Opinion
NOT TO BE PUBLISHED
APPEAL from a judgment of the Superior Court of San Diego County, No. SCD204817 Bernard E. Revak, Judge.
McDONALD, J.
Tomasa Ramirez (Ramirez) appeals a judgment following her jury conviction of one count of second degree murder (Pen. Code, § 187, subd. (a)). On appeal, she contends the trial court: (1) erred by finding she knowingly and intelligently waived her Miranda rights and denying her motion to suppress extrajudicial statements she made to police; and (2) abused its discretion by allowing an expert witness to testify for the prosecution during the sanity phase of her trial.
All statutory references are to the Penal Code unless otherwise specified.
Miranda v. Arizona (1966) 384 U.S. 436 (Miranda).
FACTUAL AND PROCEDURAL BACKGROUND
At about 6:40 p.m. on February 17, 2007, Mercedes Ramirez, Ramirez's mother (Mercedes), screamed and ran out of the apartment in which she and Ramirez lived. Nigatu Mengistu, a neighbor, heard her screaming and opened his door. She said, "Por favor, por favor, " in Spanish. After he asked her if she was okay, she started to fall and he caught her. He saw she was bleeding all over her body. He took her into his apartment and had her sit in his bathroom. She lifted one arm and began bleeding profusely. Mengistu called 911 and reported that someone had been stabbed with a knife.
San Diego Police Officer Jose Ramos arrived and saw Mercedes bleeding from multiple areas of her body, primarily from her chest and back. She appeared very pale. In Spanish, Mercedes told him: "My daughter killed me." As they conversed, Mercedes became unresponsive, stopped breathing, and fell to the floor. Paramedics arrived and transported her to a hospital. She later died from multiple stab wounds.
During this period, Ramirez called 911 from her apartment and stated: "Yes, emergency, I just stabbed my mom and she went out." She identified herself and then explained: "My voices told me to do it." She said she "washed out the knife that I stabbed my mom [with]." When asked if she stabbed her mother, Ramirez replied: "Yes, I just stabbed my mom, my mom because my voices was telling me to." She stated the knife she used was in the sink and that she had washed it. When told help was on the way, Ramirez stated: "Okay, thank you. I'm sorry for this, ma'am, I can't believe I did this to a mother." When officers arrived at the door, Ramirez hung up and opened the door for them. As one officer detained her in handcuffs, Ramirez spontaneously stated: "I did it, the voices in my head told me to do it." When paramedics asked the officer how big the knife was, Ramirez interjected, stating: "I put it in the sink and washed it." When one officer retrieved a knife from the sink to show to the paramedics, Ramirez stated: "That's the knife."
Ramirez was arrested and questioned by police in a videotaped interview conducted that evening. She told police that she had been playing cards with Mercedes at a table that evening. Mercedes said something that probably got her upset and she (Ramirez) began to hear voices. Ramirez went outside to smoke. The voices she heard told her to stab Mercedes. When she returned, she went into the kitchen and grabbed a knife. Ramirez told police that she then "blanked out and stabbed my mama for some reason that I didn't even want." She stabbed Mercedes in her back and shoulder five or six times. She initially stabbed Mercedes when she was sitting in the chair and then three times in the back when she was near the door.
During trial, the videotape was played for the jury and a transcript of the interview was made available to the jury.
On February 21, police questioned Ramirez in an audiotaped interview. She began the interview by stating: "I know I'm guilty. I know that I did wrong." She explained she began hearing voices while she was playing cards with Mercedes between 4:00 and 6:00 p.m. on February 17. She initially stated the voices told her to "stab your mom." However, she later stated the voices told her to hurt someone. They did not tell her to hurt Mercedes. Ramirez went outside to smoke a cigarette. She wanted to cut herself, but instead stabbed Mercedes. She felt pressured by the voices and "just blacked out." She had heard voices for years, but they had never before told her to hurt someone. She said she did not mean to stab Mercedes. Ramirez stated: "For the law and stuff, I know I... broke the law. And I know I'm guilty. I know I did wrong. But, I know at the same time here, I'm suffering too."
During trial, the audiotape was played for the jury and a transcript of the interview was made available to the jury.
An information charged Ramirez with murder (§ 187, subd. (a)) and alleged that in committing the murder she personally used a dangerous or deadly weapon (§ 12022, subd. (b)(1)). She pleaded not guilty and not guilty by reason of insanity and denied the deadly weapon use allegation.
On June 4, 2007, the trial court declared a doubt about Ramirez's competence to stand trial and suspended criminal proceedings on the felony complaint against her. On October 7, 2008, following a four-day bench trial, the court found Ramirez was competent to stand trial and reinstated the criminal proceedings. On November 12, 2008, the instant information was filed against her.
Guilt phase. During the guilt phase of her trial heard by a jury, the prosecution presented percipient witness testimony and other evidence substantially as described above. The prosecution also presented the expert testimony of Jaga Glassman, M.D., a psychiatrist. Glassman reviewed Ramirez's records and interviewed her on December 8, 2008. He diagnosed Ramirez's condition as intermittent explosive disorder. Persons with that disorder generally act impulsively and do not think through the consequences of their acts. They often have violent explosions of anger. Glassman also diagnosed her condition as mentally retarded, with a low IQ and cognitive impairment. There was evidence she had brain damage, possibly from early, untreated seizures. Although he believed she had a personality disorder, her symptoms were not sufficient to support a diagnosis of a separate personality disorder. Her psychotic symptoms were related to her personality disorder and possible organic brain damage. Glassman believed the mental health system had trained Ramirez to blame her explosive behavior on her psychotic symptoms and she received psychiatric treatment rather than taking responsibility for her behavior. He believed she blamed her stabbing Mercedes on the voices she heard because she had learned to do so. There was no evidence she was responding to voices when she was interviewed by police. He did not believe her story to police about hearing voices, because she gave different stories at different times. Based on the police interview, it appeared to him that Ramirez had some kind of argument with Mercedes that made her (Ramirez) angry. However, he could not say whether Ramirez acted out of simple anger or under the influence of her intermittent explosive disorder.
In her defense, Ramirez presented the expert witness testimony of Alan Abrams, M.D., a psychiatrist. Abrams diagnosed her as having borderline intellectual functioning, which meant she had significantly subnormal intelligence with an IQ between 70 and 75. She was on the boundary between borderline intellectual functioning and mild mental retardation. She lacks the ability to think abstractly and instead thinks "concretely, " meaning she focuses on the details of life rather than the big picture. That is often a sign of cognitive impairment. Abrams also diagnosed Ramirez's condition as a psychotic disorder, not otherwise specified. She had marked problems with functioning in the world, with mood stability, and with accurate perception of reality. Although she had many symptoms of schizophrenia, her emotions were too unstable for her to be diagnosed as schizophrenic. She is not clearly bipolar, because she rarely has periods of normal functioning. She has mood instability and distorted perceptions of reality.
In February 2007, Ramirez was attending a day treatment program at Bayview Hospital. During that time, she was having difficulty perceiving reality and was struggling with auditory hallucinations that told her to do harmful things. During the week before the instant incident, she told her psychiatrist she was trying to avoid the voices, ignore them, and fight them off. She also was becoming increasingly paranoid. Abrams believed Ramirez's illness worsened during that week, she experienced hallucinations, and she was unable to sufficiently inhibit her behavior to withstand the pressure of the hallucinations. She acted irrationally in response to the voices telling her to hurt someone. She felt unable to do anything but submit to the hallucinations, the pressure of which did not lessen until after the stabbing. When she washed the knife afterward, it was because of learned habitual behavior to wash a dish if it was dirty. When she called 911, she operated on a primitive level and did what she had done in the past in similar situations.
The jury found Ramirez not guilty of first degree murder, but guilty of second degree murder. It found true the deadly weapon use allegation.
Sanity phase. During the sanity phase of the trial, Ramirez presented the expert testimony of Gregg Michel, Ph.D., a clinical psychologist. He was appointed by the trial court to evaluate whether Ramirez was legally insane at the time of the incident. He interviewed her on February 10, 2009. At that time, she was not overtly psychotic, but her speech was disjointed and illogical at times. Although she was not acutely psychotic, there were signs of psychosis, such as confabulation and perseveration. Michel diagnosed Ramirez's condition as paranoid schizophrenia. He believed she was always psychotic, even when she had good contact with reality and did not act bizarrely. Based on Ramirez's purposeful act of selecting the knife and stabbing Mercedes, he believed Ramirez knew the nature and quality of her acts. However, because her actions showed she had decompensated and was psychotic, she did not know what she was doing was morally or legally wrong for a short time before until a short time after the stabbing. It was not important that she knew right from wrong shortly after the stabbing. She could have quickly recovered afterward and, at the time she spoke with police, known her acts were wrong. In Michel's opinion, Ramirez was legally insane at the time she stabbed Mercedes.
Abrams also testified as an expert for Ramirez on the question of her sanity. He reviewed her long and eventful mental health history, which began with her first psychiatric hospitalization in 1986. During the three-week period preceding the stabbing, her treating psychiatrist reported that her hallucinations, delusions, and paranoia were increasing and she was at increased risk of decompensation. Abrams testified that Ramirez's mental illness is very unstable and she changes mental states rapidly. During those times when she is severely ill, she cannot understand that she is mentally ill and that her hallucinations are hallucinations. When she feels dominated by hallucinations or delusions, she is unable to control her thoughts and that leads to destructive behavior. In his opinion, Ramirez knew that she had a knife in her hand and stabbed Mercedes, but she lacked the ability to distinguish right from wrong. She lacked the ability to understand her act was legally or morally wrong or both. He believed that at the time Ramirez stabbed Mercedes she was in an irrational, psychotic state and felt so much pressure from auditory hallucinations that she acted in accordance with them.
The prosecution presented the percipient testimony of Lizbeth Garcia, Ramirez's niece, who lived with Ramirez and Mercedes periodically during 2000 and 2005. During the six-month period preceding February 17, 2007, Garcia stayed overnight at the apartment Ramirez shared with Mercedes. During that time, Ramirez helped with the cooking and cleaning, took the bus to medical appointments and to cash her checks, and went to the store alone to purchase items Garcia and Mercedes requested. Garcia testified that Ramirez acted normally at times and angrily toward Mercedes at other times. Ramirez and Mercedes argued occasionally about Ramirez's smoking in their home, taking her medications, or playing her music too loudly. Garcia knew Ramirez had been hospitalized several times during December 2006 and January 2007. After the stabbing, Garcia told police Ramirez had a mental problem and had been talking to herself four days earlier.
Phillip Hanger, Ph.D., a clinical psychologist, testified as an expert witness for the prosecution. Although he did not interview Ramirez, he reviewed the reports of Glassman, Abrams, and Michel and transcripts of Ramirez's 911 call and her two interviews with police. Because he had not interviewed Ramirez, he was unable to diagnose her condition or state an opinion about her sanity at the time of the stabbing. Nevertheless, Hanger disagreed with how Michel reached his conclusions, explaining there was missing information, gaps, or leaps in his conclusions about Ramirez's mental condition. He believed there was no evidence in Michel's report to support his conclusion that Ramirez was schizophrenic. Furthermore, Michel's report did not refer to Ramirez's 911 call, which, according to Hanger, showed she was aware of the nature and wrongfulness of her actions. Hanger also criticized Abrams's conclusion that Ramirez satisfied the requirements for legal insanity because her interviews with police showed she knew right from wrong and knew she was guilty and Abrams did not consider that information in reaching his conclusions. Furthermore, Abrams relied on hallucinations as showing Ramirez did not have awareness or control, but, according to Hanger, persons who hallucinate can comprehend right from wrong.
Glassman also testified as an expert witness for the prosecution. He was not convinced Ramirez had a primary psychotic disorder involving major breaks from reality, such as a delusion, typically involved in a finding of not guilty by reason of insanity. Although Glassman concluded Ramirez was seriously mentally ill with intermittent explosive disorder, mixed personality disorder, and mild retardation, those conditions did not make her incapable of knowing right from wrong. A person who is delusional can still know the difference between right and wrong. In his opinion, Ramirez knew that stabbing Mercedes was wrong both legally and morally, but did so because she was angry at Mercedes. He believed Ramirez's claims—about hearing voices and needing to be hospitalized—that she made during the 911 call and interviews with police were part of a pattern of evading responsibility and blaming her bad behavior on those symptoms. In his opinion, a psychotic person cannot be completely fine immediately before and after a violent act, but psychotic or delusional during that act. Because Ramirez said she was doing fine during the day and did not hear voices until the night when she was playing cards with Mercedes, and she was not hearing voices when she spoke to police later that night, the evidence did not show she was actively psychotic at the time of the stabbing. The jury found Ramirez was sane at the time she committed the murder.
Sentencing. The trial court sentenced Ramirez to state prison for an indeterminate term of 15 years to life for her murder conviction and a determinate term of one year for her deadly weapon use in committing the murder. She timely filed a notice of appeal.
DISCUSSION
I
Knowing and Intelligent Waiver of Miranda Rights
Ramirez contends the trial court erred by finding she knowingly and intelligently waived her Miranda rights and denying her motion to suppress extrajudicial statements she made to police.
A
The Fifth Amendment of the United States Constitution provides that "[n]o person... shall be compelled in any criminal case to be a witness against himself." This provision applies to the states under the Fourteenth Amendment's due process clause. (Malloy v. Hogan (1964) 378 U.S. 1, 8.) The Fifth Amendment right against self-incrimination generally applies to preclude the admission of involuntary pretrial confessions or other incriminating statements made by a defendant during coercive police interrogation. (Dickerson v. U.S. (2000) 530 U.S. 428, 433-435; Oregon v. Elstad (1985) 470 U.S. 298, 304 (Elstad).) If a defendant's statements were obtained " by 'techniques and methods offensive to due process, ' [citation] or under circumstances in which the [defendant] clearly had no opportunity to exercise 'a free and unconstrained will, ' [citation] the statements would not be admitted." (Elstad, at p. 304.)
Miranda sets forth an exclusionary, prophylactic rule that unless certain warnings are given to a defendant, statements made by the defendant during custodial interrogation are presumed involuntary and are generally inadmissible at trial. (Miranda, supra, 384 U.S. at pp. 478-479; Elstad, supra, 470 U.S. at pp. 306-307; Tankleff v. Senkowski (2d Cir. 1998) 135 F.3d 235, 242.) "Consequently, unwarned statements that are otherwise voluntary within the meaning of the Fifth Amendment must nevertheless be excluded from evidence under Miranda." (Elstad, at p. 307.) Miranda stated that a defendant in custody "must be warned prior to any questioning that he has the right to remain silent, that anything he says can be used against him in a court of law, that he has the right to the presence of an attorney, and that if he cannot afford an attorney one will be appointed for him prior to any questioning if he so desires." (Miranda, at p. 479.) Each of the four warnings is an "absolute prerequisite" (id. at p. 471) to the admission in court of the suspect's statements to police. (Id. at pp. 468, 471.) "The defendant may waive effectuation of these rights, provided the waiver is made voluntarily, knowingly and intelligently." (Id. at p. 444, italics added.)
Elstad notes: "[T]he Miranda presumption, though irrebuttable for purposes of the prosecution's case in chief, does not require that the statements and their fruits be discarded as inherently tainted. Despite the fact that patently voluntary statements taken in violation of Miranda must be excluded from the prosecution's case, the presumption of coercion does not bar their use for impeachment purposes on cross-examination." (Elstad, supra, 470 U.S. at p. 307.)
A waiver is knowing and intelligent if it is "made with a full awareness of both the nature of the right being abandoned and the consequences of the decision to abandon it." (Moran v. Burbine (1986) 475 U.S. 412, 421, italics added (Moran).) In making a determination whether a waiver was knowingly and intelligently made, a court considers the totality of the circumstances surrounding the interrogation. (Ibid.; People v. Neal (2003) 31 Cal.4th 63, 79.) In making that determination, courts should consider various factors, including the defendant's age, experience, education, background, intelligence, mental capacity, capacity to understand his or her rights, whether he or she appeared to understand those rights, and whether those rights were individually and repeatedly explained to the defendant. (Fare v. Michael C. (1979) 442 U.S. 707, 725; U.S. v. Crews (9th Cir. 2007) 502 F.3d 1130, 1140.) The prosecution bears the burden to show, by a preponderance of the evidence, that the defendant made a knowing and intelligent waiver of his or her Miranda rights. (People v. Whitson (1998) 17 Cal.4th 229, 248; People v. Cortes (1999) 71 Cal.App.4th 62, 69.)
We apply federal standards in reviewing a defendant's claim that extrajudicial statements were elicited from him or her in violation of Miranda. (People v. Peracchi (2001) 86 Cal.App.4th 353, 360; People v. Bradford (1997) 14 Cal.4th 1005, 1033.) In reviewing a trial court's ruling on a claim that statements or confessions are inadmissible because they were obtained in violation of a defendant's rights under Miranda, "we accept its resolution of disputed facts and inferences, and its evaluations of credibility, if substantially supported [by evidence] [citation], but we independently determine from the undisputed facts, and those properly found by the trial court, whether the challenged [statements or] confessions were obtained illegally." (People v. Samayoa (1997) 15 Cal.4th 795, 829.) Alternatively stated, we apply the independent or de novo standard of review to the extent "the trial court's underlying decision entails a measurement of the facts against the law." (People v. Waidla (2000) 22 Cal.4th 690, 730.) Extrajudicial statements obtained in violation of Miranda are inadmissible to establish the defendant's guilt. (People v. Sims (1993) 5 Cal.4th 405, 440.) However, the erroneous admission of extrajudicial statements obtained in violation of Miranda is not per se reversible error. (Id. at p. 447; People v. Johnson (1993) 6 Cal.4th 1, 32-33, disapproved on another ground in People v. Rogers (2006) 39 Cal.4th 826, 879.) Rather, we apply the harmless error analysis of Chapman v. California (1967) 386 U.S. 18, 24 to determine whether reversal is required. (Sims, at p. 447; Johnson, at pp. 32-33; Peracchi, at p. 363.) Under the Chapman standard, an error is reversible unless it is harmless beyond a reasonable doubt. (Chapman, at p. 24.)
B
Ramirez moved in limine to exclude evidence of the extrajudicial statements she made to police during the February 17 and 21, 2007, interviews on the ground she did not knowingly and intelligently waive her Miranda rights. The trial court viewed the videotape of the February 17 interview and listened to the audiotape of the February 21 interview.
At the beginning of the videotaped February 17 interview, Ramirez answered the detectives' questions regarding her name, date of birth, residence address, telephone number, and other preliminary matters. Ramirez volunteered information regarding her case manager and psychiatrist and that she received day treatment at Bayview Hospital. Detective Holden then informed her that she was under arrest and read her her Miranda rights. Every time he read a right, Ramirez responded: "Mm-hm." At the conclusion of reading those rights, Holden asked her: "Do you understand each of these rights that I've explained to you?" Ramirez replied: "Yes, please." Holden then asked her: "Okay, and having in mind and understanding of your rights as I've told you, are you willing to talk to me and my partner, Detective Tibbits?" Ramirez replied: "Mm-hm." Holden asked for clarification: "Is that a yes or no?" She asked him to repeat the question. Holden repeated the question whether, having in mind and understanding her rights, she was willing to talk to him and Tibbits. Ramirez replied: "Yes." Thereafter, in response to the detectives' questions, Ramirez described the events that transpired earlier that evening substantially as stated above. When Holden asked her what Mercedes had said to her to make her angry, Ramirez replied: "I just don't want to talk about this anymore. I just need to take my medication, that's all."
The trial court ruled that evidence of Ramirez's statements during the February 17 interview was admissible "[u]p to the point where Ms. Ramirez says I don't want to talk anymore." The court excluded evidence of Ramirez's statements made after she stated she did not want to talk anymore. The court explained its reasoning for its ruling, stating:
"[T]his is my feeling about it from a legal standpoint. Up to the point where Ms. Ramirez says I don't want to talk anymore, I would allow that portion to come in, on many levels.
"She indicated to the advisement that she understood her rights, even though she responded to a couple of the questions uh-huh or huh-huh, other than a yes or a no, but she did, ultimately, when asked by the detective if she understood, and he needed a yes or no, she did indicate yes.
"But even before that, there's an awful lot of lucid conversation with Ms. Ramirez. She can remember, for example, numerous telephone numbers, doctors' names, types of medical insurance or Medi-Cal or social security. She could talk about a number of outside agency employees that she's dealt with, knew their names and knew how to get [ahold] of them. So I think there is a lot of lucid conversation that she engages in with the detective.
"So I'm going to allow that portion up until she says I don't want to talk anymore. Thereafter, that's out. Anything after that is out."
Ramirez's counsel noted for the record that the detailed information that Ramirez gave the detectives was merely a recitation of information she typically gave when she called police several times a year regarding her mental health issues. The court replied:
"I think from a legal standpoint my ruling is the correct ruling. [¶] Now, you're certainly welcome to present to the trier of fact what you have told me. I'm just saying from my point of view, I would allow the jury to view that and then make whatever determination they want based on all the evidence that they hear. But I see nothing defective in the taped interview up until the point where Ms. Ramirez says I don't want to talk anymore. At that point, I think the conversation terminates. And I view that as an invocation [of her rights]. So it's going to stop [there]."
At the beginning of the audiotaped February 21 interview, Detective Steve McDonald introduced himself and Detective Cindy Oblinger to Ramirez and stated the date and time. McDonald then stated: "[Y]ou have the right to remain silent. Do you understand?" Ramirez replied: "Yes, they already... read that to me. So I know what you're gonna say, and I will say yes." McDonald asked her: "Oh, okay. Do you remember everything on here [presumably referring to his Miranda warning card]?" She replied: "Yes." He stated: "Well, let me just read that to you and go.... " She interjected, stating: "Yeah. Go, go, go, go through it again. [¶]... [¶] Okay. So I can hear it again." McDonald then read her her Miranda rights. Ramirez confirmed that she understood those rights. He then asked her: "You don't mind talking to us about the...." Ramirez replied: "No, I don't mind. [¶]... [¶] I don't mind. I will answer all you guys' questions." She then volunteered: "And I would like to talk to you about how I feel what I did. 'Cause I feel, I know I'm guilty. I know that I did wrong. And ever since I've been here, I know I've been crying, trying to pull myself together...." Thereafter, in response to the detectives' questions, Ramirez described the events of February 17 substantially as stated above.
The trial court rejected Ramirez's arguments that she did not understand her rights and ruled evidence of her statements during the February 21 interview was admissible. The court stated: "[F]rom a legal standpoint, I don't see any legal impediment to [admission of] this particular tape."
C
Ramirez asserts that because she did not knowingly and intelligently waive her Miranda rights during the February 17 and February 21 interviews, the trial court erred by admitting evidence of the extrajudicial statements she made to police during those interviews. In moving to suppress that evidence, she relied solely on the videotape and audiotape of her interviews and did not present any other evidence on the issue of whether she knowingly and intelligently waived her rights. Because we are in as good a position as the trial court was to consider that evidence and there are no disputed facts decided by the trial court on this issue, we apply the de novo or independent standard of review and make our own determination whether Ramirez knowingly and intelligently waived her Miranda rights during those interviews.
February 17 interview. Considering the totality of the circumstances as shown by the evidence presented on Ramirez's motion to suppress evidence of her February 17 statements, we conclude Ramirez knowingly and intelligently waived her Miranda rights before making the challenged statements to police. Based on our independent viewing of the videotape of the February 17 interview, it is apparent Ramirez understood and rationally responded to the detectives' preliminary questions and gave them detailed background information regarding her name, date of birth, residence address, telephone number, and other rudimentary matters. Ramirez also volunteered information regarding her case manager and psychiatrist and that she received day treatment at Bayview Hospital. During that initial, pre-Miranda warning period, Ramirez appeared alert, lucid, and rational. In responding rationally and appropriately to the detectives' preliminary questions, she showed she understood their questions. As Detective Holden then read to Ramirez each of her Miranda rights, Ramirez responded to each right: "Mm-hm." Her response to the reading of each right showed she was attentive and her apparent affirmative response (i.e., "Mm-hm") shows she presumably understood each right. At the conclusion of reading those rights, Holden asked her: "Do you understand each of these rights that I've explained to you?" Ramirez replied: "Yes, please." Holden then asked her: "Okay, and having in mind and understanding of your rights as I've told you, are you willing to talk to me and my partner, Detective Tibbits?" Ramirez replied: "Mm-hm." Holden asked for clarification: "Is that a yes or no?" She asked him to repeat the question. Holden repeated the question whether, having in mind and understanding her rights, she was willing to talk to him and Tibbits. Ramirez replied: "Yes."
Contrary to Ramirez's assertion, we do not interpret her "Mm-hm" responses as "ambiguous" or otherwise showing she did not understand each right. Based on our viewing of the videotape, we believe her "Mm-hm" responses were meant to be affirmative responses. The video shows Ramirez physically nodding her head up and down (i.e., affirmatively) simultaneously with each "Mm-hm" verbal response.
Based on the totality of the circumstances, including Ramirez's demeanor and appropriate responses to Holden's questions whether she understood her rights and was willing to talk to them, we conclude she was fully aware of boththe nature of the rights being waived and the consequences of her decision to waive them. (Moran, supra, 475 U.S. at p. 421.) None of the other relevant circumstances revealed during the interview show her waiver was not knowing or intelligent. Her age (i.e., 36 years old), background, and the level of intelligence revealed during the interview do not show she did not understand her rights or the consequences of waiving them. (Fare v. Michael C., supra, 442 U.S. at p. 725; U.S. v. Crews, supra, 502 F.3d at p. 1140.) Furthermore, although during the interview Ramirez made references to her mental health issues and hearing voices earlier that evening, the information disclosed by those references did not show she had a mental or other condition that made her incapable of understanding her rights and the consequences of waiving them. (Fare, at p. 725; Crews, at p. 1140.) Her mental illness and intellectual impairments apparent during the interview were not so severe to preclude her from understanding her Miranda rights and the consequences of waiving them. Likewise, contrary to Ramirez's assertion, her comments during the interview regarding her wallet and other matters and possible misunderstanding that she was going to jail afterward do not show she did not understand her rights and the consequences of waiving them. We conclude Ramirez knowingly and intelligently waived her Miranda rights before making the extrajudicial statements to police during the February 17 interview. (Moran, supra, 475 U.S. at p. 421; Miranda, supra, 384 U.S. at p. 444; People v. Neal, supra, 31 Cal.4th at p. 79.) Therefore, the trial court correctly admitted Ramirez's statements to police during the February 17 interview up to the point when she invoked her right to remain silent by stating, "I just don't want to talk about this anymore."
Even were we to consider, as Ramirez suggests, the psychological evaluations of her presented during her pretrial competency hearing, we nevertheless would conclude her mental illness and subnormal intelligence did not show she did not have the capacity to understand her rights and the consequences of waiving those rights.
February 21 interview. Considering the totality of the circumstances as shown by the evidence presented on Ramirez's motion to suppress evidence of her February 21 statements, we conclude Ramirez knowingly and intelligently waived her Miranda rights before making the challenged statements to police. Based on our independent review of the audiotape of the February 21 interview, it is apparent Ramirez was fully aware of both the nature of her Miranda rights and the consequences of her decision to waive those rights. (Moran, supra, 475 U.S. at p. 421.) Shortly after the beginning of the audiotaped February 21 interview, Detective McDonald read Ramirez her Miranda rights. He stated: "[Y]ou have the right to remain silent. Do you understand?" Ramirez replied: "Yes, they already... read that to me. So I know what you're gonna say, and I will say yes." Her response showed she was already familiar with her Miranda rights because she had been read them before (i.e., during the February 17 interview) and that she wanted to waive her rights. Following up on her stated knowledge of her rights, McDonald asked her: "Do you remember everything on here [presumably referring to his Miranda warning card]?" She replied: "Yes." Nevertheless, McDonald wanted to read all of her Miranda rights, stating: "Well, let me just read that to you and go...." She interjected, stating: "Yeah. Go, go, go, go through it again. [¶]... [¶] Okay. So I can hear it again." McDonald then read her all of her Miranda rights. Ramirez confirmed that she understood those rights. He then asked her: "You don't mind talking to us about the.... " Ramirez replied: "No, I don't mind. [¶]... [¶] I don't mind. I will answer all you guys' questions." She then volunteered: "And I would like to talk to you about how I feel what I did. 'Cause I feel, I know I'm guilty. I know that I did wrong. And ever since I've been here, I know I've been crying, trying to pull myself together...."
Based on our review of the totality of the circumstances, including Ramirez's apparent demeanor and appropriate responses to McDonald's questions whether she understood her rights and was willing to talk to them, we conclude she was fully aware of boththe nature of the rights being waived and the consequences of her decision to waive them. (Moran, supra, 475 U.S. at p. 421.) None of the other relevant circumstances revealed during the interview show her waiver was not knowing or intelligent. The level of intelligence she revealed during the interview does not show she did not understand her rights or the consequences of waiving them. (Fare v. Michael C., supra, 442 U.S. at p. 725; U.S. v. Crews, supra, 502 F.3d at p. 1140.) Furthermore, although during the interview Ramirez made references to her mental health issues and hearing voices during the evening of February 17, the information disclosed by those references did not show she had a mental or other condition that made her incapable of understanding her rights and the consequences of waiving them at the time of her February 21 interview. (Fare, at p. 725; Crews, at p. 1140.) Her mental illness and intellectual impairments apparent during the interview were not so severe to preclude her from understanding her Miranda rights and the consequences of waiving them. Likewise, her digressions to irrelevant topics during the interview do not show she did not understand her rights and the consequences of waiving them. We conclude Ramirez knowingly and intelligently waived her Miranda rights before making the extrajudicial statements to police during the February 21 interview. (Moran, supra, 475 U.S. at p. 421; Miranda, supra, 384 U.S. at p. 444; People v. Neal, supra, 31 Cal.4th at p. 79.) The trial court correctly admitted Ramirez's statements to police during the February 21 interview.
Even were we to consider, as Ramirez suggests, the psychological evaluations of her presented during her pretrial competency hearing, we nevertheless would conclude her mental illness and subnormal intelligence did not show she did not have the capacity to understand her rights and the consequences of waiving those rights.
II
Testimony of Prosecution's Expert Witness
Ramirez contends the trial court abused its discretion by allowing Hanger to testify as an expert witness for the prosecution during the sanity phase of her trial.
A
Expert opinion testimony may be admissible if it relates to a subject matter beyond common experience and would assist the trier of fact. (Evid. Code, § 801, subd. (a); People v. Torres (1995) 33 Cal.App.4th 37, 45 ["Opinion testimony may be admitted in circumstances where it will assist the jury to understand the evidence or a concept beyond common experience."].) Evidence Code section 801 provides:
"If a witness is testifying as an expert, his testimony in the form of an opinion is limited to such an opinion as is:
"(a) Related to a subject that is sufficiently beyond common experience that the opinion of an expert would assist the trier of fact; and
"(b) Based on matter (including his special knowledge, skill, experience, training, and education) perceived by or personally known to the witness or made known to him at or before the hearing, whether or not admissible, that is of a type that reasonably may be relied upon by an expert in forming an opinion upon the subject to which his testimony relates, unless an expert is precluded by law from using such matter as a basis for his opinion."
Expert opinion testimony "will be excluded only when it would add nothing at all to the jury's common fund of information, i.e., when 'the subject of inquiry is one of such common knowledge that men of ordinary education could reach a conclusion as intelligently as the witness.' " (People v. McDonald (1984) 37 Cal.3d 351, 367, overruled on another ground in People v. Mendoza (2000) 23 Cal.4th 896, 914.) "A trial court has broad discretion in determining whether to admit expert testimony and its ruling will be reversed on appeal only where the record reveals an abuse of discretion." (People v. Ramos (2004) 121 Cal.App.4th 1194, 1205.)
B
Before trial, the prosecution proffered the expert opinion testimony of Hanger, stating:
"Dr. [Hanger] is going to testify in general about the reports of and the testimony of both Dr. Michel and Dr. Abrams. He, obviously, didn't interview [Ramirez]. So while he can't form an opinion on her sanity or insanity, he's prepared to sort of critique the way they came to their conclusions. He's been doing this many years. He's a supervisor at the County facility, and he's basically just going to testify in general that you need to support findings like that with facts, and he doesn't believe that those two doctors did so."
Ramirez objected to expert opinion testimony by Hanger. She argued that although Hanger ostensibly would testify, based on his review of Michel's and Abrams's reports, they could not possibly have concluded she was not guilty by reason of insanity, the effect of his testimony would be to say that she was sane. She argued Hanger's expert testimony would be "simply a back door approach to getting another expert in who has not seen" her. She further argued that the addition of testimony by another expert witness would only confuse the issues for the jury. Also, she argued Hanger's testimony was unnecessary because the prosecutor could accomplish the same objective through cross-examination of Michel and Abrams. In reply, the prosecutor argued Hanger's testimony would assist the jury and the court should exercise its discretion to allow it.
The trial court ruled that Hanger's expert opinion testimony was admissible, stating:
"[W]hat comes to my mind is in civil cases, for example, where there's a medical malpractice lawsuit, frequently, doesn't one side call an expert who wasn't there during the surgery or the procedure and say well, it was done wrong, he or she did this wrong, they did this wrong, and this is not an acceptable method of performing this type of surgery? I think we hear it all the time in medical malpractice cases, don't we, in this courthouse? [Every day], practically.
"So I think if you take a look at the expert testimony instruction, I think the jury's entitled to hear from this doctor as to the methodology.
"Now, I'm a little concerned about what [Ramirez's counsel] said about coming to a conclusion. And I don't think he's going to. I would not permit that.
"As I understand what he's going to say is the defense experts had come to the conclusion that she was insane at the time. Didn't use proper methodology. In other words, this is lacking or that's lacking or this was not a valid reason.
"And I think that's up to the jury to decide whether or not that is a proper area for the doctor to talk about and what weight to give to the testimony of any of the experts who testify.
"So I think that it is proper, because even though it's something unusual in my experience, and, again, that I've rarely had this situation come up, I still think that you're entitled to present this doctor, as long as he's not going to form an opinion as to sanity or insanity. And I understand he's not."
Ramirez argued: "He's not going to do it expressly, but he's going to infer that it must be sane, it must be sanity." The court replied:
"I don't think so. As I understand it, and I thought I saw some document here the other day which I no longer have about this doctor and what he's going to talk about, but I think that he is entitled to say that the method is improper, and leave it at that. So I'll allow that testimony of Dr. [Hanger]."
During the sanity phase of the trial, Hanger testified substantially as described above, criticizing the insanity conclusions Michel and Abrams reached in their reports because of improper reasoning and/or insufficient evidence to support their conclusions.
C
Ramirez asserts the trial court abused its discretion by admitting Hanger's expert opinion testimony because his testimony was irrelevant and did not address matters beyond the common knowledge of the jury. She argues Hanger's testimony was irrelevant and would not assist the jury because he discussed the reports of Michel and Abrams, which were not admitted in evidence, and he did not address their trial testimony. Hanger criticized the reasoning and methodology used in Michel's and Abrams's reports that concluded Ramirez did not know her actions were legally or morally wrong at the time of the stabbing. The trial court could reasonably conclude Hanger's critique of and disagreement with their reasoning and methodology involved matters that were not common knowledge and therefore would assist the jury. To the extent Michel's and Abrams's testimony at trial differed from their reports, those differences went to the weight of Hanger's testimony and not its admissibility. Ramirez had the opportunity to cross-examine Hanger and attempt to discredit his testimony by emphasizing those differences.
Ramirez notes Hanger criticized Michel for not considering her 911 call in reaching his conclusion that she was legally insane, but Michel testified at trial that he did, in fact, consider that 911 call. Likewise, Ramirez notes Hanger criticized Abrams for not considering her police interviews in reaching his conclusion that she was legally insane, but Abrams testified at trial that he did, in fact, consider those interviews. However, to the extent Michel's and Abrams's trial testimony differed from their reports, those differences only potentially affected the weight of Hanger's testimony, not its admissibility.
Ramirez also argues Hanger's testimony involved matters that were common knowledge to the jurors. However, the manner in which psychologists and psychiatrists evaluate defendants to determine whether they knew their acts were morally or legally wrong at the time of their acts is complex and often involves technical terms and reasoning, and therefore is not generally within the common knowledge of jurors. Accordingly, the trial court could reasonably conclude Hanger's expert opinion testimony criticizing the reasoning and methodology of Michel and Abrams was not irrelevant and would assist the jury in determining whether Ramirez was legally sane or insane at the time of the stabbing. Were the determination of a defendant's legal sanity or insanity a matter of common knowledge as Ramirez apparently asserts, the jury would not be assisted by expert opinion testimony on that issue and therefore in this case even Michel's and Abrams's testimony presumably would not have assisted the jury. We, like the trial court, conclude Hanger's expert opinion testimony criticizing the expert opinions set forth in Michel's and Abrams's reports could provide some assistance to the jury in weighing their expert testimony at trial that Ramirez did not know her actions were legally or morally wrong at the time of the stabbing. We conclude the trial court did not abuse its discretion in admitting Hanger's testimony.
Assuming arguendo the trial court erred in admitting Hanger's expert opinion testimony, we nevertheless would conclude that error was harmless under People v. Watson (1956) 46 Cal.2d 818, 836.
DISPOSITION
The judgment is affirmed.
WE CONCUR: McCONNELL, P. J., IRION, J.