United States District Court, District of Columbia
L. FRIEDMAN, United States District Judge
1981, John W. Hinckley, Jr. was a profoundly troubled
twenty-five-year-old young man suffering from active and
acute psychosis and major depression. His mental condition
had gradually worsened over the preceding years - beginning
as early as 1976 - ultimately resulting in a deep obsession
with the actress Jodie Foster and the film Taxi
Driver. Mr. Hinckley began to identify with the main
character in the film, Travis Bickle, who unsuccessfully
plots to assassinate a presidential candidate in order to win
the affections of a young woman. At numerous points in the
years leading up to 1981, Mr. Hinckley travelled to Yale
University in New Haven, Connecticut seeking to establish
contact with Jodie Foster, leaving notes, letters, and poems
at her dormitory and even speaking with her on the phone
several times. After failing in his effort to establish a
personal relationship with Ms. Foster, Mr. Hinckley then
sought to impress her through stalking President Jimmy
Carter, travelling to Washington, D.C., Columbus, Ohio, and
Dayton, Ohio over a three-day period in September of 1980. On
October 9, 1980, Mr. Hinckley was arrested with several
firearms and ammunition in his suitcase at the Nashville,
Tennessee airport, where President Carter was scheduled to
make a campaign appearance.
the presidential election in November, 1980, Mr. Hinckley
next travelled to Washington, D.C. and began following
President-elect Ronald Reagan. On March 30, 1981, after
several more unsuccessful trips to New Haven, Mr. Hinckley
wrote a letter to Ms. Foster describing his plan to kill
President Reagan in order to impress her. That same day, Mr.
Hinckley attempted to assassinate the President of the United
States in the driveway of the Washington Hilton Hotel,
shooting and severely wounding President Reagan, Presidential
Press Secretary James Brady, Secret Service Agent Timothy
McCarthy, and Metropolitan Police Officer Thomas Delahanty.
Mr. Brady suffered permanent brain damage and eventually died
from his injuries in 2014. After a seven-week trial before a
jury in 1982, Mr. Hinckley was found not guilty by reason of
insanity and committed to St. Elizabeths Hospital. Shortly
after his trial, Mr. Hinckley attempted suicide and continued
to suffer from active symptoms of serious mental illness.
more than 34 years later, Mr. Hinckley is 61 years old and
suffering from arthritis, high blood pressure, and various
other physical ailments like many men his age. He has been
under the care of St. Elizabeths Hospital for over three
decades. Since 1983, when he last attempted suicide, he has
displayed no symptoms of active mental illness, exhibited no
violent behavior, shown no interest in weapons, and
demonstrated no suicidal ideation. The government and the
Hospital both agree that Mr. Hinckley's primary diagnoses
of psychotic disorder not otherwise specified and major
depression have been in full and sustained remission for well
over twenty years, perhaps more than 27 years. In addition,
since 2006, Mr. Hinckley has successfully completed over 80
unsupervised visits with his family in Williamsburg,
Virginia, fully complying with the Court's strict
conditions, with two minor exceptions. The government and its
expert, Dr. Raymond Patterson; an independent expert who
conducted a comprehensive risk assessment in this case, Dr.
Katherine Murphy; and all of Mr. Hinckley's treatment
providers both at St. Elizabeths Hospital and in Williamsburg
now agree - unanimously - that Mr. Hinckley is clinically
ready for full-time convalescent leave and that, with certain
conditions, he will not be a danger to himself or others. In
the view of most of the experts who testified before this
Court, Mr. Hinckley has by now received the maximum benefits
possible in an in-patient setting.
carefully considering the relevant legal authorities, the
expert reports, the testimony presented at the evidentiary
hearing held in April of 2015, Mr. Hinckley's entire
history and clinical record over thirty-four years, and the
briefs filed by the parties, the Court will grant the
Hospital's proposal for full-time convalescent leave in
Williamsburg, Virginia, with additional and modified
conditions as discussed below. A summary of the testimony,
the Court's findings of fact, analysis of Mr.
Hinckley's risk factors, the Court's conclusions, and
the conditions that will be required by the Court for
convalescent leave are detailed in the remainder of this
HOSPITAL'S PROPOSAL FOR CONVALESCENT
Witnesses from St. Elizabeths
Verne "VJ" Hyde-Forsenic Clinical
Katherine Murphy - Forensic
3. Dr. Nicole Johnson - Director of the Forensic Outpatient
Witnesses from Mr. Hinckley's Williamsburg Treatment
Deborah Giorgi-Guarnieri - Treating
Jonathan Weiss -Case
Witnesses from the Hinckley
Government's Expert Witness: Dr. Raymond F.
Hinckley's Identified Risk
Hinckley's Mental Health: Depression, Psychosis, and
Isolation and Mr. Hinckley's Integration into the
Hinckley's Level of Insight into his Mental
History of Suicide
Difficulty in Relationships with Others, Particularly
Deception, Underreporting, and Need for
Specific Proposals in the Hospital's (e)
Hospital's Proposed Treatment Plan and Frequency of
Monitoring, Risk Management, and
Financial Support and
matter is before the Court on the proposal of St. Elizabeths
Hospital for the conditional release of John W. Hinckley, Jr.
to full-time convalescent leave in Williamsburg, Virginia,
pursuant to 24 D.C. Code § 501(e) - a so-called
"(e) proposal" or "(e)
letter." Over the years, the Hospital has submitted
a series of proposals to this Court, seeking to expand the
scope or duration of Mr. Hinckley's activities outside
the grounds of the Hospital. The government has consistently
opposed these proposals in whole or in part. On some
occasions, Mr. Hinckley has submitted his own petition for
expanded conditions of release under 24 D.C. Code §
501(k) (a so-called "(k) petition"). On each
occasion, the Court has considered the Hospital's
proposal, the government's opposition, and Mr.
Hinckley's position on the Hospital's proposal along
with his own (k) petition, if any. After conducting an
evidentiary hearing, the Court has either granted the
Hospital's request - invariably with modifications or
additional conditions imposed by the Court - or has denied
the request. The Hospital's latest proposal contemplates
full-time "convalescent leave" in Williamsburg,
Virginia - in short, the Hospital proposes fully transferring
Mr. Hinckley's care to a team of mental health
professionals in Williamsburg, with oversight by the
Hospital's Forensic Outpatient Department, permitting Mr.
Hinckley to reside full-time in Williamsburg.
the course of the last twelve years, the Court has
incrementally expanded Mr. Hinckley's privileges outside
the Hospital, always contingent upon careful monitoring and
his and his family's compliance with the numerous
conditions imposed by the Court. The Hospital has
characterized its requests for gradually expanding Mr.
Hinckley's freedom as a series of phases, each of which
entails greater integration into the world outside the
Hospital, In December 2003, the Court allowed six local
one-day visits by Mr. Hinckley with his parents outside of
the confines of St. Elizabeths without the supervision of
Hospital personnel and within a 50-mile radius of Washington,
D.C. - so-called "Phase I" visits. Beginning in
November 2004, after review of the Phase I visits by the St.
Elizabeths Hospital Review Board, the Court permitted local
overnight visits by Mr. Hinckley with his parents in a hotel
within a 50-mile radius of Washington, D.C. ("Phase
II" visits). Each visit was thoroughly assessed by the
Hospital and Mr. Hinckley's treatment team before a
subsequent visit took place, and a written report on each
visit was provided to the Court. There were a total of six
Phase I visits and eight Phase II visits.
in 2006, the Court permitted visits outside of the Washington
metropolitan area to the home of Mr. Hinckley's parents
in Williamsburg, Virginia ("Phase III" visits). See
Hinckley HI, 407 F.Supp.2d at 265-68. The Court
permitted three initial visits by Mr. Hinckley to his
parents' home, with each visit lasting three nights in
duration. See Id. at 267. Thereafter, the Court
permitted additional visits of four nights, See id.;
Hinckley IV, 462 F.Supp.2d at 45-47; Order,
United States v. Hinckley (Aug. 18, 2006) [Diet. No.
229]. In 2007, the Court permitted six additional Phase III
visits and expanded the duration of those visits to six
nights. See Hinckley V, 493 F.Supp.2d at 77-78,
After allowing several additional visits in 2008, later that
year the Court permitted Mr. Hinckley to continue making
Phase III visits under the same terms and conditions until
further order of the Court. See Order at 1, United States
v. Hinckley (Aug. 15, 2008) [Dkt, No. 281]. Mr. Hinckley
made at least 24 Phase III visits. See Hinckley VI,
625 F.Supp.2d at 5-6.
- after an evidentiary hearing that lasted six days - the
Court authorized so-called "Phase IV" visits, which
allowed Mr. Hinckley to make visits of up to ten days to
Williamsburg. While Phase III was regarded as an opportunity
for outings representing a "change of venue" from
the Washington, D.C. area to Williamsburg, Phase IV was
conceived of as a "transitional stage, " in which
Mr. Hinckley would be expected to focus on social and
vocational integration into his mother's community. See
Hinckley VI, 625 F.Supp.2d at 6. To that end, the
Court authorized twelve Phase IV visits, each with a duration
often days and nine nights, and each subject to the
successful completion of the previous visit, with a written
report to the Court. See Order at 2, United States v.
Hinckley (July 20, 2009) [Dkt No. 311].
these Phase IV visits, Mr. Hinckley was required to remain
under the supervision of his mother or siblings at all times
whenever outside of his mother's home, except for periods
of limited, .duration in which he was allowed to engage in
activities within a defined geographic area that were
designed by the Hospital to acclimate him to the Williamsburg
community. See Order at 1-2, United States v.
Hinckley (July 20, 2009) [Dkt. No. 311], Such activities
included establishing therapeutic relationships with two
Williamsburg-area treatment providers whose services had been
arranged for him during his visits - a psychiatrist and a
combined individual therapist and case manager. Mr. Hinckley
also was permitted to spend four hours twice a week
performing volunteer work with a local organization, which
could increase if deemed appropriate by the treatment team
and his participating employer. Id. at 11-12.
upon Mr. Hinckley's ongoing participation in local
volunteer work, he also was afforded a limited amount of
unsupervised time in the Williamsburg community to engage in
social and recreational activities. Specifically, Mr.
Hinckley was allowed up to three hours of unaccompanied time,
twice a week, between the hours of 8:00 a.m. and 9:00 p.m.,
"for specific social, recreational, religious, or
shopping related activities." Order at 12-13, United
States v. Hinckley (July 20, 2009) [Dkt. No. 311]. At
least two weeks before each Phase IV visit, the Hospital was
required to submit a detailed, day-by-day itinerary of Mr.
Hinckley's proposed activities to the Court, the
government, and Mr. Hinckley's counsel. Id. at
4-5. In particular, the Hospital was required to provide
specific details, including time and place, of the time Mr.
Hinckley was to spend outside the supervision of his family
members. Id. at 3.
Hinckley also was permitted up to two hours of unaccompanied
time twice daily within the confines of his mother's
housing subdivision during specified hours. Order at 2, 13,
United States v. Hinckley (July 20, 2009). Mr.
Hinckley also was given permission, subject to a number of
conditions, to obtain a driver's license and to drive the
Hinckley family's car with a family member or treatment
provider with him at all times. Id. at 14. Among
many other restrictions imposed on Mr. Hinckley during his
visits to Williamsburg and during his use of unsupervised
time in the community, Mr. Hinckley was required to carry a
GPS-enabled cell phone anytime that he was not accompanied by
his mother or siblings. Id. at 2. After each visit,
the Hospital was responsible for submitting a detailed report
of the visit to the Court, the government, and Mr.
Hinckley's counsel prior to the next visit. Id.
each ten-day Phase IV visit, Mr. Hinckley was required to
meet at least once with his Williamsburg-area psychiatrist,
Dr. John J, Lee. After interviewing and assessing Mr.
Hinckley during these sessions, Dr. Lee was required to
complete a checklist describing his observations and fax it
to the Hospital within a week of the appointment. Dr. Lee
also was required to participate in a telephone conference
call with Mr. Hinckley's St. Elizabeths Hospital
treatment team after each visit to discuss the visit and any
concerns or issues relating to Mr. Hinckley or his treatment
goals, and to participate by telephone in the meetings of the
treatment team to discuss Mr. Hinckley's Individual
Recovery Plan every three months or as scheduled. Order at
3-5, United States v. Hinckley (July 20, 2009) [Dkt.
No. 311]. Mr. Hinckley also was ordered to meet at
least once during each visit with his Williamsburg-area case
manager and individual therapist, Mr. Carl Beffa. Mr. Beffa
was required to communicate after each visit with Mr.
Hinckley's primary therapist at St. Elizabeths, Dr.
Sidney Binks, to discuss and collaborate on the course of
therapy for Mr. Hinckley. He also was required to complete a
checklist of observations, communicate with the treatment
team after each visit, and participate in treatment team
meetings in the same manner as Dr. Lee. Id. at 5-7.
the Court's authorization of Phase IV visits expanded the
duration of Mr. Hinckley's visits to Williamsburg to ten
days, St. Elizabeths remained Mr. Hinckley's residence
and the Hospital treatment team remained his primary
clinicians. The Court ordered that if there were any signs of
"decompensation" or deterioration in Mr.
Hinckley's mental condition during his visits to
Williamsburg, no matter how slight, or any indication of
danger to himself or to others, or of elopement (that is,
attempt to escape or abscond), Mr. Hinckley would immediately
be returned to the Hospital. Order at 7, United States v.
Hinckley (July 20, 2009) [Dkt. No. 311].
Hinckley began making Phase IV visits in late 2009. He soon
began volunteering two days a week, for four hours each day,
at the hospital library of Eastern State Hospital in
Williamsburg. Although Eastern State is a psychiatric
hospital, Mr. Hinckley's relationship with the
institution was and is that of a volunteer employee, not a
patient. Beginning in 2012, with the imminent closure of the
hospital library due to staffing and funding changes, Mr.
Hinckley began volunteering in the cafeteria at Eastern
State, where he helped at the cash register and took orders
from patrons. He has received positive reviews from his
supervisors in both volunteering capacities about his work
and his interaction with patrons and employees.
Hospital's Dec. 14, 2012 Revised (e) Letter at 10-11.
According to the Hospital, Mr. Hinckley also made use of his
twice-weekly periods of unsupervised time in the community,
as well as his daily periods of unsupervised time within his
mother's subdivision. He obtained his driver's
license and now operates the Hinckley family's vehicle
during his visits, accompanied by a family member.
Id. at 19.
2011, Mr. Hinckley had completed twelve ten-day Phase IV
visits, without any reported incidents of misbehavior and in
compliance with all of the Court's specific directives.
Upon motion by Mr. Hinckley and the Hospital, the Court
entered an interim order permitting an indefinite number of
additional Phase IV visits under the terms and conditions
specified in the Court's July 2009 Order. Such visits
were authorized to continue until the Court ruled on the
Hospital's next petition for expanded conditions of
release. See Order at 2, United States v. Hinckley
(May 13, 2011). Subsequently, Mr. Hinckley completed an
additional 21 ten-day Phase IV visits - or a total of 33
ten-day Phase IV visits - without any reported incidents of
misbehavior and in compliance with all of the Court's
specific directives, with two notable exceptions discussed
separate occasions - in July 2011 and in September 2011 - the
Secret Service observed Mr. Hinckley deviating from the terms
of the itineraries that governed the use of his unsupervised
time in the Williamsburg community. It was also discovered
that Mr. Hinckley had lied to St. Elizabeths staff and others
about these deviations. On each occasion, Mr. Hinckley was
scheduled to attend a movie during his three-hour
window of unsupervised time, and on each occasion, Mr.
Hinckley reported afterward to his clinical unit
administrator at the Hospital, Mr. Kevin Shamblee, that he
had attended the movie, even describing and recommending it.
See Hinckley VII, 40 F.Supp.3d at 13, 37, 39-40,
59-60. Mr. Hinckley made similar misrepresentations to the
expert witnesses retained by the government when they later
interviewed him in preparation for the upcoming evidentiary
hearing before this Court. See Id. at 13, 37, 39-40.
Secret Service had been monitoring Mr. Hinckley on both
occasions, and their surveillance reports showed his claims
to be false. On both days, as the Secret Service reported,
Mr. Hinckley arrived at the movie theater and spoke with
someone in the ticket booth but did not buy a ticket.
Instead, he spent the remaining hour or two of his
unsupervised free time at a nearby chain bookstore, Barnes
& Noble, and a fast-food establishment, before being
picked up by his mother to return home. See Hinckley
VII, 40 F.Supp.3d at 13-14, 42. When confronted with
this evidence, Mr. Hinckley later admitted being dishonest
about the deviations from his itineraries. See id, at 13-14.
These incidents occurred after the Hospital submitted its
July 2011 (e) letter to the Court, but before the evidentiary
hearing held with respect to that (e) letter. Considerable
time was devoted to the incidents during the hearing. See
Id. at 59-61.
ultimate goal of these Phase IV visits and activities was to
determine if Mr. Hinckley is ready to be released from the
Hospital to live independently in Williamsburg with the
support of his mother (so long as she is healthy and alive),
his siblings, and psychiatric and counseling professionals in
the Williamsburg community. See Hinckley VI, 625
F.Supp.2d at 6; Hinckley V, 493 F.Supp.2d at 66.
With this goal in mind - and after an evidentiary hearing
lasting a total of more than ten full days - the Court
authorized Mr. Hinckley's Phase IV visits to Williamsburg
to expand from ten to seventeen days in February
2014, See Hinckley VII, 40 F.Supp.3d at 66-71; Order
at 1. United States v. Hinckley (Feb. 26, 2014). As
has been the case with every one of Mr. Hinckley's visits
to Williamsburg, Mr. Hinckley was required to remain under
the supervision of his mother or siblings at all times,
except when he was participating in preapproved unsupervised
activities. Order at 7, United States v. Hinckley
(Feb. 26, 2014). The Hospital, as always, was required to
thoroughly assess each visit before any subsequent visits
took place. Id. at 1.
addition to expanding the number of days in Williamsburg, the
Court also expanded Mr. Hinckley's unsupervised time and
various privileges. Hinckley VII, 40 F.Supp.3d at 68-70;
Order at 1. United States v. Hinckley (Feb. 26,
2014) [Dkt, No. 455]. On each trip, Mr. Hinckley was
permitted: (1) up to six unsupervised outings outside of his
mother's housing subdivision lasting up to four hours,
between the hours of 9:00 a.m. and 9:00 p.m.; and (2) two
120-minute unaccompanied walks per day within his
mother's subdivision, between the hours of 8:00 a.m. and
5:00 p.m. standard time and 8:00 a.m. and 9:00 p.m. daylight
savings time. Order at 2-3, United States v.
Hinckley (Feb. 26, 2014) [Dkt. No. 455], Mr. Hinckley
was further permitted to volunteer at Eastern State Hospital
or engage in other work or volunteer activities with the
Hospital's approval. Id. at 2. Mr. Hinckley also
was given permission to drive the Hinckley family's car
unaccompanied while in Williamsburg as long as he was
"using the vehicle to travel to destinations where
people w[ould] be expecting him, such as to mental health
treatment appointments, approved volunteer and employment
activities, as well as to any specific social or educational
activities arranged by him and Mr. Weiss." Id.
at 1-2, 
Court, however, continued to require detailed itineraries to
be prepared by the Hospital in advance of each visit. Order
at 3, United States v. Hinckley (Feb. 26, 2014)
[Dkt. No. 455]. The Court stated that if the itineraries
"contain the kinds of social and other interactive
activities that show progress, " the Court would
consider a motion to modify the itinerary requirement at a
later date. Id. In addition to the itineraries, Mr.
Hinckley was ordered to continue his practice of maintaining
a daily log of his activities while in Williamsburg,
Id. Mr. Hinckley also was required to continue
carrying a GPS-enabled cell phone anytime his mother or
siblings did not accompany him. Id. at 6.
Hinckley was permitted to use the Internet during his visits
"only under the constant supervision of his mother or
siblings or with the use of technology or technologies that
can both track his internet use and restrict it to the use of
certain sites." Order at 7, United States
v. Hinckley (Feb. 26, 2014). Mr. Hinckley's use
was restricted to particular sites approved by the Hospital
in advance, which were to be included in the itineraries.
each 17-day Phase IV visit, Mr. Hinckley was ordered to meet
weekly with his Williamsburg-area psychiatrist, Dr. Deborah
Giorgi-Guarnieri. Order at 4, United States v.
Hinckley (Feb. 26. 2014). Additional visits were
permitted if "clinically necessary." Id.
At each appointment, Dr. Giorgi-Guarnieri was required to
"monitor Mr. Hinckley for any signs of deterioration or
decompensation in his mental condition" and be
"especially alert for anger, psychosis, depression, any
ideas of elopement, endangerment to self or others,
noncompliance with conditions of release, or rejection of the
supervision provided to Mr. Hinckley by his responsible
persons." Id. Dr. Giorgi-Guarnieri also was
ordered to assess and monitor the risk factors identified in
the Hospital's checklists, which she was required to
complete and provide to the Hospital, along with
"written feedback summarizing her contact with Mr.
Hinckley, " after each appointment. Id. In
addition to these meetings, Dr. Giorgi-Guarnieri was tasked
with participating by telephone in: (1) post-visit conference
calls with the Hospital's inpatient treatment team to
discuss Mr. Hinckley's progress; and (2) the inpatient
treatment team's Individual Recovery Plan meetings
scheduled every two months for Mr. Hinckley. Id. Dr.
Giorgi-Guarnieri also was charged with verifying that Mr.
Hinckley was taking his medications as prescribed,
prescribing any additional medications in the case of an
emergency psychiatric situation, and facilitating any acute
hospitalization needed in such a situation. Id. at
Court also approved the substitution of Mr. Jonathan Weiss, a
licensed clinical social worker, for Mr. Beffa as Mr.
Hinckley's case manager. Order at 5, United States v.
Hinckley (Feb. 26, 2014). Mr. Weiss was tasked with
identifying opportunities to increase Mr. Hinckley's
"socialization, enrichment, or mental health support in
the Williamsburg community." ]d- Mr» Weiss was
required to monitor Mr. Hinckley's attendance and
progress in his volunteer and daytime activities and
communicate at least once per visit with Mr. Hinckley's
work supervisors. Id. As with Dr. Giorgi-Guarnieri,
Mr. Weiss was required to provide written feedback to the
Hospital after each visit. Id. Mr. Beffa continued
in his role as Mr. Hinckley's individual therapist, with
whom Mr. Hinckley was required to meet weekly for both
individual and group therapy during his visits. ]d- at 5-6.
Mr. Beffa also was required to provide the Hospital with
written feedback after each visit. Id. at 6.
this writing, Mr. Hinckley has completed twenty-seven 17-day
visits to Williamsburg. With the exception of one incident
described below, see infra at 35-36, 63. Mr. Hinckley appears
to have complied fully with the conditions imposed by the
Court. See Patient's Ex. 1, Hospital's Dec. 19, 2014
(e) letter at 2-4.
accounts, Mr. Hinckley's socialization has improved
dramatically since the Court's last Opinion and Order.
Mr. Hinckley has participated in numerous activities at the
suggestion of his case manager, Mr. Weiss, including bowling,
attending lectures, attending outdoor musical concerts, and
joining a community center for exercise and the ability to
take various classes. Hospital's Dec. 19, 2014 (e) letter
at 2. Mr. Hinckley also has developed several new social
relationships in the Williamsburg community, in particular
with two local photographers. Mr. Hinckley has begun
attending regular group meetings with the local chapter of
the National Alliance on Mental Illness ("NAMI").
14 According to the Hospital, Mr. Hinckley also has
demonstrated initiative in developing relationships. For
example, he expressed an interest in developing relationships
with certain members of his therapy group. But establishing
social relationships outside the group with group members is
prohibited by the group's rules so long as Mr. Hinckley
continued within that cohort. Therefore, at Mr. Beffa's
suggestion, Mr. Hinckley agreed to switch his group therapy
time and has since begun developing relationships with at
least two former group members, in addition to individuals he
has met at his NAMI meetings. Id.
diligent efforts by both Mr. Hinckley and Mr. Weiss, Mr.
Hinckley has been unable to secure additional volunteer or
paid employment opportunities due to some resistance within
the Williamsburg community. Mr. Hinckley has, however, begun
assisting with landscaping and yardwork at the local
Unitarian Universalist Church. Id. at 3. Mr.
Hinckley's efforts to obtain paid employment have been
further hindered by his part-time residence in the area.
HOSPITAL'S PROPOSAL FOR CONVALESCENT LEAVE
December 19, 2014, the Hospital submitted the original
version of its current proposal for full-time convalescent
leave for Mr. Hinckley. Patient's Ex. 1, Hospital's
Dec. 19, 2014 Letter to the Court [Dkt. No. 494] (the
"Hospital's Dec. 19, 2014 (e) Letter"). On
March 20, 2015, the Hospital filed a revised (e) letter,
Patient's Ex. 2, Hospital's March 20, 2015 Letter to
the Court [Dkt. No. 516] (the "Hospital's March 20,
2015 Revised (e) Letter"), adding eleven proposed
conditions of release to the original eight listed in the
December (e) letter. The core of the Hospital's proposal
is to transition Mr. Hinckley from 17-day visits to residing
full-time on convalescent leave in< Williamsburg, Virginia
- initially with his mother. Dr. Katherine Murphy, the
forensic psychologist who has performed risk assessments in
this case, appropriately refers to this as Phase V
convalescent leave. Patient's Ex. 7, Violence Risk
Assessment Update at 61 (Mar. 31, 2015) [Dkt. No. 558]
("Murphy Rpt."). Although the Hospital previously
proposed that the next step in Mr. Hinckley's integration
would be a series of 24-day visits, the Hospital now believes
that 24-day visits would provide only minimal clinical
benefits to Mr. Hinckiey above the 17-day visits, while
continuing to hinder Mr. Hinckley's ability to establish
residency in the Commonwealth of Virginia, become eligible
for government benefits, obtain paid employment, and
otherwise complete his integration into the Williamsburg
community. See Hospital's Dec. 19, 2014 (e) Letter at
1-2. The Hospital proposes that Mr. Hinckley's
professional services would be provided by a Williamsburg
treatment team - consisting of Dr. Giorgi-Guarnieri, Mr.
Weiss, and Mr. Beffa - as well as a board-certified music
therapist, and that over time Mr. Hinckley would cease
meeting with the Hospital's inpatient treatment team in
the District of Columbia. Id. at 4-5; Hospital's
March 20, 2015 Revised (e) Letter at 1-2. Mr.
Hinckley's case would be overseen and managed by the
Hospital's newly-created Forensic Outpatient Department,
headed by Dr. Nicole Reid Johnson.
Hospital believes that after countless visits of gradually
expanded duration to Williamsburg over nearly thirteen years,
Mr. Hinckley is ready for full-time convalescent leave - with
conditions. As the Hospital explained in its proposal:
Mr. Hinckley has spent several years, since 2006, gradually
integrating into the community in Williamsburg. Over the
course of the past several months, he has undertaken
noticeable efforts at addressing the concerns raised in the
December 2013 Opinion regarding the quality of these efforts.
Notably, Mr. Hinckley has made tremendous efforts to
diversify his activities, increase his exposure and
engagement to others, and has begun to create social roots
from which his further development in this community can
grow. He has not evidenced any signs of decompensation or
increased risk for violent recidivism during this time
period. His attempts at fully integrating into this area
continue to be Mr. Hinckley's primary focus. It is the
Hospital's opinion that this process will be more
effective for him as a full-time resident in the area.
Hospital's Dec. 19, 2014 (e) Letter at 4.
the Hospital's (e) Letter of December 2014 and Revised
(e) Letter of March 2015 state that full-time convalescent
leave in Williamsburg now is appropriate, with the following
1. While residing in Williamsburg, VA on [convalescent leave
("CL")], Mr. Hinckley will receive psychiatric
follow up with Deborah Giorgi-Guarnieri, M.D. She will write
his psychiatric prescription which will be filled at a
pharmacy in Williamsburg. Dr. Giorgi-Guarnieri will meet with
Mr. Hinckley twice per month for the first three months and
no less than monthly, thereafter.
2. Mr. Hinckley will receive both individual psychotherapy
and group therapy with Carl Beffa, LCSW, on a weekly basis.
3. Mr. Hinckley will continue to receive case management
services from Jonathan Weiss, LCSW. They will meet at least
twice per month for the first year. Thereafter, case
management meetings will occur no less than once per month.
4. Dr. Giorgi-Guarnieri, Mr. Beffa, Mr. Weiss, and Elizabeth
I-Ialey, MT-BC, will communicate via email or fax with the
Director of Forensic Services of the Forensic Outpatient
Department (FOPD) via a receipt of monthly clinical notes.
Mr. Weiss and/or Dr. Giorgi-Guarnieri will also make
telephone contact with FOPD prior to Mr. Hinckley's
monthly visits to Washington, DC. The Director of Forensic
Services will be responsible for forwarding these documents
to the Court.
5. Mr. Hinckley will utilize the services of a Primary Care
Physician (PCP) which will be identified by his family
following clarification of benefits. The PCP will be
responsible for any medication for Mr. Hinckley's medical
6. For the first six months, the Williamsburg treatment
providers, Dr. Giorgi-Guarnieri, Mr. Beffa, Mr. Weiss and Ms.
Haley, will meet with Mr. Hinckley in person for bi-monthly
treatment planning conferences. Thereafter, at the discretion
of the Williamsburg treatment team, these meetings may occur
on a semi-annual basis, indefinitely.
7. While residing in Williamsburg on CL, Mr. Hinckley will
make weekly calls to the FOPD.
8. While residing in Williamsburg on CL, Mr. Hinckley will
also be-required to travel to Washington, DC on a monthly
basis to meet with staff members from the FOPD for the first
(four) 4 months at which time they will review and determine
how often he will need to come to their office for
appointments. He may travel to Washington, DC unaccompanied
for these regularly scheduled appointments.
9. To ensure that Mr. Hinckley has appropriate continuity of
care during his transition to community placement, a current
member of his inpatient treatment team will be present at his
regularly scheduled monthly meetings with the FOPD. This will
occur for the first four (4) months or at the discretion of
10. While residing in Williamsburg on CL, Mr. Hinckley will
continue to attend his scheduled structured activities in
addition to any future employment or alternative constructive
11. Upon receipt of a [court order] for CL to reside in
Williamsburg, Saint Elizabeths Hospital Social Work staff,
and Mr. Weiss, will work with Mr. Hinckley to apply for
Social Security and Virginia Medicaid benefits and any other
benefits he may be eligible for leading up to his release.
12. Mr. Hinckley will be allowed to travel unaccompanied and
without supervision for personal, recreational or clinical
purposes. Mr. Hinckley will avoid traveling to government
13. In the event of a psychiatric emergency, Dr.
Giorgi-Guarnieri will arrange for emergency hospitalization
in the immediate vicinity. She will coordinate with FOPD to
determine if further assessment and treatment should be
undertaken at SEH [Saint Elizabeths Hospital
14. Mr. Hinckley shall not travel fifty miles outside of
Williamsburg, VA without Court approval. He will be permitted
to travel to and from Washington, DC, unaccompanied for the
purpose of meeting with FOPD
15. Mr. Hinckley's Media Plan to refrain from seeking or
accepting invitations to give interviews with members of the
press should remain in place
16. Mr. Hinckley will be permitted to access the Internet, as
needed. If Mr. Hinckley creates any online account for email
or social media services, he is required to share the
username and password to the FOPD as well as his Williamsburg
17. Mr. Hinckley will submit to monthly drug and alcohol
screens at the FOPD, and in Williamsburg at the discretion of
18. Should placement fail due to unavailability of family in
the Williamsburg area, FOPD will work with Mr. Hinckley and
the Williamsburg treatment team for the development of an
19. Should one of the individually named Williamsburg
treatment providers become unavailable, FOPD will work with
the team to establish a replacement provider as soon as
March 20, 2015 Revised (e) Letter at 1-3.
Hinckley supports the Hospital's proposals and has not
submitted his own, separate petition for expanded conditional
release privileges under 24 D.C. Code § 501(k), as he
has sometimes done in the past. See Patient's Response to
the Government's Opposition to Saint Elizabeths
Hospital's Recommendation for Convalescent Leave (Apr.
17, 2015) [Dkt, No. 524] ("Patient's
April 10, 2015, the government filed an opposition to the
Hospital's proposal. The government acknowledges that
"[b]oth Dr. Patterson and Dr. Murphy conclude that Mr.
Hinckley is mentally stable, generally compliant with his
treatment, and clinically ready to reside in the community
given appropriate conditions, " Government's
Response to St. Elizabeths Hospital's Recommendation for
an Expansion of Defendant's Conditional Release at 1-2
(Apr. 10, 2015) [Dkt. No. 522] ("Opp."). It
nevertheless opposes the proposed convalescent leave plan
without significant additional conditions beyond those
suggested by the Hospital. Id. In the
government's view, the Hospital's plan inadequately
addresses; (1) "financial sustainability of Mr.
Hinckley's placement in Williamsburg;" (2)
"communication and coordination of duties between
treatment providers in Williamsburg and the District of
Columbia;" (3) "a housing transition plan [in
Williamsburg], and the possible alternative placement in the
District of Columbia should [the] Williamsburg placement
become infeasible;" and (4) "Mr. Hinckley's
potential accelerated mental deterioration based upon his
clinical history." Id. The government therefore
requests that the Court instead impose the following 35
conditions, some of which overlap substantially with the
1. Mr. Hinckley may reside in the community solely with his
mother at her home in Williamsburg, Virginia. If his mother
is not present, Mr. Hinckley may not have an overnight
non-family guest or stay at any location other than his
mother's home. Mr. Hinckley may only return to the
District of Columbia for the purpose of scheduled visits with
the Hospital. While in the District of Columbia, Mr. Hinckley
may not reside or spend the night at any location other than
2. Prior to placement on convalescent leave, the Hospital and
Williamsburg treatment teams shall provide each other, the
Court, both counsel, and the U.S. Secret Service with a list
of all treatment team providers, their telephone numbers and
email addresses. Both treatment teams shall notify all
parties of any changes in the contact information.
3. The Forensic Outpatient Department (FOPD) treatment team
shall include Verne "VJ" Hyde so long as he is
employed by the Hospital. If Mr. Hyde is no longer employed
by the Hospital, the treatment team shall include at least
one of the following inpatient treatment team members: Dr.
Benjamin Adewale, Denise Brown, or Dr. Sidney Binks.
4. Mr. Hinckley shall maintain weekly telephone contact with
Mr. Hyde, Dr. Nicole Johnson or another designated member of
the Hospital's FOPD treatment team. For the first three
months of Mr. Hinckley's outplacement, Mr. Hyde, Dr.
Johnson or another designated member of the FOPD treatment
team shall speak with Mrs. Joann Hinckley at least once per
week. Thereafter, the FOPD treatment team shall maintain
telephone contact with Mrs. Hinckley bi-monthly. They shall
document their contact with Mr. Hinckley and his mother in
Mr. Hinckley's medical chart.
5. Prior to his outplacement, Mr. Hinckley shall be fitted
with an ankle monitoring device, to be supervised by the U.S.
Secret Service or another United States Government agency or
contractor for the Government. Mr. Hinckley shall consent to
the installation of a tracking devise on his vehicle, which
will be monitored by the U.S. Secret Service or another
United States Government agency or contractor for the
Government. Mr. Hinckley shall provide the FOPD treatment
team with this vehicle's information, and shall drive no
other vehicle without previously giving that vehicle's
information to the FOPD. Mr. Hinckley shall also consent to
installation of monitoring software on his computer, which
will be monitored by the United States Secret Service or
another United States Government agency or contractor for the
Government. Mr. Hinckley shall provide the FOPD treatment
team with this computer's information. Mr. Hinckley shall
use no other computer, laptop, tablet, netbook, phone, or
other internet-enabled device without providing that
device's information to the FOPD. The FOPD shall
immediately notify both parties of any changes in Mr.
Hinckley's vehicle or electronic devices.
6. Pursuant to this Court's February 26, 2014 Order,
Condition #17, Mr. Hinckley shall carry a GPS-enabled cell
phone when he is away from his mother's residence. Mr.
Hinckley shall provide the cell phone company, subscriber
information and phone number of this cell phone to the FOPD.
If the number, cell-phone company, or any subscriber
information changes, Mr. Hinckley must immediately inform the
FOPD. FOPD shall immediately notify both parties of any
changes relating to Mr. Hinckley's cell phone. Mr.
Hinckley shall not use any other phone at any time except in
case of emergency if his cell phone is not functioning. Mr.
Hinckley consents to the United States' (or any of its
agents or contracting designees) obtaining and using any
cell-site or other geopositional data from his cell phone to
determine his location at any point in time.
7. Mr. Hinckley may be permitted to drive unaccompanied only
within a thirty mile radius of Williamsburg, Virginia, unless
he is traveling to Washington, D.C. for the purpose of his
monthly scheduled appointment with his FOPD treatment team.
Except for his scheduled monthly visit to the Hospital in
Washington, D.C, if Mr. Hinckley desires to travel further
than thirty miles outside of Williamsburg, he must make a
request to the FOPD at least seven business days in advance.
The FOPD shall notify the parties in writing with[in] 24
hours of receiving the request. If the Government files an
objection, Mr. Hinckley may not travel unless approved by the
8. Mr. Hinckley shall notify Mr. Weiss before going to any
9. Mr. Hinckley shall not travel to government centers,
facilities and sites, or to areas where the current or former
Presidents, Vice Presidents, members of Congress or the
Executive Branch, any other federal or state political
figure, or any U.S. Secret Service protectee who will be
visiting in the District of Columbia, Williamsburg, or any
other area. If Mr. Hinckley enters a protected area, he shall
leave the area immediately if requested by law enforcement or
as soon as he becomes aware that an above individual is or
will be present. On other occasions, Mr. Hinckley may enter
government facilities to attend to personal business only
with prior notice and approval of the FOPD or if accompanied
by a family member or Williamsburg treatment team member.
10. The Government shall notify the Court and Hospital
promptly if the data it obtains from the ankle bracelet, cell
phone, vehicle or computer- or internet-usage yields any
information showing that Mr. Hinckley has violated any
conditions of release.
11. The Department of Behavioral Health through the FOPD
shall be responsible for ensuring that Mr. Hinckley receives
appropriate psychiatric treatment and medication while
residing in Williamsburg. Mr. Hinckley shall travel to the
FOPD at 35 K Street N.E., Washington D.C., once per month for
monitoring of his mental condition and compliance with the
conditions of his release. He shall meet with the FOPD
treatment team and shall participate in an individual
psychotherapy session with Dr. Binks at the Hospital during
that same monthly visit. Immediately following that
appointment, Mr. Hinckley shall return directly to his home
in Williamsburg, Virginia.
12. FOPD shall notify the U.S. Secret Service, counsel for
Mr. Hinckley and counsel for the Government of the date and
time of his scheduled FOPD appointment. They shall provide
the intended travel route and time of departure from
Williamsburg, Virginia. Notice shall be provided at least two
weeks prior to the scheduled appointment by all parties. Mr.
Hinckley shall travel directly to and from the FOPD on the
designated route and may stop only for food and/or gas along
13. Mr. Hinckley shall participate in structured activities
in the [Williamsburg] community, such as a volunteer position
or paid employment, which are approved by the FOPD treatment
team. He shall be responsible for volunteering and/or working
at least three days each week, Mr. Hinckley shall provide a
weekly schedule of his volunteer/employment activities to Mr.
Weiss and his treatment team at the FOPD, Mr. Hinckley shall
consent to any employer or volunteer organization speaking
with any treatment clinicians involved in his care. Mr.
Hinckley shall promptly notify Mr. Weiss and the FOPD
treatment team of any changes in his place of employment
and/or volunteer activities.
14. Mr. Hinckley shall complete a daily log of his activities
while on convalescent leave which shall include his
work/volunteer hours, social contacts/meetings, scheduled
appointments with treatment providers, errands and
recreational activities. He shall bring the log to his
monthly appointments at the FOPD for review.
15. Dr. Giorgi-Guarnieri will provide psychiatric treatment
and prescribe medication for Mr. Hinckley at a frequency of
at least once per [week] for the first six months of his
convalescent leave. Thereafter, Mr. Hinckley shall meet with
her as often as required but not less than twice per month.
Dr. Giorgi-Guarnieri shall promptly notify the FOPD treatment
team of any changes in Mr. Hinckley's prescribed
psychiatric medication. Dr. Giorgi-Guarnieri will monitor Mr.
Hinckley for any signs of deterioration or decompensation in
his mental condition and will be .especially alert for anger,
psychosis, depression, any ideas of elopement, endangerment
to self or others, noncompliance with the conditions of
release, or rejection of the supervision provided to Mr.
Hinckley by his responsible persons. If any such items are
detected, she will immediately notify designated staff at the
FOPD. Dr. Giorgi-Guarnieri will continue to assess and
monitor the risk factors identified in the Hospital's
checklists, which she will complete and return to the FOPD
and Williamsburg treatment teams along with written feedback
summarizing her contact with Mr. Hinckley prior to his
scheduled monthly FOPD appointment. Dr. Giorgi-Guarnieri also
will participate in monthly telephone conference calls with
the FOPD treatment team and other Williamsburg treatment
providers prior to Mr. Hinckley's scheduled monthly FOPD
appointment. If necessary, Dr. Giorgi-Guarnieri will
facilitate acute hospitalization for psychiatric emergencies.
She shall immediately notify designated members of the FOPD
treatment team of any psychiatric emergency. FOPD shall
notify the Court and counsel within 24 business hours.
16. Mr. Jonathan Weiss, a licensed clinical social worker,
will provide case management services to Mr. Hinckley. Mr.
Hinckley shall meet with Mr. Weiss at least twice per month.
Mr. Weiss will make recommendations to Mr. Hinckley and the
FOPD treatment team for opportunities to increase Mr.
Hinckley's socialization, enrichment, or mental health
support in the Williamsburg community. Mr. Weiss will consult
with each of Mr. Hinckley's work and volunteer
supervisors no less than once a month to confirm Mr.
Hinckley's attendance and adequate work performance.
These reports shall be integrated into Mr. Weiss's
monthly progress notes for Mr. Hinckley's case
management. Prior to Mr. Hinckley's monthly FOPD
appointment, Mr. Weiss will provide written feedback to the
FOPD and Williamsburg treatment teams, summarizing any
contact with Mr. Hinckley related to case management and
recommendations. He will also participate in monthly
telephone conference calls with the FOPD treatment team and
other Williamsburg treatment providers prior to Mr.
Hinckley's scheduled monthly FOPD appointment. Mr. Weiss
will collect monthly progress notes from Williamsburg
providers and ensure their delivery to Dr. Johnson every
month. Mr. Weiss will also corroborate Mr. Hinckley's
self-report with the reports of treatment providers and
family members by noting and addressing any discrepancies.
17. Mr. Carl Beffa will continue to serve as Mr.
Hinckley's individual and group therapist in the
Williamsburg area. Mr. Hinckley will meet at least once
weekly, with Mr. Beffa for individual therapy sessions and at
least once weekly for group therapy sessions. Prior to Mr.
Hinckley's monthly FOPD appointment, Mr. Beffa will
provide written feedback to the Hospital and Williamsburg
treatment team, summarizing his contact with Mr. Hinckley. He
will also participate in monthly telephone conference calls
with the FOPD treatment team, Dr. Johnson and all
Williamsburg treatment providers prior to Mr. Hinckley's
scheduled monthly FOPD appointment.
18. Mr. Hinckley shall participate in individual music
therapy sessions at least once per month in Williamsburg,
either with Ms. Elizabeth Haley or another board-certified
music therapist. The music therapist shall agree to maintain
monthly contact with the, treatment teams. Prior to Mr.
Hinckley's monthly FOPD appointment, the music therapist
will provide written feedback to the FOPD and Williamsburg
treatment teams, summarizing his or her contact with Mr.
Hinckley. He/She will report to the FOPD and Williamsburg
treatment teams any emergency issues that may be disclosed
during sessions. He/She will participate in monthly telephone
conference calls with the FOPD treatment team and other
Williamsburg treatment providers prior to Mr. Ilinckley's
scheduled monthly FOPD appointment.
19. Dr. Nicole Johnson of the Hospital shall conduct weekly
telephone calls with Mr. Hinckley to assess the status of
risk factors. She shall prepare a progress note summarizing
the content of weekly phone calls. Dr. Johnson shall consult
with each member of the Williamsburg treatment team and a
family member of Mr. Hinckley's prior to [the] FOPD
visits. Dr. Johnson shall oversee the preparation of a
monthly summary of Mr. Hinckley's progress in
Williamsburg. Dr. Johnson shall submit the monthly progress
notes of all Williamsburg treatment providers along with her
monthly summary to the Court and both counsel every month.
Dr. Johnson shall corroborate Mr. Hinckley's self-report
with the reports of treatment providers and family members by
noting and addressing any discrepancies.
20. The Williamsburg treatment team, Dr. Giorgi-Guarnieri,
Mr. Weiss, Mr. Beffa, and the music therapist shall meet with
Mr. Hinckley in person for bi-monthly treatment planning
conferences, They shall provide a copy of the treatment plan
to Mr. Hinckley's FOPD treatment team. At a frequency of
not less than twice per year, the FOPD treatment team shall
meet in person with Mr. Hinckley and the Williamsburg
treatment team in Williamsburg for purposes of treatment
planning and communication of treatment progress, concerns,
21. Mr. Hinckley will utilize the services of a Primary Care
Physician (PCP) which will be identified by his family
following clarification of benefits. The PCP will be
responsible for any medication for Mr. Hinckley's medical
22. Mr. Hinckley shall comply with all requests by the
Hospital and/or the FOPD for information relating to any
medical and/or psychiatric treatment he may receive by
parties in the community. Any health care provider shall
provide all treatment information and records regarding Mr.
Hinckley's care to the Hospital or the FOPD upon request.
23. Prior to Mr. Hinckley's placement on convalescent
leave, the Hospital's social work staff and Mr. Weiss
shall identify all possible government assistance programs
for which Mr. Hinckley may be ...