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On her way to her daughter’s school, she was traveling at full speed when she hit a Toyota Corolla stopped at a traffic light, forcing it into the intersection, where it collided with another car. Five-year-old Miles Jenness, who was riding in the Toyota, sustained a traumatic brain injury and a severed spine and died days later.

An Atlanta-area psychologist with a years-long history of bipolar disorder, Wierson has pleaded not guilty by reason of insanity to charges including vehicular homicide and reckless driving.

Prosecutors want a judge to bar Wierson from using an insanity defense. But if that defense is allowed, they want to introduce evidence they say shows that she wasn't taking all of her medication. Defense attorneys argue that if the state succeeds, the insanity defense would be completely gutted for this case and others.

A three-judge panel of the Georgia Court of Appeals on Wednesday heard arguments in the case. Now the judges must decide whether Wierson’s lawyers can use the insanity defense at trial and, if so, whether the state can try to prove that she wasn’t taking her medication. They did not indicate how or when they might rule. But they may not have the last word — either side could appeal to the Georgia Supreme Court.

Court records describe Wierson as irate at the scene of the wreck, where she was arrested after throwing things at first responders and into the street. Witnesses said they thought Wierson was “under the influence of some type of intoxicant.� Her lawyers assert that she was suffering a psychotic break that rendered her legally insane.

Robert Rubin, a lawyer for Wierson, called the entire situation “a horrible tragedy.� His client, he said, is “haunted by the tragic consequences of her psychotic behavior, but it was wholly without any intention and moral culpability since she was mentally ill at the time.�

Bruce Hagen, a lawyer who represents the Jenness family in a separate civil case pending against Wierson, said his clients have been “patiently waiting for justice."

“The Jennesses are really interested in seeing Ms. Wierson held fully criminally accountable for the death of Miles,� Hagen said. “If the issue is that she willfully stopped taking her medication, their position is she should not then benefit from claiming temporary insanity brought on by the very predictable result of not taking her medication.�

There are two tests for insanity under Georgia law, both having to do with the person's mental state “at the time of� the alleged crime. The first says a person shall not be found guilty of a crime if she “did not have mental capacity to distinguish between right and wrong� related to the act. The second says a person shall not be found guilty of a crime if the person acted because of "a delusional compulsion� that “overmastered" her will.

Two experts — one hired by the defense, and one engaged by the court — found that Wierson met both of those criteria.

But prosecutors argue that it doesn’t matter whether she could distinguish right from wrong. All that matters for a traffic offense is that Wierson was driving in a way that violated the law, and that caused the boy's death, they say.

The delusional compulsion defense only applies if the person would have been justified in their actions if the delusion were true, prosecutor Thomas Williams said. But “no one is ever justified in driving recklessly.�

Therefore, her mental state is not relevant, and her lawyers are simply trying “to evoke an emotional response and to confuse the jury,� prosecutors argue.

Wierson's lawyers contend that the state's arguments are inconsistent with Georgia case law, arguing in a brief that the state “must still prove that the driver's actions were of her own accord and not an external factor that forced her into a choice and overpowered her will.� Every action Wierson took that day “was a result of her delusional compulsion and her inability to distinguish right from wrong,� her lawyers argue.

If Wierson is allowed to use an insanity defense, prosecutors say they should be allowed to produce evidence showing she had intentionally stopped taking her medication, making her psychotic break “a reasonable and foreseeable consequence of her own actions.�

Wierson had been diagnosed with bipolar disorder in 2005 and had been using several medications, including lithium, according to court filings. Urine and blood tests from the day of the crash suggested she hadn't been taking the lithium as prescribed, and her brother said she had stopped taking it weeks before the crash, prosecutors wrote.

Evidence of Wierson's medication levels will be critical to the jury's assessment of her state of mind and the crux of her insanity defense, prosecutors argue.

Wierson's lawyers insist that she had been taking her medication properly. That the lithium wasn't detected is evidence that her dosage was too low, not necessarily that she didn't take it as directed, they wrote. But even if she hadn't taken her medication, “the law is clear that there is no exception to the insanity defense for medication or therapeutic noncompliance.�

Allowing medication-compliance evidence will “confuse the issues" and improperly cause the jury to judge Wierson based on her “conduct as a patient and not on her mental state at the time of the offense.�