Background
A Superior Court jury convicted Victor Peña of kidnapping and ten counts of aggravated rape arising from an incident in January 2019. Peña had committed to Bridgewater State Hospital for multiple competency evaluations — and was found competent each time. The judge heard from three mental-health experts and credited the opinion of a Bridgewater forensic psychologist who concluded Peña did not suffer from a major mental illness, had capacity “likely higher” than he presented, and was able to communicate and understand the proceedings. The judge found his conduct “seemingly designed to delay this trial.”
At trial, Peña raised a defense of lack of criminal responsibility due to mental disease or defect and sought jury instructions on that defense, which the judge allowed. However, the judge denied Peña’s motions to present his demeanor to the jury in an unmedicated state. Peña had been prescribed risperidone at Bridgewater — an antipsychotic used to address mood stability, impulsivity related to antisocial personality disorder, and self-reported psychotic symptoms — but the prescription was on an as-needed basis, he had only “partially” accepted it during incarceration, and there was no evidence he was taking it at trial. Peña argued on appeal that this ruling violated his constitutional right to present evidence of his mental condition to the jury.
The Court’s Holding
Affirmed. The Appeals Court upheld the denial of Peña’s motions to appear in an unmedicated state, holding that the trial judge did not err or abuse discretion in finding that unmedicated demeanor evidence had little or no probative value on the mental-disease defense.
Massachusetts recognizes that a defendant who is medicated at trial may introduce evidence of the medication’s effects when they are relevant — particularly where a controlled appearance due to medication might create unfair prejudice in a case turning on lack of criminal responsibility. Commonwealth v. Gurney, 413 Mass. 97, 101–103 (1992); Commonwealth v. Louraine, 390 Mass. 28, 34–35 (1983). But the right to appear unmedicated is not absolute and must be assessed case by case.
Here, the key distinction from Louraine — where the defendant had diagnosed paranoid schizophrenia treated with maximum doses of antipsychotic medication that enabled him to “control himself” — was the absence of any competent evidence of a psychotic disorder. Peña’s risperidone prescription addressed antisocial personality disorder and impulsivity, not hallucinations, delusions, or mania. His Bridgewater providers concluded the medication likely had only “minimal impact” on his presentation and that there would be very little change if he stopped. Moreover, it was unclear whether he was even taking the medication during trial; defense counsel stated twice he did not know. Without evidence that medication was materially altering Peña’s demeanor, evidence of his unmedicated state had little probative value and the motions were properly denied.
Key Takeaways
- A defendant raising a lack of criminal responsibility defense does not have an automatic right to appear before the jury in an unmedicated state; the right attaches when the medication is actually shaping the defendant’s presentation in a way that is relevant to the mental-disease defense.
- The predicate for a Louraine-type motion is evidence that (1) the defendant has a diagnosed condition requiring medication, (2) the medication materially affects the defendant’s observable demeanor, and (3) that altered demeanor is relevant to the defense. All three elements should be established before filing such a motion.
- Where medication is prescribed on an “as-needed” basis and it is unclear whether the defendant is complying with the prescription at trial, there is little basis for the argument that the jury is seeing a medicated rather than unmedicated presentation.
- Antisocial personality disorder generally does not constitute a mental disease or defect under Massachusetts law; prescribing risperidone to address impulsivity related to that diagnosis does not convert it into one.
Why It Matters
Commonwealth v. Pena clarifies the evidentiary prerequisites for a motion to present unmedicated demeanor to a jury. The decision draws a practical distinction between the paradigm case — a defendant on high-dose antipsychotic medication for a diagnosed psychotic disorder whose outward control is pharmacologically induced — and a defendant prescribed a low-impact medication for personality disorder on an as-needed basis. Defense counsel raising lack-of-criminal-responsibility defenses should secure clear expert testimony about both the diagnosis and the medication’s measurable effect on demeanor before seeking an unmedicated appearance; without that foundation, the motion is unlikely to succeed.
The decision also illustrates the tension between a defendant’s right to present a complete defense and the trial court’s discretion to manage how that defense is presented. The right to place before the jury “any evidence which is at all probative of his mental condition,” Louraine, 390 Mass. at 34, may be “tempered” by the judge, Commonwealth v. Brown, 449 Mass. 747, 770 (2007). Probative value is the threshold question, and where medication has minimal observable effect, the answer tips against the motion.