It ain't over 'til it's over. Baseball? No... the trial of recently convicted organized crime figure Vincent "Chin" Gigante. Now in a federal prison hospital facility in Butner, North Carolina, government doctors are carefully examining Chin's physical and mental status. His New York defense team is preparing to convince the court that Chin is not competent to be sentenced.
The court may find Mr. Gigante incompetent to be sentenced because he cannot meet the standards for competency. Federal jurisdictions differ in their interpretation of the standard. The general premise is that a defendant is incompetent for sentencing if he or she cannot understand sentencing proceedings. Federal courts in New York have adopted a two-pronged test: whether the defendant can 1) meaningfully exercise the right to allocution (i.e. make a statement on his or her own behalf, or 2) comprehend what is happening [U.S. Code § 4244].
"If Chin is found not competent to be sentenced, how competent was be to stand trial a mere three months earlier?"
Court documents reviewed by The Forensic Echo describe the lawyers' intention to have Chin examined by psychiatrists of their choice. If Chin is found not competent to be sentenced in September, how competent was he to stand trial a mere three months earlier?
This news story examines the science, strategy, tragedy and absurdity of a struggle over a man's fate that continues beyond this day. We look through the lens of a profession respected for its insights into the human brain and behavior, humbled by the limits of its own expertise. There are scores of lessons for the law and psychiatry community to learn from Vincent "Chin" Gigante, but as with Chin himself, we must look beneath the surface.
The reputed gangster in the bathrobe fueled fantasies and cynicism through protracted courtroom maneuvers and hearings. Who can forget the innocuous and bedraggled looking Chin, eyes downcast, staggering into court escorted by devoted sons clutching his arms? It was enough to whip New York's cop and mobster tabloid sycophants into a hysterical frenzy. Far from the gaudy nouveau riche persona of Gambino boss John Gotti, another object of media fascination, Chin assumed the trappings of more unassuming royalty in an elegant townhouse with his long-time girlfriend, only blocks from the 15-room apartment of the late Jacqueline Kennedy Onassis. He may yet return there.
Mr. Gigante's attorneys can thank precepts of English Common Law for his potential break. "If, after he be tried and found guilty, he loses his senses before judgment, judgment shall not be "pronounced..." [4 W Blackstone, Commentaries 24] Has Chin lost his senses?
Judge Jack Weinstein presided over Chin's Federal trial in the Eastern District of New York. He revealed his own doubts about Mr. Gigante when he ordered the government to conduct a full psychiatric and physical examination immediately after the trial. The results, and Chin, are due in New York this fall. Judge Weinstein will preside over a hearing to determine if the man before him is competent. Sound familiar?
In 1970, Chin was awaiting trial on charges he attempted to bribe police officers in Old Tappan, New Jersey. According to the local police officials reached for this story, the original charges stemmed from Mr. and Mrs. Gigante sending five dollars inside Christmas cards to several of the officers. Lieutenant John Volpe of the Bergen County Prosecutor's office in New Jersey also confirmed this. Chin's personal psychiatrist, Dr. Michael Scolaro, wrote to prosecutor John Cariddi. Dr. Scolaro indicated that he had treated Vincent Gigante since 1966 and explained that his patient had expressed fears that his neighbors might believe he was homosexual. This may have prompted Mr. Gigante and his wife to bribe police officers in an attempt to counteract the delusion. Dr. Scolaro described his patient as severely ill and being treated with high doses of Thorazine, Trilafon and Stelazine, at times together with Artane. These major tranquilizers, especially in combination or at higher doses, are noted to cause mental confusion, especially in those with evidence of even minor brain damage. Dr. Scolaro also mentioned that his patient was engaged in psychotherapy.
In May 1971, Henry Davidson, M.D., a prominent psychiatrist, was asked by the prosecution to examine Mr. Gigante. He wrote, "he seemed drowsy in the entire hour I spent with him... in my judgment, he is overmedicated... I couldn't elicit much of anything." Dr. Davidson proposed hospital treatment to restore competency.
Dr. Scolaro fumed at the recommendation. His response was dramatic . . . and ominous. In a letter dated July 26, 1971, he warned 'if this patient is forced to be hospitalized at a time when . . . questionable specific therapeutic indication . . . , such an experience could... result in a severe or permanent mental decompensation . . . I will hold personally culpable all those individuals . . . directly or indirectly responsible for his hospitalization or commitment." The charges against Mr. Gigante were eventually dropped.
"Who can forget the innocuous and bedraggled looking Chin, eyes downcast, staggering into court escorted by devoted sons clutching his arms?"
Mr. Gigante apparently did not share his psychiatrist's reservations about hospitals. He continued to be frequently admitted to psychiatric hospitals by Dr. Scolaro and, in the decades to follow, by subsequent private psychiatrists. Mob figures later referred to Chin's hospitalizations as "tune-ups."
In 1990, after a lengthy period of scrutiny and technical surveillance by law enforcement, Chin was indicted on racketeering charges related to a scam to control the contracts awarded by the city of New York to replace all the windows in public housing projects. But was he competent to stand trial? Could he understand the charges against him and assist in his own defense?
"God told me not to answer"
The wheels of psychiatry and justice turned again. Psychiatrist Stanley Portnow, and later, Abraham Halpern, were retained by the defense. The court appointed psychiatrists Daniel Schwartz and Jonas Rappeport. Each physician conducted interviews during 1990 and 1991, at times in tandem; they enlisted the assistance of psychologists to test Mr. Gigante's thinking and other intellectual abilities.
Psychological testing contemporaneous with the arrest in 1990 began with the efforts of Andrew Kelly, Ph.D., Director of the Department of Psychology at St. Vincent's Hospital in New York City, where Chin was hospitalized shortly after his arrest. Mr. Gigante refused to take the Bender Gestalt on the several occasions he was approached, stating, "dots make me nervous. God told me that it is hot outside...I don't want to draw and God told me not to." Dr. Kelly, who also attempted to administer the WAIS-R, eventually abandoned these efforts.
In February 1991, Roland Parker, Ph.D. performed psychological testing, at the request of Dr. Portnow. He was specifically asked to evaluate Mr. Gigante's memory, in view of Chin's past history as a boxer, and to determine whether he was malingering. Dr. Parker tested Chin with the WAIS-R, the Wechsler Memory Scale, and projective testing. The psychologist reported Chin's performance on the testing as so poor, "he could only remember four digits forward, less than a telephone number" He found Mr. Gigante to have IQ results of 65 (Verbal), 75 (Performance), and 69 (Full Scale). These results were actually an improvement from scores in the 50's range in IQ testing performed in 1971 by George Cassidy, Ph.D. As for the question of malingering, Dr. Parker declared "there are no reliable test approaches to distinguish malingerers from (non) malingerers." Nevertheless, he concluded that Mr. Gigante was not malingering.
The four psychiatrists provided their reports in early 1991 with findings that Mr. Gigante was unfit to proceed. Dr. Portnow, who listed eleven meetings with him, described his examinee as mute and refusing to elaborate on voices he stated he heard. Mr. Gigante described seeing people whom he thought were spying on him. Dr. Portnow characterized Chin's visions of people as hallucinations. The psychiatrist read accounts of the criminal charges to Chin, warning him to remember the charges or he might never again see his mother. Without mention of whether his examinee was likely to fear the white-haired, portly psychiatrist, Dr. Portnow wrote that his subject was still unable to "give a satisfactory recitation of charges." For example, Chin responded that the accusations dealt with "windows... and they can have my mother's windows." Barry Slotnick, his attorney, was "my brother's attorney."
"Mr. Gigante refused to repeat the charges against him or to acknowledge anyone other than God as his attorney"
Dr. Rappeport, himself a patriarchal figure of forensic psychiatry, also noted that Mr. Gigante refused to repeat the charges against him or to acknowledge anyone other than God as his attorney. He also described a response pattern of Chin to questions-he would look away, mumble, then return to the discussion, refusing to answer, but recalling the question nonetheless. Despite this pattern of recall, Chin repeatedly stated he was unable to remember the information he was asked for-or alternatively, that God instructed him not to answer. Regardless, Dr. Rappeport was influenced by the relative consistency of reported sick behavior over so many years. He concluded that Chin was not likely to improve.
Dr. Schwartz felt the response of "God told me not to answer" was not necessarily manipulative; perhaps, he reasoned, this enabled him to decline to answer intellectual tests, such as arithmetic, that were simply too complex. While Dr. Schwartz noted these inconsistencies, he ultimately concluded that there simply was not adequate evidence for his malingering.
Dr. Halpern told The Forensic Echo that he was most impressed with the available evidence for intellectual deterioration. He suggested the structural brain deterioration, from cardiac surgery and the effects of an earlier boxing career, left Chin incapable of the ability to "reason from a simple premise to a simple conclusion...does not have the ability to relate facts concerning his actions...does not have the ability to comprehend instructions and advice and make decisions based on well-explained alternatives." The condition of brain deterioration being untreatable, Dr. Halpern concluded Chin would not regain the competence to be tried.
The possibility of Chin's structural brain deterioration was first raised with the evaluations in 1991. The SPECT scan, a high tech imaging of the brain, was ordered. SPECT, measuring the function of specific areas of the brain, was thought to provide additional concrete data about Mr. Gigante's capacity. The results demonstrated brain perfusion throughout, sufficient to be characterized as abnormal for his age. Results of a second SPECT, performed in 1993, were not appreciably different from that of 1991. This indicates that whatever the limitations in Mr. Gigante's brain function, they were not progressive from the end of 1991 to 1993 as would be expected in Alzheimer's disease.
Sudden Death
Judge Eugene Nickerson: I don't think there's any dispute, is there, that he could drop dead at any time?
Dr. Wechsler: Any time.
Judge Nickerson: The question that I have to decide is whether and to what degree, if at all will that tendency, if that's the right word, propensity to drop dead will be increased by the fact that he's under what one might call a psychological stress.
Court Transcript, January 30, 1995
"Thus began the interval of cardiologists testifying as psychiatrists."
Thus began the interval of cardiologists testifying as psychiatrists and psychiatrists testifying as cardiologists. Mr. Gigante, consistently portrayed by the defense as someone too sick to run an organized crime family, was now characterized as too sick to survive the rigors of a trial.
Chin's cardiac condition increasingly became the focus of attention. At the later trial, onlookers were treated to the peculiar spectacle of Bernard Wechsler, M.D., the Chin's cardiologist, shouting in Mr. Gigante's ear, "I'm going to take your blood pressure." The shouting, according to Dr. Wechsler, was to overcome the hallucinations.
No one witnessed anyone else shouting at Chin, including the psychiatrists he clearly heard during the evaluations. This absurd display may have distracted attention from Mr. Gigante's legitimate cardiac concerns. Even cardiologists retained by the prosecution conceded that he experienced occasional spurts of ventricular tachycardia (v-tach), which placed him at risk for sudden death.
Dr. Wechsler showed the court progress notes from an early 1997 Mount Sinai Hospital admission, with strips of EKG readings showing the v-tach pattern. Not noted by examiners or by the court is the notation on February 18, "feels well... awake, alert, talkative." This observation by a physician contrasts noticeably with Chin's behavior during the March 7,1997 visit with Francis Weld, M.D., a cardiologist retained by the prosecution. Dr. Weld saw Mr. Gigante after he had been released from the hospital. "I ain't sick no more," was all he would say. The cardiologist documented, "he stared vacuously . . . not participating spontaneously in any discernible way."
Enough!
By now, Judge Nickerson would be forgiven for staring vacuously at seemingly never-ending medical and psychiatric testimony. Was Chin physically and psychologically fit to proceed with trial? Or would the apparently fragile defendant unceremoniously drop dead in the middle of the courtroom as the public looked on in horror? Was a merciless judge forcing too much from this man? If Judge Nickerson was looking to cut to the chase, the government gave him a golden opportunity.
The prosecutors assiduously held on to their own evidence of competency, about to spout forth in tape recordings or live testimony from the likes of Salvatore "The Bull" Gravano, Dominick "Baldy Dom" Canterino, Venero "Benny Eggs" Mangano, Anthony "Tony Ducks" Corallo, and Vincent "Fish" Cafaro. Well aware of what the evidence would show, the prosecution deliberately withheld it from the psychiatrists. Assistant Attorney General Andrew Weissman told The Forensic Echo that it was the best strategy they could have used.
The court did its part by preventing the psychiatrists from attending the hearings. Judge Nickerson declared, "I don't want the doctors here. I don't want the doctors to be making a judgment on their assessment of the credibility of the witnesses. I'm going to make that assessment and tell them what my assessment is." In that final assessment, the mobsters were to be believed. And, by directive of a court order, the psychiatrists were to believe them too.
The government's witnesses testified at length about Chin's actions and decisions as head of the Genovese Family, and the common assertion that Chin's "crazy act" was just that-an act. Chin's executive functions included running a numbers operation, resolving disputes, arranging kick backs, leading meetings, investigating unauthorized killings, saving the life of a marked man and authorizing the murder of others. Chin was The Boss.
"The Judge told the psychiatrists to accept these findings as true. Three out of four psychiatrists changed their conclusion."
The judge turned to the psychiatrists and said: You are to accept these findings as true. Now tell the court to what extent, if any, these findings alter your assessment of Gigante's competency to stand trial? Three out of four psychiatrists changed their conclusion. Dr. Halpern refused to accept the court's findings as true. The judge declared Chin competent, ordered medical precautions to monitor and maintain his blood pressure, and ordered him to stand trial beginning June 23, 1997, "no matter what."
Judge Nickerson would not be presiding over the trial of his reluctant defendant. After ruling on Chin's competency, he recused himself from the case because his wife was diagnosed with Alzheimer's disease. He did not foresee that Chin's competency question, like a Phoenix out of the ashes, would rise again.
According to hospital records, Chin underwent not one but two valve replacement operations. His later heart surgery in December of 1996 was timely. A flurry of medical reports, even those of prosecution cardiologists, noted the complexity of the procedure and Chin's precarious cardiac arrhythmia. Mr. Gigante, in the same operation, underwent a double bypass, replacement of the aorta, and repair of an aortic aneurysm.
The latter procedure alone is associated with an operative mortality of 50 percent. In over five hours of surgery, Mr. Gigante's brain was dependent on reverse circulation by low pressure pumping for 29 minutes.
Spearheaded by Barry Slotnick, the chief rabbi of New York mob attorneys, the defense strategy began the process of paralleling the deterioration of the Chin's heart with his mental status. Attorneys Michael Marinaccio, Philip Fogtia and Steven Kartagener carried the issue before Judge Nickerson's successor, Judge Weissman.
"Gigante's brain was dependent on reverse circulation by low pressure pumping for 29 minutes"
Pictures Don't Lie
Additional neuropsychological testing was then performed by a defense retained specialist, Wilfred Van Gorp, Ph.D. Dr. Van Gorp, an Associate Professor of Psychology at the Cornell Medical Center, is the director of the neuropsychological testing at New York Hospital, one of America's most renowned departments of Psychiatry.
Unlike previous neuropsychological testing batteries, Dr. Van Gorp performed a number of tests—the Rey 15 Word Test, the California Verbal Learning Test, the Portland Digit Recognition Test (PDRT), and the Warrington Faces and Word Recognition tests, all of which have previously researched effectiveness in demonstrating that a person is likely to be faking intellectual deficit.
Selection of these tests was inspired by research of what are known as forced choice techniques [Pankratz, L. Perceptual and Motor Skills 57, 367-72 (1983)]. These exercises involve showing the examinee a word, or a picture, or numbers, then asking the examinee to remember the items from a choice of two. Responding at the rate of chance would result in approximately 50 percent correct answers, so even those with considerable brain damage would be expected to correctly select approximately half of the time. Those who malinger memory impairment, therefore, would theoretically choose the wrong answer, and respond correctly well below the rate for chance.
Dr. Van Gorp's IQ findings, in the intellectually impaired range, did not differ greatly from those of 1991, when Chin was later ruled by Judge Nickerson to be engaging in organized crime activities. Mr. Gigante's participation in the testing and his comments to the examiner during the testing were interpreted as a sincere desire to do well.
"The tests only distinguish someone who almost definitely is faking. They cannot be used to determine that someone is not."
His results showed choices on the various batteries did not fall below the probability of chance. These findings were trumpeted by the defense as evidence that Mr. Gigante was not malingering. However, this is a distortion. The tests can only distinguish someone who almost definitely is faking. They cannot be used to determine that someone is not.
Moreover, the best research on some of these tests, such as the Warrington, examined patients with minor head injury who were involved in personal injury suits, comparing them with another group that had suffered more serious traumatic brain injury [Binder, L. and Kelly, MP. Assessment 3, 403-9 (1996)]. There is no available research to determine whether people who may be motivated by financial reward have the same determination to malinger as those facing murder charges, or the savvy of someone who has been under surveillance for almost 30 years. A closer analysis of the Dr. Van Gorp's data reveals that these results, while not conclusive of malingering, certainly further raise the possibility. For example, the (PDRT), which Dr. Van Gorp scored at 42, and interpreted, "above the cut off score for malingering," is actually lower than 119 out of a sample of 120 traumatic brain injured patients [Millis, S.R. and Putnam, S.H., Perceptual and Motor Skills 79, 384-6 (1994)]. This interpretation is akin to saying that the person who graduates next to last in his class has a degree.
Additionally, Dr. Van Gorp did not perform certain tests, specifically the MMPI or the General Memory and Attention/Concentration subtests of the Wechsler Memory Scale [Mittenberg, W. and Azrin, R. et al. Psychological Assessment 5, 34-40 (1993)] which provide a more established instrument of detecting malingering than the subsets chosen.
Laurence Binder, Ph.D., the developer of the PDRT [Binder, L. Journal of Clinical and Experimental Neuropsychology 8, 323-346 (1993)] was contacted by The Forensic Echo. He commented that Mr. Gigante's report did not point out that he performed at below the cutoff for malingering on one of the two scales of the PDRT. Dr. Binder, an expert in the testing of malingering who is based at the Oregon Health Science Center, noted, "(Chin's) scores on a few scales were just incredibly low. . . . I mean, we're talking about tests, like the Boston Naming, that are amazingly simple . . . and yet he scores low average on logical memory.. .taken together, it just doesn't make any sense." For example, The Trail Making Test [Davies, A. Jl. Clinical Psychology 24:96 (1968)], which involves connecting the dots of consecutive numbers, required 228 seconds for Chin to connect 25 choices. With the age appropriate time for this task to be 45 to 50 seconds, Dr. Binder suggested, "I would conclude he just wasn't trying." But, added Dr. Binder, Chin did demonstrate effort on other tests.
A PET scan of the brain was performed to follow up these neuropsychological test findings. Monte Buchsbaum, M.D., a respected neuroimaging specialist based at Mount Sinai Hospital, interpreted the test, which offers a higher resolution image of brain functioning than SPECT. Dr. Buchsbaum commented, "There was a statistically significant difference between the PET Scan of Mr. Gigante and that of age matched controls." Deficits, according to Dr. Buchsbaum, that were consistent with Alzheimer's or multiple infarct dementia.
The expert added that the decreased activity in one of Mr. Gigante's temporal lobes could not be attributed to antipsychotic medicine he was reportedly taking. While he conceded he was limited in his interpretive potential by the lack of a previous PET scan available for comparison, Dr. Buchsbaum concluded this was definitely an abnormal scan. Mr. Gigante's PET scan was not consistent with the pattern typically seen with chronic schizophrenia, especially in those with significant symptoms of apathy and withdrawal, which is characterized by decreased activity in the frontal lobes [Volkow, N.D., Am. Jl. Psychiatry 144: 151-8 (1987)].
"Deficits were consistent with Alzheimer's or multiple infarct dementia."
Dr. Halpern concluded from the relatively unchanged findings on IQ testing, and from Dr. Buchsbaum's study, that Chin was incompetent to stand trial as a result of the intellectual deterioration of a dementia. This dementia, he maintained, was not the result of a progressive Alzheimer's, but of a vascular origin.
Judge Weinstein patiently heard it all again. He reviewed the recent medical and psychological information and on June 3, 1997, upheld Judge Nickerson's earlier determination of competence. The trial began on June 25th.
Chin attended every day of his trial, sitting passively in a wheelchair, mumbling to himself and virtually ignored by his attorneys. His large family filled nearly half the courtroom each day while his brother, Father Louis Gigante, doted over him during breaks in the proceedings. His defense was limited to attempts by his lawyers to dismantle the credibility of a string of mob witnesses.
"A jury found Gigante guilty of racketeering and murder conspiracy. Chin's first and only public reaction was to turn and look at his family."
On July 25, a jury found Vincent Gigante guilty of racketeering and murder conspiracy. Upon the reading of the verdict, Chin's first and only public reaction was to turn and look at his family, many of whom burst into tears.
Down but Not Out
A defendant convicted of such criminal charges ordinarily would face a 30-year prison sentence. But Judge Weissman ordered the government to conduct physical and psychological examinations to determine Chin's competency for sentencing. His lawyers have already told the court of an intention to have psychiatrists of their choosing examine Mr. Gigante upon his return to New York.
In a gesture that would later be described by defense attorney Steven Kartagener as an expression of great civility, Judge Weinstein allowed Chin to self-surrender within 24 hours to the Federal medical facility in Butner, North Carolina. He traveled there at his own expense, accompanied by family members and government guards.
The psychiatric legal question continues to be complex. Any one of the following scenarios is a possible explanation of his diagnosis, his sincerity, and his competence to receive sentencing:
- Schizophrenia, Dementia, not malingering, and incompetent for sentencing
- Schizophrenia, Dementia, malingering, and incompetent for sentencing
- Schizophrenia, Dementia, malingering, and competent for sentencing
- Schizophrenia, not malingering, and incompetent for sentencing
- Schizophrenia, malingering, and competent for sentencing
- Dementia, not malingering, and incompetent for sentencing
- Dementia, malingering, and incompetent for sentencing
- Dementia, malingering, and competent for sentencing
- No illness, malingering, and competent for sentencing
Attorney Steven Kartagener continued to play the death card. In a letter to Judge Weinstein, he wrote, "We firmly believe that if he were to be held at MCC or MDC (local correctional facilities) there is substantial possibility that he would die." The letter cited Chin's cardiac problems and requested the court to allow Chin to remain on house arrest upon his return, pending resolution of his pre-sentence litigation.
What if Chin is found competent? In that event, his options open. He can be provisionally sentenced and sent to a hospital for care or treatment. If and when he recovers, the court can then resentence him, with the option to modify the provisional sentence. If he is very lucky, he will be modified back to the familiar arms of those who love him.
But if he's found competent, he will be sentenced to the correctional facility of the court's choice, possibly to reemerge at age 99. Unless, of course, his doctors persuade the court that Chin finally has a condition that can be diagnosed to a real degree of medical certainty. That may yet happen. Attorney Kartagener's letter informed the court that Vincent Gigante may have thyroid cancer.
If Vincent Gigante has been faking or exaggerating symptoms, to the successful end of fooling four forensic psychiatrists and scores of other mental health professionals, what does this say about psychiatry? But was everything done to answer this question that could have been? Or did the experts charged with teaching the court just fail to bite the bullet and be decisive in expressing their suspicions more openly?
Defense psychiatrists privately voiced their discomfort with Judge Nickerson's ruling that they would have to accept his findings that Mr. Gigante did have an executive role in the affairs of the Genovese crime family until at least well into 1991. They scoffed at the credibility of convicted murderer turned informant Sammy "The Bull" Gravano, even as they accepted the reliability of Mr. Gigante, a convicted drug trafficker who had already withheld his second (Esposito) family, if not his third (Genovese) from them. Dr. Rappeport told The Forensic Echo it was his belief that Mr. Gigante was an underling in the Mafia-a "shill" who was held up as a front man and did not actively conduct Mafia business.
Behavioral Fingerprints
The four psychiatrists reportedly considered records from a 1960-64 prison term for drug trafficking as part of the Genovese crime family operations. These records referred to his earlier acquittal for the attempted murder in 1957 of then Genovese boss Frank Costello. Included in this evaluation was the observation that Chin took pride in the praise showered upon him by clergy and recognition as a "henchman" with "racketeers," "giving him the role of a Jekyll and Hyde personality." Yet, nowhere did the reports reflect a discussion with Mr. Gigante about his role in organized crime. It's hard to imagine the analysis of a person's understanding of racketeering charges without a documented discussion of the Genovese family and his relationship, whatever it was, to it.
The psychiatrists had access to information that Mr. Gigante managed to develop a second family. Three children were born to Chin and Ms. Olympia Esposito between 1964 and 1970, while he was raising children with his first wife in New Jersey This contradicts our appreciation of residual symptoms of schizophrenia, such as social withdrawal.
How could someone so intellectually "burned out," and as described by psychiatrists, pathologically dependent upon his mother, maintain friendships for over twenty years with people who were at least visiting with him on videotaped surveillance? Those who have such a deteriorated course find themselves quickly isolated from people to whom they can no longer relate.
"If he gets pinched, all them years spent in that f—asylum would be for nothing"
The evidence from surveillance included the 1985 voice recording of Genovese captain Giuseppe Sabato discussing the possible arrest of organized crime figures, including Chin. "Fat Tony" Salerno, the reputed head of the family, responded, "If he gets pinched, all them years he spent in that f-ing asylum would be for nothing." who else could Tony Salerno have been referring to on tape recorded conversations as "Chin?"
Could a schizophrenic or the less disabled schizoaffective run an organized crime operation? Dr. Halpern told The Forensic Echo that he considered the explanation of "synthetic sanity." Namely, in order to maintain his position in the hierarchy, Chin advanced the notion within his syndicate that he was faking illness. This sounds, on its face, too much to believe. But perhaps a man clever enough to conceal his capability from some of America's most highly trained psychiatric and law enforcement professionals is certainly cagey enough to fool the simple world of good fellas like Benny Eggs and Fat Tony.
However, the mob had the advantage of observing Mr. Gigante in a much more naturalistic setting. And with tradition dictating the "elimination" of member officers for having mental illness, in part because of the perceived secrecy risks, Chin would likely have been a target if the Family believed he was anything less than a "crazy act."
Ah, "The Robe." While nobody will ever believe that Sol Wachtler, former New York Chief Justice, was emblematic of someone psychotic, neither was the once fashionable, later pajama-clad Chin in his strolls around Greenwich Village. Peculiar as those with schizophrenia can be, most of the shabby clothes they wear are the only ones they may have. Having schizophrenia does not mean one forgets how to dress. Caricatured behavior is suggestive of malingering [Wachspress,M., Berenherg A.N., & Jacobson A. Psychiatric Quarterly 27:463-73 (19.53)].
Dr. Scolaro's 1971 letter and Dr. Wechsler's omnipresence and "blood pressure reports" in the court are notable. Physicians just don't carry on like this. These examples of theatrical behavior we appreciate in the context of caricature.
"A nursing care facility would lose certification for this symbolic neglect of a patient."
And then, the dirty fingernails. Chin was distinguished by neglect of his hygiene, from shaving to bathing, to even the soiled robe he wore when he wandered about. Even a nursing care facility would lose certification for this symbolic neglect of a patient. How is a man so beloved by his personal family allowed to suffer the indignity of dirt caked on his body and person? How is it that even as they were aware of his tendency to roam, no concerns were raised by St. Vincent's Hospital that somebody might rob or mug the old, confused man?
More than Meets the Eye
Mr. Gigante looked up at the jury as the verdict was being read. The one occasion of looking back at his family was after the verdict was rendered. This illustrates his awareness of the gravity of the moment, given his reported lack of involvement otherwise. He was not observed to look at the jury, or at his family, at any other time during the trial.
The relationship of elevations of Chin's blood pressure to the stress of evaluations, and of the hearings, contradicts the defense position that he is unaware of his surroundings. While one can not infer that he is able to communicate the circumstances related to his charges, this highly aroused response supports that he was aware of the seriousness of the situation. The same response to questions about his case would cause Chin to fail a lie detector test, which monitors level of arousal through different physiological responses.
Mr. Gigante's blood pressure may also be a deeper story. Some can voluntarily increase their blood pressure as well as lower it. If we are to consider Chin's very composed and controlled method to his confusion should we not also consider a method to his perfusion?
"Was he exceptionally paranoid-to the point of being schizophrenic?"
There was ample basis for questioning Chin's illness just on the basis of his symptoms. When asked about the content of his hallucinations, Chin offered only that God told him not to cooperate. This lack of depth to the hallucinations—given that Mr. Gigante had other experiences than just meeting with psychiatrists—is not consistent with genuine auditory hallucinations. Nor are the accounts provided by Reverend Louis Gigante of Chin's seeing animals. While visual hallucinations are present in some with schizophrenia spectrum disorders, these are traditionally life-sized representations of people. Animals are seen more frequently in drug withdrawal or intoxication [Goodwin, D.W. et al. Archives of General Psychiatry 24: 76-80 (1971)].
Hallucinations distracted Chin, according to the accounts of examiners; when he was being questioned about conflictual material, he was described as looking off, and then engaged by the interviewers. When Chin returned to the conversation, he was able to respond to the original question. Too impressive for a person with reported memory impairment to the degree described.
Also notable was Chin's reported challenging of Dr. Portnow: "You think I'm lying." Someone who is malingering symptoms more likely raises this confrontation out of context [Resnick, P. in Clinical Assessment of Malingering, New York: Guilford Press (1997) p. 60]. Ideas of persecution involve pursuit, intent to harm, surveillance, following, but not ideas that a doctor thinks one is lying.
"Physicians who repeatedly described Chin as depressed or psychotic conceded he can never get better."
Physicians who repeatedly described the Chin as depressed or psychotic were quite willing to concede the point that he cannot ever get better. This perspective reflects either archaic understanding of 1990's psychiatry or disingenuous analysis. It is especially troubling that these words emanated from physicians who have devoted such attention to a patient seldom reserved for anyone outside the geriatric meal tickets of Beverly Hills. The standard medical perspective is that psychosis, symptomatic of several conditions, and depression, are treatable. Dr. Schwartz told The Forensic Echo that this aspect of the case only caused him to further question the legitimacy of the presentation.
Chin's cardiac prognosis following surgery did not bode well. Yet patients who have undergone cardiac surgery are prescribed an aggressive cardiac rehabilitation plan. No mention of this plan was included in cardiology evaluations for the court. How was this omitted, particularly for a patient so personally attended to by his physician?
Chin is reported to have raised the level of secrecy within his organization to forbid even mention of his name. When referring to him, associates were to point at their chins and use the expression "that guy." He was notoriously hard to monitor, even as government witnesses later placed him at meetings of the organized crime "Commission." He traveled little, often late at night, and was visited by few. This is exceptional, even for an organized crime figure. Was he exceptionally paranoid . . . to the point of being schizophrenic? Or, if he was faking schizophrenia, was he a paranoid man whose personality assisted him in maintaining his anonymity?
Broken Mind—Broken Heart?
In all likelihood, if Chin was malingering schizophrenia, his paranoia represented a healthy caution. The organized crime world is rife with betrayal and insurrection and the need to be wary of it. A paranoid personality disorder alienates others at the workplace and the family. Everything we can observe about Chin demonstrates the stability of his organization and of his family. It is impossible to imagine such a personality would beget a stable business and well adjusted children-unless he were absent, and allowed others to raise his family.
Chin presented himself in a very mentally debilitated fashion during interviews. This, along with abnormal psychological testing and abnormal SPECT scan, moved at least one psychiatrist to conclude unfitness to proceed on the basis of a multi-infarct dementia. But no area of stroke has ever been demonstrated, and he did not exhibit evidence for neurologic deficit that traditionally accompanies the cognitive deficits of multi-infarct dementia. Therefore, this conclusion can only explain that Chin hasn't deteriorated mentally in the past several years-even as it cannot be established that he ever deteriorated, apart from normal aging, in the first place.
Ultimately, competency is task specific. Even if profoundly demented, Chin might still have the capacity to understand the process of sentencing or to address the court to further his own interest. Even some persons with mental retardation have been found to be competent, based on their demonstrated abilities for these specific tasks. The examination never fully addressed what Chin could do relative to his criminal case.
The psychiatric experts found the persistence of the presentation to be supportive of true psychopathology. The repeated hospital admissions afforded Mr. Gigante exposure to numerous mental health professionals who repeatedly supported the clinical impressions of his private psychiatrists. Even with the inconsistencies of his presentation, he was not meaningfully participating in his forensic examinations. Neither was he apparently involved when he appeared in court during the trial.
"The most compelling evidence of Chin's incapacity is the lack of surveillance evidence showing organized crime involvement after 1991."
Perhaps the most compelling evidence for Chin's current incapacity is the lack of surveillance evidence for his continued involvement in organized crime after 1991. However, this would require a de facto acceptance of the surveillance prior to then, which the defense has never been prepared to do.
"The Cornell studies demonstrate a 35 percent incidence of brain deterioration in patients one year after undergoing cardiac bypass."
Stronger support for the theory of brain deterioration can be drawn from what we are now learning about the consequences of cardiac surgery. Denise Barbut, M.D. of New York Hospital-Cornell Medical Center, has been conducting research in the neuropsychological consequences of open-heart surgery. According to Dr. Barbut, the Cornell studies have demonstrated a 35 percent incidence of encephalopathy, or deterioration of the brain, in patients examined one year after undergoing cardiac bypass. Dr. Barbut's research has attributed this not to changes in blood pressure but, more frequently to microscopic sclerotic plaques that break away from vessels as they are manipulated in surgery. [Barbut D. and Caplan, L. Brain Complications of Cardiac Surgery (in print)]. The more plaques that embolize into tinier cerebral vessels, the more likely the patients are to suffer small strokes.
"Clamping of the aorta, followed by clamp release, are each followed by a flurry of particles that embolize out into the circulation, a flow which has been correspondingly detected in the brain," explained Dr. Barbut. These two operative events, according to the research, account for over 60 percent of the embolization. For this reason, she asserts, the percent likelihood of brain deterioration in patients who have undergone valve replacement (associated with plaque collection on the diseased valve) is likely to be higher. Dr. Barbut asserted this degeneration would be especially pronounced in a patient with a genetic predisposition to Alzheimer's disease.
The presence of malingering is most appropriately monitored on a forensic psychiatric unit. Trained personnel can carefully observe and institute treatment to restore competency This was not adequately done in the case of Chin.
Evaluations by the court appointed psychiatrists should be isolated from those conducted by defense psychiatrists. With the free flow of information, perhaps the experts feel more informed, but the subtle influence of the defense psychiatrists contaminates the objectivity of the independent experts, no matter how ethical they may be.
"What would your mother say to a psychiatrist?"
The outflow of information from Chin, as from the prosecution, was also tightly controlled. Father Louis Gigante, former councilman and Bronx-based priest, was the spokesperson for his brother. Chin's mother also provided a history to the examiners. Question: What would your mother say to a psychiatrist? Answer: What would she say to a police officer?
Get Nosy with Chin
Nowhere in the examination is there a record of an interview with Mr. Gigante's girlfriend, Ms. Esposito. Is the companion not a person's logical official advocate? How did this "burned out" schizophrenic develop a relationship with her? How is she now involved in his care? Dr. Schwartz told The Forensic Echo he "didn't feel it was my place to talk to her." Dr. Rappeport said he, too, didn't think he had the right to do so. Judge Nickerson, described in one tabloid as a romantic, granted Chin's request to be allowed to continue evening visits with Ms. Esposito, even after he had moved back in with his estranged wife.
And what about Chin's legal wife? How did the children of the Gigante family reconcile with their father's second family? To what do the apparently well-adjusted Gigante offspring attribute their normalcy, being the product of not only a reportedly very ill man, but also one who was pursued, surveilled, and isolated for their formative years? Dr. Portnow told The Forensic Echo that family members had little more to offer than sentiment about how sick Mr. Gigante was. Careful questioning would have identified discrepancies which could have been further pursued-or validated the position of the defense. Any forensic examination of malingering that considers a well-orchestrated effort to withhold information must include the interview of as many close acquaintances and family as possible. How do you learn that someone is malingering? You ask. And ask. And ask.
The prosecution could have better responded to the maintenance of Chin as an outpatient. Any examination in his home should have included an analysis of his function, much the way an occupational therapist performs a functional evaluation or an assessor determines the need for guardianship. This would have provided far more credible information on his competency to go to trial than videotapes of strapping, cigarette smoking guys wearing sunglasses and tight shirts, with "attitude," kissing him on the cheek as they call on him.
Where the Bodies Are Buried
There is a wealth of information already available from Chin's hospitalizations at Mount Sinai. The early 1997 notation in the medical record suggests staff may have observed a more intact and able Chin than did doctors who met with him for medicolegal examinations. Prosecutors who invest millions of dollars on surveillance equipment would find it cheaper, and perhaps equally effective, to subpoena records from medical and not just psychiatric hospitalizations, where nurses and other trained professional staff are obligated to record very detailed observations of the patient. Was Chin truly mumbling when he believed he was unobserved? This provides far more detailed and credible input than the recollections of a sleep-deprived law enforcement agent that, "he sure looked okay to me."
The temporary nature of dramatic and seemingly psychotic symptoms of a possible examinee is strongly suggestive of malingering, particularly when
