AUGUSTA, Maine — A psychiatric nurse practitioner who has treated Leroy Smith III since he was charged with murder in the May 2014 death of his father told a judge Wednesday that even if the court ruled that Smith could be forcibly medicated, he likely would still have delusions, although he would be better able to manage them.
Smith, 26, is accused of killing and dismembering 56-year-old Leroy Smith II at their Gardiner apartment in May 2014. He then allegedly placed the remains in a wooded area along a dirt road in Richmond.
After hearing arguments about a motion by the state to force Leroy Smith III to take antipsychotic medication to see if he can become competent to stand trial, Justice Donald Marden said he would accept written reports from Assistant Attorney General Deborah Cashman and Smith’s defense attorneys, Pamela Ames and Scott Hess. Hess said he expects a ruling within two weeks.
In January, Marden found Smith not competent to stand trial after a forensic expert testified that Smith likely suffers from schizophrenia, paranoid schizophrenia or a delusional disorder.
On Wednesday, Smith, who has in the past claimed to be God and spoken of conspiracies involving the Hells Angels, the Ku Klux Klan, and the bands Phish and Slayer, appeared in court with a shaved head, mustache and goatee. He sat silently and almost motionless during the hours-long hearing in the Capital Judicial Center, nodding only when psychiatric nurse practitioner Miriam Davidson told the court that Smith believes he does not have a mental illness and is being held unjustly.
Hess argued that there is not enough evidence of a “substantial likelihood” — language from a new statute that allows the state to force individuals to take medication in certain instances — that antipsychotics would make Smith competent to stand trial, or that the side effects of those medications would not interfere with his ability to assist his attorneys with his defense.
“They’re not sure these medications are going to work,” Hess said in closing arguments. “They think they will, but they have to try a number of medications” to see what works.
Davidson, who has worked with Smith since he arrived at Riverview in June 2014, said she diagnosed Smith with delusional disorder — in which the only symptom is typically the delusion itself — but has not ruled out schizophrenia. According to Davidson, delusional disorder does not respond as well to medication as schizophrenia.
Although Smith told Riverview staff that he was previously hospitalized three times in Massachusetts and was given antipsychotic medications — which he said were not helpful — he refused to authorize release of those medical records to attorneys or medical personnel in Maine, Davidson said.
In response to questions by both the prosecution and defense, Davidson said she was confident of a “substantial likelihood” that an antipsychotic medication could restore Smith to competency.
The drugs would not work immediately, and might not eliminate the delusions completely, because “many people don’t ever see a full remittance,” but they could make the delusions “less intrusive” and allow Smith to make rational decisions, she said.
Instead of potentially interfering with his ability to react to events at the trial, she said, “I believe it would enhance his ability to react.” But without them, the delusions are likely to continue, she said.
Also on Wednesday, forensic psychologist Peter Donnelly told the court that he concurred with a previous diagnosis of delusional disorder and said that while Smith was intelligent and cooperative during their meeting and understood the charges against him, he expressed “oddities of thought,” and at one point spontaneously made comments about the delusions noted by Davidson.
“It became clear to me that he doesn’t have the ability to maintain rational thought and that his ability to assist in his defense would be compromised,” Donnelly said.
Smith has refused antipsychotic medications while in custody except on three occasions, including a 10-day period during which he voluntarily took Seroquel because it also is used to treat sleep disorders, and two “psychiatric emergencies” — one last month in which he reportedly punched an employee in the face — that prompted staff to inject two different atypical antipsychotics, Zyprexa and Haldol, to ensure his safety and that of those around him.
Davidson said that while Smith was taking Seroquel, “he was a little more approachable and more able to talk and express his concerns.” But she said he stopped the medication because he felt it wasn’t helping him sleep.
Ames said Tuesday that Smith discontinued the medication because of side effects.
“If they dope him up so completely so that he can’t think at all and he’s just a zombie, it may help his delusions, but it’s not going to help his defense team in preparing him for trial,” Ames said Tuesday.
But in closing, Cashman said the side effects noted were “substantially unlikely” to cause side effects that could impede his ability to assist his attorneys.
In response to questions by Hess, Davidson acknowledged that antipsychitocs are sedating, and that older-generation antipsychotics such as Haldol can cause permanent movement disorders, while newer atypical antipsychotics such as Zypexa can cause metabolic side effects such as weight gain and diabetes. But she said close monitoring would avoid this.
Marden said that because the case is the first under the new law, he would accept findings of fact and analysis from the attorneys before issuing his decision.
If Smith is found not competent to stand trial, he will return to Riverview. If a judge determines he is not likely to become competent for a year, the murder charge would be dismissed and Smith would be civilly committed to Riverview in custody of the commissioner of the Maine Department of Health and Human Services, and he could only be released by successfully petitioning the commissioner to release him.