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December 17, 1975

Edward CARTER, Jr.

The opinion of the court was delivered by: GESELL


 GESELL, District Judge.

 This matter is again before the Court on the further applications of St. Elizabeth's Hospital and Mr. Carter that Mr. Carter be released, either unconditionally or conditionally, for maximum security at the Hospital where he is being held, having been found not guilty by reason of insanity. Recent previous proceedings involving Mr. Carter are covered by this Court's Order of January 6, 1975, and the decision of the United States Court of Appeals for the District of Columbia Circuit in No. 75-1110 (July 22, 1975).

 A medical staff conference held November 18, 1975, determined that there is no longer a basis for diagnosing Mr. Carter as a sexual sadist and that "the patient is without mental disorder." A copy of the staff report is annexed. The record contains the pertinent St. Elizabeth's file, a voluminous document, and, in addition, the Court had the benefit of the testimony of Dr. Joseph T. Smith, the psychiatrist on the staff of St. Elizabeth's most directly responsible for the present diagnosis and recent care of Mr. Carter. Dr. Smith altered his prior testimony somewhat because of two circumstances: first, a more scientifically grounded determination that Mr. Carter does not suffer from any organic brain damage; and, second, Mr. Carter's new unsworn acknowledgement that he made up his insanity defense out of whole cloth from the outset.

 In short, Mr. Carter is presented as a man without mental disease or defect who simply had a tendency to rape. On this basis, Dr. Smith concluded that while Mr. Carter may have criminal inclinations he does not belong at St. Elizabeth's. The U.S. Attorney, who opposes release, attempted to obtain an appraisal of the likelihood of Mr. Carter's future conduct. Dr. Smith acknowledged that Mr. Carter's behavior controls, while improved, are still inadequate under stress. It was noted that Mr. Carter has performed exceptionally well and avoided uncontrolled behavior under stress "in house," but Dr. Smith acknowledged it is impossible to make any firm prognosis as to what Mr. Carter might or might not do, particularly under sex stress, if released. Dr. Smith recommended that Mr. Carter be granted gradual independence under conditional release circumstances in order to allow him to be returned to the community under a controlled transition.

 Based on the entire record the Court is satisfied that no basis exists for continuing Mr. Carter as a patient at St. Elizabeth's. Although Mr. Carter apparently bamboozled the U.S. Attorney and St. Elizabeth's, the proof as a whole establishes he is without mental disorder. The present state of Mr. Carter's health controls. Dixon v. Jacobs, 138 U.S.App.D.C. 319, 427 F.2d 589 (1970).

 Obviously the appropriate thing to do would be to set aside the not guilty finding and prosecute for the underlying offense. It is apparent, however, that the finding of not guilty by reason of insanity cannot be reopened or re-examined. Kepner v. United States, 195 U.S. 100, 24 S. Ct. 797, 49 L. Ed. 114 (1904); Fong Foo v. United States, 369 U.S. 141, 82 S. Ct. 671, 7 L. Ed. 2d 629 (1962); Illinois v. Somerville, 410 U.S. 458, 93 S. Ct. 1066, 35 L. Ed. 2d 425 (1973).

 A prodigious judicial effort has been devoted to the "insanity defense" in criminal cases over the last two decades, particularly in this jurisdiction. Trial judges, although never consulted in the fashioning of the changing rules, have sought to apply these rules with care and the U.S. Attorney has been responsibly attempting to make them work. A basic underlying difficulty continues to be the lack of adequate medical knowledge properly to diagnose mental illness. Very little is really known about the human mind. Doctors are obliged to reach conclusions on unconfirmed theories and facts largely obtained from the offender who can withhold or concoct data at will. Conscious of a need for greater certainty, physicians and psychologists attempt to categorize mental illnesses under constantly changing, elusive definitions. Examining experts frequently disagree. The composite attitude of the St. Elizabeth's staff itself changes, not only as theories and definitions change but because differing conclusions are reached as new staff members are added to the staff which constantly turns over. Yet, in the nature of things, judges are unable to take any action except on the advice of these experts, even though the judge recognizes that that advice in the present state of knowledge is necessarily volatile and inexact.

 As long as the present system obtains, the courts must exercise their responsibility in reliance upon inadequate medical advice, and thus it will unfortunately continue to be impossible to assure adequate protection of the public which, in the end, should be a primary concern.

 Mr. Carter shall forthwith be unconditionally released from St. Elizabeth's Hospital.



 Cite as 415 F. Supp. 15 (1975)

  U.S. v. Edward Carter, Jr.

 Criminal No. 69


 Report on 507 Notes

 November 18, 1975 sb: Joseph T. Smith, M.D., - Medical Officer (Psychiatry)


 Edward Carter was presented at a Medical Diagnostic Staff Conference which was attended by psychiatrists, psychologists, social workers, nurses and forensic technicians. The diagnoses which have been maintained in his chart up to the present time are (1) Sexual Sadism, (2) Non-Psychotic Organic Brain Syndrome with Circulatory Disturbance. The conference listed the symptoms associated with organic brain syndrome as follows: (1) impairment of orientation, (2) impairment of memory, (3) impairment of all intellectual functions such as comprehension, calculation, knowledge learning, etc. (4) impairment of judgment, and (5) lability and shallowness of affect. Mr. Carter was examined by the whole group and found to have no impairment of orientation, no impairment of memory, no impairment of judgment, no lability or shallowness of affect. His intellectual functioning was within normal range for his I.Q. which is low normal. Brain scan, EEG and neurological examinations are essentially negative. The group agreed that since these symptoms of an organic brain syndrome were all lacking, there is no reason to continue this diagnosis so it is deleted. When the diagnosis of sexual sadism was given to the patient in 1970 at a Diagnostic Staff Conference, it was stated that this diagnosis of sexual sadism may be open to some question because of (1) lack of ability to confirm the extensive history that he gave of rapes. He originally reported something like 300 rapes and today he says that he was lying at that time to create an impressive background of sexual problems for his own insanity defense. (2) It was also pointed out there that he had given a different sexual history to Dr. Clark when he came to the Hospital in December 1964. At that time, he did not mention the rapes or any sexual deviation. (3) It was also pointed out that psychological studies show very little to suggest any sexual psychopathology. The conference then listed various aspects of sexual sadism. The criteria that were listed for sexual sadism included (1) inflicting pain to obtain sexual gratification. It was obvious from the history that he has inflicted pain on people. Also that he has obtained sexual gratification. But it was never shown that he inflicted pain specifically for the purpose of sexual gratification. Another criteria might be a history of torturing animals in childhood or enuresis. There was no history of such cruelty to animals or of enuresis. (2) another criterion could be the evidence from psychological reports. Although the psychological reports showed that he was immature emotionally and that he was immature sexually, and that he had underlying hostility and aggression, it did not shown psychosexual pathology. (3) Another criteria would be poor impulse control. Although the history indicates poor impulse control, he has shown no poor impulse control in John Howard for the last 40 months. As the group confronted these and decided that there is nothing presently to indicate that he either is or is not a sexual sadist, and so the group ended up by saying that they don't know whether he is or not. Psychological testing shows a fairly consistent pattern throughout the period of time that he has been in the Hospital, but attention should be drawn to the final paragraph in the psychological test done by Ms. Judith Rumreich on November 1, 1974, where she states "it is likely that in a similarly highly structured setting, Mr. Carter would be able to function effectively, but his capacity for assaultive outburst under conditions of stress should not be ignored in less structured settings." This statement does not really mean very much when taken generally because the same is true of almost anybody. Most people placed under sufficient stress in an unstructured situation are capable of assaultive outbursts. The significant thing is that under the same circumstances, Mr. Carter would not fail to act the same as anybody else as far as outbursts go. The only present evidence to support a diagnosis of Sexual Sadism come from the patient himself. The patient is obviously an unreliable witness - He claims now that he fabricated the 300 rape story to get an insanity defense in 1969. Today he says it was only 12 rapes. Without more objective evidence the diagnosis of Sexual Sadism is meaningless. Available police reports show a history of general criminal activity such as burglary, auto theft, homicide, assault with intent to commit rape etc. rather than a distinct pattern of torturing women for sexual gratification. Without more to go on the diagnosis of Sexual Sadism is dropped and the patient is without mental disorder.

 [ILLEGIBLE WORD], / Medical Officer (Psychiatry)

 [ILLEGIBLE WORD], / Chief, Post-trial Branch


 CARTER, Edward




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