State v. Cunningham

[Cite as State v. Cunningham, 2026-Ohio-2772.] IN THE COURT OF APPEALS OF OHIO ELEVENTH APPELLATE DISTRICT PORTAGE COUNTY STATE OF OHIO, CASE NO. 2025-P-0047 Plaintiff-Appellee, Criminal Appeal from the - vs - Court of Common Pleas ERIK A. CUNNINGHAM, Trial Court No. 2019 CR 00022 Defendant-Appellant. OPINION AND JUDGMENT ENTRY Decided: July 20, 2026 Judgment: Affirmed Connie J. Lewandowski, Portage County Prosecutor, and Daniel Sallerson, Assistant Prosecutor, 241 South Chestnut Street, Ravenna, OH 44266 (For Plaintiff-Appellee). Daniel D. Eisenbrei, Milligan Pusateri Co., L.P.A., 4686 Douglas Circle, P.O. Box 35459, Canton, OH 44735 (For Defendant-Appellant). EUGENE A. LUCCI, J. {¶1} Appellant, Erik A. Cunningham, appeals the judgment of the Portage County Court of Common Pleas, convicting him, after a trial to the bench, of murder, with two firearm specifications. Mr. Cunningham did not dispute that he murdered the victim, his wife, L.C., but, instead, asserted the affirmative defense of not guilty by reason of insanity (“NGRI”). At issue is whether the trial court erred in concluding that Mr. Cunningham failed to establish, by a preponderance of the evidence, the defense of NGRI and whether the trial court committed prejudicial error by allowing an expert to testify to the out-of-court statements of another expert in alleged violation of the Confrontation Clause of the United States and Ohio Constitutions. We affirm the trial court’s judgment. I. Introduction {¶2} On December 31, 2018, Mr. Cunningham shot and killed his wife. This fact is not in dispute. Evidence demonstrated that L.C. was hit with a shot across her scalp, a shot to her clavicle, and a shot to her head. The autopsy report stated the cause of death as “[g]unshot wounds to the head and base of the neck.” Several days later, on January 3, 2019, Mr. Cunningham voluntarily surrendered himself to the Portage County Sheriff’s Office (“PCSO”), admitting his actions. Deputy Gary Hoffman spoke with Mr. Cunningham regarding his inculpatory statements. Deputy Hoffman did not have any suspicion that Mr. Cunningham was under the influence of any intoxicant at the time Mr. Cunningham arrived at PCSO. {¶3} When the deputy asked, “[W]here did you shoot your wife?” Mr. Cunningham explained “I think I’ve said all I’m going to say about that[.]” When the deputy asked whether Mr. Cunningham was intoxicated or under the influence of an intoxicant at the time he arrived at PCSO, the latter responded in the negative. While at PCSO, Mr. Cunningham stated that he believed he was of “sound mind” at the time of the incident. He admitted, however, to using drugs. Mr. Cunningham specifically stated to PCSO staff that he used methamphetamine on the day of the incident. Investigators went to Mr. Cunnigham’s home and confirmed L.C. was deceased. Mr. Cunningham was held at the Portage County Jail pending charges. PAGE 2 OF 42 Case No. 2025-P-0047  II. Factual Background and Relevant Procedural History {¶4} In 2018, Mr. Cunningham, his wife, L.C., and their children, two boys, ages seven and three, lived in Brimfield Township in a residential neighborhood. On December 30, 2018, the day before the incident, Mr. Cunningham called 911 because he apparently believed he was being spied upon. Officer Robert Putnam of the Brimfield Police Department responded to the call at Mr. Cunningham’s home. When the officer arrived at the residence, he noticed the cable box was open and wires were exposed. The officer also noticed a Roomba vacuum taken apart and multiple children’s toys disassembled in the garage of the home. Officer Putnam asked if Mr. Cunningham would be willing to speak with mental health providers at Coleman Health Services (“Coleman”). Mr. Cunningham agreed. {¶5} Officer Putnam stated that he had confronted and addressed individuals with past methamphetamine use and such individuals tend to be “taken apart.” Officer Putnam, however, admitted he had no objective basis to conclude Mr. Cunningham was under the influence of alcohol or any drug. His opinion was based solely on his prior experiences. {¶6} Mr. Cunningham met with a pre-screener at Coleman, Kenneth Dampier. Mr. Dampier, at the relevant time in question, had an undergraduate degree in psychology and a master’s degree in social work. He pointed out that he worked with law enforcement with “anybody . . . in a mental health crisis, if they were suicidal, homicidal, psychotic or anything like that . . . .” Mr. Dampier was tasked to determine whether Mr. Cunningham was a danger to himself, a danger to others, or he was unable to take care of himself. Mr. PAGE 3 OF 42 Case No. 2025-P-0047 Dampier was essentially asked to determine whether Mr. Cunningham met the criteria for an involuntary hold at the treatment center. Mr. Dampier observed that: When individuals come to Coleman they have a dual diagnosis where they’re dealing with both mental health and they’re dealing with substance abuse. And sometimes when you’re dealing with substance abuse they exacerbate symptoms that’s going on. . . . So you’re presenting to me as like psychotic, but you’ve never had a psychotic presentation, so it’s like, is it substance induced or is this organic psychosis almost like. ... There are four criteria[] for a pink slip. The first one is threats of suicide, acts of suicide[,] or with suicidal behavior. There is homicidal behaviors or threats to homicide. . . . The third one is inability to take care of yourself. . . . Or the fourth one is just would benefit from a higher level of care . . . or for monitoring.1 {¶7} Mr. Dampier indicated that Mr. Cunningham did not exhibit or admit to any of these criteria. Mr. Cunningham’s main focus during the interview was his concern that his cell phone had been “hacked.” He did not indicate he and L.C. had any specific problems and did not demonstrate any unusual body language when Mr. Dampier brought up L.C. {¶8} Mr. Dampier stated that when intake occurs at Coleman, he evaluates that person for “[r]isk, imminent risk for themselves and the community as well.” When Mr. Cunningham arrived at Coleman, he was assessed for “increased paranoia.” Mr. Cunningham denied drug use “in general,” but admitted using Suboxone. Nevertheless, Mr. Dampier confirmed that Mr. Cunningham had been previously treated with Suboxone. 1. The phrase “pink slip,” in this context, refers to a formal manner in which an individual is involuntarily committed for hospitalization due to harm the individual might cause to others or him/herself. PAGE 4 OF 42 Case No. 2025-P-0047 Mr. Dampier stated that prescribed Suboxone is used for those “that have usually an opioid background or like usually opioid polysubstance use background.” {¶9} Mr. Dampier stated that Mr. Cunningham did not exhibit any indications that he would hurt himself or others, nor did he present any auditory or visual hallucinations. Moreover, Mr. Cunningham did not report any sort of psychosis to Mr. Dampier other than paranoia. Mr. Dampier stated he spoke with Mr. Cunningham’s parents (who brought him to Coleman on December 30, 2018), and neither parent relayed information that was “out of ordinary from what [Mr. Cunningham] said . . . or it would’ve been an issue for a pink slip.” Mr. Dampier asserted neither parent indicated any concern with Mr. Cunningham’s behavior and he documented nothing concerning any sort of psychosis during his interview. {¶10} While Mr. Dampier recognized and noted Mr. Cunningham’s possible drug use, which the former was aware might enhance his potential psychotic symptoms, he concluded Mr. Cunningham’s situation did not justify an involuntary hold. Mr. Dampier determined that “there was nothing evident or overt to be seen for [Mr. Cunningham’s] rights to be taken away.” Indeed, under the circumstances, Mr. Dampier observed that he had no basis to believe that a second opinion regarding Mr. Cunningham’s mental state, in light of his admissions, would require an involuntary commitment. Mr. Cunningham was therefore discharged. {¶11} Mr. Cunningham returned home on December 30, 2018. During the day, Courtney Rose, a close friend of L.C., and her children visited the Cunningham residence. Ms. Rose spoke with L.C. in the garage, out of Mr. Cunningham’s earshot. L.C., who was emotional during the conversation, explained that Mr. Cunningham had been acting PAGE 5 OF 42 Case No. 2025-P-0047 strangely. She also stated he accused her of cheating on him and that he had struck her several times. Ms. Rose stated she observed bruises on L.C.’s back and lumps on her head. {¶12} The following evening, on December 31, 2018, L.C. was shot and killed by Mr. Cunningham in their garage. The eldest of their young children heard the gunshot and apparently observed his deceased mother in the garage. Mr. Cunningham, however, advised the child not to speak about the event. Nothing suggests the boy said anything after the incident. {¶13} On January 1, 2019, Mr. Cunningham, his wife, and the children, were expected to attend dinner at his parents’ residence. They did not arrive, but Mr. Cunningham explained to his mother (“N.C.”) that L.C. was with her friends. N.C. drove to the Cunningham home, retrieved him and the two children. When she arrived, she noticed the “house was a mess.” N.C. stated she spoke with Mr. Cunningham about his paranoia and “him shutting off the light in the basement and then it would be on again. And windows in the basement being open and he’d close them and then they’d be open again. Stuff like that, paranoid stuff.”2 Regardless of the disarray and unusual circumstances, Mr. Cunningham returned to his parents’ home with the children. He fell asleep at his parents’ home where he and the children remained throughout January 2, 2019. 2. It is not entirely clear what N.C. was describing regarding Mr. Cunningham “shutting off the light in the basement.” Mr. Cunningham admitted, however, to Dr. Lynn Luna-Jones, a forensic psychologist who interviewed Mr. Cunningham after the incident, that, on the night of the murder, he “killed the power,” and turned off the circuit breaker in order to “kill the cameras” that might be monitoring him. Mr. Cunningham told Dr. Luna-Jones, “I didn’t want them to know where I was in the house.” By “them,” Mr. Cunningham indicated the police and “bad guys [were coming] to kill him.” PAGE 6 OF 42 Case No. 2025-P-0047  {¶14} On January 3, 2019, Mr. Cunningham’s father, P.C., drove Mr. Cunningham and the children back to their home. Although Mr. Cunningham advised P.C. not to enter the garage, he did so and discovered L.C.’s lifeless body, surrounded in dried blood, on the garage floor. P.C. demanded Mr. Cunningham call 911. Mr. Cunningham, however, asked P.C. to drive him to PCSO and stated he would “take care of it.” {¶15} At approximately 8:30 p.m. on January 3, 2019, Mr. Cunningham entered the PCSO and spoke with a corrections officer, Deputy Gary Hoffman, at the front window. He explained that he had shot his wife on New Year’s Eve and wished to speak with an officer. Deputy Hoffman did not believe Mr. Cunningham was under the influence of drugs or alcohol during their conversation. Deputy Hoffman indicated Mr. Cunningham admitted to using methamphetamine on New Year’s Eve, 2018, the night of the murder. {¶16} Dr. Brian Welsh, a forensic psychiatrist working with Coleman in conjunction with a contract with the Portage County Jail, met with Mr. Cunningham on January 15, 2019. Dr. Welsh noted that, during his interview, Mr. Cunningham was logical and effectively responded to questions. Dr. Welsh asserted that Mr. Cunningham presented no evidence of disorganized thinking which, in the doctor’s opinion, is a symptom of psychosis. Dr. Welsh stated that, in Mr. Cunningham’s intake form (dated January 4, 2019), nurse’s notes demonstrate Mr. Cunningham “reports a history of intravenous methamphetamine use. That he uses for days and takes breaks, that it varies. And that his - - at least on January 4, 2019, he reports to [a nurse] that his last use of methamphetamine was actually - - [the nurse] typed the words New Year’s Eve.” The remainder of Dr. Welsh’s statements and testimony will be discussed below. PAGE 7 OF 42 Case No. 2025-P-0047  {¶17} In January 2019, Mr. Cunningham was indicted on two counts of murder, two counts of felonious assault, along with firearm specifications on all counts relating to the shooting death of L.C. Mr. Cunningham entered a plea of NGRI and was tried to the bench. After a lengthy trial, Mr. Cunningham was found guilty on all counts. The trial court determined each substantive count merged for purposes of sentence, and the State elected to proceed to sentencing on one of the murder counts. The trial court also merged two of the firearm specifications. In total, Mr. Cunningham was sentenced to 15 years to life on the murder count and a total of six mandatory years on the two firearm specifications (three years each). Mr. Cunningham was therefore ordered to serve an aggregate term of 21 years to life in prison. This appeal follows. {¶18} Mr. Cunningham assigns two errors for this court’s review. They shall be addressed in turn. III. First Assignment of Error: Was the Trial Court’s Rejection of Mr. Cunningham’s NGRI Defense Against the Manifest Weight of the Evidence? {¶19} Mr. Cunningham’s first assignment of error reads: {¶20} “The trial court clearly lost its way and created a manifest miscarriage of justice by rejecting appellant’s insanity defense against the manifest weight of the evidence.” {¶21} Under this assignment of error, Mr. Cunningham claims the trial court erred to his prejudice when it determined he failed to establish the affirmative defense of NGRI. Specifically, he argues that the trial court created a manifest miscarriage of justice by rejecting the defense of NGRI based upon conjecture that his psychosis was a result of voluntary methamphetamine intoxication, despite the absence of toxicological evidence PAGE 8 OF 42 Case No. 2025-P-0047 of such intoxication, and the presence of severe mental disease which persisted years after the date of the offense. Mr. Cunningham also asserts, given his claimed psychoses, which were established, in his view, via the testimony of his experts, that the trial court lost its way when it concluded he knew the wrongfulness of his actions at the time of the incident. We do not agree. A. Legal Standards {¶22} The manifest weight of the evidence standard guides the analysis of evidentiary support for an NGRI defense. State v. Schmid, 2025-Ohio-14, ¶ 20 (2d Dist.). In applying this standard, we bear in mind that the weight and credibility of evidence related to the insanity defense are decisions primarily left to the trier of fact, in this case, the judge. See, e.g., State v. Thomas, 70 Ohio St.2d 79, 80 (1982). {¶23} A court considering whether a verdict is supported by the manifest weight reviews the entire record, “weighs the evidence and all reasonable inferences, considers the credibility of the witnesses and determines whether, in resolving conflicts in the evidence,” the finder of fact clearly lost its way and “created such a manifest miscarriage of justice that the conviction must be reversed and a new trial ordered.” (Citation omitted.) State v. Wells, 2012-Ohio-4459, ¶ 56 (11th Dist.), see also State v. Thompkins, 1997- Ohio-52, ¶ 25. “‘The discretionary power to grant a new trial should be exercised only in the exceptional case in which the evidence weighs heavily against the conviction.’” Thompkins at ¶ 25, quoting State v. Martin, 20 Ohio App.3d 172, 175 (1st Dist. 1983). {¶24} Insanity is an affirmative defense that the defendant must prove, and “‘has no bearing on the sufficiency of the evidence’” to support the State’s case. State v. Moore, PAGE 9 OF 42 Case No. 2025-P-0047 2024-Ohio-994, ¶ 56 (6th Dist.), quoting State v. Garrett, 2022-Ohio-4218, ¶ 127. The defense of NGRI does not relieve the State of its burden to prove the elements of the charged offense(s), but it permits a defendant to present evidence sufficient to support the affirmative defense and obtain an acquittal on the ground of insanity. R.C. 2901.05(A) (“Every person accused of an offense is presumed innocent until proven guilty beyond a reasonable doubt, and the burden of proof for all elements of the offense is upon the prosecution. The burden of going forward with the evidence of an affirmative defense, and the burden of proof, by a preponderance of the evidence . . . is upon the accused.”). A person is NGRI “only if the person proves . . . that at the time of the commission of the offense, the person did not know, as a result of a severe mental disease or defect, the wrongfulness of the person’s acts.” R.C. 2901.01(A)(14). {¶25} “‘Where the insanity is simply a temporary condition brought on by the voluntary ingestion of drugs or alcohol, it does not suffice to establish an NGRI defense.’” State v. Bernardo, 2025-Ohio-1399, ¶ 13 (5th Dist.), quoting State v. Swanson, 2014- Ohio-549, ¶ 14 (6th Dist.). See also State v. Toth, 52 Ohio St.2d 206, 210 (1977), (“It is a well-established rule in Ohio that the defense of insanity cannot be successfully established simply on the basis that the condition resulted from the use of intoxicants or drugs, where such use is not shown to be habitual or chronic.” (Citation omitted.)), overruled in part on other grounds, State v. Muscatello, 55 Ohio St.2d 201, 203 (1978).3 3. We emphasize that Mr. Cunningham does not take issue with the sufficiency of the State’s evidence on the murder charge. Mr. Cunningham conceded this point, and therefore we need not directly consider the sufficiency of the evidence on the primary, substantive charge. PAGE 10 OF 42 Case No. 2025-P-0047  B. Summary of Expert Testimony4 1. Expert Witnesses Supporting the State’s Position a. Dr. Brian Welsh5 {¶26} As noted above, Dr. Welsh is a psychiatrist associated with the Portage County Jail. Dr. Welsh, a medical doctor with a specialty in forensic psychiatry, met with Mr. Cunningham on January 15, 2019. During the interview, Dr. Welsh observed Mr. Cunningham to be logical and coherent during his interview. He observed no unusual thinking and no indication of psychosis. Mr. Cunningham reported a history of hospitalization for psychiatric issues in 2010. Mr. Cunningham recognized he was psychiatrically hospitalized from March 4, 2010, through March 8, 2010, at St. Thomas Hospital in Akron, Ohio, following a drug overdose. Mr. Cunningham also reported he had a history of paranoia, but Dr. Welsh did not observe any such symptoms during his interview. {¶27} Dr. Welsh was aware of Mr. Cunningham’s substance use, including his use of methamphetamine. According to official notes taken from a nurse at the time of Mr. Cunningham’s admission to the jail, Dr. Welsh observed Mr. Cunningham admitted to methamphetamine use on the day of the incident. Dr. Welsh cited the jail intake form that inquired into whether Mr. Cunningham “use[s] drugs not prescribed by a physician and it’s marked yes. What kind? Answered methamphetamine. Method of use is IV, which is intravenous. How much? Varies. How often? Used for several days and then take a break 4. The transcript of proceedings has multiple volumes that occurred across many days. The transcript of proceedings, however, start each day of testimony with a new numerical sequence, i.e. “p. 1.” Accordingly, this court shall provide a date of the testimony of each expert for ease of reference. 5. Dr. Welsh’s testimony occurred during the proceedings that took place on June 4, 2025. PAGE 11 OF 42 Case No. 2025-P-0047 for a day or two and restart. Last used New Year’s Eve. And this is dated January 4, 2019.” {¶28} Dr. Welsh testified he utilized these notes during his interview with Mr. Cunningham. When the doctor asked Mr. Cunningham questions about his use of methamphetamine (for purposes of the psychiatric evaluation), the latter acknowledged using the drug at or around the time of the incident. {¶29} Mr. Cunningham requested medication from Dr. Welsh to help him sleep and address his anxiety. The doctor obliged but stated the medications were not issued to quell or address psychotic episodes. Dr. Welsh stated that he prescribed no anti- psychotic medications because he did not “think an anti-psychotic would be necessary.” {¶30} Dr. Welsh testified that, while Mr. Cunningham did not appear to show any signs of psychosis, he did admit that, prior to the incident, he was concerned about statements made by L.C. Mr. Cunningham stated that “[s]tuff my wife would say wouldn’t make sense.” Dr. Welsh observed that even if someone reports paranoia[,] if I don’t see any evidence of paranoia at the time and the person has disclosed using meth, then I usually wait for some time for the effects of the methamphetamine, which can cause psychosis, to wear off, so that I’m not unnecessarily prescribing medication. {¶31} Dr. Welsh stated that when he does not see any evidence of psychosis or severe depression, which he did not perceive when he interviewed Mr. Cunningham, he would also look to a history of mental illness or long-term psychiatric treatment before prescribing any medication for these disorders. Dr. Welsh confirmed that Mr. Cunningham did not have “evidence of . . . long-term psychiatric treatment, long-term symptoms of schizophrenia and current evidence of schizophrenia.” Accordingly, during his interview PAGE 12 OF 42 Case No. 2025-P-0047 with Mr. Cunningham, Dr. Welsh elected to proceed with prescribing medications for Mr. Cunningham’s anxiety and sleep issues. {¶32} Dr. Welsh next met with Mr. Cunningham on June 4, 2019. The doctor noted no evidence of psychosis and observed logical thinking. The doctor again met with Mr. Cunningham on August 27, 2019, when he requested to be evaluated for anxiety issues. At this meeting, Mr. Cunningham denied any “suicidal thinking” and, although he was “feeling down,” the doctor did not think this symptom was “necessarily depression.” While Dr. Welsh did not “rule out” psychosis, he still did not observe any evidence of psychosis and Mr. Cunningham’s thought processes were clear and logical. Given the timeframe of Dr. Welsh’s involvement with Mr. Cunningham between the time of the incident, Mr. Cunningham’s statements and admissions, and his interviews, Dr. Welsh determined that Mr. Cunningham, when the incident occurred, experienced “likely a substance-abuse psychosis rather than another source of psychosis.” b. Dr. Lynne Luna-Jones6 {¶33} Dr. Luna-Jones, who was a court-appointed expert, is a board-certified forensic psychologist. She has performed approximately 3,000 competency and sanity evaluations for courts, prosecutors, and attorneys. The doctor was asked by the trial court to perform a competency evaluation on Mr. Cunningham. On March 18, 2019, Dr. Luna- Jones issued the evaluation. The report was issued approximately three and one-half months after the murder. {¶34} In her report, Dr. Luna-Jones stated Mr. Cunningham indicated that around November of 2018 his routines changed due to his drug use and he was regularly without 6. Dr. Luna-Jones’ testimony took place over the course of the proceedings occurring on June 11 and 12, 2025. PAGE 13 OF 42 Case No. 2025-P-0047 sleep. On December 31, 2018, Mr. Cunningham reported he had been awake for 36 to 72 hours straight. {¶35} Dr. Luna-Jones stated that, according to his parents, Mr. Cunningham became paranoid at or around February 2017. His parents indicated he began to withdraw from society and had “completely quit coming to work” due to social anxiety. {¶36} Dr. Luna-Jones, like Dr. Welsh, reported that Mr. Cunningham, upon his admission to the Portage County Jail, conceded he used methamphetamines intravenously. And, during January 4, 2019, he admitted his most recent use was December 31, 2018, the date of the murder. Dr. Luna-Jones stated Mr. Cunningham, at the time of the interview, showed signs of depression but did not appear overly “anxious, afraid, angry, embarrassed, or ashamed.” Instead, he was alert and oriented, with an “appropriate affect, logical thought process, appropriate speech, [and] appropriate mood,” and had no hallucinations. {¶37} Dr. Luna-Jones reported that, at the time of the offense charged, Mr. Cunningham was diagnosed with a problematic pattern of stimulant use, particularly methamphetamine. She also noted that, at the time of the offense, Mr. Cunningham reported he was under the influence of methamphetamines. She determined Mr. Cunningham’s intoxication with methamphetamines was voluntary. And Dr. Luna-Jones ruled out psychosis and/or adjustment disorder with anxiety. Mr. Cunningham denied experiencing delusional beliefs, auditory or visual hallucinations and, according to the doctor, there was no indication he was experiencing any perceptual disturbances during his evaluation. PAGE 14 OF 42 Case No. 2025-P-0047  {¶38} During the interview, Mr. Cunningham indicated that the best outcome for his case would be “if [he is] found not guilty by reason of insanity.” Further, during the evaluation, Mr. Cunningham was able to discern and articulate the basic concepts of “legal guilt” versus “not guilty by reason of insanity.” The record indicates, therefore, Mr. Cunningham was aware of the legal implications associated with a finding of “guilty” versus a determination of NGRI. {¶39} Mr. Cunningham reported he stopped taking all his prescribed medications in September 2018 and commenced researching conspiracies. Mr. Cunningham advised Dr. Luna-Jones that he had concerns about L.C. being a “sociopath[.]” He advised the doctor his feeling never went away because, in Mr. Cunningham’s view, L.C. would “lie” and he could never know “what was true” regarding her representations and behavior. Mr. Cunningham reported he thought L.C. was Satan; he admitted, however, that L.C. never made any threats to harm him that he took seriously. {¶40} Dr. Luna-Jones stated Mr. Cunningham reported he injected methamphetamine around 6:00 a.m. on December 31, 2018. Mr. Cunningham was unsure of how much he used on that date because he lost “track of all this stuff.” He told the doctor he wanted to scare L.C. and, in attempting to do so, punched her in the head. Mr. Cunningham then reported he shot L.C. and “killed the power” in the home to avoid being seen or “monitored.” {¶41} When Dr. Luna-Jones asked Mr. Cunningham about the wrongfulness of murdering L.C., he recognized his actions were wrong “because it ends a person’s life without their consent.” Mr. Cunningham also acknowledged his actions at the time of the incident were illegal. PAGE 15 OF 42 Case No. 2025-P-0047  {¶42} Considering the foregoing, Dr. Luna-Jones opined, based upon a reasonable degree of psychological certainty, that Mr. Cunningham did not have a severe mental defect at the time of the alleged offense. She emphasized that, on the day/night of the murder, she did not find Mr. Cunningham had any mental health problems other than those caused by his substance use (a fact he admitted to on the date of the murder) and maladaptive personality traits. Moreover, Dr. Luna-Jones opined, with a reasonable degree of psychological certainty, that Mr. Cunningham knew the wrongfulness of his actions when he assaulted and murdered L.C. c. Dr. Sara West7 {¶43} In April 2025, Dr. Sara West, a medical doctor and forensic psychiatrist, was asked to evaluate Mr. Cunningham as it related to his plea of NGRI. Dr. West issued a report on May 9, 2025. In the report, Dr. West cited all outside sources of information upon which she relied, including all previous reports issued by prior mental health professionals in the underlying case. While Dr. West offered her medical/psychiatric opinion on Mr. Cunningham’s sanity as a result of her interview with him, she also engaged in a thorough comparison of Mr. Cunningham’s history of evaluations with both the State’s and defense’s experts/witnesses. {¶44} Specifically, after interviewing Mr. Cunningham, Dr. West became concerned with certain inconsistencies or mismatched information Mr. Cunningham provided with other psychiatric/psychological experts. Dr. West testified that due to certain inconsistencies reported throughout Mr. Cunningham’s post-incident evaluations regarding his beliefs, behavior, and activities, she elected to focus on “information that 7. Dr. West’s testimony occurred during the June 12, 2025 proceedings. PAGE 16 OF 42 Case No. 2025-P-0047 was garnered in a fashion that was closest to the event[.]” Dr. West stated she “felt like that would be the most accurate reflection of the information given people’s natural tendency to forget information.” She punctuated this point by noting that Mr. Cunningham admitted to her, in the April 2025 interview, that he did not remember certain facts or features pertaining to the incident. Moreover, Dr. West testified that she found the inconsistencies problematic because they “mainly surrounded his reports regarding his use of methamphetamine. . . and voluntary intoxication with methamphetamine [which] is a very critical piece of information in relation to the assessment of his sanity in terms of this case.” {¶45} Dr. West elaborated: Because voluntary intoxication generally does not provide a severe mental illness in that one chooses to use methamphetamines and, therefore, the results of it are by choice than related to a severe mental illness . . . Some results of [extensive methamphetamine use] include, which I think [are] relevant in this case, reports of paranoia that would be a specific type of psychosis and then more generally psychosis which can include disorganization. I find that people who utilize meth may exhibit some common symptoms including . . . paranoia and a tendency to perseverate or focus on things and take them apart, so I guess that’s the best way of describing it, taking apart phones, pulling apart electronics, digging in walls for wires, those kinds of things, so it stuck out to me that some of the features that were described that are consistent throughout Mr. Cunningham’s report may very well be associated with methamphetamine use. {¶46} Dr. West continued that Mr. Cunningham represented to Dr. James Karpawich that he had not used substances prior to the murder—a statement contradicted by both Dr. Luna-Jones’ report and the intake report to which Dr. Welsh testified. Dr. West opined Mr. Cunningham’s statements appeared fundamentally inconsistent because he both acknowledged methamphetamine use at or near the time PAGE 17 OF 42 Case No. 2025-P-0047 of the murder (and possibly after) but also denied the same to other expert evaluators. She observed that “I’m concerned about the discrepancies between [Mr. Cunningham’s] report regarding his substance use. It is unclear to me, based on several reports, all of which cite a little bit different information, when he actually last utilized methamphetamine.” {¶47} Mr. Cunningham additionally reported to psychologist Dr. Steven Neuhaus, whose testimony will be addressed below, on May 5, 2019, that he had not used drugs on either December 30 or 31, 2018. Nevertheless, he reported to jail personnel and Dr. Luna-Jones he used methamphetamine on the day of the incident. {¶48} Considering her interview, in relation to the various reports she evaluated, Dr. West provided the following diagnostic impressions of Mr. Cunningham on December 31, 2018: She determined Mr. Cunningham had a stimulant use disorder. In support, she cited Dr. Luna-Jones’ report (which was issued shortly after the murder, in March 2019) wherein Mr. Cunningham stated he used larger amounts over longer periods and failed to fulfill major role obligations due to his methamphetamine use. Dr. West also determined Mr. Cunningham was experiencing stimulant intoxication on the day/night of the murder. She noted Mr. Cunningham presented evidence of “hypervigilance, interpersonal sensitivity, anxiety/tension/anger, stereotyped behaviors and impaired judgment. Additionally, he experienced the following signs or symptoms: psychomotor agitation and confusion.” {¶49} Finally, Dr. West determined Mr. Cunningham suffered from a substance- induced psychotic disorder. To this point, the doctor stated she considered that Mr. Cunningham may have been experiencing a primary psychotic disorder at the time of the PAGE 18 OF 42 Case No. 2025-P-0047 murder. She opined, however, his symptoms are more effectively explained by his methamphetamine use “as he has not experienced similar symptoms since maintaining long-term sobriety following his arrest.” {¶50} Dr. West concluded, with a reasonable medical certainty, that Mr. Cunningham was not suffering from a severe mental disease or defect on December 31, 2018. In support, Dr. West observed that although Mr. Cunningham was diagnosed with unspecified schizophrenia spectrum and other psychotic disorders at Coleman on December 30, 2018, he failed to directly report his substance use. Further, Mr. Cunningham expressed paranoid ideas while at his parents’ home from January 1 to 3, 2019, and his mother explained she attributed these experiences to his “drug use.” Dr. West opined that, without substance use, Mr. Cunningham has not experienced another psychotic episode since the date of the murder and has remained stable without sustained treatment with antipsychotic medications. {¶51} Dr. West also determined, with a reasonable degree of medical certainty, that Mr. Cunningham knew the wrongfulness of his actions. In support, she pointed to certain, post-incident, circumstantial evidence that might lead to the reasonable inference that Mr. Cunningham knew his actions were wrong. Specifically, Mr. Cunningham, after he murdered L.C., “told [his children] the cops would be coming” and he expected them to take him away to jail for murder. Dr. West further noted that he advised his eldest son to keep his mother’s death a secret from the grandparents (Mr. Cunningham’s parents) because if the child said something, he could be going away to prison. Dr. West also emphasized he lied to his parents regarding L.C.’s whereabouts after the murder and prevented his father from entering the garage on the day he turned himself into PAGE 19 OF 42 Case No. 2025-P-0047 authorities. Finally, Dr. West found it important to note that Mr. Cunningham, after his father discovered L.C.’s body, began “chugging” a bottle of Captain Morgan because he knew he “was going to jail.” {¶52} Considering her evaluation, analyses of other reports, and independent assessment, Dr. West opined, with reasonable medical certainty, that Mr. Cunningham was not suffering from a severe mental disease or defect on the night of the murder and he had knowledge of the wrongfulness of his acts. 2. The Defense’s Experts a. Dr. Robin Belcher-Timme8 {¶53} Dr. Timme, a board-certified forensic psychologist, testified on Mr. Cunningham’s behalf.9 Dr. Timme stated that, at the time of the offense, Mr. Cunningham was suffering from acute symptoms of a serious mental illness which included “[s]chizoaffective disorder, which is a combination of mood disorder, extreme depression, and a psychotic disorder, specifically, very delusional beliefs.” Given these observations, Dr. Timme concluded that Mr. Cunningham was incapable of understanding the wrongfulness of his actions at the time of the incident. {¶54} In formulating these opinions, Dr. Timme met with and interviewed Mr. Cunningham on February 28, 2024. Dr. Timme administered the Minnesota Multiphasic Personality Inventory, Third Edition (“MMPI-3”), a tool specifically designed to assess “severe psychopathology[.]” Dr. Timme pointed out that there was no indication Mr. Cunningham was attempting to manipulate the “clinical picture” through “feigning[,]” 8. Dr. Timme’s testimony occurred during the proceedings which took place on June 9, 2025. 9. Dr. Timme, while he was being sworn in, stated he generally is referred to as “Dr. Timme” rather than Dr. Belcher-Timme. Given the doctor’s expressed preference, we shall refer to him throughout as Dr. Timme. PAGE 20 OF 42 Case No. 2025-P-0047 “over[-]endorsing symptoms[,]” or potential malingering. Dr. Timme also reviewed a separate test conducted on Mr. Cunningham in 2019, the MCMI-III, which, in the doctor’s view, “described a man that was even more acutely psychotic . . . independent of drug use.” {¶55} Dr. Timme testified that he also reviewed Mr. Cunningham’s mental health history in relation to “intergenerational transmission of addiction.” Dr. Timme stated that “the research shows that about 75 percent of people who have a serious mental illness also struggle with co-occurring substance use disorder.” Still, Dr. Timme testified there was no evidence that Mr. Cunningham was intoxicated or using substances on December 30, 2018, when he visited Coleman. And, Dr. Timme noted Coleman did not do a urine screen on that date. {¶56} Dr. Timme asserted Mr. Cunningham’s symptoms of psychosis were persistent at the time of his interview. As such, he took issue with Dr. Luna-Jones’