Affirming Trial-Court Discretion to Exclude Sell-Hearing Purpose from Cross-Examination without Violating the Confrontation Clause

Case: State v. Gregory

Court: Supreme Court of North Carolina

Date: March 21, 2025

Disposition: Per curiam — Affirmed

Introduction

State v. Gregory addresses the permissible scope of cross-examination where a defendant asserts insanity and seeks to impeach the State’s central expert witness by referencing the expert’s prior testimony at a Sell hearing—a proceeding at which the State sought authorization to forcibly medicate the defendant to restore competency for trial. The trial court barred defense counsel from informing the jury of the purpose of that prior proceeding (forced medication under Sell v. United States), although it permitted impeachment with the content of the prior testimony. A divided Court of Appeals found no error; the North Carolina Supreme Court issued a per curiam affirmance.

In a detailed dissent, Justice Riggs, joined by Justice Earls, concluded that the limitation violated the Confrontation Clause and constituted an abuse of discretion because it prevented the jury from understanding a key motive and context capable of undermining the expert’s credibility. The case thus crystallizes a tension between broad cross-examination rights—especially on expert bias—and the trial court’s Rule 403 gatekeeping authority to exclude evidence likely to cause unfair prejudice or juror confusion.

Background and Procedural History

The defendant, Kendrick Keyanti Gregory, committed a series of violent offenses in August 2015 at age twenty. The factual elements of the crimes were not contested at trial; the sole dispute was whether Mr. Gregory, who had a well-documented history of severe mental illness consistent with schizoaffective disorder, met North Carolina’s legal standard for insanity at the time of the offenses. For more than a year preceding the crimes, he repeatedly sought psychiatric care (including twenty attempts at admission within eight months), reported suicidal ideation and command auditory hallucinations, and went untreated for several weeks before the offenses.

Following arrest, the State and the detention facility struggled to manage the defendant’s illness; he was found incompetent to proceed on two occasions. In 2020, the State sought a court order under Sell v. United States to medicate him involuntarily to restore competency. At the Sell hearing, Dr. Nicole Wolfe (a forensic psychiatrist at Central Regional Hospital) testified that Mr. Gregory would not regain capacity without antipsychotic medication and described the risks of untreated psychosis. A second State expert, Dr. Brandon Harsch, testified about diagnoses and treatment. The State prevailed; the record reflects that forced medication was undertaken to restore competency.

In 2021, at trial on the merits, the defense presented two experts who opined that Mr. Gregory’s schizoaffective disorder prevented him from distinguishing right from wrong at the time of the acts. Dr. Wolfe was the State’s sole expert on the ultimate issue of insanity; she concluded Mr. Gregory was legally sane. Defense counsel sought to cross-examine Dr. Wolfe not only about the content of her Sell-hearing testimony but also about its purpose—i.e., that she had testified to facilitate forced medication to bring Mr. Gregory to trial. The trial court, invoking Rule 403, prohibited any mention of the Sell purpose, allowing only use of the prior statements themselves. The jury ultimately convicted after unusually extensive deliberations.

The Court of Appeals affirmed in a divided opinion, holding there was no error. The North Carolina Supreme Court affirmed per curiam. Justice Riggs dissented.

Key Issues Presented

Whether excluding the purpose of a prior Sell hearing from cross-examination of the State’s expert violated the defendant’s Sixth Amendment right to confront and impeach the witness’s credibility.
Whether the trial court’s Rule 403 balancing—finding the purpose of the Sell hearing substantially more prejudicial or confusing than probative—constituted an abuse of discretion.
How differences between competency-to-stand-trial and insanity-at-the-time-of-offense standards should shape evidentiary rulings concerning expert credibility.
Whether any error was harmless under North Carolina’s constitutional and non-constitutional prejudicial-error standards (N.C.G.S. § 15A-1443).

Summary of the Opinion

The Supreme Court issued a per curiam affirmance, leaving intact the Court of Appeals’ holding that the trial court committed no reversible error in limiting cross-examination about the Sell hearing’s purpose. While the High Court did not provide a majority rationale, the effect is to approve the trial court’s Rule 403 exclusion under the circumstances and to reject the asserted Confrontation Clause violation on this record.

Justice Riggs dissented, reasoning that the limitation foreclosed highly probative impeachment on bias and motive, particularly critical where Dr. Wolfe was the State’s sole expert on the decisive question of legal sanity. The dissent concluded the restriction was both an abuse of discretion and a constitutional violation not shown to be harmless beyond a reasonable doubt.

Analysis

Precedents and Authorities Cited

Confrontation and cross-examination:
- State v. Legette, 292 N.C. 44 (1977): Recognizes that even partial restraints on cross-examination concerning a witness’s credibility can amount to abuse of discretion and a constitutional violation.
- Davis v. Alaska, 415 U.S. 308 (1974): Emphasizes that exposing a witness’s biases, prejudices, or ulterior motives is a core function of the Confrontation Clause.
- Napue v. Illinois, 360 U.S. 264 (1959): Highlights that credibility assessments—often turning on subtle indications of interest or motive—may be determinative of guilt or innocence.
- State v. Bacon, 337 N.C. 66 (1994): Endorses broad scope in cross-examining experts to test the value and credibility of their testimony.
- State v. Whaley, 362 N.C. 156 (2008): Stresses the heightened importance of cross-examining the State’s sole witness on an ultimate issue.
Evidentiary gatekeeping:
- N.C. R. Evid. 403; State v. DeLeonardo, 315 N.C. 762 (1986): Relevant evidence may be excluded if its probative value is substantially outweighed by the danger of unfair prejudice, confusion, or misleading the jury; “unfair prejudice” entails a tendency to prompt decision on an improper basis.
Insanity and competency standards:
- State v. Jones, 293 N.C. 413 (1977): North Carolina’s insanity standard (capacity to know nature and quality of the act or to distinguish right from wrong in relation to it).
- State v. Bundridge, 294 N.C. 45 (1978): Distinguishes competency to stand trial from insanity at the time of offense; endorses wide latitude in admitting evidence bearing on a defendant’s mental condition in insanity cases.
Forced medication to restore competency:
- Sell v. United States, 539 U.S. 166 (2003): Authorizes involuntary medication to restore competence if necessary to further important governmental interests and medically appropriate.
- United States v. Bush, 585 F.3d 806 (4th Cir. 2009): Collects cases applying a clear-and-convincing-evidence standard for Sell hearings.
Prejudicial error standards:
- N.C.G.S. § 15A-1443(a), (b): Defines prejudicial error and harmless error, including the “harmless beyond a reasonable doubt” standard for federal constitutional errors.

Legal Reasoning and Competing Perspectives

Because the High Court’s decision is per curiam and contains no elaboration, its legal reasoning must be inferred from the affirmance of the Court of Appeals and the trial court’s evidentiary ruling. The dissent provides the developed argument on the other side.

Implied majority posture

By affirming, the Supreme Court leaves in place a framework in which:

The trial court may, under Rule 403, exclude reference to the purpose of a prior Sell proceeding (forced medication) during cross-examination of a State’s expert, where the court concludes that the danger of unfair prejudice, confusion of the issues, or misleading the jury substantially outweighs the probative value.
Where the defense is permitted to impeach with the substance of the expert’s prior statements or testimony from the Sell hearing (i.e., content-based impeachment is allowed), the Confrontation Clause is not necessarily violated by excluding the specific purpose or label of the prior proceeding.
On this record, either there was no constitutional error or any error was harmless; the per curiam affirmance does not specify which path the Court took.

The State argued that alerting the jury to forced medication risks emotional decision-making and juror confusion, especially in an insanity trial where mental-health themes are already prominent. The trial court evidently credited that risk and chose to cabin impeachment to the prior statements themselves, avoiding the charged topic of forced medication as a governmental act.

The dissent’s reasoning

The dissent forcefully contends that the excluded context—the purpose of the Sell hearing—was itself highly probative of bias and motive. According to Justice Riggs:

Dr. Wolfe gave materially different portrayals of Mr. Gregory across the Sell hearing and the later jury trial: at the Sell proceeding, symptoms were “representative of genuine mental illness” and she urged involuntary antipsychotic medication; at trial, similar symptoms were recast as malingering and manipulation.
Without knowing that the earlier testimony was offered to help the State forcibly medicate Mr. Gregory to bring him to trial, the jury lacked a critical lens to assess whether context or motive played a role in the shift.
Given that Dr. Wolfe was the State’s “sole direct evidence on the ultimate issue” of sanity, the bar on bias exploration violated core Confrontation Clause principles articulated in Davis v. Alaska, Napue, and North Carolina cases like Legette and Bacon.
Rule 403 does not justify exclusion absent a demonstrated, “substantially” outweighing risk of unfair prejudice; here, the risk-of-prejudice rationale was thin, especially because the jury already knew the hospital had involuntarily medicated Mr. Gregory under clinical policies for violent or aggressive patients.
Under either constitutional or non-constitutional harmless-error tests, the State could not show harmlessness, given the length and difficulty of jury deliberations and their focused questions about the insanity standard.

Reconciling the two perspectives

The core legal fault line is familiar: the breadth of cross-examination on bias versus the court’s power to limit evidence that is too prejudicial or confusing. The dissent advocates a strong view of the right to reveal the purpose of the Sell proceeding as bias evidence, especially where the expert’s testimony evolved. The affirmance indicates that, at least in this case, the court deemed it sufficient that the defense could use the content of the Sell testimony to impeach credibility—without invoking the emotive “forced medication” purpose—thus mitigating prejudice while preserving a meaningful confrontation opportunity.

Impact and Forward-Looking Implications

Cross-examination boundaries in insanity trials: Trial courts in North Carolina may rely on Rule 403 to exclude the purpose of prior Sell hearings from cross-examination when they find substantial risks of unfair prejudice or confusion, provided defendants retain the ability to impeach with the substance of the prior testimony.
Expert bias litigation: Defendants should anticipate that courts may differentiate between content-based impeachment (allowed) and purpose-based impeachment (potentially excluded), particularly where the prior proceeding involves forced medication.
Pretrial motion practice: Prosecutors are likely to seek in limine orders barring references to “forced medication” or “Sell hearing” while conceding the use of prior statements for impeachment. Defense counsel should be prepared with offers of proof and narrower alternatives (e.g., neutral descriptors, limiting instructions) to preserve the bias argument.
Record-making for appellate review: Trial judges should articulate Rule 403 findings on the record, including why probative value is substantially outweighed and whether less-restrictive means (sanitization, limiting instructions) could suffice. A clear record will matter for deference on appeal.
Substantive mental-health defenses: Although the standards for competency and insanity differ, this case underscores the practical reality that testimony across competency-restoration proceedings and trial may diverge; litigants should anticipate and plan for credibility contests grounded in chronology, new data, and context.
No categorical rule: The per curiam affirmance does not purport to adopt a categorical ban on disclosing Sell purposes in every case; it affirms the trial court’s discretionary call on this record. Future cases with different facts, probative showings, or less risk of prejudice may come out differently.

Complex Concepts Simplified

Sell hearing: A court proceeding where the State seeks authorization to medicate a defendant against his will to restore trial competency. The State must show, by clear and convincing evidence in many jurisdictions, that the medication is necessary to further an important governmental interest and is medically appropriate. It is not about guilt or innocence; it is about the defendant’s present ability to stand trial.
Competency vs. insanity:
- Competency to stand trial asks whether the defendant now understands the proceedings and can assist counsel.
- Insanity at the time of the offense asks whether, at the time of the conduct, the defendant understood the nature and quality of the act or could distinguish right from wrong as to that act.
Rule 403 balancing: Even relevant evidence can be excluded if its value is substantially outweighed by risks such as unfair prejudice (deciding on emotion or improper basis), confusion, or misleading the jury. Courts can allow a “sanitized” version of the evidence to reduce those risks.
Confrontation Clause and bias: The Sixth Amendment guarantees a meaningful opportunity to cross-examine prosecution witnesses, including probing for bias, motive, or interest. Courts can impose reasonable limits, but the core ability to expose a witness’s motive in testifying is constitutionally protected.
Malingering: A forensic term describing the deliberate exaggeration or fabrication of symptoms for secondary gain. It is a credibility question commonly explored through cross-examination and record review.
Harmless error (N.C.G.S. § 15A-1443): For federal constitutional errors, the State must prove the error was harmless beyond a reasonable doubt. For other errors, the defendant must show a reasonable possibility of a different result absent the error. The dissent viewed the restriction here as prejudicial under either standard.

Practical Guidance for Litigants and Courts

For defense counsel

Make a detailed offer of proof specifying how the Sell purpose bears on expert bias or motive, including any material shifts in the expert’s conclusions.
Propose less-restrictive alternatives: use neutral phrasing (e.g., “a prior competency-restoration proceeding involving court-authorized medication”), request a limiting instruction, or stipulate to a non-inflammatory description to reduce Rule 403 concerns.
Maximize content-based impeachment: juxtapose the expert’s Sell-hearing statements with trial testimony, highlight omissions, and explore whether new records (or lack thereof) actually explain the change.
Preserve constitutional objections with specificity (Confrontation Clause and state-law evidentiary grounds), and ensure the Rule 403 reasoning (and your alternatives) are on the record.

For prosecutors

Seek pretrial rulings to exclude explicit references to “forced medication” while conceding use of prior testimony content. Offer limiting instructions focused on relevance and avoiding juror confusion.
Prepare experts to explain any evolution in opinion by reference to additional records, clinical observations, or refined diagnostic criteria rather than contextual motives.
If the jury already knows about clinical involuntary medication, distinguish that from the judicial Sell process to mitigate prejudice and confusion.

For trial judges

Conduct explicit Rule 403 balancing on the record, addressing probative value (bias and motive) and the particular prejudice risks posed by references to forced medication.
Consider whether tailored, neutral terminology and limiting instructions would adequately protect against prejudice while preserving the defendant’s confrontation rights.
Be attentive to the unique salience of expert credibility when the expert is the State’s lone witness on an ultimate issue, as emphasized by Whaley and Bacon.

Conclusion

State v. Gregory, via per curiam affirmance, signals that North Carolina trial courts retain substantial discretion under Rule 403 to exclude references to the purpose of prior Sell hearings during cross-examination, so long as defendants can still use the content of prior testimony to impeach an expert. The case thus emphasizes judicial gatekeeping to avoid undue prejudice and juror confusion in an emotionally charged area, while leaving open fact-specific room for robust impeachment on credibility.

Justice Riggs’s dissent highlights the countervailing constitutional stakes: when a State’s sole expert on sanity has previously supported forced medication to restore competency and later recasts the defendant as malingering, the jury’s fair assessment of credibility may hinge on understanding that context. The dissent would afford broader cross-examination to expose potential motive and bias, especially in insanity trials where expert testimony is often decisive.

Practitioners should treat Gregory as affirming a flexible, context-dependent approach rather than a categorical rule. The durable lesson is twofold: build a meticulous record—on both probative value and prejudice—and, where necessary, craft narrower means (sanitized descriptions, limiting instructions) that preserve the essence of confrontation while honoring the court’s evidentiary management role.