The opinion of the court was delivered by: Paul L. Friedman United States District Judge
This matter is before the Court on the proposal of St. Elizabeths Hospital for the conditional release of John Hinckley pursuant to 24 D.C. Code § 501(e) -- a so-called "(e) proposal" or "(e) letter." This is the third such proposal that the Hospital has submitted in the last four years. On each occasion, after considering the Hospital's proposal, Mr. Hinckley's views on the Hospital's proposal, sometimes Mr. Hinckley's own petition under 24 D.C. Code § 501(k) (a so-called "(k) petition"), and the government's opposition, and after an evidentiary hearing, the Court has granted the Hospital's request -- never precisely under the terms and conditions proposed by either the Hospital or Mr. Hinckley, and usually with additional conditions crafted by the Court.
At first, the Court allowed local day visits by Mr. Hinckley with his parents outside of the confines of St. Elizabeths Hospital without the supervision of Hospital personnel within a 50-mile radius of Washington, D.C. -- so-called Phase I visits. It then permitted local overnight visits by Mr. Hinckley with his parents within a 50-mile radius of Washington, D.C. (Phase II). Each visit was thoroughly assessed by the Hospital before a subsequent visit took place. There were a total of six Phase I visits and eight Phase II visits. By order of December 30, 2005, the Court permitted so-called Phase III visits to begin in January 2006; these were visits outside of the Washington metropolitan area to Mr. Hinckley's parents' community. See United States v. Hinckley, 407 F. Supp. 2d 248, 265-68 (D.D.C. 2005) ("Hinckley III"). The Court permitted three initial visits by Mr. Hinckley to his parents' home, each visit to last three nights or 76 hours. See id. at 267. Thereafter, the Court permitted visits of four nights, or 100 hours in duration. See id. These periodic visits have continued to this day and each, according to the Hospital's reports to the Court, has been therapeutic, without incident and, by all measures, successful.*fn1
The Hospital's current (e) letter is premised on the notion that Mr. Hinckley is ready for Phase IV in which, over the period of approximately one year, he would be integrated into his parents' community with more and more absences from the Hospital, greater freedom, more independence, and more privileges. The ultimate goal of Phase IV is to determine if Mr. Hinckley is ready to be released from the Hospital to live independently in his parents' community. Even then, of course, it is contemplated that he would have the support of his parents, so long as they are alive and healthy, his siblings, and psychiatric and counseling professionals in his parents' community. In order to begin the Phase IV process, the Hospital's (e) letter recommends the expansion of Mr. Hinckley's current conditional release to include the following five elements:*fn2 (1) the addition of Mr. Hinckley's siblings, Scott Hinckley and Diane Sims, to be formally included as responsible persons/custodians in addition to Mr. Hinckley's mother; (2) the addition of a case manager, Mr. Karl Beffa, a licensed social worker in his parents' community; (3) six two-week visits, followed by one one-month visit in his parents' community, with a reduction in the amount of supervised time he will be required to spend with a custodian/responsible person; (4) permission to obtain a D.C. driver's license, and specific plans for how to do so, including driver's education; and (5) Dr. John Lee's receipt of court letters submitted to the Court under seal and other pertinent treatment team notes and individual therapy notes from the Hospital.
The most important of these recommendations, of course, is the expansion of visits by Mr. Hinckley to his parents' community from what are now a maximum of four nights or 100 hours to six visits of two weeks and one visit lasting as long as one month. The Hospital also recommends increasing the amount of time that Mr. Hinckley would be permitted to go about unaccompanied in his parents' community without the supervision of his parents or siblings, so that he could further his transition into the community, improve his life skills and increase his independence. Under the Hospital's recommendation, Mr. Hinckley would be permitted unaccompanied day visits throughout the community between the hours of 9:00 a.m. and 5:00 p.m. and from 9:00 a.m. to 9:00 p.m. during daylight savings time. He would be required to personally prepare and submit itineraries to the treatment team twice a week outlining his proposed activities for each day, and he would meet both with a psychiatrist, Dr. John Lee, and with a licensed social worker, Mr. Karl Beffa, during the visits to his parents' community.
As has been its practice in prior years, the Court held an extensive evidentiary hearing on the Hospital's (e) proposal, and heard testimony over the course of five full days in April and May of this year and final arguments on the morning of the sixth day. The witnesses who testified at the hearing were: (1) Scott Hinckley, Mr. Hinckley's brother; (2) Diane Sims, Mr. Hinckley's sister; (3) Dr. Paul Montalbano, Pretrial Chief of the Forensic Service Unit at John Howard Pavilion, St. Elizabeths Hospital, who for each proceeding before this Court has prepared a thorough Risk Assessment with respect to Mr. Hinckley; (4) Verne James Hyde, Mr. Hinckley's music therapist at St. Elizabeths Hospital; (5) Dr. Nicole Rafanello, a Clinical Administrator at St. Elizabeths Hospital, with clinical administrative responsibilities for Mr. Hinckley, and the author of the Hospital's (e) letter; (6) Dr. John Lee, a psychiatrist whose practice is located in the community in which Mr. Hinckley's parents reside; (7) Dr. Robert Phillips, a psychiatrist retained as an expert witness by the government and the former Director of Forensic Services for the State of Connecticut Department of Mental Health; and (8) Dr. Raymond F. Patterson, a psychiatrist retained as an expert witness by the government and the former Medical Director and former Associate Acting Superintendent at St. Elizabeths Hospital, former Commissioner of Mental Health in the District of Columbia, and former Forensic Director for the State of Maryland.*fn3
The professionals who work with Mr. Hinckley at the Hospital (called to the stand by Mr. Hinckley's counsel) and the government's experts were all in substantial agreement about Mr. Hinckley's current diagnosis. All agree that he is currently mentally ill and suffers from two Axis I disorders: psychotic disorder, not otherwise specified ("psychotic disorder NOS"), and major depression. All the experts agree that there have been no active symptoms or symptoms of any significance of these Axis I disorders in many years. All the experts describe Mr. Hinckley's psychotic disorder NOS and major depression as being in full remission. All the experts also agree that Mr. Hinckley suffers from an Axis II disorder: narcissistic personality disorder. Most of the experts believe that this disorder is "significantly attenuated," and all agree that it is significantly reduced, although he still shows some symptoms of this disorder. For the Hospital, Dr. Rafanello testified that Mr. Hinckley currently has shown no active symptoms of depression or any delusions, has shown insight into his Axis I diagnoses, and is less socially isolated and somewhat less self-absorbed and more open than in the past. Transcript of Evidentiary Hearing (April 18, 2007), Testimony of Dr. Nicole Rafanello ("April 18 Rafanello Test.") at 43-44.
In its opinion of December 30, 2005, after having heard testimony from Dr. Montalbano, Dr. Phillips and Dr. Patterson, among others, the Court found the following as facts:
1. Mr. Hinckley's current diagnosis is psychotic disorder not otherwise specified (Axis I), in remission; major depression (Axis I), in remission; and narcissistic personality disorder (Axis II).
2. Mr. Hinckley's Axis I diagnoses have been in remission for at least eleven, and perhaps as many as seventeen years.
3. Mr. Hinckley's narcissistic personality disorder is significantly attenuated from its previous state. Mr. Hinckley continues to exhibit symptoms of grandiosity and self-importance, but no longer exhibits the intense self-absorption that was present during the 1980s.
4. Mr. Hinckley has exhibited no evidence of delusional thinking for approximately sixteen years and no evidence of obsessive conduct for at least nine years.
5. Mr. Hinckley has continued to exhibit deceptive behavior even when there have been no symptoms of psychosis or depression. Such deceptiveness may relate to his narcissistic personality disorder.
6. Mr. Hinckley continues to be guarded and defensive.
7. Mr. Hinckley's self-reporting underrepresents his problems and pathology due to a tendency to minimize problems and avoid negative aspects of situations to ...