1.Donna Maddox — Direct/Cross/Redirect
380 linesJune 10, 2019
THE COURT: All right. How's everybody this morning?
BOYD YOUNG: Good.
THE COURT: Ready to go?
BOYD YOUNG: Yes, sir.
THE COURT: All right. I've got a note from one of the jurors and she is involved in a big group of churches that does an evening, like, a Sunday -- a Bible School type thing and wanted to know if she could -- we could stop at 5:00 o'clock each evening this week. And so, my thing is that's about what we've been doing anyway. We'll try to honor that, except if we start deliberations and that may be a reason to tell her no. Any objection to that? I'm not going to address her directly, but --
RICK HUBBARD: No sir, Your Honor. I guess I'd ask just also for planning today, how long does, is the Defense will go? Think we'll finish it tomorrow?
BOYD YOUNG: I doubt we'll finish it tomorrow. It'll be probably Wednesday.
RICK HUBBARD: How far into Wednesday? Are we going to be doing closings and charge? That's what I'm trying to get at is we're not going to be doing that, like, after lunch, or are we going --
THE COURT: If we get done Wednesday, maybe we can do everything Thursday. That way we won't run into having to come back the next day. I'll do whatever the jury wants to do. I'm kind of going to manage them like I've done before is you all work until you want to break and then stop. And they pick -- they did that really well, I thought, the way they managed their time last -- last week. So, all right, bring the jury, please.
BAILIFF: Yes, sir. (Whereupon, the jury came into open court at approximately 9:05 a.m.)
THE COURT: Thank you, all. Everybody's weekend good?
JUROR: Yes.
THE COURT: Any issues with anything, anybody communicating with, interrogating, inquiring?
JUROR: No.
THE COURT: No issues for the Court to take up? Like I said, we can do it in-camera. Okay, good enough. Ready to continue on. Call your witness.
BOYD YOUNG: Your Honor, the State -- the Defense calls Dr. Donna Maddox.
DR. DONNA MADDOX, being first duly sworn, testified as follows:
COURT CLERK: Have a seat on the stand. Once you're seated, state your full name, spelling your last.
DONNA MADDOX: Good morning. Donna, middle name Schwartz, S-C-H-W-A-R-T-Z, last name Maddox, M-A-D-D-O-X.
DIRECT EXAMINATION By Mr. Young:
BOYD YOUNG: Good morning, Dr. Maddox.
DONNA MADDOX: Good morning.
BOYD YOUNG: Can you tell the ladies and gentlemen of the jury a little bit about yourself, who are you, what your work history is, your education and experience?
DONNA MADDOX: Sure. I'm originally -- well, raised in Columbia for 50 years. I went to Lower Richland High School. I went to college at Furman University and I graduated in 1985 with a Bachelor of Arts Degree in psychology. Then I went to medical school at the University of South Carolina School of Medicine here in Columbia -- well, next door in Columbia, and I graduated from there in 1989. Then I did a four-year residency in general psychiatry, and I finished -- that was -- at that time it was run by the Department of Mental Health and the University of South Carolina. So I finished that program in four years. Then I took an additional year of training in forensic psychiatry, which is a one-year Fellowship, and I finished that in 1994. I'm licensed to practice medicine in South Carolina and Georgia. After I finished residency I worked for a number of years at the Department of Mental Health and while I was there I conducted Court ordered evaluations, similar to Dr.
Friarson's, looking at peoples competency to stand trial and criminal responsibility. Then I went over to USC and worked at the Medical School for 17 years, and there I basically did forensic work. I worked in the prison. I worked at the Department of Juvenile Justice. Just various areas. And I also performed evaluations similar to what I've done today. And then after that I finally retired. I spent the last eight years of my career working at the Department of Mental Health, and I was an inpatient psychiatrist there. So for four years I worked at Bryan Psychiatric Hospital, and that's the hospital in Columbia. I'm the acute -- hospital when people are civilly committed from the emergency room they go into treatment there. So I work there. And then I remarried and moved to Anderson, South Carolina six years ago and I worked for four years at Patrick Harris Hospital, which is the sister hospital to Bryan. So Patrick Harris Hospital is the acute psychiatric inpatient unit for the Upstate. And there I was -- I was a Psychiatric Service Chief and I ran a 40 bed unit of females who are acutely mentally ill. So I retired from the State. I had my 28 years of service, so I retired from the State two years ago. And since then I've been engaged in the full-time practice of private forensic psychiatry.
BOYD YOUNG: Have you been qualified as an expert in forensic psychiatry in the State of South Carolina?
DONNA MADDOX: I have.
BOYD YOUNG: Do you know about how many times?
DONNA MADDOX: Over 800.
BOYD YOUNG: Have you been retained by both the State and the Defense -- not the same case, but in different cases over your years of service in South Carolina?
DONNA MADDOX: I have.
BOYD YOUNG: Your Honor, at this time the Defense would offer Dr. Maddox as an expert in forensic psychiatry.
RICK HUBBARD: No objection.
THE COURT: All right. Dr. Maddox is offered as an expert in the field of forensic psychiatry. She can offer her opinions to that end.
BOYD YOUNG: Dr. Maddox, can you tell the jury a little bit about the difference between treating patients, clinically seeing patients versus evaluating patients?
DONNA MADDOX: Yes. In forensic psychiatry -- the focus is a little different in forensics, because there's a legal issue involved. You're evaluating someone, number one, to determine a diagnosis. That's important, because you can't make -- you can't advise the Court or lawyers in legal decisions if you don't understand what's going on with the patient. And then you have very specific focuses that you're looking for. You're answering legal questions. And when you treat -- so let me back up. So when you're a forensic psychiatrist you are advocating for an opinion. You're not on -- forensic psychiatrists are not on anybody's side. They're looking for a diagnosis in trying to answer a legal question. When you treat patients, you're their advocate. So if you're an inpatient in a psychiatric hospital and you're my patient, I'm going to do everything I can to help you. I'm going to prescribe medications. I'm going to make sure that you're safe, that you're not a danger to anybody, and we'll help you with discharge. So when you treat patients you see them in a different context. You're with them for a longer period of time. So, for example, at Patrick Harris the average length of stay of a patient was usually two weeks. And so, every day I would round on that patient. You would have inpatient, you would have inpatient evaluations. You would read the nurse's notes everyday. So you get a little bit -- you know your patient in a different way. You observe them more frequently because you're on the unit, so you have more interactions with them. So the focus is different, one is for treatment and to help and to cure. In forensics, it's just to render an opinion that would hopefully assist a jury or Judge in making a decision.
BOYD YOUNG: And can you tell the jury what your role was in the Tim Jones case?
DONNA MADDOX: Yes. Mr. Young called me, I believe, the day after Mr. Jones was sent to the Department of Corrections, and he was -- he called me and I came down -- I believe it was a Saturday actually. I was a day off. But I drove to Columbia at the time from Anderson and I evaluated Mr. Jones at the -- at the Kirkland Prison where he was being housed. And so, it was my opinion at that time he was clearly psychotic. There was no question in my mind. You know, the cause we didn't know yet, but there was no question that he was psychotic. And what happened over the course of time, I was involved in a very big case. I would not have had the time to be the forensic expert in this case, because that takes a lot of work and a lot of hours. And so, Mr. Young used me as a consultant over the last few years. So since 2014 -- I saw Mr. Jones on September 13th, 2014. So I have seen him almost every year. I didn't see him in 2018. But I would go by once a year, check on him, see his progress. I was keeping up with this treatment. What -- what kinds of treatments he was receiving. So I've been a consultant in this case where I've come a few times since the trial has started and have done some evaluations. So my role is not then to render an opinion about whether he was criminally responsible, as you saw in the first phase, but my job has been to just be a consultant, order tests when needed, oversee treatment, those sorts of -- sorts of things.
BOYD YOUNG: Over the course of time in that role, have you come to a diagnosis of Mr. Jones?
DONNA MADDOX: I have.
BOYD YOUNG: And can tell the jury what that is and how you came to that conclusion?
DONNA MADDOX: Yes. Mr. Jones meets the diagnostic criteria for schizophrenia, and I based that on my evaluations of him from 2014 until the present. And I do agree -- we certainly know that he was using synthetic cannabis, and that can cause psychosis in somebody, and that certainly may have contributed to what I saw on September 13th, 2014. But what the issue is, is usually people that have substance induced psychosis -- I've treated them -- I spent the last seven, eight years doing that. They usually clear up within a month. You can bring them into the hospital. You give them medications. They clear up, and then they're no longer psychotic. You can eventually take them off their medications and they're fine. If they use these kinds of substances again, they will get sick again. But in this case I have followed him since 2014 and in my opinion he continues to have symptoms of psychosis.
And so, based on that, the diagnostic criteria for schizophrenia says that you had to have symptoms for six months. Well, we know he's been confined since September of 2014. This is five years later, four and half years later. He still has symptoms of psychosis. So he diagnostically, he's had the criteria for more than six months. In my opinion, he's had delusions in the past. The last time I saw him I did not consider him delusional. He had delusions about his son. He's continued to report hallucinations off and on. Even despite being on medications the entire time that he's been confined he still has those symptoms. And then mainly, the main thing you see in schizophrenia which differentiates it from a substance induced psychoses, is you see a deterioration of function. That's one of the hallmarks of schizophrenia. It's someone that was doing well, then they got sick and their function has continued to decrease.
So he went from being a father, a full-time worker, going to -- wanting to go to school at some point, or go to medical school, to the point where he's murdered his children. He's in -- been confined. He had a suicide attempt. So his function continues to deteriorate. In my opinion, he's also had what's called cognitive decline. Cognition is just your -- it's about six things that your brain does. Paying attention to things, your ability to concentrate, your ability to make decisions. Those sort of things. He's had a decline in that, that as well over -- over a period of time. And in the old days we recognize that. They used to call schizophrenia dementia praecox before they really knew what schizophrenia was. They realized that there was some cognitive dysfunction that you have with that as you continue to have it over time. So based on those things, he's had delusions, hallucinations, a deterioration of function. And he also has what's called negative symptoms of schizophrenia.
There's two kinds of symptoms you see in schizophrenia. Positive means your brain's doing something it's not supposed to do. It's making up things. It's making you believe things that aren't true, or it's making hallucinations. Negative symptoms is your brain stops doing some of the things that it normally does. And the main negative symptom he has it's what's called a flat affect. If I took a picture of his emotions, how -- you know, you see me. I'm talking, I use my hands, my voice has a lot of intonation. If I'm happy you would be able to tell. Persons with schizophrenia, they're outside expression of emotion flattens out. And so, you don't see him very animated. There's times that he may be, but overall he's not a very emotionally expressive person now. And that's called a negative symptom of schizophrenia. So since September 14th, 13th when I saw him in 2014 he was psychotic. 2015 he'd gotten a little bit better. He was on medications. But he still was having symptoms. 2016 he was still much better. He was getting medications. But he had tried to kill himself and had a little bit of -- much more negative symptoms then. So initially what I saw is the positive symptoms early on, and then as he remained treated on all of his medications he's developing more negative symptoms now, which is consistent with that illness.
BOYD YOUNG: Does schizophrenia always present the same? I mean, would you say, all right, because schizophrenia is always exactly like this?
DONNA MADDOX: No. It's just like every other medical illness. There's always going to be outliers, or there's always going to be somebody that's not textbook, that we see that all the time. In fact, I've got a case right now, the person got the symptoms in their 40s, and that's usually very late for the onset of schizophrenia, but it happens. I had patients in the hospital -- I had one woman, she had retired from a job and got schizophrenia in her late 40s. So there's -- all illnesses in medicine work that way. Not everybody is a textbook case. And so, that's the question. How do you piece together that this is schizophrenia and not just from substance. And I think one of the most important things that I also considered in that is the family history. You know, we know that his mother was institutionalized. And I try to look at the most recent research. If you look at our DSM, which is a book that's lets us diagnose schizophrenia, they report that if you have a parent with schizophrenia you may have about one in one-hundred chance. Well, the most recent articles that I looked up said you have a one in three chance as a child of a schizophrenic. You have a one in three chance of getting a major mental illness. You have a one in two chance of just having mental illness. And so, based on his family history, that's a strong genetic component. He did do the drugs, which I think contributed to him having the symptoms. But you have to take it at the point of 2014 on he still has those symptoms, and he clearly meets the diagnostic criteria for schizophrenia.
BOYD YOUNG: Now, I think you talked about your evaluation of him on September the 13th, 2014. That was the day after he was admitted to Kirkland?
DONNA MADDOX: Yes.
BOYD YOUNG: And then you saw him in June 24th, 2015. This was prior to his suicide attempt?
DONNA MADDOX: Yes.
BOYD YOUNG: And how was he doing at that point in time?
DONNA MADDOX: At that point he was only on one medication for psychosis. He was on the Geodon. They had him on Prozac, an antidepressant. They had him on a medicine called Inderal, and that's a medicine for side-effects. You can get tremors from some of the medicines, or you can have problems where you can't sit still. That medicine helps. He was on Geodon, which is an antipsychotic. He was on a medicine for nightmares. He was on another antidepressant for sleep, and then a medicine for his stomach. He reported at that time -- he looked much better than when I saw him in 2014. It was night and day. There was improvement in him, but he was still having some symptoms. But he said his -- he felt like his thinking had cleared up. He said it had been a while since he had had any hallucinations. And he -- he was definitely in a much better place. He was having a lot of issues about his crime. Thinking back about his children and what he had done.
BOYD YOUNG: What did he say about the lack of auditory hallucinations?
DONNA MADDOX: He said part -- he felt like part of him was gone because he no longer heard them. He said, "I got along with them for years." The main symptom -- so he didn't have positive symptoms of schizophrenia. That point that he had the flat affect, that's the first time I noticed that he definitely was getting some of the negative symptoms that you see with schizophrenia.
BOYD YOUNG: Is that an odd thing for somebody to say, that they tried to fake mental illness?
DONNA MADDOX: No, and it's not -- I have a lot of people with schizophrenia that say that. Most of the times with schizophrenia the voices -- they don't say nice things. They -- they're just horrible. They say awful things. When you're trying to concentrate on a task. It's when you're nervous is when the symptoms will come a lot of times. So say if you're in a crowded room and you're scared, that's when the voices will come, and they usually say not nice things to people. And that's because it's coming from their own brain. You know, their brain is what's making those hallucinations, so they know just what to say to usually harm you. They're very good at that. Sometimes people are lucky and some of them will have voices that, say, maybe tell them jokes. In my hospital it wouldn't be uncommon. You might see a lady in the corner just laughing because she's responded to hallucinations. Sometimes they're pleasant, but mostly they're not. And they -- they make running commentaries about what you're doing. They -- you know, they may say things like you're ugly, you're a bad person, you know, that person hates you. Look at everybody looking at you. They -- they don't say very good things.
BOYD YOUNG: Did you think that he was -- that that was indication that he was malingering or was it indication that he was not?
DONNA MADDOX: To me it's an indication he wasn't malingering. What happens is people are so used to living with those voices they learn how to cope with them. They might have strategies. And so, when they're gone it's kind of like I'm getting a free day off. You kind of -- you didn't plan on it, so you don't know what to do. You have to fill the time. Or I think a better example would be somebody that's in chronic pain. You know, when they're pain's relieved, they've spent so much time trying to learn how to deal with the pain that it's kind of at a loss for a little period of time. So that's certain -- I have a lot of patients on the inpatient unit that have said they feel like part of them is -- they're different and they have to readjust.
BOYD YOUNG: The next time you saw Tim was on April the 18th of 2016. This was after his suicide attempt. What did you notice about him at that point?
DONNA MADDOX: Well, at that point he was on two antipsychotic medications and you could tell. He definitely was having side-effects from the medications. The first thing I noticed is he had what's called Parkinsonian features. His facial muscles were not moving. These medications can cause side-effects that look like Parkinson's. And so, he wasn't blinking his eyes very much. And so, he looked -- even though last time I'd seen him I called him a flat affect. You know, he didn't have a lot of emotional expression. Well, it was even worse with him being on the medication. So he didn't have a lot of movements of his muscles and those sorts of things. He was on a much stronger medication. He was still on the Geodon, but Dr. Wood added Prolixin which was one of the older -- these are -- those are old drugs since the '80s that we used to use. There's a lot newer medicines now, but it's still a very good medication. So she had added a second antipsychotic medication. So I saw that he was having a lot of side-effects from his medications. He said it stated the voices were gone. But he told me that he had hallucinated and the voices were telling him to hang himself, which was how his suicide attempt came about.
BOYD YOUNG: Did you notice a change in his cognitive level --
DONNA MADDOX: Yes.
BOYD YOUNG: -- during that evaluation?
DONNA MADDOX: Yes. One of the things I do, when I do an exam I'll -- I do -- I try to assess cognition. And there's different tests that psychiatrists use. But you're looking -- one of the tests that I did on him when I would see him, it's called a Test of Verbal Fluency. And you'll probably practice this at home tonight. I practiced all these tests on my husband. But you -- it's a frontal lobe function. It's a part of your brain that you're trying to measure, like, how quickly are people thinking, how rapid are they able to come up with placing objects in categories. And so, the test I usually will give, I'll give you a minute, and I'll say name every word you can think of that starts with the letter D, and then you have a person. If you get 11 then you pass. Sometimes I might make it a category test. I'll say name every fruit you can think of in the next minute. So the first time I saw Mr. Jones he scored -- and I try to do that. I try to assess cognition as I go along.
The first time I did the test he got 23 words in a minute. That is -- that's one of the highest scores I had ever seen. He did one thing that was interesting though. He had what's called perseveration. And what that means is his brain came up with the same word twice. And sometimes peoples brain will do that on it's own, but usually it can mean that there's a dysfunction there. So the example would be if you're given words that start with the letter D, they may say the word dog twice. They'll say, "Did I say that?" It's like their brain is going back to the same pattern. It's trying to come up with information using the same strategy. So you can see perseveration in people with dementia or people with certain kinds of brain trauma. So we did 23. So he scored excellently. I saw him -- the evaluation in April he got six. So he went from doing superior -- superior performance on that test to below average when I gave it to him in April.
BOYD YOUNG: And did you order neuro-psych testing as a result of that?
DONNA MADDOX: Yes. And -- I did. I recommended neuro-psych testing at that point, because that was a decline in function and I didn't know what was causing it. Sometime schizophrenia can do that. Again, they used to call it dementia praecox because it attacks the chemical system of your brain, but it still affects how your brain functions. And then I would -- also the first time I had evaluated him I did not see -- he had hair when I saw him, so I did not appreciate the skull depression that he had. His hair covered that up. But I'd learned from speaking with one of the Department of Corrections that he had had the automobile accident. So because of those two things, the decrease in his function and the history of the head injury, I recommended that you all get neuropsychological testing.
BOYD YOUNG: And is that the Dr. Brawley testing that was ordered by you?
DONNA MADDOX: Yes.
BOYD YOUNG: After that testing did you then order imaging?
DONNA MADDOX: Yes. He had some abnormalities on his neuro-psych testing. Some of them were probably secondary to medication side-effects. He was having motor symptoms. So part of the neuro-psych testing is you have to look at motor function. But the functioning that I was concerned of was the frontal lobe issues. And so, yes, Dr. Brawley recommended further workup, and then at that point I ordered the MRI.
BOYD YOUNG: I'm going to skip forward a little bit to the time of the trial. Did you get a call about May 8th this year to come in and see Mr. Jones? What was called about and what did you see and what happened?
DONNA MADDOX: Yes, I did. I think this was during jury selection. I don't know if you all had started yet, and you may have already been in trial. He had had -- he had been reporting some hallucinations, and that was kind of new for him. So what had happened -- I'll fast-forward a little bit but put it into context. When he was at the Department of Corrections he was held as a safekeeper. And so, Dr. Beverly Wood, whom I know -- I've worked with. I used to work at the Department of Corrections. I was one of her contract psychiatrists when I was here in Columbia. She -- he had been on a very high dose, probably the highest dose of Geodon I've ever seen. I think he was on 320 milligrams at one time. I've used 240 before, but I'm not that brave. But he was on very high doses of Geodon in the prison. And what happened is by the time he had got back here to Lexington, he was only on 40 milligrams. So his dose had gone from a very, very high dose to a very low dose. And so, some of his symptoms were returning, which could be expected. If you have somebody with schizophrenia and their symptoms are controlled and they come with a lot of stress, it's just like any other medical illness. You have hypertension, and you're not sleeping well and you're getting up real early everyday, and even though you're taking your medicines you may have symptoms. And so, it's just like any other illness. So at that point I recommended that his medication be increased to 60 milligrams a day to prevent any further hallucinations for him.
BOYD YOUNG: And then did you get another call on May the 22nd during the trial?
DONNA MADDOX: I did.
BOYD YOUNG: And who called you on the 22nd?
DONNA MADDOX: Officer Salis, (phonetic), called me at 7:00 o'clock in the morning.
BOYD YOUNG: And what did he tell you and what did you do in response to that?
DONNA MADDOX: He was concerned. He reported that the night before when he had -- Mr. Jones had come back from the trial, that when he dropped him off at the jail that night that they put him on suicide watch. He reported that Mr. Jones had not been sleeping and that he was very concerned about his mental state. That he wasn't the same. That he was more withdrawn, more quiet, and he had noticed some symptoms. So I came down here and evaluated him. He was having some symptoms, so I wanted to increase is medications again to a dose of 80 milligrams. So what started at that point is I called Dr. Woods at the Department of Corrections to figure out -- there was some concern about why his medication had been decreased and that he needed. And she told me directly that what had happened, when he was at where he was being held at Lee County and Kirkland to get his medicines, with Geodon you have to have 320 calories with that medicine or else it's not as effective.
So what they did in the Department of Corrections, they would give it to him with a teaspoon of peanut butter and he would take his medication at night. And what happened at Lee County, he was not getting his medications regularly, and there were nights when they were not giving him a snack. And so, he asked for tapering the medication because he wasn't able to take it as prescribed, and she noticed. She reported that she saw a slow decline in his functioning with him not being on that medication. The other problem that happened is the Prolixin he was on, which is a very good medication. She had to change that to another medicine. What happened in the United States, there was a shortage of Prolixin. So normally that's a very cheap drug. It's about five cent a pill. When it went up it was absorbent in cost. And so, the Department of Corrections couldn't afford that medication. Plus, there was even a shortage at our hospital.
We had to take all the patients off of Proxilin for a period of time. And so, he had -- she had started him on another antipsychotic called perphenazine, which it's an older one but it's very effective as well. So what happened is I asked to increase his medications to 80 milligrams. I got a call from the jail that night from the jail nurse. I had spoke with them earlier as well and they complied with that. I had to write a prescription because their psychiatric nurse practitioner was on vacation that week, so I wrote a prescription and they called in. My understanding was they raised his dose.
BOYD YOUNG: Did you -- I think you've already talked about this a little bit, but can you explain to the jury a little bit further about your consideration of whether or not this was drug induced psychosis and how you arrived at the conclusion that -- or what was your conclusion regarding that?
DONNA MADDOX: Sure. Drugs definitely played a part in it, as it does with many mental illness. If you look, one of our areas of training is called dual diagnosis. It is not uncommon at all. Many are people with major mental illness are using drugs. Some -- some are self-medicating. Some are just abusing drugs. That's very common in the mentally ill population. So I think the -- the synthetic marijuana definitely contributed to forming his symptoms, but he meets the criteria for schizophrenia. The criteria says for six months you have to have these symptoms. He's had them for five years without any drugs, and being medicated. So in my opinion, even though the substance has certainly contributed -- which it does many times. You can have somebody who's got a genetic predisposition to schizophrenia and they develop the symptoms when they're using marijuana, or they'll develop the symptoms under the guise of their drug. So it contributes, but it doesn't cause it.
BOYD YOUNG: Did you consider the possibility that he was faking or malingering?
DONNA MADDOX: Yes.
BOYD YOUNG: And what did you conclude with regard to that?
DONNA MADDOX: He under reports. If anything, he under reports symptoms. For example, the hallucinations that he would generally report, he would say they were just vague. Well, the reason they're vague is they say little things like get up now, move now. They're not anything contextually that -- you know, they're not telling him to go shoot the President. You know, if you heard a voice like that you would remember something like that. But they comment on things that he's doing. So they're -- they're -- the content of them is not something that's memorable. So if you asked him last week what did they say, if he didn't write them down he's not going to remember the content of them. He's never -- I saw him on the first visit. You can't malinger the -- he's so labile. He had a lot of emotion about -- I mean, screaming, crying, cursing. It was clear that he was responding to things.
What I see lasting now that I don't think he's faking -- so, for example, if you ask him what your illness is he can tell you all the symptoms, delusions, hallucinations. But just like every other schizophrenic patient I have, he lacks insight. He can't tell when he's having symptoms. So, for example, last week when I saw him, the other week, he was very paranoid. I've not seen him like that since probably his first visit. And when I went in to see him about his mental state he's like, "Who told you I was up all night singing Twinkle Twinkle Little Star?" Well, nobody told me that. Nobody told me that. And he goes, "I wasn't doing that." So when he's having his own symptoms he can't recognize them even though -- even though he can tell you what the symptoms are. And that's the way most patients are with schizophrenia. They know something's wrong with them, but when they're having the symptoms they're not able to identify those things. And so, in my opinion he's -- I've not seen him intentionally fake his symptoms. I've seen him under report and not tell everything that's going on with him. And so, I think what he's more consistent with is not being forthcoming with all the symptoms that he's having.
BOYD YOUNG: Does the South Carolina Department of Corrections medicate people just to pacify the population?
DONNA MADDOX: Oh, no. They've done studies -- epidemiological studies in the Department of Corrections. Thirty-three percent of women usually have mental illness in the Department of Corrections. Seventeen percent of males have mental illness in the Department of Corrections, generally across the United States. In South Carolina when we worked at the Department of Corrections, they were only identifying about eight to 10 percent of the males, so we were missing half the males that were mentally ill. And one of the reasons that happened is they're usually quiet. A lot of people with schizophrenia are not out there raising cain. They are in their cells. They don't go outside. So they don't always come to the attention of the mental health professionals unless you ask questions specifically or something happens. So they're under represented, first of all, in the South Carolina Department of Corrections. I gave that lecture.
We went there to the Department of Corrections to talk about those things to -- when Osmond was the Director. But what happens is -- so most of them are not getting attention. And there are so many people that are in need of mental health treatment. It certainly was not my practice to treat people that need it. When they came in, these clients were usually quite sick and they were in need of psychiatric treatment. You do have some. Every -- every hospital has them, every prison has them. You have a group of people that are drug-seeking. But people don't drug-seek for Geodon or perphenazine. Those are not the kinds of drugs you would want to be on. They sedate you. They -- they make your muscles feel heavy. They put you at risk for a permanent mood disorder called tardive dyskinesia. These are not the drugs that have any street value. You can't -- there's one antipsychotic called Seroquel you can sell in the prison and make $10 a pill because it helps people sleep. But all these other ones, they don't have those effects and they are not a drug that you would see prescribed to a drug-seeker.
BOYD YOUNG: Your Honor, at this time the Defense would offer for a Court's exhibit a copy of Dr. Maddox's report.
RICK HUBBARD: Your Honor, we object. She's testified with what's going on.
THE COURT: We've done that with all the experts. The reason the reports don't come in is she's right here. She can testify to everything she knows and be cross-examined. The report can't be cross-examined. She's here. So --
BOYD YOUNG: If I misspoke. I was offering it as a Court's exhibit at this time.
THE COURT: Oh, okay. Yeah, I'll accept it as a Court's exhibit.
RICK HUBBARD: And I don't have any problem with that.
THE COURT: Yeah, okay.
BOYD YOUNG: If I misspoke, I apologize. I meant to offer it as a Court's exhibit.
THE COURT: Okay. We've gone through this same scenario each time with the CV and the reports.
BOYD YOUNG: Yes, sir.
THE COURT: Perfect. So we're on the same page. I may have misunderstood. (Whereupon, Court's Exhibit number 120 was marked for identification.)
BOYD YOUNG: Thank you. Please answer any questions that the State may have.
DONNA MADDOX: Certainly.
CROSS-EXAMINATION By Mr. Hubbard:
RICK HUBBARD: Doctor, good to see you again.
DONNA MADDOX: You, too.
RICK HUBBARD: Now, you were hired in this case basically pretty much like you were in -- what case was that in 2014? Ricky Lee Blackwell, Spartanburg death penalty case with Mr. Young --
BOYD YOUNG: I would object.
DONNA MADDOX: No, that was a little bit different.
THE COURT: How she got hired. A It was different. In the Ricky Blackwell case it was a sentencing issue, and actually I -- you are correct in the sense I was treating him. I believe I was prescribing his -- Mr. Blackwell's medications. I might be wrong, Mr. Hubbard, but I think I was actually doing some of the prescribing. But I did -- yes, I was hired early on to oversee his treatment, and then I think I got called in the sentencing phase. It's sort of similar but I think I actually treated Mr. Blackwell.
RICK HUBBARD: You got called in the sentencing phase to offer a diagnosis?
DONNA MADDOX: Of depression. That's right.
RICK HUBBARD: So it's very similar?
DONNA MADDOX: Yes, actually it is. Yeah.
RICK HUBBARD: You say your first meeting was just a day after the Defendant gets to the Department of Corrections, on September 13th?
DONNA MADDOX: Yes, sir.
RICK HUBBARD: And you've reached a diagnosis of schizophrenia, continuous type, and an unspecified neuro-cognitive disorder --
DONNA MADDOX: Yes.
RICK HUBBARD: -- is that correct? Now, you've had the opportunity to review the reports by all the various experts, both by the Defendants and the Court appointed?
DONNA MADDOX: I think I reviewed most of them, yes. I put the ones in that I used in the report. But yes, I'm aware of kind of what both sides have been saying.
RICK HUBBARD: And although you make your own opinion, you definitely would consider what these other folks have said, they're observations, because they're professionals as well?
DONNA MADDOX: Sure.
RICK HUBBARD: And I think you would agree that sometimes experts disagree?
DONNA MADDOX: Sure. Even doctors disagree. Not only does experts, but in medicine sometimes you'll get second opinions. That's right.
RICK HUBBARD: So you mentioned Dr. Tora Brawley. You've done a lot of work with her in the past?
DONNA MADDOX: Yes.
RICK HUBBARD: Including on a number of death penalty cases?
DONNA MADDOX: Yes.
RICK HUBBARD: You've called her in to look at somebody because you think there's some neuro-cognitive deficits, so you want her to run tests. And you did that in this case?
DONNA MADDOX: That's correct. It depends. Sometimes I'll be allowed -- if I recommend neuro-psych testing I can recommend somebody, but sometimes it's the lawyers rule -- have someone else in mind. So if there's no one else I would recommend her because I know that she -- I trust her methodology.
RICK HUBBARD: Trust her methodology. She was brought into this case at your recommendation?
DONNA MADDOX: Yes.
RICK HUBBARD: She did testing that was back in -- when was that? April 19th of 2016.
DONNA MADDOX: I think so. I've got her report. I'll be glad to look at that.
RICK HUBBARD: Only testing you asked her to do was neuro-cognitive testing?
DONNA MADDOX: Yeah, that's what she does, neuropsychological testing. Neuropsychological testing, you can have an MRI that shows the structure of your brain, but it doesn't tell you what the brain is doing. So it's the gold standard. If you want to see how someone's brain is functioning, you want a neuropsychological testing. So that's her -- that's what she did her fellowship in. That's her speciality.
RICK HUBBARD: Sure. And it has since come to light that while she was doing that testing the Defendant was on 320 milligrams of Geodon --
DONNA MADDOX: Yes.
RICK HUBBARD: -- which I think you made a comment that you're not brave enough to prescribe that much to anyone, but Dr. Wood was?
DONNA MADDOX: Yes.
RICK HUBBARD: And you're aware that the Defendant himself, when he later saw Dr. Kruse for the same type of testing, said I couldn't think straight because of all the Geodon?
DONNA MADDOX: Yes, I'm aware he said that.
RICK HUBBARD: And he was so smart, so alert, he was able to tell the actual dosage, the dosage per pound, and a breakdown, almost like a doctor talking about Geodon?
DONNA MADDOX: I would not be surprised. I wasn't aware that he knew all the breakdowns with me. Some of the times he didn't know the doses. He always knew his medication, but there was sometimes where he may not have known the exact doses. But some of the times when I saw him his medications were being titrated.
RICK HUBBARD: And Dr. Brawley concluded with that testing that he had a low IQ, about an 89, 87, somewhere in that range, and he scored the first percentile on a whole host of tests testing various parts of his brain, correct?
DONNA MADDOX: Yes, that's fair.
RICK HUBBARD: And that's the lowest you get. I mean, anything lower you're pretty much dead, agree?
DONNA MADDOX: No.
RICK HUBBARD: What percentile is as low as you get?
DONNA MADDOX: It's as low as you can go. But believe it or not, even with one percentile, a lot of demented patients may show up and they can -- they can still -- they can do some rudimentary things. But yes, that's as low as you can go. If you line 100 people up, he would be at the back of the line.
RICK HUBBARD: In February of this year when Dr. Kruse tested him and gave him a similar array of tests, he was in the 70, 80 and even 90 percentile. A huge difference, correct?
DONNA MADDOX: Sure.
RICK HUBBARD: I noticed in your report you say that you considered and rely on Dr. Brawley.
DONNA MADDOX: Absolutely.
RICK HUBBARD: That her testing is what you relied on. You didn't even mention, even when you -- let's specify. The first report we got from you, you went and you updated it, because the first one we got was in March 19th of this year, and you've got an update from last month, May 29th.
DONNA MADDOX: That's correct, because I saw him the two times and I felt that would be unfair to you not to memorialize what my findings were. So I updated it so you all would have my most current observations.
RICK HUBBARD: And in updating it you had Dr. Kruse's information and you discounted it because that's nowhere -- it did not affect your opinion on his cognitive issues at all. You made no change.
DONNA MADDOX: That's correct.
RICK HUBBARD: You went with Dr. Brawley over Kruse as far as the assessment?
DONNA MADDOX: No, not at all. That's not -- that's not how it works. To diagnose -- first of all, there's three different kinds of cognitive disorders if you diagnose if you look in our book. One is called a major neuro-cognitive disorder, and that means you think somebody has dementia. That means it's very serious. They have impairments, for whatever the cost. There's about eight different causes of dementia. But when you diagnose a major neuro-cognitive deficit, you think that they have dementia. There's also a diagnosis called minor neuro-cognitive impairment, which means they have some impairments, usually one global area of cognitive function, sometimes more than one, but for dementia you have to have four. I made the lowest diagnosis there is, and unspecified means that I know that there's something wrong with his cognition. But it's not -- I'm not saying that it's at the level that it's a dementia or a severe impairment. But I'm just recognizing that there's been some cognitive impairment. You can have that level of cognitive impairment from schizophrenia. He could have that level of cognitive impairment from an abnormal -- you know, from a head injury. But what happened in the DSM-5, they want us to base it -- psychiatrists, you have to have a test or some kind of basis for that. I could have based it on the MRI. But at that time it doesn't matter that he scored better when Dr. Kruse saw him. It mattered that he had the cognitive deficit when he was tested by Dr. Brawley. And so, that -- that diagnosis attribute -- it doesn't matter. If he's schizophrenic and he's on 320 milligrams of Geodon, he's got a cognitive deficit.
RICK HUBBARD: Well, Doctor, that brings in a whole issue of its harder to diagnose schizophrenia when somebody's high on drugs. And that would be the issue you'd be dealing with, with that same test. If he's on 320 milligrams of Geodon, which is supposed to help with schizophrenia, how in the world do you get a schizophrenia diagnosis when somebody is that high? How do you know that the effects you're seeing aren't from the drugs?
DONNA MADDOX: That's a great question. And that really is, that's the question. What I did -- I'm lucky because I've had the five year sense. And so, I base my diagnosis on the fact that he -- even on medicine -- we know he's not using the drugs anymore, and five years later, in my opinion, he still meets the criteria. He still has symptoms.
RICK HUBBARD: Right. But the last -- the most recent cognitive test was this year and he did great.
DONNA MADDOX: Sure.
RICK HUBBARD: Even if he had schizophrenia, he did great.
DONNA MADDOX: Sure.
RICK HUBBARD: Right?
DONNA MADDOX: Sure.
RICK HUBBARD: And that's not in your report.
DONNA MADDOX: But he still meets the criteria for a neuro-cognitive disorder. Whether he did well or not, he still has impairments. And it could -- I don't know what it's from. It could have been the head injury, it could be drugs. It could be the medication side-effects. All I'm saying is there's something there. I don't know the cause. There's too many questions about it.
RICK HUBBARD: With schizophrenia you diagnosed -- you made a diagnosis of that. Now, schizophrenia, you would agree with me, is one of the most debilitating mental illnesses we know?
DONNA MADDOX: It can be, yes. For people with schizophrenia we call it the rule of threes. Thirty percent get better, thirty percent stay the same, and thirty percent have a continuing deteriorating course even with medication.
RICK HUBBARD: They get better without medication?
DONNA MADDOX: No. No. You must have medications for this illness.
RICK HUBBARD: That's the point.
DONNA MADDOX: Yes.
RICK HUBBARD: It's a debilitating disease. If it's not treated it just gets worse and worse?
DONNA MADDOX: Absolutely. And even some people that do get medication, they get worse, too.
RICK HUBBARD: People with schizophrenia have commonly experienced social and functional deficits such as social -- difficulty obtaining and maintaining employment, challenges to independent living that significantly impact your quality of life?
DONNA MADDOX: Yes.
RICK HUBBARD: Now, up until really the day of this murder, or these murders, he was working at Intel, had just gotten a promotion four months before.
DONNA MADDOX: Yes.
RICK HUBBARD: Was living, maintaining his life, sending his kids to school, dressing his kids, doing all the things that you're supposed to do, and going to work at a very high stress --
DONNA MADDOX: Yes.
RICK HUBBARD: -- really challenging job? He was doing it?
DONNA MADDOX: Yes.
RICK HUBBARD: And you mentioned that in diagnosing him he's kind of an atypical patient if he, in fact, had schizophrenia, because most of them get it in their late teens, early 20s, right?
DONNA MADDOX: Yes.
RICK HUBBARD: So he would be atypical if, in fact, he has this disease?
DONNA MADDOX: Yes. In my opinion, he's -- he reported in his history he had had some hallucinations, but I considered that to be his first psychotic break, that's correct. And I believe he would have been in his 30s, which is much older than you would normally see.
RICK HUBBARD: Usually when there's an onset of psychosis it's proceeded by a month, or even years of prior disturbances?
DONNA MADDOX: Yes, it's called a prodome. Sometimes -- and it's just like any other illness. Before your hypertension gets diagnosed you might not be feeling well for a few weeks. Something doesn't feel right. You can tell something's wrong with you and it's not until somebody measures your blood pressure and you realize what your symptom is. So that's right, normally there's a prodrome. You can see a slow deterioration in function. Some people it's really fast, and some people it's insidious.
RICK HUBBARD: So there should be a very physical history of a slow breakdown of this man over a period of time, both at his job, in his relations, and just how he lived on a daily basis, absent drugs?
DONNA MADDOX: Correct.
RICK HUBBARD: And you think you see that with Mr. Jones?
DONNA MADDOX: Well, my diagnosis is based on my observations from 2014 through now. But yes, I would beg to differ. He was getting in trouble with DSS. He lost his marriage. So he had a deterioration in his personal relationships, and he was getting into some legal situations with his children, which had not -- as far as I know, had not been his history. So I would say that there was some decline.
RICK HUBBARD: A breakdown of his marriage. While he was married, that was actually the most stable period of his life. Was it nine years, no drugs, no alcohol, no arrests.
DONNA MADDOX: That's correct. And I don't think DSS had been called during that period of time while they were together.
RICK HUBBARD: So that's when it was -- DSS was involved.
DONNA MADDOX: Right.
RICK HUBBARD: It was because how he controlled that family --
DONNA MADDOX: Right.
RICK HUBBARD: -- and how he ran that house?
DONNA MADDOX: Correct.
RICK HUBBARD: But he was continuing to do well at work, make money?
DONNA MADDOX: Yes.
RICK HUBBARD: Get promotions?
DONNA MADDOX: Yes.
RICK HUBBARD: He was high functioning?
DONNA MADDOX: Yes.
RICK HUBBARD: It didn't affect his daily life?
DONNA MADDOX: Not that I -- not his daily function in terms of vocation and earning a living and finances. That's correct.
RICK HUBBARD: Now, again, we go back to a number of experts and look at the same information, the same case. And experts differ?
DONNA MADDOX: Sure.
RICK HUBBARD: Obviously you know Dr. Frierson. You've known him for many years?
DONNA MADDOX: Yes, and respect him greatly. We were colleagues at USC for a number of years. He was a year ahead of me in medical school. So we've known each other since 1985.
RICK HUBBARD: He's exceptionally well thought of.
DONNA MADDOX: Oh, absolutely. Certainly by me.
RICK HUBBARD: And we've heard from Dr. Dorney out of Georgia.
DONNA MADDOX: Yeah, I don't know her.
RICK HUBBARD: I didn't either. And then, of course, Dr. Wood --
DONNA MADDOX: Yes.
RICK HUBBARD: -- from SCDC.
DONNA MADDOX: And I hold her in very high esteem as well.
RICK HUBBARD: None of them came up with the assessment of schizophrenia. Frierson obviously said it's not there. Dr. Dorney has schizoaffective, and then Dr. Wood, she changed her diagnosis multiple times. One time schizoaffective, then maybe she's got undiagnosed psychosis. She's all over the place. But you would agree experts can disagree?
DONNA MADDOX: Yes. But I would like to -- if I can answer that. Schizoaffective disorder and schizophrenia, if you read the DSM, you can change that diagnosis. I've done that. I had a certain patient of mine, there was a period of time she was very manic. I added a mood stabilizer through an antipsychotic, and then she remained psychotic. So you -- actually, the DSM, you can see that diagnosis change. So what happens is, if you think somebody has schizoaffective disorder, which is schizophrenia plus a mood disorder, if you treat the mood disorder and they remain psychotic for a period of -- it's predominantly psychosis, you can change a diagnosis back. So changing that is not necessarily meaning that peoples' opinions differ. It means the patient has changed over time. They're clinical symptoms. So I think what's more important is the fact that, I think, every one of the experts has agreed he's been psychotic. I think people are just not -- they're attributing different causes for psychosis.
RICK HUBBARD: To the extent it was Dr. Frierson, there was no organic psychotic disorder that he found, it was simply when he chose to take drugs and got high, right?
DONNA MADDOX: I wouldn't -- I think he diagnosed a synthetic cannabis induced psychosis.
RICK HUBBARD: And then as far as what his job was, he didn't say he was psychotic that night? You're aware of that? He was paranoid. Didn't reach the level of psychosis.
DONNA MADDOX: Okay. I would not -- I trust you and would not disagree with that.
RICK HUBBARD: Now, schizoaffective, typically to get to that you have to rule out schizophrenia as being a sole independent stand alone mental health issue; right?
DONNA MADDOX: Right.
RICK HUBBARD: So --
DONNA MADDOX: But I can show you -- they're interchangeable.
RICK HUBBARD: Sure.
DONNA MADDOX: You can -- clinically you can change them. So say, for example, when I saw Mr. Jones he was much more psychotic than him having any mental disorder. When I first saw him I didn't pick up any depression in him. He was psychotic. So when I saw him the following year and he was on an antidepressant I was a little surprised. But, of course, I had not seen him in a year. So their presentations, you can get comorbid illnesses with schizophrenia. And so, that's not -- it's just the course of the illness. People have different -- different outcomes or different prognoses.
RICK HUBBARD: Both you and Dr. Frierson would agree that schizoaffective just wasn't in this case, right?
DONNA MADDOX: I have not seen it. That's why each of the data points -- I've got one, two, three, four, five, six data points for him since 2014. I have not in any of those evaluations appreciated a significant mood component. Now, also keep in mind, he's been on antidepressants. So maybe having not been on those I would see more, but I have not appreciated -- appreciated mood symptoms in him.
RICK HUBBARD: He had not sustained euphoria or manic episodes?
DONNA MADDOX: No. In my opinion, not.
RICK HUBBARD: No significant symptoms of depression outside of his separation force?
DONNA MADDOX: He's had a few symptoms, but not enough to meet the criteria for a major mood disorder, in my opinion.
RICK HUBBARD: And he would often describe his mood, I guess, as I'm happy one minute, I'm sad the next. That's clearly not bipolar?
DONNA MADDOX: No. In my opinion, I do not diagnose him with bipolar disorder.
RICK HUBBARD: But it would all show a trait, and you would agree with this, wouldn't you, of borderline?
DONNA MADDOX: Sure, it could. Borderline personality disorder -- personality disorders are different from mental illness. They don't -- some of them, they don't usually have genetic components. It's the way that you adapt to the world. And usually you have to have things that go on in your childhood, in your upbringing. So people with borderline personality disorders, I didn't diagnose him with that, but they'll have rapid shifts in their mood. In their mood, based on things -- maybe they're -- maybe you're really happy, and then all of a sudden you start thinking badly about yourself and your mood decreases. So it's not uncommon for them to have mood shifts all during the day. You can also get a psychosis with that kind of personality disorder if they're under enough stress. But certainly you can cause someone with frequent suicidal ideation, intense unstable relationships, reckless behavior and frequent mood shifts, they would meet the criteria of borderline personality.
RICK HUBBARD: Borderline would include also things like frantic efforts to avoid real or imagined abandonment?
DONNA MADDOX: Oh, absolutely. Those people that, if you break up with them, they might stalk you. They're trying to get you back. They could resort to all kinds of behaviors to maintain a relationship.
RICK HUBBARD: Chronic feelings of emptiness or no one loves me?
DONNA MADDOX: The emptiness, I mean, is emptiness. I don't think it's no one loves me. It's just they don't feel anything. They're just empty.
RICK HUBBARD: Unlovable?
DONNA MADDOX: They can believe that at times, sure.
RICK HUBBARD: Which is, of course, going back to Frierson and Kruse. They both found elements of that, or traits of that?
DONNA MADDOX: I would not argue with that. It's certainly -- that personality trait is most common in people that have been abused or have been exposed to abuse. You get that disorder from witnessing trauma or being a victim of trauma, and my understanding that he had some traumatic experiences in childhood. So that would certainly be consistent with his history.
RICK HUBBARD: Let's talk a little bit about his history, because there's never a point in time in his history where DSS or some from of social services had to enter the house and threaten his dad and his parents or his grandmother, they were going to take him and remove him from the home?
DONNA MADDOX: That's correct.
RICK HUBBARD: Although there is law enforcement out there on multiple occasions, no one ever said this child's in danger?
DONNA MADDOX: Correct.
RICK HUBBARD: There was never a time when he as a child went to school and the school said, oh, my gosh, this child's not eating?
DONNA MADDOX: That's right.
RICK HUBBARD: He's being underfed?
DONNA MADDOX: Not that I'm aware of.
RICK HUBBARD: He never got to school with, say, a piece of bread and some grapes?
DONNA MADDOX: Not that I'm aware of.
RICK HUBBARD: He was being taken care of. There was never a time when anybody ever made an allegation he was being physically abused?
DONNA MADDOX: Not that I'm aware of.
RICK HUBBARD: In fact, he absolutely adamantly denies any physical abuse growing up?
DONNA MADDOX: He certainly minimized, I think, some of his traumas, but that's correct.
RICK HUBBARD: He never came to school with bruises on his arms, his face, his neck where the school said, oh, my gosh, we've got to look into this?
DONNA MADDOX: Not that I'm aware of. I didn't see any reports indicating that.
RICK HUBBARD: Safe to say we would know by now, wouldn't we?
DONNA MADDOX: Sure. Sure.
RICK HUBBARD: So it's not there?
DONNA MADDOX: Well, it's not reported, or it's not like -- I can't answer that.
RICK HUBBARD: And regardless of what kind of life he had growing up, his father always tried to be there, go to his events, do all those things that dads are supposed to do. He showed up for big events?
DONNA MADDOX: I don't have that specific knowledge because I've just kind of been overseeing his treatment, but I wouldn't disagree with you. If you say it, I'm sure it's been presumed.
RICK HUBBARD: He didn't fail to show up for, like, sports events or, say, a graduation?
DONNA MADDOX: No. I'm going to take your word for it.
RICK HUBBARD: Now, you never ordered or asked for any type of testing from a psychologist, a neuropsychologist for -- to see if he had any form of psychosis or personality disorder, correct?
DONNA MADDOX: I didn't need one. I've been doing this for 29 years. I'm pretty good at picking psychotic patients, making the diagnosis. You would use that testing in someone if you weren't sure of their diagnosis, but I didn't feel that was indicated. I certainly would have if I needed it.
RICK HUBBARD: But Frierson did?
DONNA MADDOX: Yes. But -- and that's different. He's -- he was doing the forensic evaluation. Had I been doing an evaluation for that purpose, I may have. But when you're clinically overseeing someone or following them along, his diagnosis was clear to me. I didn't need an extra test to help me figure that out.
RICK HUBBARD: If you want a forensic evaluation, first you have to basically do what you would say is a clinical evaluation. You have to see if he has a psychosis?
DONNA MADDOX: That's correct.
RICK HUBBARD: So that was step one, and that testing dealt with step one?
DONNA MADDOX: Yes, but I saw him psychotic. On September 2014 there is no question. I was absolutely certain. With my observations, clinical training and experience, there was no question in my mind he was psychotic. The issue was what was the cause.
RICK HUBBARD: And having had available Dr. Kruse's scientific objective data saying that there was no psychosis but signs of malingering as to the testing specifically for psychosis, you discounted that because you felt comfortable with your opinion?
DONNA MADDOX: I discounted that because it was five years later. I saw him closer to decline than on those. I saw him at that point. It was -- I had no doubt -- if she says he's malingering, perhaps he was malingering, but that was five years later. When I saw him he was not malingering.
RICK HUBBARD: But, Doctor, if he had schizophrenia and you saw him in 2014, then he has schizophrenia now?
DONNA MADDOX: Yes. In my opinion he does.
RICK HUBBARD: So what does five years later matter?
DONNA MADDOX: Five years later he doesn't have acute positive symptoms. He's got hallucinations. He doesn't have the delusions anymore. He's got the negative symptoms you see in schizophrenia and the hallucinations. But he's on medication. He's been medicated now for five years, so there's a big difference.
RICK HUBBARD: What's his delusion?
DONNA MADDOX: The delusion involved his son.
RICK HUBBARD: And that's gone now because the son's gone?
DONNA MADDOX: He still had it the third -- the third visit. He still believed that the -- his son was meaning him harm.
RICK HUBBARD: His son was doing what?
DONNA MADDOX: The intent. The son had blown out the electrical outlets to perhaps harm him to -- in retaliation for them divorcing.
RICK HUBBARD: Did you not listen to a phone call he had with his dad, his aunt, just -- it was November of 2014 where he doesn't mention any of that. He says the entire event was because Nahtahn was a catalyst. Nahtahn wanted to go back to his mom. He lost it. Basically, between the lines, he killed his son for that reason, and it was Amber's fault. Not his son's fault. You can put this one on Amber. If she had been here instead of next door bopping the boy next door, this wouldn't have happened. Are you aware of that phone call?
DONNA MADDOX: Yes. But that's still -- in my opinion, that's still months later after medication. At the time I saw him he had -- I think he'd gotten one does of medication. And so, I have that data point before anyone else saw him and before he had been medicated and he was very clear at that time. He was very focused on his son's behavior and was very focused on the electrical sockets being burned out and believed that this child somehow was responsible for wiring the house to try to kill him, which is absolutely not true. So I consider that a delusion.
RICK HUBBARD: While he was at SCDC and he was complaining of hallucinations, Tishiro Inabinet--
DONNA MADDOX: Yes.
RICK HUBBARD: -- were those folks that I think you said looked at what Tishiro Inabinet had to say.
DONNA MADDOX: Yes. He was his case manager as soon as he went into Supermax. And so, I met with -- the day that I met Mr. Jones, I consoled with Mr. Inabinet.
RICK HUBBARD: Part of his job was to keep his eyes on Mr. Jones to see how he was acting?
DONNA MADDOX: Absolutely, yes.
RICK HUBBARD: And he said although he complained of hearing voices, he was never observed to be responding to internal stimuli as if he was hallucinating. He was never disorganized in his thinking or behavior.
DONNA MADDOX: I agree with both of those. I have not seen him actively hallucinating and, no, I agree with both of those. And even when he was psychotic acutely, his affect was very labile, but he was generally able to stay on task.
RICK HUBBARD: Dr. Wood basically said she accepted he was psychotic because he kept talking about he was hallucinating, but he never displayed disorganized thinking or behavior while he was at SCDC?
DONNA MADDOX: I wouldn't disagree with that. That would be consistent with my observations as well.
RICK HUBBARD: Basically you've had an opportunity to observe him, and a lot of which you've based your opinion on are your observations with him?
DONNA MADDOX: Yes.
RICK HUBBARD: It was also based on his self-report. What he's telling you.
DONNA MADDOX: Certainly.
RICK HUBBARD: And that he's hearing voices or seeing things. And then you -- you address that when he -- when he says that?
DONNA MADDOX: Yes, I assess it.
RICK HUBBARD: May 8th, 2019, when you saw him, he was going through jury selection as you said, right?
DONNA MADDOX: Yes.
RICK HUBBARD: So you had upped his Geodon. He was getting nervous.
DONNA MADDOX: Yes.
RICK HUBBARD: May 22nd of this year, this happened to be the day, I believe, or right at the time we had Dave Mackey from the FBI testify, Amber Kyzer testify. I think we had Mike Phipps.
DONNA MADDOX: Yes. That was a very emotional day in Court, yes.
RICK HUBBARD: And he wasn't suicidal, but he was demanding more Geodon?
DONNA MADDOX: That's correct.
RICK HUBBARD: And they put him in a -- basically what he called a skirt, a robe --
DONNA MADDOX: A turtle suit.
RICK HUBBARD: -- a turtle suit, and he was all upset because men don't wear dresses and skirts. Men wear pants. So he showed out?
DONNA MADDOX: That's fair to say. He certainly -- I think he stayed naked. He did not -- he refused to wear the turtle suit.
RICK HUBBARD: He asserted control?
DONNA MADDOX: I call it a preoccupation with religion and some of -- that I had not seen before. I actually considered that a symptom of his illness. And all the other interviews that I had, because I've never had him at that level, and he was very religiously preoccupied, talking about the clothes people are supposed to wear, and that wearing a turtle suit was against his religious belief. And I don't know any religious belief that would be consistent with that. I consider that a religious preoccupation that I have not seen in him in any of the other times I interviewed him. That's what concerned me, because that was a change in his thinking.
RICK HUBBARD: When you first saw him in September of 2014 that was seven days after Daily--
DONNA MADDOX: -- yes.
RICK HUBBARD: And you said he was psychotic?
DONNA MADDOX: Yes.
RICK HUBBARD: And then as to that jail call from November of 2014, based on what you're saying, that delusion about his son was still -- still going on?
DONNA MADDOX: All I can tell you is the data points I have, and he still had it later when I saw him. Now, I certainly -- your call would make you wonder whether he was being accurate in reporting it or not, and I can't say.
RICK HUBBARD: And that get's us down to, I guess, this point. He has lied about so many things at different times. You would not consider him for a minute to be an accurate historian?
DONNA MADDOX: No, not at all. And it depends on the context. Certainly there's people that have criminal charges. That's one of the things we're trained for. You know, they may fabricate symptoms to get out of punishments, or they may fabricate symptoms to be able to get financial rewards or things like that. Part of my whole private practice as an outpatient doctor at USC is I took care of Workers' Comp patients. And, you know, there's a lot of times there was malinger there because they were out of work and needed money. So yeah, no, you have to take those things into account.
RICK HUBBARD: As far as delusions, he's not having delusions anymore, is he?
DONNA MADDOX: No, not -- he certainly was paranoid the other week when I saw him, which also caused me to increase the medicine. Again, the -- you know, "Who said I was up all night singing Twinkle Twinkle Little Star," and he was upset about that. So he had some paranoia. But I don't think it was a delusion. I agree with you.
RICK HUBBARD: Well, reporting Twinkle Twinkle Little Star is not diagnostic schizophrenia? That's just being scared?
DONNA MADDOX: No, that's paranoid ideation.
RICK HUBBARD: Paranoia?
DONNA MADDOX: Yes.
RICK HUBBARD: So even Dr. Frierson says he suffers from a level of paranoia, most of it was drug induced. He's wanting more drugs, Geodon at that time.
DONNA MADDOX: Geodon is not a drug you ask for. It has no street value. It does not get you high. Geodon decreases your dopamine which makes you non-hallucinate. It does not -- any kind of medication that would have any street value at all.
RICK HUBBARD: It calms him down?
DONNA MADDOX: Right. It calms schizophrenics down.
RICK HUBBARD: And it's been used for other types of --
DONNA MADDOX: Psychosis.
RICK HUBBARD: And anger issues, things like that?
DONNA MADDOX: I don't do that, but I've seen other clinicians -- there's certainly -- there's clinicians of people who are having posttraumatic stress disorder and they have paranoid ideation from that, but it's in much lower doses. But yeah, you can use it for -- I don't use it for behavior. I use it for symptoms, but it can happen.
RICK HUBBARD: Bottom line as far as delusions is concerned, he's not having -- you would say it's because he's being properly medicated?
DONNA MADDOX: Yes. And he's not -- and he's not doing drugs. And he's not using synthetic marijuana. Both of those matter.
RICK HUBBARD: But it's also true that the delusion he complained about, that his little boy was conniving, going to hurt him trying to get back to mom, that little boy's gone, so there's no one to be delusional about?
DONNA MADDOX: Yes and no. Sometimes it doesn't work that -- I've seen -- certainly seen cases where the person's death, that the patient can continue to have delusions. He doesn't. So I don't -- I would say it's because he's medicated and he's not using drugs.
RICK HUBBARD: Well, when he killed his son and his other children, he was just taking care of the matter himself?
DONNA MADDOX: I'm sorry?
RICK HUBBARD: He was just taking care of the matter himself?
DONNA MADDOX: He certainly took it into his own hands.
RICK HUBBARD: Going back -- I see in your report, this goes to him being a reliable historian. You mentioned that Eli had threatened to cut his mother up and feed her to the dog?
DONNA MADDOX: Yes.
RICK HUBBARD: Do you realize that he ended up saying later--
DONNA MADDOX: -- I would not be surprised. Can you tell me what date that was.
RICK HUBBARD: It's in your report.
DONNA MADDOX: Yes.
RICK HUBBARD: It's on page two of your report.
DONNA MADDOX: Thank you.
RICK HUBBARD: Thank you, Dr. Maddox.
DONNA MADDOX: You are very welcome.
THE COURT: Mr. Young.
REDIRECT EXAMINATION By Mr. Young:
BOYD YOUNG: Dr. Maddox, have you ever been hired by Dr. Hubbard's office?
DONNA MADDOX: I have.
BOYD YOUNG: Have you been hired by Mr. Hubbard's office in a case in the case of Clinton Northcutt?
DONNA MADDOX: Yes, but Mr. Donny Myers was the Solicitor then. I believe he was -- I think it was Mr. Myers, and Deyton Riddle who hired me on that case.
BOYD YOUNG: That was a death penalty case here in Lexington?
DONNA MADDOX: It was.
BOYD YOUNG: And that was a case that you were retained and worked for the State in that case?
DONNA MADDOX: Yes.
BOYD YOUNG: Thank you, Mr. Maddox. That's all I have.
DONNA MADDOX: Thank you.
RICK HUBBARD: No more questions.
THE COURT: We're due for a break. Head to the jury room. Don't talk about the case.
(Whereupon, the jury was excused from the courtroom.)
THE COURT: We'll stand at ease for a few minutes.