Thursday, February 27, 2014

How Can States Measure Mental Retardation when Imposing the Death Penalty?

The Supreme Court will hear oral arguments on Monday in Hall v. Florida, the case testing whether Florida's method of determining mental retardation solely by reference to an IQ number (at or below 70) violates the Court's ruling in Atkins that states may not impose the death penalty on the mentally retarded.  Here's a portion of my preview of the case, from the ABA Preview of United States Supreme Court Cases, with permission:


Freddie Lee Hall was tried and convicted for the 1978 murder of Karol Hurst. He was sentenced to death. (Hall’s co-defendant, Mack Ruffin, also convicted of murder in a separate trial, was sentenced to life in prison.) Hall’s conviction and sentence were upheld on direct appeal by the Florida Supreme Court.

Hall later filed a motion in the Florida courts to vacate his sentence based on mitigating evidence of his mental retardation and the brutal abuse he suffered as a child. (Hall filed this motion after the Supreme Court ruled in 1987 in Hitchcock v. Dugger, 481 U.S. 393, that capital defendants must be permitted to present non-statutory mitigating evidence in the penalty phase of a capital trial.) The Florida Supreme Court vacated Hall’s death sentence and remanded for a new sentencing proceeding.

At the resentencing hearing in December 1990, Hall presented uncontroverted evidence of his mental retardation. Hall’s family members testified to his childhood mental disabilities, including difficulties understanding, thinking, and communicating. His school records indicated that his teachers repeatedly identified him as “mentally retarded.” Hall’s former attorneys testified that because of his mental disabilities and problems with communications, Hall could not even assist with his own defense. And evidence from clinicians concluded that Hall was “extremely impaired psychiatrically, neurologically and intellectually,” that he showed signs of “serious brain impairment,” and that he “is probably incapable of even the most . . . basic living skills which incorporate math and reading.” One test, the Wechsler Adult Intelligence Scale—Revised, or “WAIS-R,” administered by a graduate student, put Hall’s IQ at 80. Another test, the Revised Beta Examination, scored Hall at 60 (the lowest possible score), in the range of mental retardation. (Earlier tests, a Beta Test and a Kent Test, put Hall’s IQ at 76 and 79, respectively. But these tests are not considered as reliable as the Wechsler test. Indeed, Florida does not permit the use of the Kent or Beta tests to determine mental retardation at sentencing in capital cases.) Based on this last test and other evaluations, one doctor concluded that Hall was “mentally retarded” and that the mental retardation was “longstanding.”

The trial court nevertheless again condemned Hall to death, and the Florida Supreme Court affirmed. He later sought postconviction relief. This was denied, and the Florida Supreme Court affirmed.

In 2001, Florida enacted a statute, § 921.137, that prohibited the execution of persons with mental retardation. The law defined mental retardation as “significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the period from conception to age 18.” The law further defined “significantly subaverage general intellectual functioning” as “performance that is two or more standard deviations from the mean score on a standardized intelligence test specified in the [relevant Florida] rules.”

The next year, the Supreme Court ruled in Atkins v. Virginia, 536 U.S. 304 (2002), that the “mentally retarded should be categorically excluded from execution.” The Court explained that the “diminished capacities” of persons with mental retardation “to understand and process information, to communicate, to abstract from mistakes and learn from experience, to engage in logical reasoning, to control impulses, and to understand the reactions of others” undermined the traditional justifications for the death penalty and made it more likely that persons with mental retardation would be wrongfully convicted and executed.

In 2004, Hall filed a claim under Florida Rule of Criminal Procedure 3.203, which established a process for Atkins claims, arguing that his death sentence violated Atkins. A hearing was held on Hall’s motion in 2009. Hall presented evidence similar to that in his previous case. In particular, Dr. Greg Pritchard testified that he administered the Wechsler Adult Intelligence Scale-III, or “WAIS-III,” on which Hall scored 71. Dr. Pritchard also considered the results of a WAIS-IV test administered by Dr. Joseph Sesta in 2008, on which Hall scored 72, and a WAIS-III test administered by Dr. Bill Mosman in 2001, on which Hall scored 69. The trial court excluded Dr. Mosman’s report, however, because Dr. Mosman died, and Hall’s attorney was unable to provide the state with the raw data underlying the report. Dr. Harry Krop testified that Hall’s IQ was 73 on the WAIS-R.

The trial court denied Hall’s motion on the ground that Hall was unable to demonstrate “an I.Q. score of 70 or lower.” The trial court set that particular threshold because the Florida Supreme Court interpreted § 921.127 two years earlier, in Cherry v. State, 959 So.2d 702 (Fla. 2007), to mean that only persons with an IQ of 70 or under qualified as mentally retarded. (The condemned prisoner in Cherry had an IQ of 72. The Florida Supreme Court denied relief.)  The Florida Supreme Court, relying on its holding in Cherry, affirmed. This appeal followed.


The Supreme Court ruled in Atkins that a state violates the Eighth Amendment’s ban on cruel and unusual punishment when it executes a mentally retarded person. But the case did not define mental retardation. As a result, states have developed their own approaches to defining mental retardation. Florida’s approach, under the state Supreme Court ruling in Cherry, defines mental retardation rigidly, as an IQ test score of 70 or below.

The parties in this case argue whether Florida’s approach violates Atkins. More particularly, they argue whether executing a person, like Hall, who has IQ test scores above 70 but nevertheless has severe and well documented deficiencies in his intellectual functioning and adaptive behavior, violates the Supreme Court’s prohibition on executing the mentally retarded.

Hall argues first that Atkins forbids the execution of persons meeting the clinical definition of mental retardation. According to Hall, that definition does not set a rigid cutoff; instead, it incorporates three prongs: (1) “significantly subaverage” intellectual functioning; (2) limitations in adaptive functioning; and (3) onset before age 18. Hall says that the Court in Atkins recognized this, because it cited two clinical sources that contained definitions that incorporated these three prongs, and because it repeatedly described IQ, again citing these and other clinical sources, as only a rough measure of mental retardation. (Hall, and the Court, refer to the definitions of mental retardation promulgated by the American Association on Mental Retardation, or the AAMR, now the American Association on Intellectual and Developmental Disabilities, or the AAIDD, and the American Psychiatric Association, or APA.) Hall contends that Florida’s rigid cutoff for mental retardation impermissibly redefines the clinical definition of mental retardation under Atkins. (Hall notes that the plain language of § 921.137 can be squared with Atkins. It is the Florida Supreme Court’s rigid interpretation of § 921.137 that violates Atkins.)

Next, Hall argues that Florida’s rigid approach does not comport with the commonly accepted clinical definition of mental retardation. In particular, Hall claims that Florida’s rigid approach fails to take into account the standard error of measurement, or SEM. As Hall explains, “in Florida, an obtained IQ test score of 71—notwithstanding that it is clinically indistinguishable from a score of 70, in light of the inherent measurement error in the test—bars a defendant from presenting any evidence of limitations in adaptive functioning.” This is so, even though that evidence may be compelling, and even though psychiatrists may have diagnosed the defendant as having mental retardation. Hall points (again) to the nearly identical definitions promulgated by the AAIDD and the APA, both of which account for measurement error within a range of plus- or minus-five points. Hall says that an obtained IQ score plus or minus one SEM yields a confidence interval equating to a 66 percent probability that a person’s true IQ test score falls within that range. (If a person’s score is 70, with a SEM of 2.5 points, there is about a two-thirds chance that the person’s actual IQ is between 67.5 and 72.5.) He claims that the definitions promulgated by the AAIDD and the APA both account for the SEM and the resulting confidence interval. He says that they also look to guidelines on intellectual functioning and adaptive behavior, in addition to IQ scores, and require clinical judgment to determine mental retardation. Hall contends that both the AAIDD and the APA reject a specific cutoff score as the measure for mental retardation.

Hall says that Florida’s rigid approach is inconsistent with these commonly accepted clinical definitions. Moreover, he contends that other death-penalty states have rejected Florida’s rigid approach, and that Florida is in a small minority of states that have adopted a rigid cutoff without consideration of the SEM. He claims that Florida’s rigid approach will result in an unacceptable risk of executions of individuals who are mentally retarded.

Finally, Hall argues that there is no genuine dispute that under accepted clinical standards, he is mentally retarded. Hall says that all of his scores, save his score of 80, an outlier, are in the 95 percent confidence interval for a “true” score of 70, or two standard deviations below the mean IQ score. He contends that while those scores alone are insufficient to yield a diagnosis of mental retardation, they would prompt any competent clinician to investigate his adaptive behavior. And based upon that investigation—through all the evidence of his poor intellectual functioning and adaptive behavior submitted at earlier hearings—Hall says that he is mentally retarded.

The state argues first that Atkins left states substantial leeway in enforcing the ban on executing the mentally retarded. The state says that Atkins did not prescribe any particular diagnostic criteria or definition of mental retardation and, in particular, did not hold that states must apply the AAMR or APA definitions. Indeed, the state claims that Atkins relied on a national consensus against executing the mentally retarded that included Florida’s § 921.137 and other states with varied definitions of mental retardation. In other words, the state says that Atkins recognized a national consensus against executing the mentally retarded, but not a national consensus around a definition of mental retardation. Florida claims that the Court in Atkins relied on its own judgment about the mentally retarded and why they cannot be executed, not on a particular medical definition of mental retardation; instead, it left that to the states.

The state argues next that the Court should not eliminate the states’ roles in enforcing Atkins. The state claims that the Court has traditionally deferred to the states in defining mental conditions for the purposes of criminal law. Moreover, the state says that deference is particularly appropriate here, where diagnostic criteria for mental retardation (including criteria for evaluating intellectual functioning, adaptive functioning, and even the age of onset) have changed so much over time and are constantly evolving. In particular, the state points to the changing ways that authorities have relied on IQ. Given these differences, the state says that a person could be labeled mentally retarded under one definition but not under another. The state claims that it would be particularly inappropriate for the Court to force the states to agree with any one particular authority under these circumstances. The state also suggests that the APA, the AAIDD, and similar groups seek to limit the application of the death penalty. According to the state, if the Court requires states to adhere to (evolving) clinical criteria developed by these groups, then these groups “would have unavoidable incentives to adopt even more expansive definitions of mental retardation” in order to serve their political purpose, to limit the application of the death penalty.

Third, the state argues that its approach is appropriate under Atkins. The state says that its definition generally conforms to the clinical definitions. It claims that its approach requires a finding on all three prongs (intellectual functioning, adaptive functioning, and age-of-onset), and that its IQ threshold is a long-settled way of determining mental retardation. It contends that consideration of the SEM is appropriate for some purposes (like education, or determining eligibility for services), but not here, where Hall introduced numerous and varying test scores that fell above 70. The state says that a defendant can still introduce other mitigating evidence that satisfies some non-statutory definitions of mental retardation.

The state contends that there is no national consensus on how to use the SEM, or how to consider clinical criteria. Still, it says that its approach is consistent with other states. It claims that Hall’s approach would undermine its important interests in finality (because Hall’s approach would necessarily lead to subsequent challenges based on constantly evolving clinical definitions) and an objective determination of mental retardation.

Finally, the state argues that Hall is not mentally retarded. The state says that Hall’s crime—involving a multi-step plan that was cold, calculated, and premeditated—shows that he was not mentally retarded when he committed the crime. It also says that Hall’s medical evidence (including the results of his IQ tests) fail to show that his mental state was attributable to mental retardation. Instead, it says, Hall’s evidence suggests that his mental state was attributable to his difficult childhood, abusive mother, and poverty.


According to an amicus brief filed by nine other states in support of Florida, ten states use “an obtained IQ test score above 70 [as] a conclusive, bright-line cutoff (without using the SEM) in evaluating the intellectual function prong of mental retardation.” Two other states have adopted bright-line cutoffs above 75. A number of other states either do not use a rigid cutoff, or allow application of the SEM in evaluating IQ scores. A number of other states have not firmly determined their approaches. (Thirty-two states in all still have the death penalty, according to The amicus brief for Arizona and eight other states contains an appendix with a summary of state laws and rulings on determining mental retardation and another appendix with each state’s burden of proof.)

As a result, Hall potentially directly affects ten, or maybe twelve, states—those with rigid cutoffs for determining mental retardation. If the Court rules for Hall, those states will have to adjust their determination criteria to take into account the SEM, and possibly other factors. (The Question Presented asks only whether a state must consider the SEM. Still, there is nothing preventing the Court from saying more about the definition of mental retardation. It seems unlikely that the Court will prescribe a particular comprehensive definition or approach, though. Instead, if it rules for Hall, it will likely continue to give the states substantial room to craft their own definitions, within the broad boundaries of its ruling.)

On the other hand, if the Court rules for Florida, those states may obviously retain their rigid definitions. In that case, there is a possibility, although it seems quite slim, that other states that currently consider the SEM or other factors may simplify their own definitions and follow Florida’s approach.

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