Nicolas Guaman Case: One Set of Medical Records, Two Interpretations

Nicolas Guaman, an Ecuadorian laborer who is facing multiple charges in the death of Milford resident Matthew Denice, fell two stories from a roof in 2005, sustaining a head injury.

Has this injury had a lasting impact? in a competency hearing to determine if Guaman should be tried in the case, drew different conclusions from the same medical records.

The medical records are not a public record. But the testimony of the doctors and questioning by attorneys were made in Worcester Superior Court, making public for the first time some of the details of Guaman's injury, and whether the two doctors assigned to evaluate his competency think it is relevant.

Guaman, now 35, according to the testimony, sought treatment in August 2005 at The Miriam Hospital in Providence.

He had fallen two stories while working on a construction site, according to the doctors. He was admitted to the hospital, and released the following day. He did not seek followup treatment.

Since the fall, Guaman told both doctors, he has had difficulty hearing out of his right ear. He told the state-appointed psychologist, Hanya Bluestone, that he has had anxiety since that fall going up on ladders. According to Bluestone, he said this had impacted his ability to work and the family for several years before his arrest relied on the income his wife earned as a restaurant worker.

Bluestone said she examined his medical records. EMTs who found him reported he was sitting upright, against a wall, and conscious and alert. At the hospital, a CAT scan was performed, and the findings were normal, she said. A test that determines injury from a concussion was performed, and came back normal. He was kept overnight for observation, and released the following day.

When asked if the fall had any significance relating to his competency, Bluestone restated that all of the tests were normal. "There was no indication from the medical records that there were any significant issues that would affect his capacity."

Bluestone reported that Guaman was not able to specifically name the charges he faces, but he was aware that he was in the Worcester County jail, and he knew he was before the Superior Court "because of an accident."

He knew there had been a death, Bluestone said, because his attorney had reported that to him. "He was aware that the charges he faced were serious."

When he was asked about the records, defense-appointed neuropsychologist Paul Spiers said Guaman reported he has suffered memory loss, headaches and blurred vision at times, which Spiers said could have resulted from the fall.

Under cross-examination by the prosecutor, Spiers said Guaman has an absence of any memory of the crash involving Denice, or of the consequences.

"Yes, so he said to me," Spiers said.

Although the tests conducted at Miriam Hospital to determine if Guaman had suffered a traumatic brain injury were "all normal," Spiers reported, he said a head injury resulting in loss of consciousness "no matter how brief" could lead to a seizure disorder, including a form of epilepsy. 

Spiers testified that he believes Guaman is not competent to stand trial. "He has a fixed, neuropsychological deficit. His ability to keep track of verbal information we were giving him was not good."

Superior Judge Janet Kenton-Walker has taken the competency testimony and reports under advisement, and is expected to issue a decision in the coming weeks.