ARAPAHOE COUNTY — — Denver Post reporter Jordan Steffen’s updates from Day 39 of the Aurora theater shooting trial at the Arapahoe County Justice Center in Centennial, Colorado.
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Day 39
Defense attorneys will continue presenting their case as the Aurora movie theater trial moves into its 39th day on Monday.
After two days of testimony, the defense’s first expert witness, Dr. Jonathan Woodcock stepped off the witness stand. Woodcock — the first of four psychiatrists to interview James Holmes after the July 20, 2012, shooting — said that Holmes was insane on the night of the shooting.
But during hours of aggressive cross-examination, Arapahoe County District Attorney George Brauchler ripped into Woodcock’s evaluation and credibility. He challenged the thoroughness of Woodcock’s review of the case before he rendered an opinion on Holmes’ sanity earlier this year.
Two court-appointed psychiatrists called during the prosecution’s case said they believe Holmes is mentally ill, but legally sane at the time of the attack.
Holmes has pleaded not guilty by reason of insanity to the attack that left 12 people dead and 70 others wounded. If convicted, Holmes could face the death penalty.
Trial resumed at 8:40 a.m.
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LIVE: Watch the live feed of the trial
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8:59 a.m.
On Monday morning, before the jury was brought into the courtroom, Judge Carlos Samour Jr. told the attorneys that he had finished drafting a full set of jury instructions. He will allow both sides to go through the instructions.
The judge asked if the attorneys would have any time next week to schedule a hearing without the jury to go over the instructions.
“I want to as much work as we can ahead of time,” Samour said.
Samour and the attorneys will meet twice more to go over the jury instructions and verdict forms. The judge said he has drafted five different verdict forms.
The judge then asked the attorneys about the limiting instruction he’s been giving for witnesses and evidence, reminding jurors that they may only consider that evidence in how it relates to Holmes’ no guilty by reason of insanity plea. The judge will give the jury the instruction for the Denver nurse who testified on Friday.
Prosecutor Karen Pearson objected to defense attorneys calling a doctor from Denver Health Medical Center on Monday. She objected to that doctor being endorsed as an expert.
Defense attorney Dan King said they are calling these doctors because they treated Holmes when he was taken to the hospital in November 2012. They treated his psychosis and King said they should be allowed to testify their observations and how they treated Holmes.
He said they are not going to ask the doctors about sanity.
Pearson said it is not appropriate for the psychiatrist who treated Holmes at the Denver hospital to talk about what they thought Holmes was suffering from.
Samour said he is not going to exclude the doctor’s testimony. If the prosecution wants more time to prepare for the doctor’s testimony he will order the defense delay calling the doctor.
“I’m not comfortable excluding her testimony,” Samour said.
Pearson said she is prepared for whenever defense attorneys call the doctor.
Next, defense attorney Rebekka Higgs gave the judge a video recording of Holmes taken in the hospital in November 2012. The video was taken by a defense investigator.
Pearson objected to the video being admitted as evidence because it is hearsay.
“There is no exception for this to come in,” Pearson said.
Part of the video was played during open statements.
The video is about 40 minutes long, Higgs said. Defense attorneys plan to introduce the video sometime this week.
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VIDEO: Watch the testimony from Dr. Philippe Weintraub
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9:13 a.m.
The jury was brought into the courtroom.
Samour gave the jury a limiting instruction about the doctor who testified on Friday. That doctor ran Holmes’ labs and ordered a potassium supplement in November 2012. She never met with him in person.
Higgs called Jose Manuel Sanchez-Lopez. Sanchez-Lopez lives in southern California.
In the fall of 2010 and spring of 2011, Sanchez-Lopez worked at the pill coating factory where Holmes worked after finishing his undergraduate degree. He was employed as a quality control technician.
Holmes worked a machine that helped to coat pills.
When Higgs asked if Sanchez-Lopez was in the courtroom, he pointed toward the jury box. Higgs directed his attention to the defense table.
Sanchez-Lopez said he was nervous.
“I don’t recall him being in school at the time,” Sanchez-Lopez said.
When Holmes worked at the factory, he worked the second shift. It started at 3:30 p.m. and ended at 12:15 a.m. Sometimes they would stay until 2 a.m.
“We were working the same shift,” Sanchez-Lopez said.
Sanchez-Lopez calls Holmes “James.” They would greet each other at the beginning of each shift, he said.
Holmes worked on one machine while Sanchez-Lopez moved around the lab inspecting the machines. He would walk through the area of the lab where Holmes was working.
When he walked by, Holmes would not initiate conversations. He answered in “short, one-word answers.”
“He was very quiet. Not social at all,” he said. Holmes was never rude.
“He was like that with everybody,” Sanchez-Lopez said.
Once Holmes asked Sanchez-Lopez to come and check a machine. During that exchange, Holmes told Sanchez-Lopez that he was going back to school. At the time Holmes was living with his parents.
“He said something about a full scholarship,” he said.
When Sanchez-Lopez asked Holmes why he was working, Holmes told him he just “wanted to by his slushie machine.”
Holmes’ co-workers laughed at the response, but Holmes did not laugh.
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9:25 a.m.
Holmes’ co-workers would try to teach him Spanish. When he would try to pronounce words, his co-workers would laugh.
He had the same expression he gave after talking about his slushie machine. It appeared that Holmes did not understand why people were laughing, Sanchez-Lopez.
Holmes did not eat his lunch in the break room. Instead, he would go to the parking lot and eat his lunch in his car.
The group would celebrate everyone’s birthdays at the end of the month. Holmes only came once.
“We weren’t expecting him,” Sanchez-Lopez said. “He wasn’t social at all.”
Even after a week or two Holmes never interacted with his co-workers.
During one “episode,” Sanchez-Lopez said he saw Holmes staring at the wall.
“He looked spaced out,” Sanchez-Lopez said. “He was staring at it like someone was talking to him.”
Holmes had a “smirk” on his face, he said.
Sanchez-Lopez had never seen Holmes do that before. When he asked Holmes if he was OK, Holmes did not respond.
“It was like I wasn’t there,” he said.
Sanchez-Lopez left and when he came back Holmes had gone back to work.
Sabnchez-Lopez had never seen Holmes do that before. When he asked Holmes if he was OK, Holmes did not respond.
“It was like I wasn’t there,” he said.
Sanchez-Lopez left and when he came back Holmes had gone back to work.
Higgs handed Sanchez-Lopez a photograph of the machine Holmes used when he worked at the factory. The photograph was admitted as evidence and shown to the jury.
The machine works similar to a drying machine with nozzles that would spray the coating while the pills churned inside. It took 30 minutes to two hours to coat the pills.
Holmes was in charge of documenting batches and then alerting a supervisor that they needed to take a quality sample.
Sanchez-Lopez said Holmes showed up to work on time, left on time and was able to communicate well.
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9:32 a.m.
Prosecutor Rich Orman cross-examined Sanchez-Lopez.
The last time he saw Holmes in person was in 2011.
“About a year and a half before the massacre at the theater?” Orman asked.
Higgs objected to the question. Samour sustained the objection.
Sanchez-Lopez did not hang out with Holmes. Friends never stopped by the factory to see Holmes.
“You don’t know if he resented having to take that job?” Orman asked.
Higgs objected. Samour overruled the objection.
“Correct,” Sanchez-Lopez answered.
Sanchez-Lopez said he didn’t know if Holmes found the job to be boring and beneath him. He was never under the impression he was trying to start a career at the factory.
Orman asked about the smirk Sanchez-Lopez said he saw on Holmes’ face. Holmes was not allowed to read while operating the machine.
“There’s not a great amount of intellectual activity during that time?” Orman asked.
“Correct,” Sanchez-Lopez said.
Orman asked if Sanchez-Lopez has ever heard of daydreaming. He said he had.
Holmes maintained good eye contact when he spoke with Sanchez-Lopez. He dressed in “normal clothing” and a lab coat provided by the company.
Sanchez-Lopez stepped down.
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9:47 a.m.
Defense attorney Tamara Brady called David Maldonado. Maldonado also worked at the pill factory while Holmes worked there. He is still employed there.
He said he remembers working with Holmes for three weeks. Maldonado was the supervisor on Holmes’ shift.
Holmes worked on the machine that coated the tablets. The coating helps people swallow the pills.
When Maldonado first met Holmes would become nervous and “pull into a corner.” For the first few weeks Holmes would take his goggles off and acted intimidated.
Maldonado went to the company’s HR department and asked about Holmes. He would continue to try and talk with Holmes.
Two weeks after Maldonado took over the shift, Holmes put in his two-week notice.
“I just felt he was intimated by me,” Maldonado said.
Holmes was pleasant with other people but “he didn’t socialize much with anyone,” he said.
“The only time he stepped into our lunch room was during a baby shower,” Maldonado said. “He was mainly just standing, applauding, eating cake and then he went back to work.”
Maldonado said Holmes appeared to act like a “5 to 9-year-old boy.” He never caused any trouble.
A few days before Holmes left, Maldonado saw him chatting with his co-workers.
Maldonado was worried it was “more than just shyness.”
“He was odd. He did not act normal,” Maldonado said.
Math that other employees needed a calculator to do math calculations, but Holmes could do them in his head.
Orman cross-examined Maldonado.
Maldonado said he only knew Holmes for a few weeks. He has not seen Holmes in person since he left the factory.
The only time he spent with Holmes was at work, he said.
“He was quiet and he did what he was supposed to,” Maldonado said.
In June 2013, Maldonado met with a defense investigator. He told the investigator Holmes was a good employee.
Holmes would respond to people once they started talking to him. It is not typical for people with Holmes’ education level to hold that job.
Orman asked if Holmes was overqualified.
Maldonado said everyone has to “do what they have to do to get a job.” People in the industry can move up, he said.
Holmes was always dressed appropriately and there was nothing unusual about Holmes’ hygiene.
Maldonado stepped down.
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10:04 a.m.
Next, King called Dr. Rachel Davis.
Davis is a psychiatrist who works at the Denver Health Medical Center’s psychiatric emergency room. She also works at the University of Colorado. Davis graduated from medical school in 2005. She completed her residency in 2009. She is board certified in psychiatry, she said.
King handed Davis a copy of her resume. He then asked that Davis be qualified as an expert witness in psychiatry.
Pearson objected, but Samour overruled the objection and admitted Davis as an expert witness.
Davis was part of the team that treated Holmes in November 2012.
Samour asked King and Pearson to approach for a bench conference. After the conference, the judge gave the jury a limiting instruction.
The psychiatric consult team was called to evaluate Holmes. The team is called when the admitting medical team feels there is a psychiatric issue.
In November 2012, Davis was called down. She first met with Holmes around 11:15 p.m. She was with two residents when she met with Holmes. One was on the team and one who helped her do the evaluation. Both were doing their residency in psychiatry.
They were both under Davis’ supervision. They wrote the evaluation together. The report was written “right after we had the consult,” she said.
A medical team saw Holmes before he saw Davis and her team. Holmes had been given an anti-psychotic about 30 minutes before Davis saw him.
Holmes had been at the hospital for several hours before Davis saw him. His behavior had become more organized.
“He was repeating nonsense phrases and smearing feces,” Davis said.
By the time Davis saw him he was not smearing feces and was able to participate in the conversation, she said. He was still disorganized.
Davis received notes for the jail that Holmes was taking off his clothes, behaving bizarrely, running his head in to the wall, refusing to eat or drink.
Disorganized thinking is a hallmark of psychosis, Davis said. Delirium is an altered mental status because of a medical condition, she said.
Delirium presents with a decreased level of alertness, she said. Not eating or drinking enough can cause a delirium, she said.
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10:15 a.m.
When Davis met with Holmes, he gave answers “that didn’t necessarily make sense,” she said.
He would respond, but the responses didn’t answer the question or answered the question in a bizarre manner. He did know that he was in a hospital, she said.
“Psychosis seemed to be the predominating presentation when I saw him,” Davis said.
She saw Holmes when he was admitted on Nov. 15, 2012.
Davis knew that Holmes had been refusing to eat and drink at the jail. Holmes had been given IV fluid, she said.
“He was disheveled. He had a lot of bruises and marks on him,” Davis said. “He had blood crusted on his nose.”
Holmes was partly exposed but did not appear to mind.
“It’s consistent with psychosis,” Davis said.
Holmes would pause a long time before answering questions, which is something people with auditory hallucinations sometimes do, she said.
When Davis asked Holmes why he was not eating or drinking, he told her “I didn’t know what the juice is.”
He asked “When was yesterday? How long was yesterday?”
Davis asked Holmes if he had been medicated in the jail. He replied that he uses “maps to find things.”
“He said he needed to be ‘more in line to what other people think,'” Davis said.
Davis said Holmes was psychotic at the time.
Holmes also made a statement about his food “being red.”
“It didn’t make sense and was consistent with psychotic answers,” Davis said.
Davis wrote in her report that Holmes presented with catatonic features. He presented odd body postures — such as putting arms or legs in positions that didn’t have a purpose. That is also common with catatonia.
“He said he heard eight voices,” Davis said.
She asked if he recognized the voices.
“He said ‘I think so,'” Davis said.
Holmes kept repeating “shadow point” before Davis saw him, she said.
Davis only saw Holmes on Nov. 15. She recommended that Holmes continue to be given the anti-psychotic and other medications.
King said he did not have any other questions.
The judge then released the jury for a morning break.
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10:57 a.m.
After the morning break, before the jury was brought in, Samour admitted Davis’ notes as evidence.
Pearson withdrew her objection to admitting the notes.
The jury was brought into the courtroom and Pearson started her cross-examination of Davis.
Holmes was admitted to the hospital for a fever, fast heartbeat and altered mental status, Davis said. Fever can cause a delirium.
Davis said she “mostly saw psychosis.” She spent about an hour evaluating Holmes before he was seen by other doctors. It was the first time she treated Holmes.
She never saw him again.
Holmes paused when he answered Davis’ questions. She said she did not know if that was part of Holmes’ normal speech pattern.
Davis said Holmes knew where he was. He knew why he was in jail.
Holmes told Davis he was in jail because “I pulled away from the people I knew and I drank their blood. … I was selfish.”
His answers were vague and consistent with disorganization. Holmes said he was not suicidal.
Not eating or drinking can cause a delirium. Psychosis could be a symptom of the delirium.
Davis did not provide a definitive diagnosis of Holmes. She did not have any medical history of Holmes with the exception of the previous days in the jail.
“What I saw in that period did not seem consistent with delirium,” Davis said.
It is possible that Holmes’ symptoms changed after she saw him, Davis said.
Davis has seen people do things that will cause themselves physical harm, such as not eating and drinking. Holmes complained of being thirsty and having throat pain, Davis said.
King asked Davis follow-up questions after Pearson finished her cross-examination.
The things that Holmes said to Davis would not make sense in a normal speech pattern.
“He wouldn’t function in society if he talked like he did,” Davis said.
Davis told Holmes he was “in the jail part of the hospital” before he made the statement about drinking blood.
Based on the information Davis had on Holmes she could not give a definitive diagnosis, she said. Possible conditions include schizophrenia, bi-polar disorder and schizoaffective disorder.
“What I was seeing was psychosis at that time,” Davis said.
Davis said Holmes’ symptoms were due to a psychosis, but she did order tests to rule out other medical conditions. She also recommended Holmes receive an MRI.
She ordered the MRI to rule out any underlying causes of psychosis.
Pearson also asked follow-up questions.
Holmes’ statements about drinking blood were vague and she took what he said with “a grain of salt.” Pearson suggested that Holmes’ statements were consistent given the context of the situation.
Davis said they could be, but there are different opinions based on how psychotic Holmes was.
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11:07 a.m.
Samour read Davis four questions submitted by the jury.
Can you explain the difference between psychosis and delirium?
Psychosis includes symptoms like disorganization, hallucination, withdrawal and isolation. People who are delirious can have psychotic symptoms, but they are often different from symptoms in primary mental illness not caused by a medical condition.
Doesn’t Lorazepam result in less responsiveness or catatonia?
It can have an opposite reaction in people, Davis said. It can calm people down and make people more responsive.
The next question asked about a term Davis used to describe Holmes repeating himself.
Could irregular heartbeat be caused by lack of potassium?
It could be, but that was not the case here, she said.
Davis then stepped down.
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11:23 a.m.
Next, King called Dr. Philippe Weintraub to the stand. Weintraub works at Denver Health Medical Center as a psychiatrist on a contract with the University of Colorado.
Weintraub has been a practicing psychiatrist for 35 years, he said.
In November 2012, Weintraub had been at the Denver hospital for eight years.
King gave Weintraub a copy of his resume. King then asked to have Weintraub’s resume admitted as evidence and asked to qualify Weintraub as an expert witness.
The judge admitted Weintraub as an expert witness in the area of psychiatry. Again, Samour gave the jury a limiting instruction about expert witnesses.
Weintraub was trained as a general psychiatrist and has seen people with all kinds of disorders. He has treated about 1,000 psychotic people during his career.
Weintraub worked at the state mental hospital in Pueblo in the forensic unit. There he worked with patients who have been found not guilty by reason of insanity. He worked with those patients until they were deemed safe to go back into the community. He completed competency and sanity evaluations while working at the hospital.
In November 2012, Weintraub was working at the Denver hospital. He worked on the consult team at that hospital where he worked with other doctors whose patients have psychiatric conditions.
Different psychiatrist saw Holmes at different times while he was at the Denver hospital. They all communicated during his time at the hospital.
King handed Weintraub a copy of handwritten notes taken by himself and the resident he was supervising that day. Weintraub and the resident saw Holmes together but Weintraub was ultimately responsible for the decisions made about Holmes’ care.
The notes were written right after the two met with Holmes.
Weintraub saw Holmes for the first time on Nov. 19, 2012. Holmes had been admitted four days earlier. He was discharged on Nov. 20, 2012.
Before meeting with Holmes, Weintraub reviewed Holmes’ chart and notes from the medical unit in the jail.
In the jail Holmes had developed an acute psychosis, Weintraub said.
“This psychosis was associated with a variety of behaviors which included not eating well,” Weintraub said.
Weintraub wanted to see if Holmes had improved with the treatments prescribed to him during the previous few days. His second goal was to see if he agreed with the diagnosis made for Holmes.
He did agree with the diagnosis of psychosis.
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11:40 a.m.
Weintraub said Holmes had a hard time remembering that he had come to the hospital from the jail. Holmes’ medication had been altered to include a “second-generation” anti-psychotic designed to lessen the side effects he was having.
When the two spoke, Holmes said he had heard voices. He said the medication had been helpful in lessening his symptoms and Weintraub agreed with him.
“I was quite struck with how much better he appeared to me,” Weintraub said.
Weintraub’s resident was also struck with how much better Holmes looked.
The working diagnosis when Holmes came into the hospital was that he had a delirium caused by a metabolic disturbance. By the time Weintraub saw Holmes that metabolic disturbance had resolved. What Weintraub saw was psychosis, he said.
Holmes’ metabolic abnormalities had already improved. The cause of the delirium had been eliminated.
Holmes’ symptom of psychosis came on before he stopped eating in the jail, Weintraub said. It’s not uncommon for people to have delusions about their food or be distracted from normal living.
Weintraub asked Holmes about shadows.
“He remained in restraints because he had put a blanket over his head,” Weintraub said. He said he was afraid of the shadow.
A video camera was in the room where Holmes was being held.
Weintraub felt Holmes could be returned to the jail “reasonably soon” after his assessment.
“I still felt he was sufficiently psychotic,” Weintraub said. He wanted to see improvements in his psychosis.
Weintraub was limited in the diagnosis he could make for Holmes. He did have a differential diagnosis of psychotic disorders. Those disorders included a traumatic episode, bi-polar disorder, schizoaffective disorder, depression with psychotic features.
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11:47 a.m.
Brauchler began his cross-examination by asking him about what kind of traumatic event could cause a psychosis. He asked if the shooting could cause a reaction like the one Holmes had.
“I don’t know what his state of mind was then,” Weintraub said.
Weintraub saw Holmes for 15 to 20 minutes. He doesn’t know what Holmes was like before he saw him. He only reviewed the jail records including the days before he was brought to the hospital, not the entire four months Holmes had been there.
Neuro imaging done on Holmes came back normal, Weintraub said.
Stress can also impact someone’s mental health, he said. Isolation can also affect someone’s mental health.
“The stress of facing potentially hundreds of counts of murder and attempted murder — stressful. Is that fair?” Brauchler said.
“Yes,” Weintraub said.
Weintraub said he does not know what was going on in the court case when he came to the hospital. Holmes did ask how his statements would be used.
“He wanted to know why we were asking these questions,” Weintraub said.
King did not ask any follow-up questions.
Samour read Weintraub a question from the jury.
How quickly do the anti-psychotics take effect?
It can be a few hours to calm someone down. To reach the long-term effects, it can take days.
Weintraub stepped down.
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12:05 p.m.
Next, King called David Thailing to the stand. Thailing is a detective with the Aurora Police Department.
On the night of the shooting, Thailing was called to police headquarters after 2 a.m.
Holmes was being held in one of the interview rooms on the third floor of police headquarters. Thailing was asked to keep an eye on Holmes and video record him while he waited in the interview room.
After Holmes was interviewed, Thailing recorded Holmes in the room. King handed Thailing a DVD with his recording on it.
King asked to have the DVD admitted as evidence. Prosecutors did not object and the DVD was admitted as evidence. The recording — which is about four hours long — will be played at another time, King said.
Prosecutors did not ask Thailing any questions and he stepped down.
King then asked to approach the bench and speak with the judge.
After the bench conference, King called Aurora police officer Gary Rivale to the stand.
Rivale was called to police headquarters shortly after the shooting. When he arrived he was assigned to keep an eye on Holmes as he sat in the interview room.
He watched Holmes for more than an hour. Holmes did not speak with anyone with Rivale while he was watching him.
Holmes was able to tell Rivale who he was and where he lived.
“He gave it to me like he was telling the truth,” Rivale said.
While he watched, Holmes stared at the walls, opened his eyes wide and raised his eyebrows. Rivale also watched as a detective placed paper bags over Holmes’ hands.
Orman cross-examined Rivale.
Rivale first drove to the theater and then followed the car that carried Holmes from the theater to the police station, he said. Holmes gave Rivale his information on the third floor in an interview room.
Holmes gave Rivale his full name when he asked. He gave Rivale his address
“It’s not like you asked what’s your address and he said Mars?” Orman said.
“Yes,” Rivale said.
Rivale said he had never been involved with a crime like the theater shooting.
“A massive scene like this, that was the first I’d seen in my 20 years,” Rivale said.
After the brown bags were placed on Holmes hands it looked like he was using them as puppets, Rivale said. He didn’t use voices.
Orman said if it was possible that Holmes was drumming out a beat.
“Yes,” Rivale said.
King asked Rivale about the report he wrote after interacting with Holmes. He wrote in the report that “Mr. Holmes would move his hands in a talking puppet motion.”
Orman then followed up and asked if Rivale knew that Holmes had listened to techno music during the shooting.
“Did you know that?” Orman asked.
“No,” Rivale said.
Rivale stepped down.
The judge then released the jury for a lunch break.
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1:50 p.m.
After the lunch break, before the jury was brought into the courtroom, the judge addressed a concern raised by King. King told the judge, based on some of the questions submitted by the jury, one of the jurors appears to have a medical background.
Samour will read a limiting instruction that tells jurors that they are allowed to use their own backgrounds in considering evidence, but they are not allowed to introduce facts.
“It is a fine line,” Samour said. “It’s the best I can do.”
Samour said he was uncomfortable deviating too far from the case law when drafting the limiting instruction. He asked the attorneys to read the instruction and make suggestions later.
The jury was brought into the courtroom.
Higgs called Dr. John Craig Holland to the stand. Holland is a physician at Denver Health Medical Center. Holland did his residency in internal medicine at George Washington University Hospital in Washington, D.C.
Holland was then an Army physician before he went back to do a second residency in psychiatry in 1994.
“I wanted to try something different,” Holland said.
Holland needed three years of training to be a psychiatrist.
Since 1997 his primary focus has been on working with people who are hospitalized because of a medical reason and who have some kind of problem with the way their brain works. He does the same work at Denver Health. His knowledge of mental illness and physical illness are extremely helpful in his practice. The two overlap.
Holland currently teaches psychiatry at the University of Colorado. He started working at Denver Health in 2009.
Higgs handed Holland a copy of his resume. She asked to admit his resume as evidence. The request was granted.
She also asked to qualify Holland as an expert in psychiatry and internal medicine. Samour granted the requests and admitted Holland as an expert witness in those two fields.
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2:10 p.m.
Holland treated Holmes when he came to Denver Health in November 2012. Doctors gave Holmes a different name — Brady Arkansas. The name was used because of the publicity around the case and is seen in the charts used for Holmes.
Like the last doctor, Holland and a resident met with Holmes at the same time. The resident takes the notes but Holland approves the treatment and supervises the resident.
Higgs asked to admit the notes as evidence. Orman did not object and Samour admitted the notes as evidence.
Next, Higgs handed Holland a blank calendar of November 2012. Holland said he saw Holmes twice while he was at the hospital, once on at 11:30 a.m. and 2 p.m. on Nov. 16 and at 8:20 a.m. on Nov. 20. Holmes was admitted on Nov. 15. Higgs asked Holland to mark on the blank calendar the dates and times he met with Holmes.
Holland was the last person on the consultation team to see Holmes before he was released from the hospital.
The calendar was admitted as evidence.
The team has three psychiatrists and one psychologist. Most of the time there is one team member at the hospital. There are a number of residents and students on the team as well. Someone from the team is usually on call at the psychiatric emergency room.
A team is more efficient than assigning just one doctor to each patient. Different opinions and input create a better quality of care for the patient.
Holland has seen hundreds of patients with psychosis during his career. The patients Holland sees at the Denver hospital can be acute.
“We’re kind of the arm of psychiatry to all the other specialties of the hospital,” Holland said.
Holland had little information about Holmes before he met with him. He reviewed the jail notes and notes from his team members.
Holmes had a series of unusual behaviors beginning on Nov. 11. He didn’t eat, smeared feces, was found in weird postures and other behaviors were observed in the jail. Those observations were saved in notes that Holland and others read while treating Holmes.
Copies of doctors’ notes were given to the jury to read and follow along as Holland testifies.
When Holland met with Holmes he was too sedated to do an interview.
“You couldn’t even raise him by shaking his legs,” Holland said.
The direct interview with Holmes was “really impossible,” he said. Holmes was given different medications before Holland saw him. One of the side effects was sedation and Holland then adjusted Holmes’ medication.
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2:31 p.m.
Holland said Holmes appeared to be in a psychosis. He did not have enough information to make a more specific diagnosis. He noted that Holmes’ “delirium was resolving.” On Monday, Holland said he should have written that a symptom of Holmes’ delirium was resolving, not the delirium itself. Holmes’ sodium level could not create mental health changes alone.
When Holland saw Holmes the first time on Nov. 16 his sodium was normalizing, he said.
Holmes had retained a significant amount of urine. He was unable to relieve himself because of some of the medications, Holland said.
The second time Holland went to see Holmes on Nov. 16, he was less sedated. His attention and awareness had greatly improved.
“That was much, much less impaired,” Holland said. Doctors could get Holmes’ attention without having to rub his sternum or shake his extremities.
Holmes told Holland he was “in a shadow box” and voices were telling him “to get water.” Holland looks at any type of hallucination.
The fact that Holmes had both visual and auditory hallucinations indicated that he had both delirium and psychosis.
Holmes told Holland he bit his arm for food.
“The more abnormal a thought process is the more it makes us think about a psychotic process,” Holland said.
Holmes denied having visual hallucinations or suicidal thoughts.
The auditory hallucinations were more important. Holmes told Holland that “the voices told him not to eat.”
Not eating for a couple days usually doesn’t trigger a delirium if someone is healthy. It doesn’t make them psychotic, Holland said.
“Water is way more important than food,” Holland said.
It will take longer for a younger, healthy person to feel the effects of not eating or drinking, Holland said.
“He’s having command auditory hallucinations,” Holland said. “That’s a pretty basic thing that most of the time we don’t even think about.”
Delirium onset is pretty fast. Psychosis is slow.
Delirium can go away quickly. Psychosis, for some people, never goes away.
There is rarely a family history for deliriums. Delirium is a “global disorder of the brain,” Holland said.
The cardinal feature in delirium is inattention. Delirium and psychosis can co-exists, Holland said.
If someone is psychotic their attention is there but their answers may not make sense.
Holland saw Holmes again on Nov. 20.
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2:57 p.m.
When people come to Denver Health from a jail or prison they are all kept on the same floor of the hospital which is “essentially a jail.”
During Holland’s Nov. 20 meeting with Holmes, he no longer required restraints. He was alert, conversant and could talk about the effects of his medications.
Holmes said on Nov. 20 that he no longer had visual hallucinations and the voices he heard had declined. He said he heard eight different voices — seven men, one woman.
“He was a lot better,” Holland said. “That’s what happens when people take their medicines as they’re instructed. They get a lot better.”
Holmes’ rapid improvement may have also been a result of receiving anti-psychotic medications for the first time.
By the time Holmes was released, Holmes’ potassium and sodium levels had leveled out. Holmes’ psychosis grew before he was admitted to the hospital. The psychosis was what caused Holmes not to eat or drink that month.
The delirium was “minor” compared to the psychosis,” Holland said.
Orman cross-examined Holland. He began by asking Holland about one of the progress notes he wrote while Holmes was in the hospital.
The presence or absence of delusions is considered when making a diagnosis, Holland said.
Holland was allowed to ask general questions, he said. He could ask about delusions without asking about the alleged crime.
He saw no evidence of any delusion during any of his visits with Holmes. Holland points out that he was not the only person who saw Holmes.
Holland said he spent a total of 90 minutes with Holmes.
Beginning on Nov. 11, the jail notes about Holmes’ bizarre behavior increased. Holland said he didn’t have any information about Holmes before Nov. 11.
“This is not a forensic examination. Is that correct?” Orman asked.
“That is correct,” Holland said.
Holland did not have any video from the jail to review. A non-specified psychosis doesn’t fully fit disorders such as schizophrenia.
“It doesn’t fit anything else,” Holland said.
More information could have led to a more definitive diagnosis, Holland said.
“It would have helped us a lot,” Holland said.
While he was at the hospital Holmes had two CT scans. One was after he hit his head in the jail. That scan was strictly for clinical evaluation.
The second scan was after Holmes was admitted. The reports for the two scans showed there was nothing unusual, Holland said.
— — —
3:14 p.m.
When Holland met with Holmes he was an attending physician. Holland would tell the resident he was working with what to write down.
On Nov. 20, Holland felt Holmes was safe enough to go back to the Arapahoe County jail or the state mental health hospital in Pueblo.
Higgs asked Holland follow-up questions.
Holland said he considered that Holmes had a paranoid delusion that there was something in his food. That delusion was not present during Holland’s first examination or his last examination, but Holland’s co-workers noted it.
“A lot of patients with delusions don’t like to talk about them,” Holland said.
If Holland was doing a long-term diagnosis, he would have wanted to know about Holmes’ family history, he said. He would want to know about any writings Holmes produced or any philosophical ideas. It would be important to know if there was a history of negative symptoms.
Had Holland followed up with Holmes he would have collected more information to make a more specific diagnosis, he said.
CT scans almost never show any positive findings in people with psychiatric illness, meaning a normal scan does not meant that Holmes wasn’t psychotic, Holland said.
Holland stepped down and the judge released the jury for an afternoon break.
After the jury was out of the courtroom, King said a formatting error resulted in three defense experts being incorrectly left of a list of expert witnesses submitted to the prosecution before the trial started.
King said he will file an additional endorsement today. These witnesses, however, have been disclosed to the prosecution for nearly a year, he said.
“Something happened where the name got listed onto the wrong place,” King said.
Orman said he cannot imagine that the defense would not object if he made a similar argument.
“It seems to me that they are not taking the same position they would if we had made such an error,” Orman said.
Orman did not take a formal position, telling the judge he wants to consult with Brauchler first.
Attorneys then stepped out for a break.
— — —
3:50 p.m.
After the break, Brauchler said he understands that the defense wants to call their witness as an expert and he asked to be allowed to step out of the courtroom to review the data collected by the doctor.
King said he does not have a legal objection to Brauchler’s request.
Samour asked Brauchler to contact the Colorado Attorney General’s office — which oversees legal representation for the state hospital — and see if they would let him review the materials from the testing on Holmes.
The hospital’s attorney e-mailed prosecutors during the argument and asked that they not get into the test results.
Samour told Brauchler to get in touch with the attorney. Brauchler said they can “get past” the mistake.
The jury was then brought into the courtroom.
Samour apologized for the plumbing issues going on in the restroom in the jury room.
Higgs called Philip Hubbell to the stand. Hubbell is a deputy sheriff at the Arapahoe County Jail. He primarily works in booking but he also works in the medical unit.
In 2012, Hubbell was working the graveyard shift in the medical unit. At 3:20 a.m. on Nov. 11, 2012 Holmes was in the medical unit. Hubbell was in the control room when he heard a loud bang and the deputy watching the video feed told Hubbell that Holmes was on his back in his cell.
Hubbell didn’t have time to play the video because he was more concerned about Holmes’ welfare, he said. At a later date, Hubbell saw the video of Holmes falling backwards off his bunk.
Hubbell was one of the deputies in the video.
Hubbell went into Holmes’ cell. He saw Holmes on his back with his feet facing his bunk.
“He didn’t look up at me at first. He was kind of looking around the cell,” Hubbell said.
Holmes didn’t answer when Hubbell asked about what happened.
When Hubbell asked if Holmes was injured, Holmes looked at him and asked, “What does that mean?”
A different deputy noticed a cut on Holmes’ arm, but Holmes declined treatment. Hubbell asked if Holmes fell or intentionally fell.
Holmes told him, “A little of both.”
Holmes said he was not trying to kill himself.
Hubbell asked him again if he was trying to hurt himself. Holmes looked around the cell.
“His eyes were wide open,” Hubbell said.
Holmes said he was not trying to kill himself.
— — —
4:01 p.m.
Higgs handed Hubbell a report that he wrote after the incident.
Samour then asked that Higgs and Pearson approach. After the bench conference Samour gave the jury a limiting instruction.
After Hubbell asked Holmes why he fell off the bunk, Holmes told them it was “to protect you guys.” The deputies asked Holmes who they needed protecting from.
“Me,” Holmes said.
Holmes was placed on a safety watch. His clothing was removed and he was moved to a safety cell. Holmes was able to walk to the safety cell. He did not ask any questions.
Someone noticed a white, powdery substance on the floor of Holmes’ cell. After reviewing the video, deputies never saw anything being spread on the floor.
Deputies had Holmes put on a safety gown. It’s a tear-resistant material.
Holmes’ voice was “flat,” Hubbell said. His responses were delayed and he did not ask questions.
Pearson cross-examined Hubbell.
Holmes was able to get up on his own and answer questions. When he watched the video, Hubbell saw Holmes curl into the fetal position to protect himself during the fall.
Hubbell had a lot of contact with Holmes.
“As an inmate he is very well behaved,” Hubbell said. “Very model behavior.”
Holmes’ behavior did not change after going to the hospital.
“Any conversation we would have would be if he wanted to come out. He would say ‘Yup’ or ‘Nope,'” Hubbell said.
Holmes never told Hubbell about shadow.
He stepped down.
— — —
4:13 p.m.
Next, Higgs called Deputy Bryon Peter Buenzli to the stand. Buenzli works at the Arapahoe County Sheriff’s office. In July and August 2012, he was assigned to the medical unit at the jail. Holmes is still assigned to the medical unit of the jail.
On Aug. 2, 2012, Buenzli saw Holmes using a spoon to poke at a wall outlet in his cell. Buenzli went into the cell and asked Holmes what he was doing.
“He said he was curious to what was behind the cover,” Buenzli said.
Buenzli documented the incident and warned Holmes that his behavior could result in the loss of privileges. The cover is a solid piece of plastic covering a wall outlet.
It did not appear that Holmes was trying to hide his behavior from the camera.
Holmes didn’t show any emotion when Buenzli spoke to him. There was never an issue with the cover again, he said.
On Aug. 4, 2012, Buenzli was told that Holmes was holding up a hair gel bottle up to the light in his cell. The light gives off very little heat, he said.
From what Buenzli saw there was little actual danger. When Buenzli spoke with Holmes he showed little emotion.
“We had no further issues. We never had that type of behavior again,” Buenzli said.
Buenzli is a good inmate and he has had no other problems with Holmes other than these two incidents.
Prosecutor Jacob Edson cross-examined Buenzli. Buenzli said he had regular contact with Holmes.
Inmates often back down after testing how far they can go with deputies, he said.
Higgs asked follow-up questions.
Holmes is the only inmate he’s seen holding up a bottle to a light that doesn’t put off heat.
Buenzli stepped down.
— — —
4:24 p.m.
Next, Higgs called Deputy Thomas Hobaugh to the stand. Hobaugh has been assigned to the jail since 2008. In 2012, Hobaugh was assigned to the medical unit of the jail.
On Nov. 14, 2012, Holmes was in the medical unit in a safety cell. Around 12:40 p.m., Hobaugh and another deputy were told that Holmes had rammed his head into the door of his cell.
Hobaugh contacted the nurse and his supervisor. They went in to evaluate Holmes and determined that he needed to be placed in an emergency restraint chair and an IV needed to be started. The chair has six different points and Holmes’ legs and arms were strapped down.
Higgs handed Hobaugh a DVD. The DVD was a recording that showed Hobaugh entering the safety cell where Holmes was being held. It also shows Holmes ramming his head into the wall.
Hobaugh held his flashlight so the nurse could start the IV.
The DVD was admitted as evidence. Higgs said they will play video at a later date.
Pearson cross-examined Hobaugh.
Hobaugh was on vacation when Holmes was first brought into the medical unit. When he got back, Hobaugh saw Holmes quite a bit. He continued to work in the unit into 2013.
Holmes was always polite and appeared to understand what Hobaugh asked him to do. On occasion, Hobaugh saw Holmes exercising in his cell.
Prior to November 2012, Holmes was not getting any medication. Holmes acted the same after he started taking medications.
Higgs asked follow-up questions.
Prior to November 2012, Holmes was not ramming his head in the wall or smearing feces. His behavior that November was different. Holmes has taken his medication since returning from the hospital.
Pearson also asked follow-up questions.
Before November 2012, Holmes was not taking medication and he was not ramming his head into the wall.
— — —
4:39 p.m.
Next, Higgs called Deputy Sean Robison to the stand. In November 2012, Robison was primarily working in booking but he was called to the medical unit on Nov. 14, 2012.
When he arrived at the safety cell he was asked to help put Holmes in the emergency restraint chair.
Holmes was “tense and rigid” and “yelling and groaning loudly,” he said.
Robison said he didn’t understand some of the things Holmes was saying. Holmes was wearing a “spit mask” at the time.
In May 2014, Robison told Higgs that “noises came out but he did not understand” what Holmes was saying.
A nurse and doctor came in as deputies were placing Holmes in the restraint chair.
Edson objected when Higgs asked Robison to describe how Holmes responded to the doctor inside the cell. After a bench conference, Samour overruled the objection.
Holmes said statements like:
“Where’s father?”
“There’s a shadow.”
“There’s Monica.”
Edson did not cross-examine Robison.
— — —
5:08 p.m.
Next, King called Deputy Barbara Dube to the stand. In November 2012, Dube was assigned to the medical unit of the Arapahoe County Jail.
Holmes has been assigned to the same cell since he was arrested.
At 3:59 p.m. on Nov. 11, 2012, Dube saw Holmes ram his head into the wall. The wall was about 5 feet away, she said.
The nurse was called to clear Holmes medically.
Prior to running into the wall, Holmes knelt down like he was “going to start running,” Dube wrote in her report.
Dube also saw Holmes walking around in circle in his cell. Around 10:49 p.m., Holmes fell backwards off his bunk.
“He appeared to brace himself with his butt,” Dube said.
Dube said she cannot read her own handwriting on a report she filed on Nov. 12, 2012. King asked her if it said something about Holmes “rolling around on the floor.”
“I can’t read this,” Dube said holding the piece of paper up. She has no independent memory of what happened on Nov. 12.
Dube said she had not reviewed any video of the incident on Nov. 11.
Prosecutor Lisa Teesch-Maguire cross-examined Dube.
Dube has seen other inmates demonstrate the same behavior as Holmes. She’s seen worse behavior from inmates.
During the year she worked during the medical unit Dube watched Holmes exercising and sleeping inside his cell. She served him dinner and asked him if he wanted tea or juice.
“He always said, ‘No,'” Dube said.
King asked Dube follow-up questions.
Dube is not a mental health professional.
Dube stepped down.
Before the jury was released, Defense attorneys played a video taken from a cell Holmes was in. Deputies are seen throwing back a blanket or piece of cloth Holmes had wrapped around him. Then they carry Holmes out of the cell using the blanket.
The blanket and another item are tossed back into the cell before the recording ended.
The judge then released the jury for the day.
After the jury left the courtroom, the judge asked the attorneys about the limiting instruction he’s been giving the jury.
“I don’t want the jury to get confused,” Samour said.
He said sometimes the attorneys ask for the instruction during testimony, but they do not ask for it during ally relevant testimony. Defense attorneys asked to have until morning to discuss the instruction.
Teesch-Maguire asked the judge if the defense attorneys could tell them when their expert witnesses will be in court. King said he is not required to do so, and pointed out that Brauchler denied multiple request from defense attorneys to give them a list. Teesch-Maguire said prosecutors told defense attorneys when the two court-appointed psychiatrists were going to testify.
Teesch-Maguire objected to defense attorneys calling a third employee from the pill factory where Holmes worked. The employee worked in the HR department. She thought Holmes may be autistic. Teesch-Maguire asked the judge to prevent the witness from introducing those statements.
Brady said she does plan to call the witness and ask her about the statements Teesch-Maguire is trying to block.
The judge agreed with Brady that the testimony is not cumulative.
“It seems like now the shoe is on the other side and the prosecution is objecting on cumulative grounds,” Samour said.
Samour did say it would be inappropriate for the witness to testify that she thought Holmes was autistic.
Brady said she will ask the witness if she thought Holmes was “more than shy.” Samour said that was fine.
After that, the attorneys left for the night. Trial is expected to resume around 8:40 a.m.
MJordan Steffen: 303-954-1794, jsteffen@denverpost.com or twitter.com/jsteffendp
