Appendix C-2 Sample Mental Status Examination (Dr. Bartlett)

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APPENDIX C-2 Sample Mental Status Examination (Dr. Bartlett)

District Forensic Hospital

1511 Eye St. NW

P.O. Box 2611

Washington, DC 20011

Dr. Edward J. Bartlett, M.D. Direct Dial 202-555-6887

Mental Status Examination

Name: Sickles, Daniel Edward

Date of Birth: October 29, 1971

Address: 303 Ellsmere Dr., Augusta, NY 10045

Date of Report: June 17, 2008.

Identifying Data: Mr. Sickles is a 38 year old married man who was seen pursuant to a Court Order dated March 29, 2008, by Hon. Raleigh Colston, Judge, for an evaluation of criminal responsibility stemming from charges of homicide in the death of Philip Barton Key on February 27, 2008.

Current Situation: Mr. Sickles is currently an inpatient on the Forensic Evaluation Unit at the District Forensic Hospital.

Structure of Examination: Mr. Sickles was evaluated pursuant to a court order. Before each interview I explained to Mr. Sickles the nature and purpose of my visit and interview. It was clearly explained that the contents of the interview would not be held confidential and that a report would be issued to the court and that this report might later be shared by the Judge with the prosecution and defense counsel. Mr. Sickles was instructed to answer only the questions that he felt comfortable answering. He was told that he could decline to answer any and all questions and to refuse to participate in the interview. He appeared to understand this warning and he asked appropriate questions and agreed to the interviews on each occasion.

Mr. Sickles did not refuse to answer questions at any time, but did claim to have no recollection about some of the events that I discussed with him surrounding the death of Mr. Key.

The opinion in this case is based on the following:

1. Initial interview with Mr. Sickles on April 20, 2008;
2. Follow up interview of Mr. Sickles on April 23, 2008;
3. The results of laboratory testing conducted at the District Forensic Hospital during Mr. Sickles's admission;
4. Neurological examination by Dr. Edward Nordquist, M.D.;
5. Physical examination by Dr. Ragid Amad, M.D.;
6. Records and reports of the District Metro Police Department concerning the death of Mr. Key;
7. Records of St. Mary's High School, Augusta;
8. Wechsler Adult Intelligence Scale administered April 24, 2008; and
9. Psychological testing done at this admission.

Pertinent Background: Mr. Sickles was cooperative during his two interview sessions with me and also cooperated with the psychologist who administered a test battery to him. Sickles is a member of Congress for the 3rd District of his State which includes Augusta. He had previously been a State Representative and an attorney with a private practice in Augusta.

An intake physical examination by Dr. Amad showed no significant abnormalities.

Due to lack of space and the sensitive nature of Mr. Sickles's position as a member of Congress, transfer was accomplished on April 19, 2008. This was shortly after Mr. Sickles had been released from the Detention Center on bail, pursuant to your order setting bail of March 18, 2008. Mr. Sickles came voluntarily without incident and arrived here on the 20th.

A full neurological work up, an EEG, and CAT scan was immediately ordered for Mr. Sickles. There were essentially no significant abnormalities disclosed by these procedures.

Past Psychiatric History: Mr. Sickles reported no physical or sexual abuse as a child, nor any hospitalization or treatment for a mental disease or disorder, bur reports a "blackout" occurring the night of February 26, 2008, persisting until after the death of Philip Barton Key on February 27, 2008. Sickles attributes this episode to the stress of discovery that his wife had been unfaithful to him and maintained a long-standing extramarital relationship with Key. Sickles also claimed to have drunk a quart of whiskey on the night of February 26 and to have taken a barbiturate to induce sleep that same night.

Family History: The patient is a Caucasian male born October 20, 1971, in Augusta. He was the eldest of two children of George G. Sickles and Susan Marsh Sickles of Augusta. Mr. Sickles, Sr...