In an admission by the prosecution’s witness from the Heritage Oaks Hospital, a Sacramento psychiatric facility, jurors would learn Daniel Marsh never expressed any homicidal thoughts or ideations to Dr. Joseph Sison, who evaluated Daniel while the defendant was in the facility.
But, instead, Dr. Sison, in his lengthy testimony, would repeatedly blame the habitual use of marijuana as a possible cause of agitation and aggression in Marsh.
Daniel Marsh is accused of taking the lives of the elderly couple, Oliver Northup and Claudia Maupin, back in April of 2013, in their Davis home.
Dr. Sison repeatedly stated, “I have never liked marijuana being legal, I do not understand why it is legal, it should be illegal.”
He was asked by Assistant Chief Deputy District Attorney Mike Cabral to go through the report he had written while young Daniel Marsh was in the Heritage Oaks facility.
He began with the first meeting with Marsh on December 13, 2012. He said, “Daniel was reclusive, withdrawn, depressed, but was still able to engage, to talk about his feelings.” He stated, “Most kids cannot do that, but Daniel was able to tell me he wanted help, he wanted to feel better, he was focused on feeling better.” He stated, “Daniel was insightful.”
The doctor explained how Daniel was able to express, “I’m just very depressed, haven’t been happy in awhile, just fed up, feeling more and more depressed.”
Daniel was able to tell Dr. Sison that he suffered from emotional abuse by his father and talked about the haunting effects of being bullied at school. He stated to Dr. Sison, “I am angry at school, abused by family members and having suicidal thoughts, feeling very depressed.”
At one point Marsh told the doctor, “If you lived my life, you would know what I mean.” Dr. Sison went on to explain how the evaluation process is done. He said Marsh talked about some of his family members who suffer from schizophrenia, bi-polar and emotional disorders.
Sison said during the evaluation there are several tests they do to be able to assess the patient, to better treat them. He stated, “Daniel had linear thinking and appeared to be have a quiet affect, but was responsive and a lot of kids are not. He had no lucid associations, no threats to harm anyone, just very depressed with suicidal thoughts.” The doctor stated, “But I do not know Daniel enough to know his past, don’t know how he grew up or how those things affected him.”
He said Marsh appeared to be thinking clearly and was able to express his emotions.
Dr. Sison stated, “Daniel talked about smoking marijuana to feel better and was on Prozac for about 8 months but said it did nothing for him.”
The doctor once again asserted, “I personally feel cannabis should be illegal…I try to educate my patients on the use of cannabis people use to feel better, but it can cause permanent distress later on in life, it should not be legal.”
Mr. Cabral then asked the doctor, “So, what about psychotic thoughts?” He replied, “Daniel talked about suicidal thoughts, emotions and wanting to feel better, but no psychotic thoughts.”
He said his diagnosis was severe depression with suicidal thoughts. The doctor stated, “Daniel was compliant, responsive to answers and engaging in conversation, just having a feeling of hopelessness, but did talk about how music helped him cope.”
Marsh was cognitive, showing no flatness of affect, the doctor stated, which was good.
But he did assert that he did not know what Marsh’s level of coping was, since he had no history of his past. The doctor stated that the coping mechanisms are affected by several things and he did not know about Marsh’s level.
He said he started Marsh on a small dose of Zoloft and then, after talking with Marsh a few more times, he increased the levels to 100 ml. He stated, “Daniel was feeling better, not having suicidal thoughts but appeared to be restless right before he was supposed to have a family meeting. Daniel expressed being nervous but I was not sure if it was due to seeing family or the medicine.”
Dr. Sison said Marsh was also taking 75 ml of Seroquel. He stated that he had not been able to contact the family on occasions, but did speak with the mom and got her consent to give him the medicine.
The doctor said he felt Marsh to be an insightful kid and, as the days passed, he became more engaging, getting different types of therapy while inside the facility. He felt the medicine was helping Marsh, but he said, “I did tell Daniel about the side effects of Zoloft, how it can cause aggression, psychosis.”
Mr. Cabral asked, “So, you didn’t hear/see any threats to hurt others?” “No, no discussions of threats, he actually felt relieved, wanting to talk more, became engaged more,” answered Dr. Sison.
Although the doctor did admit that Marsh had expressed having ongoing nightmares where he harmed others, he mostly wanted to hurt himself. Dr. Sison said he did not know if it was from the medication. He felt he tolerated the medicine well with no side effects.
He stated, “Daniel had haunting by traumatic events of peers taunting him, but no aggression at all, just severely depressed.”
After being on Zoloft for a few days, the doctor said Marsh was “feeling much better, feeling optimistic, not wanting to hurt himself anymore” and told the doctor, “I know I don’t want to die, I want to feel better.”
Marsh told the doctor he thought the medicine made him feel better, although he was nervous about meeting his family. The doctor said Marsh was even sleeping better and doing very well in therapy, engaging in group sessions with other children.
It was time to read the discharge summary. Dr. Sison said by the 18th of December, Marsh was even smiling, and was ready to go back home. He wanted Marsh to do follow-up care at Kaiser. But he stated he did not see any notes or recommendations from the social worker within Marsh’s file.
As cross-examination began, the defense counsel would bombard the witness with questions of Marsh’s history and whether Dr. Sison had read any prior reports, of Marsh’s previous stay at Alta Bates and other hospitalizations.
The doctor stated, “No, I did not, I spoke with the patient.”
“How did you develop the history of Daniel? quizzed Deputy Pubic Defender Ron Johnson. “I got some information from the emergency room notes, from the patient and some from the mom,” he replied.
“So which previous doctors did you talk to?” asked Johnson. “Oh, I didn’t talk to any of them,” the doctor answered.
“And you thought just from hearing from mom that he had only been on Prozac 8 months?” Johnson asked. “Yes,” the doctor replied.
“So, you never read Kaiser reports, or any others from doctors?” Mr. Johnson inquired. “No, It was Daniel who told me he took Prozac but it did nothing,” he answered.
The defense counsel asked him if he had known about Marsh’s wanting to harm others from other reports but the doctor repeatedly stated he never consulted with any doctors from Kaiser or other facilities.
Dr. Sison said his information was “self-reported.” Johnson asked, “So let me summarize this, you base your opinion on self-reporting? And not any other evidence from all the reports written by Daniel’s doctors, the ones who know the patient?”
The doctor seemed to begin to answer the defense’s questions with a bit of a stutter, “Um…well…I…I…evaluate while patients are in the hospital, I don’t have a disbelief of my patients.”
Mr. Johnson asked the doctor if he ever tried to contact the other facilities. He told Johnson he did, but could never reach them.
Dr. Sison explained to the defense that it takes a long time to get medical records. He said Marsh’s information was not available at the time.
Johnson asked, “What if you’d heard from Alta Bates Daniel had a disassociation state? What if you knew he had graphic thoughts of hurting someone?”
The doctor responded, unaware of what the defense was talking about. “What’s a dissociative state?” the doctor asked, appearing aloof.
Defense inquired into the side effects of certain drugs and whether the doctor knew of Daniel having any. The doctor said if he had known of any side effects, he would have changed the drugs.
He stated, “It is through trial and error that we learn what works on a patient.”
Dr. Sison explained to the defense that he had gained knowledge via the same website as the defense in regard to medicines and other articles written about the effects of them.
He openly admitted, however, that he does not have any knowledge of the recent journal articles written by doctors in other countries.
Johnson asked the doctor if he knew the difference between drug effects on a child’s brain versus an adult’s. The doctor said he did.
Johnson asked the doctor to explain the Black Box warning. Dr. Sison stated that it was a warning of side effects from the FDA, a safety precaution.
The defense asked about a type of “akathisia,” a feeling of restlessness or that one is crawling out of one’s skin, and which may be a side effect from some medications. Marsh had been having those sensations but the doctor stated he felt it could have come from being anxious, nervous to see his family.
Once again, the doctor repeated, “Cannabis was used every day, and those with mental illness, unless prescribed, can get worse, it really kills off a lot of neurons in the brain. Again, I feel it should not be legal.”
DDA Cabral asked about any threats made by Marsh, and if he had heard any would he report them. “Yes, I have to report to authorities and to the person, but…I really do not like breaching patient confidentiality, I really don’t and I did not want to be here but was told I could be arrested.” Laughter broke out in the courtroom.
“I really want to help my patients through educating them, and not break confidence unless I have to,” stated Dr. Sison.
Ending the day with the last re-cross, the defense asked, “Side effects that occur, can they happen five days after discharge?” “Yes,” replied Dr. Sison. He said Marsh could feel restless, with agitation and aggressive behavior.
Cabral asked, “If you were told Daniel liked to watch violence and gore, would you form an opinion?” The doctor answered, “Yes, but you have to look at data, and some is not accurate…some kids can play violent video games and watch violence and have no effects, others it can be different, a lot of data must be researched.” He stated, “Some kids appear to be fine, having no symptoms of depression or aggression and will commit suicide…you just don’t know.”
Update: The Vanguard has been unable to verify with the author whether this treating physician was qualified as a expert witness with the Court, so is correcting this article to reflect that Dr. Sison was not an expert witness. We apologize for the confusion.