TOWANDA - Three experts who evaluated John DeSisti at various points in the past two years testified at a Tuesday hearing that the 75-year-old Waverly man, accused of killing his cousin and her husband in 2006, is incompetent to stand trial and cannot be rehabilitated.

During the competency hearing, which continues at 9:30 a.m. Wednesday, evaluators stated that DeSisti shows signs of progressing moderate-stage Alzheimer's disease or dementia and no longer fully understands the details surrounding his case. DeSisti's attorney, Arthur T. Donato, has asked the court to find DeSisti incompetent to face trial for two murder charges and a burglary charge in the Nov. 2006 murders of David and Carol Keeffe of Athens Township.

In his opening statement Tuesday, Donato stated that his developing concerns over DeSisti's competency increased when he and attorney Philip Gelso met with him April 22, a day before jury selection in his trial was scheduled to begin in Bradford County Court.

During that meeting, Donato said he and Gelso asked DeSisti to consider a plea deal offered to DeSisti in which he would waive his right to a jury trial in exchange for removal of the death penalty as a possible punishment should he be found guilty. Donato said he also asked DeSisti to consider whether he would be able to testify during his trial.

When the two met with DeSisti again on April 23, Donato said he did not recall the conversation from the day before. The interaction created "serious and great doubts," Donato said, over whether DeSisti could proceed to trial that day. The trial was suspended prior to jury selection, pending a mental health evaluation.

Prosecutor Joseph McGettigan, senior deputy attorney general, said he agreed to the hearing in order to avoid a claim of incompetency mid-trial. However, in his opening statement, he said he wants to see the case go to trial. A declaration of incompetence would mean that "the Commonwealth loses the opportunity to present the case and the defense loses the opportunity to exonerate [DeSisti]," McGettigan said.

Psychologist Dr. Elliot L. Atkins and psychiatrists Dr. Richard Fischbein and Dr. John O'Brien conducted an evaluation of DeSisti on April 30, Donato said. In his testimony, Atkins stated that Donato and Gelso "had some real concerns regarding how little of their conversation he remembered."

During the April evaluation, Atkins said he, Fischbein and O'Brien took turns asking DeSisti questions. During the interview, DeSisti either could not answer, refused to answer or incorrectly answered several questions, Atkins said, particularly those relating to specific times and dates.

Refusal to answer questions is typical of a dementia patient, who may fear that an answer would reveal symptoms of his or her condition, Atkins said. Evaluators can also use interviews with family members, reliance on other medical records and observation of the patient's behaviors as indicators in their reports, he said.

During the interview, DeSisti was able to say how many times he had been in court at that point and recalled details about his construction and rental business. However, he gave varying answers to a question about how long it had been since he last saw his family and answered time-related questions in a fashion that didn't make sense, Atkins said.

The April review was a marked change from a pre-trial evaluation in which Atkins believed DeSisti was "borderline competent," able to understand the roles of participants in the trial process despite a decline in cognitive ability, Atkins said.

Atkins, who visited with DeSisti several times after an Aug. 2010 initial interview indicated his mental state needed further study, said DeSisti was evaluated in May 2011 by neuropsychologist Dr. Brenda Ivker. In that evaluation, Ivker found DeSisti to have significant impairments in his verbal abilities, attention, concentration and orientation, he said. Atkins added that Ivker found DeSisti's symptoms to be consistent with at least moderate dementia.

Fischbein, a forensic and geriatric psychiatrist, said he only had contact with DeSisti during the April evaluation and, based on Atkins' reports, believed him to be "on the cusp" of competency prior to the interview.

Fischbein said DeSisti could not complete simple tasks, such as drawing a clock showing a specific time, and gave short answers to the questions he responded to. At the examination, DeSisti was withdrawn and quiet and kept his eyes closed, a behavior he also exhibited at Tuesday's hearing.

The evaluators concluded that DeSisti showed signs of cognitive decline, and the court ordered DeSisti to be transported to Torrance State Hospital for a 40-day forensic evaluation, where geriatric psychiatrist Dr. Frank Daly issued a report declaring DeSisti incompetent to stand trial.

Daly testified that DeSisti arrived June 20 for an assessment of his competency. While at Torrance, DeSisti was unwilling to participate in psychological testing, Daly said. However, Daly was able to use the results of previous tests, which he said were better than what the hospital had resources to provide.

DeSisti refused to answer questions upon his transfer to the hospital, but was passively cooperative, often responding "I don't know" or "I don't want to tell you," Daly said. The struggle to cooperate "exemplified a lack of insight into his current problems," he said.

Daly, who said he had contact with DeSisti between eight and 10 times through interviews and observations, said DeSisti was withdrawn, passive and unmotivated, although cooperative, during his stay.

Daly said it was his opinion that DeSisti, at the time of his evaluation, lacked a true, factual understanding of his charges. For instance, Daly said, DeSisti stated while at the hospital that he believed he was accused of killing one person instead of two. Daly also did not expect DeSisti to recover to the point where he would be competent to participate in the future, as degenerate dementia cannot be reversed, he said.

In his opinion, DeSisti is "not competent to stand trial," Daly said.

Based on statements members of DeSisti's family made to his primary care physician, his cognitive decline began between 10 and 12 years ago when he began to have troubles with financial- and business-related issues at work, Fischbein said. Given the average progression of dementia, DeSisti is likely at the moderate stage at this point, he said. "I don't doubt for a minute that he has Alzheimer's," Fischbein said.

Fischbein stated that DeSisti cannot provide for himself and requires constant attention, a statement Atkins also addressed in his testimony. DeSisti needs assistance with basic functions including bathing, dressing and eating, Atkins said, describing his state as "very childlike and very dependent upon others."

When asked whether DeSisti could possibly be malingering ­- a medical term for fabricating or exaggerating symptoms - all three experts agreed that his symptoms would be difficult to duplicate purposely, particularly his speech problems and tremors.

In addition, at this stage in his dementia, DeSisti likely lacks the ability to exaggerate his symptoms, Fischbein said.

Atkins, Fischbein and Daly all stated during testimony that, in their separate opinions, DeSisti cannot make decisions in his own best interest, process new information or meaningfully assist his counsel during the trial. DeSisti is incapable of making decisions regarding a plea deal or whether to testify, Atkins added.

At the time of the April evaluation, DeSisti only had partial understanding of the details of his case and could not be restored to competence, Fischbein said, adding that the findings from his evaluation at Torrance supported his position.

Prosecutors are expected to call their own experts to testify Wednesday.

Amanda Renko can be reached at (570) 888-9652; or email: arenko@thedailyreview.com.