Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

United States v. Hinckley

United States District Court, District of Columbia

July 27, 2016

UNITED STATES OF AMERICA
v.
JOHN W. HINCKLEY, JR.

          OPINION

          PAUL L. FRIEDMAN, United States District Judge

         In 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.

         After 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.

         Today, 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.

         After 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 Opinion.[1]

         TABLE OF CONTENTS

         I. BACKGROUND.......................................................................................................................5

         IL THE HOSPITAL'S PROPOSAL FOR CONVALESCENT LEAVE....................................16

         III. THE EVIDENTIARY HEARING..........................................................................................30

         A. Witnesses from St. Elizabeths Hospital................................................................................31

         1. Verne "VJ" Hyde-Forsenic Clinical Administrator.......................................................31

         2. Dr. Katherine Murphy - Forensic Psychologist...............................................................37

3. Dr. Nicole Johnson - Director of the Forensic Outpatient Department...........................53

         B. Witnesses from Mr. Hinckley's Williamsburg Treatment Team..........................................56

         1. Dr. Deborah Giorgi-Guarnieri - Treating Psychiatrist.....................................................56

         2. Mr. Jonathan Weiss -Case Manager...............................................................................60

         C. Witnesses from the Hinckley Family....................................................................................65

         D. The Government's Expert Witness: Dr. Raymond F. Patterson..........................................67

         IV. FINDINGS OF FACT............................................................................................................73

         V. DISCUSSION.........................................................................................................................77

         A. Mr. Hinckley's Identified Risk Factors.................................................................................77

         1. Mr. Hinckley's Mental Health: Depression, Psychosis, and Personality Disorder..........78

         2. Isolation and Mr. Hinckley's Integration into the Williamsburg Community..................80

         3. Mr. Hinckley's Level of Insight into his Mental Illness...................................................82

         4. Access to Weapons............................................................................................................83

         5. The Hinckley Family's Support........................................................................................83

         6. History of Suicide Attempts..............................................................................................83

         7. Difficulty in Relationships with Others, Particularly Women..........................................84

         8. Deception, Underreporting, and Need for Monitoring......................................................86

         B. Specific Proposals in the Hospital's (e) Letters...................................................................88

         1. Full-Time Convalescent Leave..........................................................................................88

         2. The Hospital's Proposed Treatment Plan and Frequency of Appointments.....................90

         3. Monitoring, Risk Management, and Accountability.........................................................94

         4. Financial Support and Housing.......................................................................................100

         VI. CONCLUSION.....................................................................................................................101

         I. BACKGROUND

         This 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."[2] 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.

         Over 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.

         Beginning 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.[3]

         In 2009 - 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].

         During 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.

         Contingent 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.

         Mr. 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. at 10.

         During 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].[4] 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.

         Although 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].

         Mr. 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.

         By May 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 below.

         On two 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.

         The 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.

         The 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.

         In 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, [5]

         The 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.

         Mr. 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. Id.

         During 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 4-5.

         The 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.

         As of 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.

         By all 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.

         Despite 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. Id.[6]

         II. THE HOSPITAL'S PROPOSAL FOR CONVALESCENT LEAVE

         On 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.[7] Mr. Hinckley's case would be overseen and managed by the Hospital's newly-created Forensic Outpatient Department, headed by Dr. Nicole Reid Johnson.

         The 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.

         Specifically, 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 court-imposed conditions:

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 concerns.
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 the FOPD.
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 activities.
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 centers.
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 ("SEH")].
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 treatment providers.
17. Mr. Hinckley will submit to monthly drug and alcohol screens at the FOPD, and in Williamsburg at the discretion of Dr. Giorgi-Guarnieri.
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 alternative placement.
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 possible.

         Hospital's March 20, 2015 Revised (e) Letter at 1-3.

         Mr. 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 Response").

         On 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 Hospital's proposals:

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 the Hospital.
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 Court.
8. Mr. Hinckley shall notify Mr. Weiss before going to any private residences.
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 the route.
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][8] 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, and goals.
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 concerns.
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 ...

Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.