosl9eOrder or Hospitalizationo Restore ompetencyDocurnent 00 tL/@l0g

PreviousEualuations:GuyNeighbors asexamined nda comprehensiveetof standardizedsychological

instruments asobtalned y Dr.MarilynHutchinson, h.D.,n 2008. havebeenprovidedhe entiretyof the "rawdata" rom hisevaluation ufftciento permita reliableepeatnterpretatlon reanalyslsfthis estingdata(cf.Dr.AlbertPoje's eporf attached).Dr. Hutchinsonstesting esults, hicharercgarded svalidup to the presentime with regard o the psychologicaleat.uresndcapabilitiesrneasured,id not substantlatehe presence f psychotic yrnptoms r the presence f DeluslonalDisorder.

Hewasexamined t the Federal etentionCentern Englewood, olorado yDr.DavldMonow,Ph.D.n November f 2009.Dr.Monow wasof the opinionhat the defundant night uffer rorntlelus'ronal isorder, utcouldnotdeterminehat thedefendant'sdeas elative o his egal ituationandpotential egaldefense rise o the evelof a deluslon."Hisdetermlnatlon as hat DelusionalDisorder houldbe "ruledout."

Hewasalsoevaluated t the Federalacility n Butner,N.C,or treatmentand o determinewhether there s a substantial robabilityhat he will attain hecapacityo stand rial. Dr. RobertG.luckingand Dr,AngelaW. Weaverssued report n June,2010 xpressfnghe conclusionhat Mr.NelghborsssufferingrornDelusional isorder nd ncapable f standingrial asa resultof this rnentaldisease:heyals.o pined hat hiscapacity ouldberestored ffectively ndsafely y headministration,oluntary r forced, f antipsychotic edications.

My reviewof Dr.Lucking'snd Dr.Weave/s eport eveals o objective lements f behaviorsubstantiallyifferent rom he obseruations adeat Englewoodwith the onesignificant lfferencethat Mr. Neighborsame o adopta rejecting, venhostile ttitude oward he examiner, r. Luckingwhomhe uftimately ccused f biasand ackof objectivity,PersonalCorrespondgnce:

Upon rg[$!ng to_Eatic!.iate n.furthe exgrn]latiolp tfor pumoses f forrning nyopinion ecorded ere),Mr. Neighborseparatelymailedme a copyof hishandwritten legalese"to whichhe appendedhe kindobservationhat I shpuldnot take hisstance fhispersonally,hat he wasappreciative f my efforts,andhoped wouldusemy irne or thosewhoreally eededme'9.'


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Personal. ocial. nd MedicalHislorv.iGuyNeighbors as he principalnformant or the history however orroboration as

obtainedrom interview f hisspouse, swellasextensively uplicated istoricalnformationdocumentedn hiscase iles.

He s 51yearsof age,has oursiblings,osthismother deceased)t ageeightor nine,andwasraised yhis ather. Heattendedunior College fter secondarychool ndwas he recipient f a sportsscholarshipt Kansas niversityor hi5 6lglygqrs f education.Hedid not receive degree.Hiscurrentmarriagesof 3Gryears'duration the couplehas hreeadultchildren ndhascared or almost30 osterchildren n their home.He hasbeen nvolvedn community ctivitiesnctuding hurch,BigBrothers ndSisters, nd ocal chool ctivities.Hehasdoneelectronlcepair his ather'sbusiness),worked na manufacturinglant,andwasmost ecently elFemployedunning delivery ervice.Heandhiswifealsooperated usedmerchandisetore n Lawrence ndTopeka, lthough ccordingoMr. Neighbors, iswife wasmor nvolvedn the day-to{ay operation f the business. e hada hobbyof gardening.He relates he basesorthe current hargeso problems ssociated ith the usedmerchandisen hisbusinesses,unshe had n hishomeand a couple" annabis lants mong hebeddinetantsnhis obbyardeningf,TC,u, .$11Hes ecordeds and dmtts&fiJing been rrestedtage 9and ge 0 orpossessionfman'juana. edenies r:gnificantr current annabis seon other hana fewgccasionsnddenies se . rof atcohotorotherintoxicants. l-- [lYS ]h"* /*^.#*'1Tr"ro {

Hewasdiagnosed ith AttentionDeficitDisorder urlnghisschool ears andwas reatedupto the imeof hisarrestwith stirnulantmedication.He ecalled periodof "clouded"hinkingwhenfirst anestedasa likelyaftermathof abruptdiscontinuationf the prescribedtimulant.Hecontinuesto occasionallyeel hat he hasdifficulty ocusing is attention or longperiods but doesnot feel hatthisaffects isoverallperformance r understandlng.

He hashypertensionor whichhe akesLisinopril, easonalllergiesor whichhe akesloratadine, ndoccasionaljointain or whichhe akesacetamlnophenr ibuprofen.SvmfiomReview:'

Hedeniedphysicalsymptomsith theexception f long-standingoint painandoccasionalfatigue.Hedeniedunusual leepdisturbances,erceptual isturbances,ossof appetite. hysicalsymptoms f anxiety, r apses f rnemory.Hedeniedany ormof halluclnation5,6ddeniedbeingsuspiciousf the motives r behavior f peoplen hisenvironment"exceptor being n ail...") Hedenied eingpa ticulady earfulof or uncornfortableroundother nmates r custodial taff. Hewasopenaboutbeing ornewhat keptical f mentalhealthdoctors beca se heyseem o want o drugme."


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Examination:Asalways t the outset n a forensic etting, explainedo Mr. Neighborshat our encounter

wouldnot be at all confidentialn the manner f ordinaryphysician/patientommunicationsand thattheentirecontentandconclusionsf myexarninationnd nterview f himwouldbe rnade ublicasreportedo the C.ourt, lsattorney,and he UnitedStatesAttomey. He ndicatedhat he understood,and n a very riendly, lmostapologeticashion skedme to note hat hewas"taking art n thisexaminationnderdurcss-"When asked im o explain, e stated hat'the Court s requiringme totalk o you-.- andwhen pointedout that, nanycase, couldnotandwouldnotexertanyPressurenhim,and hat he could ndeedaskme o stopand eaveat any ime, he ndicatedhat heunderstood llthis o be he case, ut "justwanted hat on therecord.'

Mr. Neighbors asentirelycooperative,elaxedahhough henappropriateorceful rintense).Heuraswellgroomed, ressedn nmategarb,and exhibited o restlessness,rernulousness,abnormalmovements r rnotorweakness-

Hewas ullyalertandoriented.Hisspeech asmodulated, oherent, oaldirected, ndreflected n overallnormatto highnormal erbalabilityandeducationalevel.Hewascornpleten hisresponsesnd askedor clarification hennecessary. ecould Oadilyel l me he natureof thechargesagalnst im,estirnatehe effectsof beir6foundBuihy,and discussntlre abstract he conceptof pleaagreements heuras lsoable o express isconcerns bout he propriety f pleading uilty n hiscase.Hewas mostslgnificantly not in any ashionpreoccupiedwith the.idiosyncraticjtnd ecidedly ddcontentions e acknowledged aklng ndcondusionse acknowledgedrawing bout henatureofthe nvestigation,he ackof urisdiction,he mpropriety f hisprosecution, nd he integrity or ackthereof)of his attorneys.While hesematteisarose n responseo my specificquestions, e wasableto explain lsconvictions,n general deqti{Yhelrsourcesalbeltwtth ittleprecision:nternetmaterialcounselrom tllow inrnates, ndspotty eadingseing he rnost ubstantialecollectedources),ndmost mportantly qulddiscuss, bstractly ndhypothetically,he dfficultiespresentedf he shouldbedeceirred,nisinformed,r ust plainwrong. Hewasable o acknowledgehat hisallegations adeaboutprosecutorsouldbe lt advised, ndaccepthe possibilityf hisbeingn error.

However, e nevitably oncludedhat he ehobligatedo proceedwith the truth of mattersfactual nd egal s heperceiveshem.

ng)wasjgrnpjgeO. His oncentrationasto5t$normal- snoted boveROS}.herewasnoevidencef.p^ercgjlualisturbances,gggsdelusions,ordidheapperro lgve _eelingsf .eferen .,\

I

Thesingle bnormalityn rnental tatuswasa decided igidityof defenses heconsistentlydescribed imseJfs beset rornal l sidesn hiscurrent egalentanglement,ndappearedo see elianceon others n contradictiono hisownconvlctiDnssa form of weaknesshet wouldcolluden hisowndefeat.


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Psychologicalssessment:Dr.Poje's nalysis f the rawdata ronrpsychologkaltestings appended spartof his report.

Significantindingsnclude personal atternof rigiddefenses,ndanabsence f indicators upportingthe presence f a cognitive isorderor prychosis.Ancillarynformation:

I wasalsoable o interviewMr. Neighbors' ife. Overall erdescription f her30 plus earsashisspouse ppearedo confirm he lackof anypriorhistoryof disturbancesf moodor thinking,tendencyo stubbom elf-reliancendavoidancef dependencenothers.Diagnoses:

t. AdiustmentDisorderwith anxiety nddepresed noodIt, Rigidity f tlefensessuggestingarcissistic r obsessive ersonalityeaturesll l. ' Hypertension,seasonalRhinitis,Arthritis

gnin'ron;In my professionalpinion,whidr sheldwith reasonable edical ertainty n thebasis f the

materialshave eviewed,my examination f the defendantGuyM. Neighbors,ndmy professionaltrainlngandexperierrcen the field of AdultPsychlatry nd ForensicPsychfatry, ut'M. Neighbors oesNOT uffer rom amentaldlsease f defectuitrtctt ttectsor dirninishes is ability o understandhecharges gainsthlm, o apprec'tatehe effectof aguiltyverdict,or to assisthis attorneys,o the degreehe chooses,n hisown defense.Disctrssion:

Given hatat leastoneexamlner asdeterrninedhat thedefendant oessuffer rom a rnentaldisorder, amelyDelus'onal isorder,t appearshatsomeexpansion n the basisor myverydiffurentconclusions n order:

DefusionalDisorderaKAParanold isorder, oranoioVera,Mono ymptomatkDelusionalDisorderJs a poorlyunderstoodandyEguely escribq4_entityn thepsychiatricnosologystudyofdisorders)or more han10O ears. t is generallygreedo conslst fgl4gal gnstituent fealYles:

hatonebJ1altre?ted ut of a desireo persecute r harmout ofJelgusmoqves whichdeasare reatedasalways ndeverfactual) hlcharenot culturally erived{thusunlike eligious eliefs r shared deas bout he natureof things); nsetspontaneotslywithoutobvious riginsn a previousmental llness)n the adultor lateadultyears- t isgeneral(ycceptedhatothersymptornssuchaslUlUgilgge.ggor.bizarre erceptions) ndmood disorders nustNDTbepresentn order to even entertain his diagnosis.n rece[ygitts theeltsenFushat th" jdgt iluolyg9in PelusionalDisordermust npt be pgleqly "bizane' hasweakened bullemaiosileature whichpromotes ome esq ls osticerrors.


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Currentlysed criteria" bove ndbeyondhiscore escriptionreconiectufal,$]q!g,td, ndenrf,-gT|tffiffi tffi ro-ffi nEitYTf olftMup=otEma-tEn-reitimeare nsfficientanddurationf follow-upooshorto permit therhanconjecture,

Theverydistinctnatureof thisdisorder trongly upportshe cautionary onclusionhat it isdistinctrom other tlnessesharacterizedy he presence f delusionalhoughts:unlikeSchizophreniaand elated ltnesses,nd unlikeAffectivemood)Disorderst'tsnotaccompanledyotherconfirmatorysymptoms ndsigns; nd t ceftainlvdoqsnot rcspond o availableantip-gychgtic'mgdlcatigtrss, Iffi otlellgqrg$S. and lilgtinctive in its bi-oloqvand.

Delusional isordersraretyencounteredn clinical ractice incepersons ith the llness everset f . reportorseekdiagnosisontheirown-nothingiswrongwiththeml@n,?Slenfrely he resultof legalentarulementsaswhenStarees riserom artionc he sufftrqr may akein order o Jieh\apiggived.yrolg oI gen-!he$Ofe"), andc "tes[in he case f conjugal aranoia),o'workers, r employers ho areaccusedf ilfideli]y ormatbasance.

"Delusiont'mustalwaYs e distinguishedrom ideasbased n being irnplywrong,_-misinformJd,[email protected]|atrywas"ex@mmun|cated,,frornenceof categorizing ersons' ailure o adheib oright-thinkingltalinis! deas s'delusional", ndasa consequencemposing ospitalizationndenforced rugregimens n thoseso diagnosed.

Dqluslons re deasheld with a degreeof fixityand nfle{bilitVwhich nterrupts he normal lout@:individualswithrel iab|ydiagnosedde|usions( i .e. indborderswherethe precence f ottrer$/mptorns, !$g!t-o{-i![gs, ggegcs, IJ9!95!Iyj!Sgno5sl as n Schizophrenlcpectrumdisorders, re unable o adopthypotheticalconsiderationse.g. "what if the world was not beingeatenupby demons?).Ihg1ygEd1g:Pgl:efrom patienthotding therwise erifiabledelusioJ:l"but it_sl l glcontrast 'normal"evennormal-mistaken-loeas resuujecto examinationndhypotheslstherrfri6ilfiEoi6iland pfi'iio;ily.

ln myexamination,uyNeighbors@c rior.g!$ggized,He@nseouentlvdidnot"dig nhrs rEe!{and. asable o. n |:g.a asa matterof hYpothespossibilityf being ro,ng,hepotential f having@lic online tterances.f usinEooriudgment

Hispersonality,haracteristicatterns f perceivinBhreatsandopportunities, ndpreferred(even btigate)means f copingwith hispresent dversityn rnypmfussional pinion enderhimunlikelytoabandon isownconclusions,nlikelytoperceivehe adversarialPgl99.4,s.Ast-9!9..eY9nhanded, nlikelyo accept hat othersmayknowbetteror OepossesseAf sup eunlikelytoelinqulshontrol fhis ate o ang!!9_1,sgujgg!ge.ismentalstatus,hold th Eualprofessionalertainty,oes ot educe is apacityo doall hesehilgs.At heend, e emains


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capable f understandinghe charges, nowinghe legaland ifeconsequences,ndcooperating ithffiit rniy Oethat ewillchooseo exercise

"Sels" Consldeations:ln viewof the contested atureof diagnosisn thisrnatter, t appears ppropriateor me o

detailmy indings ndmyopinion egardinghe appropriatenessf a.ttempts t treatment: hepotentialforbenefitand ikelihood f riskshouldt be udicially eterminedhat thisdefendant oesindeed uffer rom a mentaldisease,efusesreatment. nd he courtmustconsider nforcingtreatment nan effort o "lestore' competency'

Of course, ince am irmlyof he opinionhat hedgesNOT uffer rn'n nelusional isordel:9fanyothel ntal llness,t is my opinircn ratantipsvchoticnedicatlon,oluntarilYakeno(

administered,snot likelY o-be beneficiafan! the associatedisk

It is alsopuzzllrg o-mQhat tlgpiyqbllc-rnedlcal'on (of anyphajmacologicgenerationJof adrlerse rug reactions.

typicator typlcal, Presenteds a hiEh ikelihood ffiom Delusional isorder.

Ratesf restorationo competencyasedn hebroad pectrurnfmentali!!9,ordqrs.-q94not{pt'V!e gePlisd9qlsP$lDt

lnconnectionith estimonyn United tatesS,Ghani,undertooko revlewhe hencurrentliteraturein2960and ust eyond)egardingreatment utcomesnDelusionalisorder hen reatedwith hevariety f thenavailablentipsychoticnedications.have riefly earchedoranynewrelennt studieswhichmighthavebeenofferedsfnce' lt con&sinnasoverall,patfrobgicalhi nkiqg Ssknatsiso$et-@

Gffitre hope fasmat@ee-&Lso,nete1gf.ldonotbelievetappropriateoforc'-treatment s squestionable t best.DanEerousnesso Selfand Othgru:

Based n hts ackof crirulabtgpgljrity, hishistorypt Fe"td f"t the.-"tt r:e s, a+g!!$;

"?gg!ilsrhqten'The risksof antipsvchoticreatrnenta enot negl'rgible increasedisk or.treq4dise.ase{cardiac


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ismyoplnion, lth reesonable edical ertalntv,hat hatMr. GuyNelghborstr!99tsgb!-gtharminghimselfor@---=-.--Respeaful$ubmitted,

t^ f , tat l l r . \ -lWVl^KW06ta:\Ut )JbAdn.Wtsner,M.D.Associatelinical rofesorof PslrchiatryandehavloraldencesUni,rersltyf Kansaschool f MedidneDirectorofnpatieht slthlatry,KUHospltalAttached:

ReportofAlbertFoje,Ph.D.

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