The man who killed seven elderly nursing home residents and a nurse two years ago was able to understand and plan his acts a forensic psychiatrist said in court. Dr. Nicole Wolfe examined Robert Kenneth Stewart – in the presence of his attorneys – a number of times.

She compared his responses with statements made by others, by witnesses and investigators. He gave an extensive account of his life growing up, she said. Memory lapses were only claimed in the time around the shootings.

On Mar. 29, 2009, Stewart took guns and ammunition to the parking lot of Pinelake Health and Rehabilitation Center. He shot up his wife’s blue PT eCruiser, fired at a visitor driving up in his red Ford. Michael Cotten was wounded and rushed into the building to call 911 and warn others there.

Stewart then left the rifle he’d used on top of the black Jeep he’d driven and got a long shotgun out of the car from the passenger side, according to testimony and records Wolfe used for her report on the defendant.

He went into the building where he fired that shotgun point-blank at old men and women in wheelchairs and beds, roaming the halls – in the prosecution’s view looking for his estranged wife.

Defense attorneys Jonathan Megerian and Franklin Wells admitted all these actions, but say their client was in a mental fugue from taking the sleeping aid Ambien and other medicines, doesn’t remember anything he did, and isn’t legally culpable.

A previous defense witness testified that’s just what happened and described Stewart’s treatment two days beforehand as “malpractice” saying he should have been watched or hospitalized.

Wolfe came to almost exactly opposite a conclusion. The board-certified nurse practitioner who saw him did just what any medical provider would have done on the circumstances presented at the time.

Family practice clinics like the one in Robbins have visits all the time when a spouse leaves, or have other losses. In her view, Stewart’s visit was handled correctly – just as any other would have been.

The amount of Ambien measured in his blood – as drawn nearly ten hours after the shootings – was inconsequential. That amount was most likely still present because he was so obese, she said. Stewart weighed almost 400 pounds that day, according to testimony. That drug is “lipophilic” – literally a chemical that “loves fat.”

She found Stewart’s claimed memory losses “selective” and that his psychological problems could not have prevented his knowing he was pointing a gun, shooting people.

Wolfe diagnosed the defendant as suffering from “adjustment disorder with mixed disturbance of emotions and conduct.”

“He was upset, tearful and sad,” she said. “I thought he had a personality disorder, which is a maladaptive coping style. He tended to blame others. In general, he is unhappy and wants people around him to feel his pain.”

“He wants to share, but what he is sharing is his unhappiness?” asked prosecutor Peter Strickland.

“Yes,” she said. “These were reports that someone fitting Mr. Stewart’s description had been seen that morning in the parking lot at 8:30 a.m. This is an indication: Mr. Stewart had been there for about an hour and a half before the shootings. It talks about the amount of time beforehand.”

She went over notes found in his home after the shootings, including one titled “Last and Final Days.”

“The writings were very important, because they occurred beginning eight days before the shootings,” Wolfe said. “With all the things I consider and behaviors that occurred Mar. 29 – that he had many guns and was very experienced with weapons, told me he used a shotgun for closer distances, a rifle for far away. He had two handguns in holsters, ammunition in pockets.”

He clearly had good recall right after he was arrested, she said she’d noted.

“He talked about having left the rifle on top of the black Jeep – and this is someone who reports having no recall,” she said. “At first I thought it was a typo – but the gun was (literally) on top of the Jeep and he remembered the vehicle color. To me, the memory deficits appear to be selective.

“Mr. Stewart had been taking Ambien – it has been talked about at length – but he had been taking it for years. I went through all the records, but there was no complaint about Ambien.”

His claimed amnesia begins with visit to the nurse practitioner Vonda Reives on Friday morning Mar. 29, according to Wolfe. She noted that, according to accounts from his relatives and others, he had no confusion. Sunday, when he reported no recall, he was observed walking around the blue car an hour and a half before.

“There were pauses between the shootings, reloading weapons,” she said. “It was my conclusion that there was no mental disease that would have prevented his understanding his actions or the cause of the actions at Pinelake. The writings, phone calls are all very consistent. He was thinking about killing himself. They don’t indicate he was ever out of touch with reality. Ambien can cause very strange behaviors, but I don’t consider that a fact on this particular day – and I did consider that.”

She does not consider him as having any memory disorder. His amnesia is instead more likely to have been a protective reaction to his having killed those people, she said.

“I believe he had that ability; memory loss is virtually impossible to determine – Mr. Stewart doesn't have dementia with rapid forgetting” she said. “In general, about half murder defendants don't recall significant parts of the crime. It is the body’s way of coping. It is a response to the act that was committed, not before. Has nothing to do with ability to plan and carry out the shootings. I don't view him as having a memory disorder.”

Megerian began his cross-examination by asking about Stewart’s history of depression.

“He had a sad, tearful affect – was tearful – and was given Lexapro and Xanax, and that includes the Ambien he'd been on?” Megerian asked.

Wolfe agreed.

Megerian went after her conclusion that the Ambien in his system was retained as a result of his obesity.

She said that the medicine’s half-life means that ordinarily – whether he'd taken one or 30 pills – all that Ambien would normally have been out of his system the next day. However, he’d taken it for two and a half years and it was lipophilic. Its chemical affinity for fat cells would account for its presence that much later.

“You have a study that shows this?” Megerian asked.

“No,” she said. “There are no studies of obese individuals. That's why I said the number was meaningless. The timing of the blood draws and which time they are considered therapeutic is highly variable. The 31 ng/ml is meaningless.”

Megerian asked if she had been in the courtroom when the nurse practitioner testified.

“I believe what he said was that he wasn't having thoughts of hurting himself or others,” she said.

Megerian read the statement: Stewart said he did not want to hurt himself or anybody else.

“You know he was thinking about it, don't you?” he asked.

“I know, because I read his letters,” she said.

Megerian asked about a box of records that was sent to Central Prison for use by those doing the mental evaluation but mistakenly delivered to Stewart himself. Wolfe had asked Stewart last June during one of her interviews if he’d reviewed those records.

“Did you review the records in that box?” he asked. “Why do you think they decided to draw two vials of blood? You do seem to have an opinion about what was going on in that box of records. You don't have an opinion on this?”

She does not have a medical opinion on that, she said.

He asks if she takes Reives' testimony at face value.

"I am not calling her a liar, if that's what you mean," she said.

The defense attorney pressed the point.

Yes, she said.

Megerian asks if she knows Stewart left the plug in his shotgun, thereby limiting the number of shells he could load.

He asks a great many “Do you know” questions like whether she knows the number of witnesses who described Stewart as “too calm.”

Not the number, she says. She doesn’t know the number.

He keeps returning to Stewart’s emotional state in the days before, whether the defendant saying he “didn’t want to hurt himself or anybody else” showed suicidal thoughts.

“In all these phone calls he made – late at night – he is very agitated?

“Yes.”

“That is normal behavior?”

“No.”

Megerian stood, arms folded, staring at things on the evidence table, looking like he’s thinking.

“He gets in his car, drives to Pinelake and kills people,” he said. “He did have suicidal, homicidal ideation, didn’t he?”

“He had homicidal ideation,” she said.