CLECKLEY, Justice:
The defendant below and appellant herein, Charles Rhea Hinkle, appeals a verdict by a jury in the Circuit Court of Pleasants County of guilty of involuntary manslaughter. By order dated May 17, 1995, the circuit court denied the defendant’s motions for a judgment of acquittal and a new trial, and sentenced him to one year in the Pleasants County jail. This appeal ensued.
I.
FACTUAL AND PROCEDURAL HISTORY
On June 12, 1993, the defendant finished his work shift at the Ormet Corporation, an aluminum plant in Hannibal, Ohio, at approximately 4:00 p.m. He obtained a ride to the Village Inn tavern in Paden City, West Virginia.
At the tavern, the defendant made several telephone calls attempting to locate someone to give him a ride to his car.
The defendant also ordered a can of beer, and drank approximately one-third of the beer. While at the tavern, the defendant complained of not feeling well, dizziness, and double vision. The tavern owner’s daughter then agreed to take the defendant to retrieve his car. As he was leaving' the bar, the defendant took an unopened can of beer with him.
At approximately 7:30 p.m., the defendant was traveling north on Route 2 in St. Marys, West Virginia.
Robert Barrett was driving south on Route 2 with his wife, Charlotte Ann Barrett. It appears the defendant’s ear gradually crossed the centerline and traveled in a straight line for approximately two hundred yards in the southbound lane before it collided head-on with the Barrett automobile.
As a result of the accident, the defendant and Mr. Barrett suffered severe injuries. Mrs. Barrett also sustained serious injuries, and died as a result of those injuries. Eyewitnesses reported the defendant crossed the centerline in a consistent, even fashion without attempting to swerve, brake, change directions, or stop.
Witnesses also indicated that both the defendant and Mr. Barrett were traveling at the posted speed limit. A bystander stated the defendant was semi-conscious immediately after the accident, and his breath smelled of alcohol.
An investigation of the defendant’s vehicle immediately after the accident revealed one open can of beer, which was one-half full, in the driver’s door compartment; several empty beer cans on the passenger’s floor; four full beer cans on the rear floor; three empty beer cans on the driver’s floor; and an empty glass, which smelled of beer, on the ground near the car. The defendant was transported to Camden Clark Memorial Hospital where testing revealed he had a blood alcohol level of less than one hundredth of one percent. Officer Charles Templeton of the Pleasants County Sheriffs Department, who investigated the accident, also requested that a blood sample from the defendant be tested by the crime lab. The crime lab found the defendant’s blood alcohol level to be less than one thousandth of one percent, well below the statutory definition of intoxication.
While treating the defendant’s injuries, he was given a Magnetic Resonance Imaging [MRI] scan to determine whether he had sustained any head injuries. The MRI results indicated the defendant had an undiagnosed brain disorder in the portion of his brain that regulates consciousness.
On September 13, 1993, a Pleasants County grand jury returned an indictment charging the defendant with the misdemeanor offense of involuntary manslaughter while driving a motor vehicle in an unlawful manner in violation of W. Va.Code, 61-2-5 (1923). The defendant stood trial, by jury, for this charge in Pleasants County on March 1, 1995. During the trial, the defendant’s son testified that the defendant had been having memory loss for several months prior to the accident, and that he believed the defendant had seen a doctor in New Martinsville, West Virginia. Similarly, the tavern owner stated the defendant had complained of feeling ill during the months preceding the collision,
and he had complained of dizziness, memory
loss, and double vision on the night of the accident. She, too, believed the defendant recently had been treated by a physician.
Defense witness, Ronald Washburn, M.D.,
reported the defendant’s MRI scan showed an undiagnosed brain disorder affecting the reticular activating system of his brain. Dr. Washburn reasoned that because this portion of the brain affects one’s consciousness, this disorder could have caused the defendant to suddenly lose consciousness immediately before the collision.
He also indicated the defendant had developed this brain abnormality approximately four to eight months prior to the accident,
and the disease was not caused by chronic alcohol abuse. Testifying further, Dr. Washburn surmised the defendant’s prior memory loss was a symptom of his brain disorder, but his other complaints of not feeling well, dizziness, and blurred or double vision were not related to this disease.
Concluding his opinion, Dr. Washburn determined the defendant’s brain disorder would not have been diagnosed if he had not had an MRI scan after the accident. Finally, both the defendant and Mr. Barrett testified they could not recall any details of the automobile accident.
The trial court denied the defendant’s motion to dismiss the indictment
; his motion to suppress all evidence obtained immediately after the accident showing the presence of alcoholic beverage containers in or around the defendant’s car, and statements indicating the defendant and his car smelled of alcohol; and his motions for a directed verdict of acquittal.
The trial court further denied the defendant’s proposed jury instruction regarding the insanity defense,
to which defense counsel objected.
Determin
ing that the defendant’s blood alcohol level did not establish that he was under the influence of alcohol, the trial court instructed the jury to find the defendant was not intoxicated at the time of the accident.
Likewise, the trial court directed the jury to find that the defendant suffered from a brain disorder affecting the consciousness-regulating portion of his brain.
The court further instructed the jury:
“[0]ne who suffers irom an as yet undiagnosed disease or defect cannot be convicted of involuntary manslaughter for a death resulting from his operation of an automobile unless the State proves beyond a reasonable doubt that:
“1. The driver knew or should reasonably have known of the existence of his physical or mental condition, disease or defect; and,
“2. The driver should reasonably have foreseen that his condition, disease or defect would impair his ability to drive an automobile to such a degree so as to endanger human life; and,
“3. The driver’s condition, disease or defect did contribute to the accident resulting in death; and,
“4. His decision to drive an automobile at the date and time and in the place set forth in the indictment was negligence so gross, wanton and culpable as to show a reckless disregard of human life; and,
“5. Indicated a conscious indifference to the probable dangerous consequences of driving so impaired.
“If the evidence fails to prove any of these matters beyond a reasonable doubt, then you shall find the defendant, Charles Rhea Hinkle, not guilty of involuntary manslaughter as charged in the indictment.
“If the evidence proves each of these matters beyond a reasonable doubt then you may find the defendant, Charles Rhea Hinkle, guilty of involuntary manslaughter as charged in the indictment.”
Following deliberations, the jury, on March 2,1995, returned a verdict of guilty of involuntary manslaughter. By order dated May 17, 1995, the circuit court denied the defendant’s motions for a judgment of acquittal and a new trial, and sentenced him to one year in the Pleasants County Jail.
II.
DISCUSSION
Despite the additional issues raised, disposition of this appeal begins and ends with an inquiry into whether the jury instructions were inadequate. Thus, the appeal in this ease has been limited to one issue: Whether the jury was instructed properly as to the defense of unconsciousness. The defendant claims the trial court committed reversible error when it refused to give his insanity instruction. On the other hand, the State contends the instruction offered by the defendant was imperfect, and the evidence did not support an insanity instruction. Moreover, the State urges the instructions offered were more than adequate to cover the defense of unconsciousness. This ease requires us to harmonize a conflict between the defense of unconsciousness and that of insanity.
A.
Standard of Review
In dealing with instructions, our standard of review is familiar. As a general rule, a refusal to give a requested instruction is reviewed for an abuse of discretion. When assessing whether the trial court properly exercised that discretion, a reviewing court must examine the instructions as a whole to determine if they sufficiently cover the issues in the case and focus on the facts presented by the evidence.
See United States v. Park,
421 U.S. 658, 674-75, 95 S.Ct. 1903, 1912-13, 44 L.Ed.2d 489, 502-03 (1975);
State v. Bradshaw,
193 W.Va. 519, 543, 457 S.E.2d 456, 480,
cert. denied,
— U.S. -, 116 S.Ct. 196, 133 L.Ed.2d 131 (1995).
A criminal defendant is entitled to an instruction on the theory of his or her defense if he or she has offered a basis in evidence for the instruction, and if the instruction has support in law.
See State v. LaRock,
196 W.Va. 294, 308, 470 S.E.2d 613, 627 (1996). Thus, an instruction offered by the defense should be given if the proposed instruction: (1) is substantively correct, (2) is not covered substantially in the charge actually delivered to the jury, and (3) involves an important issue in the trial so the trial court’s failure to give the instruction seriously impairs the defendant’s ability to effectively present a defense.
State v. Derr,
192 W.Va. 165, 180, 451 S.E.2d 731, 746 (1994). If these prerequisites are met, the trial court abuses its discretion in refusing the instruction “no matter how tenuous that defense may appear to the trial court.”
United States v. Dove,
916 F.2d 41, 47 (2nd Cir.1990).
By contrast, the question of whether a jury was properly and adequately instructed is a question of law, and, thus, our review is
de novo.
We consider all the jury heard and, from the standpoint of the jury, decide not whether the charge was faultless in every particular but whether the jury was mislead in any way and whether it had an understanding of the issues and its duty to determine those issues.
See State v. Guthrie,
194 W.Va. 657, 671, 461 S.E.2d 163, 177 (1995). We will reverse a conviction only if the error was prejudicial when viewed in light of the entire record. In the present ease, we find merit in the defendant’s position, and hold that, without an adequate and complete explanation of the unconsciousness defense, the omission in the charge was likely to have created a grave miscarriage of justice.
B.
Analysis
The defendant argues he was entitled to an insanity instruction. Of course, the State contends otherwise. We agree partially with the State that technically the defense was one of unconsciousness as opposed to insanity. The law on the notion of unconsciousness in West Virginia is terribly undeveloped. This is, no doubt, the reason why the defendant requested an insanity instruction in this ease, since that is where our older cases seem to place this claim.
See State v. Painter,
135 W.Va. 106, 63 S.E.2d 86 (1950);
State v. Alie, 82
W.Va. 601, 96 S.E. 1011 (1918). Indeed, there is only a paucity of American appellate courts that have discussed this defense. With regard to those jurisdictions, Section 44 of Wayne R. LaFave & Austin W. Scott, Jr.,
Criminal Law
(1972), one of the few treatises that gives this defense any extensive coverage, states: “A defense related to but different from the defense of insanity is that of unconsciousness, often referred to as automatism: one who engages in what would otherwise be criminal conduct is not guilty of a crime if he does so in a state of unconsciousness or semi-consciousness.”
Id.
at 337.
Interpreting this defense, the weight of authority in this country suggests that unconsciousness, or automatism as it is sometimes called, is not part of the insanity defense for several reasons. First, unconsciousness does not necessarily arise from a mental disease or defect. Although always containing a mental component in the form of loss of cognitive functioning, the causes and conditions are diverse; examples include epilepsy, concussion, gunshot wounds, somnambulism, coronary episodes, and certain brain disorders, as here.
See generally
LaFave & Scott,
supra,
at 339-40. Additionally, these unconscious disorders tend to be acute, unlike most eases of insanity which are typically chronic. Because cases of unconsciousness are temporary, they do not normally call for institutionalization, which is the customary disposition following a successful insanity defense.
Id.
at 338.
A further, and probably the most significant, distinction between insanity and unconsciousness rests on the burden of proof issue. Because insanity leading to criminal behavior usually does not eliminate the mental state necessary for a finding of criminal culpability, the burden can be placed on the defendant to prove insanity.
See Rivera v. Delaware,
429 U.S. 877, 879-80, 97 S.Ct. 226, 227, 50 L.Ed.2d 160, 161 (1976) (appeal dismissed; Brennan, J., dissenting);
Leland v. Oregon,
343 U.S. 790, 796-801, 72 S.Ct. 1002, 1006-09, 96 L.Ed. 1302, 1307-10 (1952). On the contrary, unconsciousness eliminates one of the basic elements of the crime — either the mental state or the voluntary nature of the act.
As such, once the issue of unconsciousness or automatism is raised by the defense, the State must disprove it beyond a reasonable doubt in order to meet its burden of proof with respect to the elements of the crime.
Patterson v. New York,
432 U.S. 197, 215, 97 S.Ct. 2319, 2329, 53 L.Ed.2d 281, 295 (1977);
Mullaney v. Wilbur,
421 U.S. 684, 701-04, 95 S.Ct. 1881, 1891-92, 44 L.Ed.2d 508, 521-22 (1975);
In re Winship,
397 U.S. 358, 361-63, 90 S.Ct. 1068, 1071-72, 25 L.Ed.2d 368, 373-74 (1970). Our allocation of the burden of proof is consistent with other West Virginia cases.
See
Syl. Pt. 4,
State v. Houston,
197 W.Va. 215, 475 S.E.2d 307 (1996) (entrapment); Syl. Pt. 2,
State v. Daggett,
167 W.Va. 411, 280 S.E.2d 545 (1981) (insanity); Syl. Pt. 4,
State v. Kirtley,
162 W.Va. 249, 252 S.E.2d 374 (1978) (self-defense).
Unconsciousness is thus a separate and distinct defense from insanity.
See State v. Massey,
242 Kan. 252, 257, 747 P.2d 802, 806 (1987);
State v. Caddell,
287 N.C. 266, 290, 215 S.E.2d 348, 363 (1975). In order to keep this distinction conceptually clear, it is better to view unconsciousness as eliminating the voluntary act requirement rather than negating the mental component of crimes. Thinking of unconsciousness in this conceptual fashion helps to avoid the temptation to collapse it into insanity which, of course, also deals with mental conditions. The defense of unconsciousness should be recognized in a criminal trial and equated with epilepsy rather than insanity. We believe this is the way the claim of unconsciousness should be viewed jurisprudentially in West Virginia.
Accordingly, we hold that unconsciousness (or automatism) is not part of the insanity defense, but is a separate claim which may eliminate the voluntariness of the criminal act.
Moreover, the burden of proof on this issue, once raised by the defense, remains on the State to prove that the act was voluntary beyond a reasonable doubt. An instruction on the defense of unconsciousness is required when there is reasonable evidence that the defendant was unconscious
at the time of the commission of the crime.
In the instant case, it is contended the defendant was, in fact, rendered unconscious at the time of the commission of the crime by-reason of an undiagnosed brain disorder affecting the reticular activating system of his brain.
Even if the trier of fact believes the defendant was unconscious at the time of the act, there is another consideration which occasionally arises. If the defendant was sufficiently apprised and aware of the condition and experienced recurring episodes of loss of consciousness, e.g., epilepsy, then operating a vehicle or other potentially destructive implement, with knowledge of the potential danger, might well amount to reckless disregard for the safety of others. Therefore, the jury should be charged that even if it believes there is a reasonable doubt about the defendant’s consciousness at the time of the event, the voluntary operation of a motor vehicle with knowledge of the potential for loss of consciousness can constitute reckless behavior. served below. Jurisdictions appear divided as to whether the defense can be put in issue by only the defendant’s testimony. In
Starr v. State,
134 Ga.App. 149, 150, 213 S.E.2d 531, 532 (1975), the court found that additional corroboration was required and, without corroboration, such an instruction was not required. On the other hand, in
People v. Wilson,
66 Cal.2d 749, 762, 59 Cal.Rptr. 156, 165, 427 P.2d 820, 829 (1967), the court said because a defendant is entitled to an instruction as to his defense, no matter how incredible his theory is, there need be no corroboration for the instruction to be given. In this case, we need not decide this issue since the defendant’s testimony was sufficiently corroborated by expert testimony and other eyewitness testimony.
We find the evidence was sufficient to require an unconsciousness instruction. Moreover, in this case the issue appears moot because the trial court not only gave an instruction on the subject but, by such instruction, may very well have decided the issue of unconsciousness as a matter of law.
The next’ questions are whether the evidence in the present case was sufficient to justify an unconsciousness instruction, and, if so, whether the instruction given by the court was adequate. Finally, we must determine whether the issue regarding the sufficiency of the jury charge was properly pre-
Four considerations lead us to reverse the defendant’s conviction. First, although the defendant failed to request a specific instruction on unconsciousness, such failure is understandable given the confusion in our cases, essentially equating this claim with insanity.
The defendant did request,
in fact, an insanity instruction, which was refused. Therefore we believe the claim to be adequately preserved for appeal.
Second, although the trial court instructed the jury that the defendant was suffering from a brain disorder, no further instruction was given (on insanity or otherwise) which required the jury carefully to focus on how the nature of the defendant’s brain disorder related to the elements of the crime. The jury should have been told that, in light of the evidence of the defendant’s brain disorder and apparent blackout, he could not be convicted unless the State proved beyond a reasonable doubt that his act was
voluntary and that he acted in reckless disregard of the safety
of others.
The instructions were not wholly wanting in this regard, for the trial court did tell the jury that it could nevertheless convict the defendant, in spite of his brain disorder, if it concluded that he “knew
or should reasonably have known
of the existence of his ... condition” and he
“should reasonably have foreseen
that his condition, disease or defect would impair his ability to drive an automobile to such a degree as to endanger human life.” (Emphasis added). This portion of the instruction, however, suffers from the infirmity that it is phrased in the language of civil negligence rather than gross negligence or recklessness. Later, in the same instruction, the trial court did refer to “negligence so gross, wanton and culpable as to show a reckless disregard for human life” which “indicated a conscious indifference to the probable consequences.” Nevertheless, viewing the instruction as a whole, as we must, the jury may well have been misguided with respect to the appropriate standard by which to measure the defendant’s liability. An instruction more faithful to the relevant standard of voluntariness (or recklessness) would require a finding that the defendant
knew
of his condition and
knew
it could impair his ability to drive.
Third, irrespective of the foregoing, we would be inclined to reverse the defendant’s conviction based on the absence of evidence justifying the “should have known” language in the charge. There is virtually no evidence in the record to indicate that the defendant knew (or reasonably should have known) of the serious nature of his brain disorder or that he knew (or reasonably should have known) that it would impair his ability to
drive an automobile so as to endanger human life.
We would be inclined to reverse for lack of sufficient evidence, which would bar retrial on double jeopardy grounds,
see Burks v. United States,
437 U.S. 1, 98 S.Ct. 2141, 57 L.Ed.2d 1 (1978);
State v. Frazier,
162 W.Va. 602, 252 S.E.2d 39 (1979), as opposed to the weight of the evidence, which does not bar retrial,
see Tibbs v. Florida,
457 U.S. 31, 102 S.Ct. 2211, 72 L.Ed.2d 652 (1982), except for the fact that the State was not given an adequate opportunity to meet the defendant’s unconsciousness claim as we have outlined it above.
Finally, our conclusion about the weight of the evidence is buttressed by the fact that evidence of the presence of alcohol was admitted by the trial court even though contemporaneous blood tests indicated the defendant was clearly not intoxicated, and the trial court so instructed the jury.
Under these circumstances, the marginal relevance of alcohol use may have been outweighed substantially by its potential to prejudice the jury,
see
W.Va.R.Evid. 401, 403, and may have obscured the jury’s deliberations. On remand, the trial court should consider more carefully the balancing factors under the West Virginia Rules of Evidence and set forth its balancing of the eounterfactors on the record.
See State v. McGinnis,
193 W.Va. 147, 455 S.E.2d 516 (1994);
Arnoldt v. Ashland Oil, Inc.,
186 W.Va. 394, 412 S.E.2d 795 (1991).
III.
CONCLUSION
Based on the foregoing, the judgment of the Circuit Court of Pleasants County is reversed, and this case is remanded for a new trial.
Reversed and Remanded.