Competency Report

January 12, 2016

Honorable John Wayne, Judge

County Court
123 Main Street
Wayne, OH 12345
RE: John Smith
CASE NUMBER: CR-2015-12-345X
Competency Evaluation

Dear Judge Wayne:

John Smith is a twenty-four year old, single Caucasian male who was referred by the court for a
Competency to Stand Trial evaluation pursuant to Ohio Revised Code (O.R.C.) Section
2945.371(G)(3). He is currently charged with assault on a peace officer, a felony of the 4th
degree, and obstructing official business, a felony of the 5th degree, for an incident that
allegedly occurred on or about October 23, 2015.

Dr. Fred Flintstone interviewed Mr. Smith at the Wayne County Jail on December 28, 2015, for
approximately 115 minutes. Mr. Smith participated in psychological testing with Dr. Flintstone for
an additional 105 minutes. He was administered the Test of Memory Malingering (TOMM) and
Wechsler Adult Intelligence Scale, fourth edition (WAIS-IV) on that date.

Prior to the commencement of this interview and psychological testing, Mr. Smith was advised
of the nature and purpose of the evaluation, specifically that the court had requested an opinion
about his current mental condition, his capacity to understand the legal proceedings against
him, and his capacity to assist counsel in his own defense. Mr. Smith was informed that the
resulting report was not confidential and that information obtained could be included in the
report that would be submitted to the Court. He was aware this information was not related to
treatment, but rather for his current criminal case. Mr. Smith was provided this information both
orally and in a written format. He stated that he understood the information provided to him,
including the limits of confidentiality and his rights concerning the evaluation.

SOURCES OF INFORMATION:

1. Wayne County Court of Common Pleas, Journal Entries ordering the present evaluation,
dated December 7, 2015.
2. Wayne County Court of Common Pleas, Indictment, dated November 1, 2015.
3. Health Medical Center, medical records, from January 22, 2014, to October 4, 2015.
4. Wayne County Sheriff’s Department, Ohio Uniform Incident Report dated October 23,
2015; Confidential Investigation dated October 23, 2015; and Action Response Sheet
dated October 23, 2015.
5. General Medical Center, medical records, dated October 23, 2015.
6. Wayne County Jail, medical records, from October 21, 2015, to December 13, 2015.
7. North Hospital, medical records, from October 4, 2015, to October 11, 2015.

SOCIAL HISTORY: Mr. Smith was born in Wayne, Ohio, on January 1, 1992. His parents
divorced when he was approximately two years old due to domestic violence in their
relationship. He reportedly had contact with his father once per year after that time. His father
never remarried. When Mr. Smith was about five, his mother remarried Craig Jones, a factory
worker. They later divorced for unknown reasons when Mr. Smith was in eighth grade. Mr.

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Smith reported that his biological father had legal involvement for failure to pay child support,
but he denied any other legal problems with his mother and stepfather. He also denied any
drug, alcohol, or mental health issues for his mother, father, and stepfather.

Mr. Smith has a total of seven siblings: two sisters from his parent’s marriage, one maternal
half-sister and one maternal half-brother, and one paternal half-sister and two paternal half-
brothers. He classified himself in the middle of the birth order. Mr. Smith was raised by his
mother and he reported having a “cool” relationship with her and his stepfather. However, he
stated, “I was running around a lot” and “I used to get whoopins a lot because I be hard to find.”
As a result, his mother “put me on punishment” or “whooped me” with “a little belt” because “I
was bad…I admit it. I was taking stuff, fighting, getting into it with teachers, stealing clothes…”
Mr. Smith denied any childhood history of physical or sexual abuse. He also denied any history
of shoplifting, fire setting, cruelty toward animals, inappropriate sexual behavior, or vandalism.
Mr. Smith reported that he was in a gang during adolescence, but he left it in 2013 “when my
father told me they was being watched” and “everybody was in jail.” He indicated that as a result
of leaving the gang, “I got jumped and fought,” but he denied any more serious retaliation.

When Mr. Smith was 16, his mother “filed me unruly,” and he moved out of her residence to live
with his grandmother. He indicated that he “never stayed out of the way of trouble” when it
presented itself to him. When asked how many physical altercations he had been involved in
during his lifetime, he stated, “I can’t even count it.” Mr. Smith stated that his most serious
altercation was “when I got shot” in December 2013 after drinking alcohol at a bar and getting
into a fight with a man who shot him in the back. At that time of his arrest in the instant offense,
Mr. Smith had relocated to the Burbank, Ohio, area and was homeless.

EDUCATION HISTORY: Mr. Smith reported that he attended Wayne Public Schools and that
he attended Roosevelt High School. He stopped attending school after completing the ninth
grade. He reportedly was in “alternative classes for all the kids that really be crazy,” which he
affirmed were Severe Behavior Handicap (SBH) classes. He was unsure if he was ever
diagnosed with a learning disability, but added that it is “hard for me to concentrate with a lot of
people around.” Mr. Smith indicated that his first suspension occurred in the sixth grade for
“cutting class,” and he was unable to estimate his total number of suspensions because they
were too numerous. Mr. Smith indicated that he was expelled from high school due to his
membership in a gang. He subsequently attended an alternative school until he was expelled for
“getting in trouble” and “messing with the chicks, cutting class.” Mr. Smith then attended another
alternative school, the name of which he could not recall, until he was expelled for being “about
to fight on my first day.” He left school at that time.

Mr. Smith reported that he attended GED classes offered at Wayne Community College. He
stated that he once attempted to take the GED test, but did not finish it because he had taken
one Ecstasy pill and “I was too jittery.” Police officers subsequently escorted him out of the
building. He has not completed a GED at this time.

EMPLOYMENT AND MILITARY HISTORY: Mr. Smith denied any employment or military
history, stating, “I ain’t really had no pay check job” because “when I caught that dope case, I
was on the run for three years.” He acknowledged selling drugs from ages 13 to 24. He reported
that he has never received Supplemental Security Income (SSI) because “they denied me.”

RELATIONSHIP HISTORY: Mr. Smith denied ever being married or having any children. He
also denied any long-term romantic relationships, indicating that his romantic relationships have
primarily consisted of brief sexual encounters.

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SUBSTANCE USE HISTORY: Mr. Smith reported that he first used alcohol at age 17 and that
since he usually consumed one bottle of wine or brandy three times per month. He denied any
period of more frequent alcohol use. He stated that he last used alcohol approximately three
months ago when he consumed “a couple” 22-ounce beers. Mr. Smith denied developing any
symptoms of tolerance or withdrawal from alcohol or any difficulty controlling his alcohol use.
However, he acknowledged that his alcohol consumption caused him problems because “I got a
tendency of attacking” and becoming violent when he drinks. Those behaviors have led to him
being “caught up in fighting,” including being “stabbed” and “shot.”

Mr. Smith reported that he began using marijuana at approximately age 12 and used it daily
between ages 18 and 19. Since that time, he decreased his marijuana use to once per month
because he concluded that it was “messing with my mind.” He stated that he last used
marijuana two months ago. Mr. Smith acknowledged that he had previously used “fake”
marijuana, but “it didn’t really do nothing” for him. He denied developing any symptoms of
tolerance or withdrawal from his marijuana use or any difficulty controlling his marijuana use.
However, he reported that “it just had me paranoid” and “stuck,” which he described as being
unmotivated.

Mr. Smith reported that he began using Ecstasy at age 23 “whenever I go out with my dude.”
However, when asked to quantify his use of that substance, he stated that he only used one-half
or one pill, three times total during his lifetime. Mr. Smith denied any other use of illicit
substances, abuse of over-the-counter medications, use of inhalants, abuse of prescription
medications, or use of the substance known as bath salts.

LEGAL HISTORY: Mr. Smith reported that his only juvenile legal involvement consisted of
status offenses, including “unruly” at age 13 and several truancy charges. He denied ever being
incarcerated at any of the Ohio Department of Youth Services facilities. Regarding his adult
legal history, Mr. Smith reported that his 2009 disorderly conduct conviction resulted from
“getting caught with a sack of weed” and his 2010 drug abuse conviction resulted from being
caught “with a couple sacks of weed.” He stated that his 2011 drug possession conviction
resulted from an incident in which he was caught selling marijuana and crack cocaine, and that
the related probation violation was due to a “dirty urine” for marijuana. Finally, Mr. Smith
reported that his 2015 criminal trespass conviction resulted from staying in a building, which he
believed was a laboratory of some sort, and helping himself to some coffee in an employee
breakroom. He had been homeless at that time because he “ran out of days” available for him to
stay at a homeless shelter.

According to available online records from Wayne County, Mr. Smith has the following adult
legal history:

2009:
• Disorderly Conduct by Intoxication, MM: Guilty of Disorderly Conduct, MM.
• Disorderly Conduct, MM: Dismissed.
• Disorderly Conduct, MM, and False Information to Police, M-1: Guilty of False
Information to Police, M-1.
2010:
• Drug Abuse, MM, and Public Gambling, M-1: Guilty of Drug Abuse, MM. Public
Gambling charge dismissed. Failed to appear in court numerous times.
• Hitchhiking, MM: Dismissed.

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2011:
• Drug Abuse, MM; Dismissed.
• Trafficking in Drugs and Drug Possession: Pled and found guilty of Drug Possession, F-
5. Trafficking in Drugs charge dismissed. Placed on one year of probation.
o Probation Violation: Failed to appear for hearing, capias issued.
2014:
• Driving Under Suspension, M-1: Reduced to lesser included charge of License Required
to Operate.
2015:
• Criminal Trespass, M-4: Guilty.
• Assault on a Peace Officer, F-4, and Obstructing Official Business, F-5: Instant Case.
Pending.

MEDICAL HISTORY: Mr. Smith reported that he has asthma, but “it been getting better”
recently and that he last used his inhaler “a couple months ago.” He denied any other medical
conditions, as well as any history of surgery, stroke, coma, seizure, or TBI. He reported that he
was shot in the back in 2013 and sustained a collapsed lung, but that he had no surgery or
complications as a result of that injury. Indeed, medical records from North Hospital indicate that
on October 10, 2015, his gunshot wound was stable.

Records from Health Medical Center indicate that Mr. Smith has no known allergies. On
January 22, 2014, he was treated in the emergency department for facial swelling after using a
new lotion that resulted in simple contact dermatitis. He was prescribed Benadryl for the
dermatitis. Notes also indicate that he had shortness of breath after being shot weeks prior.

Records from North Hospital indicate that Mr. Smith presented to the emergency department on
October 4, 2015, after he took one dose of an albuterol inhaler and “it made his heart feel
funny.” He believed that his symptoms were caused by “all the tea he drank and his energy
drinks.” Mr. Smith was diagnosed with a “medication reaction, tachycardia” and advised to
discontinue any energy drinks. He was discharged home. Mr. Smith returned on October 10,
2015, with complaints of rib pain. His chest x-ray showed no evidence of acute cardiopulmonary
process. His symptoms were also not considered to be related to “acute coronary syndrome, no
underlying acute infectious process, no pneumothorax, no pulmonary embolism, or thoracic
aortic dissection.” He was prescribed Naprosyn 500 mg and discharged home. On October 11,
2015, Mr. Smith presented with chest pain. He was diagnosed with gastroesophageal reflux
disease and prescribed Zantac. He was discharged home.

PSYCHIATRIC HISTORY: Mr. Smith reported that during childhood, he received counseling at
school for problems related to Attention-Deficit/Hyperactivity Disorder and was prescribed
Ritalin. He was unable to specify where he received those services. During adulthood, he
reportedly received mental health treatment on one occasion when he was psychiatrically
hospitalized at North Hospital at age 20. Mr. Smith indicated that on that occasion, he was
hospitalized for “one month” due to “paranoia” and “feeling a sense of something…don’t
know…I couldn’t sleep.” He characterized this as a general feeling of dread, with no threat of
harm from anyone in particular. Mr. Smith stated that the hospital “didn’t find nothing [wrong with
him], probably just going off ‘wet’ or something,” indicating that staff believed his psychological
disturbance was caused by PCP-soaked marijuana. When asked if he agreed with that
assessment, he stated, “Yeah, I probably wouldn’t put it past nobody” to give him tainted
marijuana. Mr. Smith added that he also drank “Sparks and Pepsi” prior to admission, which he

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described as an energy drink with alcohol in it. He reported that he stopped the medication the
hospital prescribed him two months later and never took any again.

Mr. Smith denied any other psychiatric hospitalizations or mental health treatment. He also
denied any history of suicide attempts, self-injurious behaviors, visual hallucinations, auditory
hallucinations, anxiety, grandiosity, or rapid speech. Mr. Smith also reported that he has never
experienced decreased need for sleep or panic attacks without being under the influence of
alcohol or drugs. He stated that he occasionally experiences a depressed mood, “but there
always be something to get me back up” and that those instances generally last for only a few
days.

Records from Health Medical Center indicate that Mr. Smith was treated in the emergency
department on October 3, 2015, for a mental health disorder. Notes indicate that “patient very
shaky, not answering questions, mom answers questions for patient, patient very agitated.” His
mother reported that he was basically homeless and had been off of his medication for
schizophrenia for several years. She believed that he was previously taking Risperdal. On that
date, Mr. Smith denied any auditory or visual hallucinations or suicidal or homicidal ideation. He
also denied having schizophrenia and refused to take any medications. He reported taking
marijuana and using alcohol occasionally. Mr. Smith was discharged on that date with an
albuterol nebulizer and a prescription for Risperdal (1 mg.).

Records from Wayne County Jail indicate that at an initial health screening on October 21,
2015, Mr. Smith was calm, not suicidal, alert, and oriented. He was placed in the general
population. His only medication prescribed through December 12, 2015, was Tylenol. He
received no mental health services or psychotropic medications.

PSYCHOLOGICAL TESTING: During testing, Mr. Smith was cooperative and worked diligently
on tasks. He appeared to be motivated and interested in the tasks, and he asked questions
when appropriate. Although there were occasional noisy distractions outside the testing room at
the jail, Mr. Smith did not appear to be overly distracted by those sounds.

The Test of Memory Malingering (TOMM) provides a systematic method to assist in

discriminating between bona fide memory-impaired individuals and those with malingering
memory deficits. The TOMM is a 50-item recognition test for adults; it includes two learning
trials and a retention trial. Validation research on the TOMM shows that the TOMM is effective
in discriminating malingerers or suspected malingerers from non-malingerers in terms of
memory. Mr. Smith’ scores on the TOMM (Trial 1: 47; Trial 2: 48) indicate that he put forth
adequate cognitive effort on that test.

Mr. Smith’s cognitive functioning was assessed using the Wechsler Adult Intelligence Scale,
fourth edition (WAIS-IV). On the WAIS-IV, Mr. Smith earned a Full Scale IQ score of 79 (95
percent CI = 75–83; 8th percentile), a Verbal Comprehension Index (VCI) score of 80 (95
percent CI = 75–86; 9th percentile), and a Perceptual Reasoning Index (PRI) score of 88 (95
percent CI = 82–95; 21st percentile). He obtained a Working Memory Index (WMI) score of 77
(95 percent CI = 72–85; 6th percentile) and a Processing Speed Index (PSI) score of 86 (95
percent CI = 79–96; 18th percentile). The discrepancy between Mr. Smith’s PRI and WMI
scores were statistically significant. Given the discrepancy between his PRI and WMI (11 points;
20.8 percent base rate), the General Ability Index (GAI) was calculated, which is a measure of
cognitive ability not influenced by deficits in working memory. Mr. Smith earned a GAI of 81 (95
percent CI = 77–87; 10th percentile), which is in the low-average range of functioning. However,
the two-point discrepancy between his FSIQ and GAI was not statistically significant. Despite

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Mr. Smith’ relative weakness in working memory, the FSIQ score of 79 is considered the most
accurate and reliable estimate of his overall cognitive ability.

MENTAL STATUS EXAMINATION: Mr. Smith is a 24-year-old Caucasian male who is six feet,
two inches tall and weighs approximately 180 pounds. He has short blonde hair, brown eyes,
and a moustache and goatee. He was dressed in standard black and white jail attire and he had
fair hygiene, although he had mild body odor. Mr. Smith made appropriate eye contact. His
speech was of normal rate and volume, and he provided information in a clear and coherent
manner. Mr. Smith’s thought process was organized, logical, and goal-oriented. He did not
demonstrate any unusual physical movements.

Mr. Smith was generally cooperative with this evaluation and provided personal information with
ease. However, he appeared to minimize his history of substance use. He had a pleasant and
friendly demeanor, occasionally laughing and making jokes when appropriate. Mr. Smith had a
euthymic mood and his affect was congruent with his mood.

Mr. Smith denied experiencing delusional beliefs or auditory or visual hallucinations, and there
was no indication by his behavior or speech that he was experiencing any perceptual
disturbances during this evaluation. He did not present with any observable symptoms of mania,
including an abnormally elevated or irritable mood, grandiosity, increased talkativeness, or
racing thoughts. In addition, Mr. Smith denied current suicidal and homicidal ideation.

During this evaluation, Mr. Smith was oriented to person, place, date, and situation. His recent
and remote memory were intact as demonstrated by his ability to recall past and recent
personal information. His attention and concentration were adequate, his insight was fair, and
he appeared to be functioning in the low-average to borderline range of intelligence.

COMPETENCY ASSESSMENT: Mr. Smith identified his current charges as “assault on an

officer” and “obstruction,” which he reported were both felonies. He indicated that if convicted of
the alleged offenses, he could receive a maximum of 18 months in “the joint.” However, he
hoped that “they’ll drop one [of the charges] at least” because “I don’t need no more felonies”
and “they stick to you,” making it difficult to find a job. Mr. Smith was able to provide a coherent
account of his behavior at the time of the alleged instant offenses, and he was aware of the
allegations against him.

Mr. Smith was capable of identifying appropriate courtroom personnel and their respective roles.
He stated that a judge does “all the work…they handle the cases. They see what’s right from
wrong. They judge upon your status.” He indicated that if he is found guilty of the alleged
offenses, the judge finds “a punishment for you,” and if he is not found guilty, “I’ll be released.”
Mr. Smith stated that a defense attorney’s role is to “help you. They get information to help you,
back you up, make the situation better,” and “speak for you. He added that the defense attorney
tries “to help you” with “the case.” Mr. Smith indicated that a prosecutor’s role is to “go through
all your information in the system and let the judge know” and make recommendations to the
judge about the defendant. When asked if the prosecutor was on his side, he responded, “No.”
He was aware that he should not discuss his current legal issues with the prosecutor in the
absence of his attorney, because the information may be used against him. Mr. Smith indicated
that a jury must “all come to one agreement” on “whether you guilty or not.” He stated that they
come to that decision by hearing testimony and deliberating together. Mr. Smith indicated that a
witness’ role is to “talk about the situation,” including “what she seen” at the time of the alleged
offense. Mr. Smith also recognized that witnesses may be called for either the prosecution or
defense side. He stated that if a witness were to provide inaccurate testimony, he would “just tell

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him [his attorney], but he has to explain how it’s not true.” Mr. Smith was aware that if he blurted
out information, “the judge [would] probably tell you to be seated…sit down” and “hand you over
to the authority” for “order in the court.” He indicated that a sheriff’s deputy is present in the
courtroom “to get the information, like the paperwork” and “guard” whoever is “out of order.” He
stated that a stenographer’s role is typing “everything that’s said” in court.

Mr. Smith identified his potential plea options as “guilty, not guilty, no contest, insanity.” He
defined a plea of guilty as “You did it”; a plea of not guilty as “You didn’t do it”; and a plea of no
contest as “You either-or. You’re in between. You might be not guilty or guilty” and “the judge”
decides the outcome. He defined a plea of not guilty by reason of insanity as “I got problems. It
happened in a way I’m not able to be guilty from. Probably I wasn’t in my mind.… I wasn’t able
to be in control” at the time of the offense. Mr. Smith also was aware that a possible outcome of
being found not guilty by reason of insanity is commitment to a state psychiatric hospital, and he
understood the maximum potential time of hospitalization when it was explained to him.

Mr. Smith indicated that a plea bargain is “agreement between the two parties” in which the
defendant gets “something they like,” which “depends on the deal.” However, he stated that it
usually includes “being set free, a piece of freedom.” He acknowledged that the defendant has
to “submit to the case” and plead “guilty” in order to take a plea bargain. Mr. Smith was also
aware that a defendant loses “the right to fight” the case by entering a plea of guilty.

Mr. Smith identified his attorney as “John Doe,” and he reported meeting with him on two
occasions, once in jail and once at court. He indicated that “he’s all right,” but he is “not paid, so
I really can’t trust him” because “you ain’t paying his bills.” Nevertheless, he identified being able
to work with him toward achieving a positive outcome for his case. Mr. Smith stated that if were
to disagree with his attorney, he would “tell him” because “I should have the choice” in decision-
making in his own case. Mr. Smith also recognized that he should not provide inaccurate
information to his attorney or withhold information from him because this may result in his
attorney being unable to adequately prepare a defense strategy.

Regarding appropriate courtroom behavior, Mr. Smith indicated that she should “just keep my
head down,” “listen and follow orders,” “stand up for myself,” “try to stay out of the way,” and
“stay calm and collected.” He stated that he should not “look at the judge, talk the wrong way,
dog the judge, f- you judge.”

DIAGNOSIS:

OPINION:

Respectfully Submitted,

Fred Flintstone, Ph.D.

Psychologist