Court of Criminal Appeals of Tennessee, Nashville
Assigned on Briefs April 22, 2015
Appeal from the Circuit Court for Bedford County No. 17682 Franklin Lee Russell, Judge
Michael P. Auffinger, Lewisburg, Tennessee, for the Appellant, Kenneth Lee Boles.
Herbert H. Slatery III, Attorney General and Reporter; Brent C. Cherry, Senior Counsel; Robert James Carter, District Attorney General; and Richard A. Cawley, Assistant District Attorney General, for the Appellee, State of Tennessee.
Alan E. Glenn, J., delivered the opinion of the court, in which John Everett Williams and Roger A. Page, JJ., joined.
ALAN E. GLENN, JUDGE
On January 9, 2013, correctional officers at the Bedford County Workhouse saw the defendant, who was serving a forty-eight-hour sentence at the facility, kneeling in his cell in the apparent act of snorting some crushed powder into his nostrils. Officers searched the cell and found three pills that were later identified as Roxicodone, which is a brand name for oxycodone, and methadone. The defendant was subsequently indicted by the Bedford County Grand Jury with one count of the introduction of a controlled substance into a penal institution and one count of the possession of a controlled substance in a penal institution.
Prior to trial, the defendant filed a notice of his "intent to introduce expert testimony relating to the mental condition of the Defendant." Specifically, he sought to introduce the testimony of a nurse practitioner about the defendant's Post-Traumatic Stress Disorder ("PTSD") and his fear that he would die during the forced withdrawal of his opiate pain medication during his incarceration. At the January 2, 2014 evidentiary hearing, Chandler Anderson, a board certified family nurse practitioner and a certified emergency nurse with eight years of experience, testified that he was familiar with "pain narcotics, " including the withdrawal symptoms associated with their discontinued use. He said he had reviewed the defendant's medical records and also spoken with him. Approximately three years earlier, the defendant had been in a serious motor vehicle accident that caused him to sustain severe injuries, including a below-the-knee amputation of one leg. As a result, the defendant was "placed on Xanax to help manage a post-traumatic stress disorder and . . . was titrated . . . from Lortab to oxycodone to . . . methadone for pain management." Anderson described the withdrawal symptoms experienced by patients who abruptly cease opiate pain medication:
The opiate withdrawal process, people in the early stages tend to get irritable, they tend to have increased anxiety, they sweat more, but the later effects, after about 48 hours, they start to be nauseated, vomit, they start to have diarrhea, intense stomach cramps, they can become more irritable, and even have . . . a confused [mental] state.
Anderson testified that the withdrawal symptoms associated with the abrupt cessation of Xanax, or benzodiazepine, were worse:
Well, again, the opiates would cause the nausea, vomiting, diarrhea, abdominal pain. Those withdrawals aren't as significant as those of benzodiazepine or Xanax withdrawals. Those people can actually have seizures, and benzodiazepine withdrawals, you can actually die from versus opiates which just make you feel very miserable.
Anderson testified that the defendant's "dosing gives three times a day, " so the six pills the defendant reported that he had brought with him to the jail would have constituted "two days worth of medication." When asked again his opinion of the effect of the defendant's not having that medication for forty-eight hours, he replied that "at the 48-hour mark, again, he would have irritability, maybe some confusion, nausea, vomiting, diarrhea, abdominal cramping, sweating. Those would be the symptoms of the opiate withdrawal."
Anderson testified that the defendant informed him of a previous period of incarceration in which he had been denied access to his medication and had gone through "withdrawals, " with his primary symptom being that he was "confused and disoriented." He said the defendant was diagnosed with PTSD after his motor vehicle accident and that patients with PTSD "typically have a feeling of impending doom and with a magnified fear of dying." He opined that the combination of the defendant's PTSD and his previous experience with severe withdrawal made him believe he had no choice other than to take his prescribed medication with him into the jail:
Well, again, if you're already afraid that you're going to die at . . . a heightened level than the normal person and you've experienced this, terrible side effects of withdrawals before, it's reasonable to say while you're not in withdrawals at the time that you go in that you are, you could be in fear that you're going to get that sick again because you, "A", you've experienced it before and, "B", you have what appears to be, to other people, an irrational fear of dying. But it's documented well in the DSM-5, ...