The Use of Telemedicine to Evaluate Competency to Stand Trial: A Preliminary Randomized Controlled Study

Dr. Manguno-Mire and Dr. Artecona are Assistant Professors of Psychiatry, Department of Psychiatry and Neurology and Dr. Thompson is Vice-Chairman, Associate Professor, and Chief, Division of Forensic Neuropsychiatry, Tulane University Health Sciences Center, New Orleans, LA. Dr. Shore is Assistant Professor, Department of Psychiatry and Dr. Croy is a Statistician in the American Indian and Alaska Native Programs, University of Colorado Health Sciences Center, Denver, CO. Dr. Pickering is staff Psychologist, Eastern Louisiana State Mental Health System-Forensic Division. Results were presented at the annual meeting of the American Academy of Psychiatry and the Law in Montreal, Canada, October 2005. Address correspondence to: Gina M. Manguno-Mire, PhD, Department of Psychiatry and Neurology, Tulane University Health Sciences Center, 1440 Canal Street TB-53, New Orleans, LA. E-mail: gmire{at}tulane.edu To investigate whether forensic evaluations can be performed reliably using telemedicine, we compared the results on a standard competency assessment instrument using telemedicine (TM) and live interviews (LI). Two board-certified forensic psychiatrists used the Georgia Court Competency Test (GCCT) to evaluate 21 forensic psychiatric inpatients. Half of the patients were randomly assigned to a telemedicine interview and half were assigned to a live interview. Total scores on the GCCT were similar for both raters, indicating high levels of agreement between telemedicine and live interviews. Patient and provider satisfaction were measured and indicated that, although patients did not express a preference for a particular interview modality, providers reported greater satisfaction with live interviews. Findings suggest that one aspect of competency to stand trial can be reliably evaluated using telemedicine and that patients perceive telemedicine as an acceptable alternative to a standard live interview. The limited sample size precludes definite conclusions and further studies involving a larger forensic study population are warranted.