United States v. Hinckley

UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF COLUMBIA

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UNITED STATES OF AMERICA )

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v. ) Criminal No. 81-0306 (PLF)

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JOHN W. HINCKLEY, JR. )

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OPINION

This matter is before the Court on the proposal of St. Elizabeths Hospital for the

conditional release of John W. Hinckley, Jr., 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. 1

1

The Court’s prior opinions in this matter set forth the relevant background facts

relating to Mr. Hinckley’s attempted assassination of President Ronald Reagan; the serious

wounding of the President, presidential Press Secretary James Brady, Secret Service Agent

Timothy McCarthy, and Metropolitan Police Officer Thomas Delahanty; the trial of Mr.

Hinckley pursuant to a thirteen-count indictment; the jury’s finding that he was not guilty by

reason of insanity on all counts; Mr. Hinckley’s years at St. Elizabeths Hospital; his successful

use of “B” city privileges under Hospital supervision during those years; decisions of this Court

I. BACKGROUND

Throughout these proceedings, the Court has expanded Mr. Hinckley’s privileges

outside the Hospital incrementally, always contingent upon careful monitoring and his and his

family’s compliance with the 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. At first, the Court allowed local

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. The Court later permitted local overnight visits by Mr. Hinckley with his

parents 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 III, 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. In 2007, the Court permitted six additional Phase III visits and expanded

and the United States Court of Appeals for the District of Columbia Circuit; Mr. Hinckley’s

mental health during those years; and the legal framework relating to Section 501(e) letters

submitted by the Hospital and Section 501(k) petitions filed by patients. See United States v.

Hinckley, 292 F. Supp. 2d 125 (D.D.C. 2003) (“Hinckley I”); id., 346 F. Supp. 2d 155 (D.D.C.

2004) (“Hinckley II”); id., 407 F. Supp. 2d 248 (D.D.C. 2005) (“Hinckley III”); id., 462 F. Supp.

2d 42 (D.D.C. 2006) (“Hinckley IV”); id., 493 F. Supp. 2d 65 (D.D.C. 2007) (“Hinckley V”);

and id., 625 F. Supp. 2d 3 (D.D.C. 2009) (“Hinckley VI”).

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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). 2

The Court’s most recent set of orders addressed so-called “Phase IV” visits,

which have allowed Mr. Hinckley to make trips 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, in 2009 the Court

authorized twelve Phase IV visits, each with a duration of ten 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).

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). 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

2

Since 2006, when Mr. Hinckley’s father’s health began to decline, Mr. Hinckley’s

mother has been the sole custodian or responsible person under the terms of the Court’s orders.

See Hinckley IV at 43-44. On January 29, 2008, John Hinckley, Sr. passed away.

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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). 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 out of 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 Phase IV visit, Mr. Hinckley was ordered to meet at least once with

his Williamsburg-area psychiatrist, Dr. John J. Lee. After interviewing and assessing Mr.

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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 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). 3 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, 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).

3

Upon Dr. Lee’s departure from the institute where he practiced, he was replaced

in 2010 by Dr. Deborah Giorgi-Guarnieri, a psychiatrist based in the Williamsburg area who

assumed Dr. Lee’s responsibilities under the Court’s Order. See Stipulation to Modify July 20,

2009 Order (Sept. 28, 2010); Order, United States v. Hinckley (Sept. 30, 2010); Hospital’s

Revised (e) Letter of December 14, 2012 at 12-13.

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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, a psychiatric hospital located in Williamsburg. Although Eastern State is a psychiatric

hospital, Mr. Hinckley’s relationship with the institution 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 has

been helping at the cash register and taking 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 Revised (e) Letter at 10-11. According to the Hospital,

Mr. Hinckley has 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 has obtained his driver’s license and has operated the Hinckley family’s vehicle during his

visits, accompanied by a family member. Id. at 19.

In 2010, the Hospital and Mr. Hinckley’s Williamsburg case manager, Carl Beffa,

initiated discussions with Colonial Behavioral Health, a regional mental health services provider,

about the possibility of providing therapeutic services to Mr. Hinckley. Colonial operates a non-

residential day program of group therapeutic activities in the Williamsburg area known as

People’s Place. Mr. Hinckley participated in an orientation session with Colonial, which was

followed by communication between Colonial and Mr. Hinckley’s unit clinical administrator at

St. Elizabeths, Mr. Kevin Shamblee, to facilitate his acceptance to participate in therapeutic

activities at People’s Place during his Williamsburg visits. 4

4

The Hospital originally included Mr. Hinckley’s participation in People’s Place

as a major component of its proposal for his expanded conditions of release. As discussed later

in this Opinion, the inability of St. Elizabeths and Colonial to reach a mutually satisfactory

agreement about the terms of Colonial’s prospective services to Mr. Hinckley — and confusion

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By May 2011, Mr. Hinckley had completed twelve 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). Since then, Mr. Hinckley has completed an additional 21 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, Kevin Shamblee, that he had attended the movie, even describing and

recommending it. See Patient’s Ex. 5; Transcript of Hearing at 96 (Nov. 30, 2011 p.m.);

Transcript of Hearing at 102 (Dec. 8, 2011 a.m.); Transcript of Hearing at 201 (Feb. 25, 2013).

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

between them about whether they had reached a firm agreement or remained in the process of

negotiation — led to a great deal of testimony during the latest evidentiary hearing held by this

Court about the viability of the Hospital’s plan. Those issues ultimately led Colonial to

withdraw its willingness to participate in the Hospital’s plan, forcing St. Elizabeths to submit a

modified (e) letter. See infra at 9-12.

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before this Court. See Transcript of Hearing at 23-24 (Jan. 30, 2012 p.m.); Forensic Psychiatric

Evaluation Concerning Expansion of Terms of Conditional Release under 501(e) (“Phillips

Rpt.”) at 72; Independent Forensic Psychiatric Evaluation of John W. Hinckley, Jr. (“Patterson

Rpt.”) at 34.

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 Patient’s Exs. 9, 26; see also Transcript of Hearing

at 73-75 (Jan. 23, 2012 p.m.) (Special Agent Bordeaux). When confronted with this evidence,

Mr. Hinckley later admitted being dishonest about the deviations from his itineraries. See

Patterson Rpt. at 34; Psychological Risk Assessment Update (“Montalbano Rpt.”) at 27. 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.

As noted above, Mr. Hinckley was permitted in 2009 to advance to his current

regime of 10-day Phase IV visits “with the purpose of acclimating him to his mother’s

community and permitting him to engage in the Phase IV activities discussed in [this Court’s]

June 16, 2009 Opinion and Order.” Order at 2, United States v. Hinckley (July 20, 2009). The

ultimate goal of these 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 community. See Hinckley VI, 625 F. Supp. 2d at 6; Hinckley V, 493 F. Supp. 2d at 66.

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II. THE HOSPITAL’S PROPOSAL FOR EXPANDED CONDITIONS OF RELEASE

A. The Hospital’s July 2011 (e) Letter

On July 29, 2011, the Hospital submitted the original version of its current

proposal for expanded conditions of release for Mr. Hinckley (the “Hospital’s (e) Letter”). The

core of the Hospital’s proposal was to gradually increase the length of Mr. Hinckley’s visits to

Williamsburg from their current 10-day duration to visits lasting nearly a month, followed by

conditional discharge from the Hospital on “convalescent leave” in that community.

Specifically, the plan called for two visits to Williamsburg of 17 days each, followed (if

successful) by six visits of 24 days each, followed thereafter (if successful, and upon an

assessment by Mr. Hinckley’s treatment providers) by release from the Hospital to reside on

permanent convalescent leave with his mother in Williamsburg, with psychiatric and therapeutic

services to be provided by professionals in that area, rather than by St. Elizabeths, with whom

Mr. Hinckley would only periodically need to touch base as an outpatient.

On September 30, 2011, the government filed an opposition to the Hospital’s

proposal, to which Mr. Hinckley’s counsel filed a reply the next month. The Court commenced

an evidentiary hearing in late November 2011. For a variety of reasons, including delays caused

by the schedules of counsel and witnesses, the hearing proceeded intermittently until its

conclusion in February 2012. Furthermore, because the Hospital had to revise its (e) proposal in

December 2012, it was necessary to reopen the hearing for additional testimony in February

2013.

B. Withdrawal of Colonial Behavioral Health

An important component of the Hospital’s original (e) proposal was Mr.

Hinckley’s anticipated participation in therapeutic group activities at People’s Place, the day

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program run by Williamsburg-area mental health treatment provider Colonial Behavioral Health.

It was contemplated that Mr. Hinckley’s participation in these activities would replicate the

therapeutic experiences that he now receives by taking part in similar group activities at the

Therapeutic Living Center at St. Elizabeths (the so-called “treatment mall”), while also providing

structure to his Williamsburg routine, opportunities for social interaction, and an additional set of

clinicians monitoring his mental and emotional status.

During the evidentiary hearing, the government and its expert witnesses expressed

serious concern over the lack of specificity in the Hospital’s plan for Mr. Hinckley to receive

services from Colonial Behavioral Health. These concerns arose not only from uncertainty about

what specific activities Mr. Hinckley would participate in, but also from doubts about whether

Colonial even offered groups that were appropriate for Mr. Hinckley, and — most fundamentally

— whether the organization had committed to providing services to him or had merely reached

an agreement in principle subject to further negotiation. A significant portion of the evidentiary

hearing focused on these questions as they related to whether the Hospital’s plan adequately

managed Mr. Hinckley’s risk of dangerousness.

After the conclusion of the evidentiary hearing in February 2012, but before the

Court had ruled on the Hospital’s proposal, the Hospital’s discussions with Colonial fell apart.

As reported to the Court, this result stemmed in part from the inability of the Hospital and

Colonial to agree on certain terms regarding Colonial’s role in Mr. Hinckley’s mental health care

treatment — specifically, whether Colonial would assume responsibility for Mr. Hinckley’s case

management and therapy, as it wished, in addition to providing therapeutic group services.

Another contributing factor cited by Colonial in withdrawing its participation in the Hospital’s

plan was what it perceived as a “general lack of coordination of oversight and management of

the plan at the local level.” Hospital’s Revised (e) Letter at 2 (quoting letter from Colonial). In

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early June 2012, Colonial informed the Hospital that it would not be participating in the

Hospital’s plan.

After the Hospital notified the Court of Colonial’s withdrawal, the Court informed

the Hospital that it had two options: it could either withdraw its pending proposal and submit an

entirely new one, or it could proceed with its original proposal but modify it to provide

alternatives to fill the role that had been contemplated for Colonial. See Memorandum Opinion

and Order at 3-4, United States v. Hinckley (Sept. 19, 2012). The Court also admonished the

Hospital that, regardless of which route it chose, it needed to provide assurances that concrete

agreements had been reached with whatever providers in Virginia were included in the plan,

along with more specifics about these providers’ roles than had previously been offered

regarding Colonial. Id. at 4. As the Court explained, the Hospital was “on notice that the lack of

specificity it provided about Colonial Behavioral Health, People’s Place, earlier in these

proceedings was a significant concern to the United States and its experts, as well as to the

Court.” Id.

The Hospital opted to proceed with a modified version of its original proposal,

and it submitted a revised (e) letter on December 14, 2012 (the “Hospital’s Revised (e) Letter”).

The revised proposal is essentially the same as the original, but it accounts for the loss of

Colonial’s participation by adding a weekly group therapy session led by Mr. Beffa and music

therapy with Ms. Elizabeth Haley, a board-certified music therapist with whom Mr. Hinckley

began meeting in late 2012. The revised proposal also marks a significant change by transferring

the role of Mr. Hinckley’s case manager from Mr. Beffa to Mr. Jonathan Weiss, a licensed

clinical social worker who has practiced social work and case management since the late 1960s

and was the clinical director of what is now Colonial Behavioral Health for over 25 years. This

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change will leave Mr. Beffa in the exclusive role of therapist. Hospital’s Revised (e) Letter at

11-13; Supplemental Report (“Murphy Supp. Rpt.”) at 2.

The government opposes the Hospital’s revised proposal for the same reasons that

it opposed the original. In late February 2013, the Court held a supplemental evidentiary hearing

that focused on the modifications to the Hospital’s proposal and on new events that had occurred

in the intervening year since the conclusion of the original evidentiary hearing.

C. The Hospital’s December 2012 Revised (e) Letter

The Hospital believes that after more than six years of visits by Mr. Hinckley to

Williamsburg, including visits of substantial duration that have included periods of unsupervised

time in the community, Mr. Hinckley is now ready to “begin to transition to spending more time

in that area and less time at the Hospital in D.C.” Hospital’s Revised (e) Letter at 16. As the

Hospital stated in its proposal:

Mr. Hinckley has utilized twelve visits on his July 2009 Court

order and ongoing visits since being granted a continuance of that

order in May of 2011. His family have reported no symptoms of

attention-seeking behavior, attempts to contact Jodie Foster, or

returning late from his unaccompanied times. He has refused

interaction with the media[.] His mood has remained uplifted and

his mental status stable while on these outings. The visits to

Williamsburg have assisted Mr. Hinckley in achieving various

treatment goals including the establishment of closer, more

connected relationships with his family members, to become more

independent in his operating of a motor vehicle, to increase his

opportunities to make good judgments, to establish therapeutic

relationships with a psychiatrist in Williamsburg, Virginia, Dr.

Debbie Giorgi-Guarnieri, and a therapist, Carl Beffa, LCSW, to

utilize mature and effective coping strategies, to become more

open and less secretive with the treatment team, to continue his

vocational pursuits through volunteering at the Eastern State

Hospital Library, to become more familiar and therefore more

confident in navigating the Williamsburg community by

automobile and, more recently in developing a therapeutic

relationship with Elizabeth Haley, music therapist.

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Id. at 20-21.

Accordingly, the Hospital proposes expanding the length of Mr. Hinckley’s

conditional release visits, while affording him greater freedom during those visits. The increased

duration of the visits will, in the Hospital’s view, allow Mr. Hinckley to more fully develop

social, vocational, and therapeutic relationships in the Williamsburg community, facilitating the

goal of moving him toward permanent residence there. Hospital’s Revised (e) Letter at 21. It

further proposes that upon successful completion of eight of these expanded visits — two of 17

days’ duration and six of 24 days — the Hospital have the authority, without seeking further

approval from the Court, to determine whether Mr. Hinckley should be placed on “convalescent

leave” status, permitting him to live full-time in Williamsburg as long as he adheres to the

conditions and restrictions placed upon him. Id. at 26-27.

Specifically, the Hospital’s Revised (e) Letter of December 2012 asks the Court

to expand Mr. Hinckley’s conditional release privileges as follows:

1. The duration of the visits to Williamsburg will increase from

their current 10-day duration to 17 days for the next two visits and

to 24 days for six additional visits.

2. Mr. Hinckley will be allowed to volunteer at Eastern State

Hospital for up to five days a week, depending on the availability

of suitable work activities.

3. During each of the first two visits (of 17 days), Mr. Hinckley

will be permitted up to six unsupervised outings lasting 4 hours

each outside his mother’s housing subdivision, for social,

recreational, shopping, and dining activities, “or for the purpose of

securing other related activities,” between 9:00 a.m. and 9:00 p.m.

4. During the third and fourth visits (i.e., the first two 24-day

visits), after his treatment providers have assessed the progress of

his previous visits, Mr. Hinckley will be permitted up to nine

unsupervised outings lasting 4 hours each under the same

conditions.

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5. During the remainder of the visits or until the issuance of a new

conditional release order, Mr. Hinckley will be permitted up to

twelve unsupervised outings lasting 8 hours each, within a 30-mile

radius and to a specific geographic location, under the same

conditions.

6. The increases in the frequency and duration of Mr. Hinckley’s

unsupervised outings, noted above, will take effect only after Mr.

Hinckley meets certain treatment goals, including but not limited

to attending his scheduled therapy sessions and contributing

financially to the cost of his treatment. 5

7. The activities in which Mr. Hinckley engages during the

periods of unsupervised time “will be listed in a general menu of

current areas of interest approved by [the] Hospital/Mr. Weiss in

advance or with notice on the day of a special activity.” The

Hospital will no longer provide the Court and the government with

an itinerary prior to each visit that sets forth the specific date, time,

address, and phone number of each activity in which Mr. Hinckley

will engage outside of his mother’s subdivision. Rather, Mr.

Hinckley will be free to choose from a range of pre-approved

options that have been included in a list of activities that he will

develop in consultation with his treatment providers. In addition,

special activities not included within this list will be permitted if

approved on the day of the activity.

8. During these unaccompanied outings, Mr. Hinckley will avoid

traveling to government centers in Richmond or to areas where the

President or members of Congress may be visiting.

9. When Mr. Hinckley is not involved in structured activities, he

will be allowed to remain unaccompanied in his mother’s

subdivision while she is away from the residence pursuing her own

activities. His mother or a sibling need not remain at home at all

times, as now. Mr. Hinckley’s mother will not, however, be away

from the home overnight.

10. Mr. Hinckley will be allowed the unaccompanied use of an

automobile while traveling to and from his volunteer activities and

his appointments with his treatment providers; while utilizing his

5

This portion of the Hospital’s original (e) letter was inadvertently omitted from

the revised (e) letter, but Hospital staff confirmed during the evidentiary hearing that the

omission was unintentional and that the Hospital expects Mr. Hinckley to meet certain treatment

goals before receiving increases in his unsupervised time.

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unsupervised free time; and while traveling to and from musical

activities that he may hear about from his music therapist.

11. Mr. Hinckley may be driven between Washington, D.C. and

Williamsburg by a professional driver without his mother or

siblings in the vehicle.

12. A minimum of two weeks will occur between each visit to

allow for the preparation of feedback reports by the Hospital.

13. The Hospital will be permitted to submit to the Court reports

that summarize two visits at a time, rather than submitting a

separate report after every visit, unless an emergency occurs

requiring that the information be communicated immediately.

14. The Hospital will provide 7-day notice to the Court, the

government, and Mr. Hinckley’s counsel prior to each visit to

Williamsburg, rather than the 14-day notice that it currently

provides.

15. The Hospital will provide 1-day notice to the Court, the

government, and Mr. Hinckley’s counsel prior to each Hospital

staff–accompanied outing in Washington, D.C. in which Mr.

Hinckley takes part, rather than the 4-day notice that it currently

provides.

16. Dr. Giorgi-Guarnieri will continue to serve as Mr. Hinckley’s

psychiatrist in the Williamsburg area. Mr. Hinckley will meet with

Dr. Giorgi-Guarnieri weekly during his visits of 17 days and at

least once during his visits of 24 days. Additional visits may occur

as clinically necessary. 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 conditions of release, or rejection of the

supervision provided to Mr. Hinckley by his responsible persons.

If any such items are detected, she will telephone the Hospital. 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 Hospital after each visit, along with

written feedback summarizing her contact with Mr. Hinckley. Dr.

Giorgi-Guarnieri also will participate in post-visit telephone

conference calls with the Hospital treatment team to discuss Mr.

Hinckley’s progress, and will participate by phone in the Hospital

treatment team’s Individual Recovery Plan meetings scheduled

every two months for Mr. Hinckley. Dr. Giorgi-Guarnieri will

verify with Mr. Hinckley that he has been taking his medications

15

as prescribed. If necessary, Dr. Giorgi-Guarnieri may prescribe

medication for emergency psychiatric situations and may facilitate

acute hospitalization for psychiatric emergencies.

17. Mr. Beffa will continue to serve as Mr. Hinckley’s individual

therapist in the Williamsburg area. Mr. Hinckley will meet at least

once weekly with Mr. Beffa for therapy sessions until the

completion of his first six 24-day visits, after which the frequency

of the sessions may be decreased based on the assessment of

treatment team members in Virginia and at the Hospital. After

each visit, Mr. Beffa will provide written feedback to Mr.

Hinckley’s Hospital treatment team that will summarize his weekly

contact with Mr. Hinckley. This feedback also will be shared with

Dr. Giorgi-Guarnieri. Mr. Beffa also will participate by phone in

the Hospital treatment team’s Individual Recovery Plan meetings

scheduled every two months for Mr. Hinckley. Any emergency

issues that may be disclosed during the sessions with Mr. Hinckley

will be shared with the Hospital and Dr. Giorgi-Guarnieri.

18. Mr. Beffa, in addition to the individual therapy that he will

provide to Mr. Hinckley, will conduct group psychotherapy

sessions in which Mr. Hinckley will be included. The goals of

these sessions will be to improve socialization and relationship-

building and to foster community reintegration.

19. Mr. Jonathan Weiss, a licensed clinical social worker, will

assume the role of Mr. Hinckley’s Williamsburg case manager,

taking this duty over from Mr. Beffa. Mr. Weiss will make

recommendations to Mr. Hinckley and the Hospital for

opportunities to increase Mr. Hinckley’s socialization, enrichment,

or mental health support in the Williamsburg community; these

recommendations will be made after first-hand investigation of the

appropriateness of Mr. Hinckley’s participation in the activities in

question and their relevance to the objectives of the visits. Mr.

Weiss also will monitor Mr. Hinckley’s progress in his volunteer

and scheduled daytime activities by communicating at least once

per visit with the relevant supervisor. He may also accompany Mr.

Hinckley on outings in the community. After each visit, Mr. Weiss

will provide written feedback to the Hospital treatment team

summarizing any contact with Mr. Hinckley related to case

management and providing recommendations.

20. Ms. Elizabeth Haley, a board-certified music therapist, will

provide individual music therapy sessions during his conditional

release visits. She will conduct at least one music therapy session

during each visit, and will provide written feedback to the

treatment team afterward. She will report to the Hospital any

16

emergency issues that may be disclosed during the sessions. She

also may communicate with Mr. Hinckley’s music therapist at St.

Elizabeths to promote continuity in this therapy.

The Hospital also recommends that certain conditions of Mr. Hinckley’s

Williamsburg visits that are presently in force remain unchanged with respect to future visits:

21. Mr. Hinckley will be required to travel with his GPS-equipped

cell phone during all unaccompanied outings.

22. Mr. Hinckley’s mother, brother, and sister will remain as the

identified “responsible persons” supervising him in Williamsburg.

They will continue to submit feedback forms to the Hospital after

each visit as well as participate in telephone or in-person

conversations with Mr. Hinckley’s treatment team members after

the visits.

23. Before each visit, Mr. Hinckley will continue to receive an

amount of medication from the pharmacy at the Hospital to cover

the duration of the visit.

24. Mr. Hinckley will be allowed to continue his daily

unaccompanied walks within his mother’s subdivision. Presently,

Mr. Hinckley is allowed two such walks each day, of up to 2 hours

in duration, except on the days in which he utilizes his

unaccompanied community time, when he is permitted only one

such walk.

25. The restrictions on Mr. Hinckley’s internet use during his trips

to Williamsburg will remain in force. These restrictions require

that a family member be present in the room with him whenever

Mr. Hinckley uses the internet.

26. The Individual Relapse Prevention and Media plans that were

previously developed will remain in effect for the duration of Mr.

Hinckley’s time spent in Williamsburg.

Finally, the Hospital proposes that after the successful completion of two 17-day

visits and eight 24-day visits to Williamsburg, the following additional conditions take effect:

27. Upon “an assessment by the Hospital staff and providers in

Virginia indicating that Mr. Hinckley is experiencing a good

mental status and that he does not present a danger to himself or

others,” at the discretion of the Hospital Mr. Hinckley will be

17

conditionally released to reside permanently on convalescent leave

to reside with his mother in Williamsburg.

28. While residing in Williamsburg on convalescent leave, Mr.

Hinckley will continue to receive psychiatric “follow up” from Dr.

Giorgi-Guarnieri, who will meet with Mr. Hinckley twice a month

for the first three months and no less than monthly afterwards. At

the outset of convalescent leave, Dr. Giorgi-Guarnieri will begin to

prescribe Mr. Hinckley’s psychiatric medication, which will be

obtained at a local pharmacy.

29. Mr. Hinckley will continue to receive weekly individual and

group therapy from Mr. Beffa.

30. Case-management services will be provided on an as-needed

basis.

30. Mr. Hinckley will make weekly calls to the Hospital’s

Outpatient Department of Clinical Operations (“OPDCO”) for the

first three months of his convalescent leave and no less than

monthly thereafter, at the discretion of the OPDCO. Mr. Hinckley

also will travel to Washington, D.C. monthly to meet with OPDCO

staff members at the Hospital. He will be allowed to travel

unaccompanied to Washington, D.C. for these regularly scheduled

appointments. A current member of Mr. Hinckley’s inpatient

treatment team will be present at these meetings, for at least the

first six months or longer, at the discretion of the OPDCO. Dr.

Giorgi-Guarnieri and Mr. Beffa will communicate with the

OPDCO “via a monthly checklist and summary as well as

telephone contact prior to his visiting the staff in D.C.”

30. Mr. Hinckley will continue to attend his regularly scheduled

activities at Eastern State Hospital until employment or an

alternative constructive daytime activity is arranged.

31. If the Hospital’s proposal for convalescent leave is approved

by the Court, a designee of the Hospital will work with Mr.

Hinckley to ensure that he has applied for Social Security and

Virginia Medicaid benefits prior to his release.

32. If the Hospital’s proposal for convalescent leave is not

approved by the Court at this time, the proposed visits of 24 days

will continue until the Court issues another conditional release

order.

Hospital’s Revised (e) Letter at 9-27.

18

In the Hospital’s opinion, Mr. Hinckley has sufficiently recovered from his

mental illness to be granted the proposed expansions of his conditional release freedom without

danger to himself or others, under the conditions outlined above. Hospital’s Revised (e) Letter

at 27. “If Mr. Hinckley’s condition warrants, or if he violates the conditions of this release, the

Hospital will return him to total inpatient care with due notice to the Court.” Id.

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 John W. Hinckley’s Reply Memorandum in Support of

Hospital’s Request for Enlargement of Terms of Conditional Release (Oct. 21, 2011). Mr.

Hinckley has, however, expressed the view that the proposed extended visits of 17 and then 24

days should take place on a regular monthly basis, in order to ensure predictability in his

availability for vocational, employment and therapeutic activities. Transcript of Hearing at

19-20 (Nov. 30, 2011 a.m.). This recommendation is inconsistent with the Hospital’s proposal

that Mr. Hinckley’s 24-day visits be scheduled at least two weeks apart, in order to afford the

Hospital time to prepare the feedback reports submitted to the Court.

The government opposes the Hospital’s proposal, deeming it “premature and ill

conceived.” See Government’s Opposition to St. Elizabeths Hospital’s Request for Expanded

Conditions of Release at 4 (Sept. 30, 2011) (“Opp.”). In particular, the government believes that

the proposal fails adequately to address the persistence of key behaviors by Mr. Hinckley that

have been recognized as risk factors for dangerousness on his part. Chief among the

government’s concerns is that Mr. Hinckley remains prone to secretiveness and deception about

his thoughts, actions, and intentions — a trait that may stymie the efforts of his treatment

providers to detect signs of decompensation or dangerousness on his part during any lengthy

conditional release. Mr. Hinckley’s deceptiveness and lack of candor, as the government sees it,

19

are tied to his ongoing diagnosis of narcissism, and they continue to manifest themselves in

particular with respect to his relationships with and interest in women.

Pointing to the record of Mr. Hinckley’s Phase IV visits to Williamsburg, the

government further argues that these visits have utterly failed in their therapeutic objective of

integrating Mr. Hinckley into that community. The government contends that Mr. Hinckley,

rather than engaging in activities to foster social and vocational integration, has adhered to an

isolated and repetitive pattern of activities during each of his visits, with the result that he has

failed to develop any social ties in Williamsburg that would ameliorate his risk of isolation and

depression. As the government puts it, Mr. Hinckley “has developed a routine of engaging in

solitary pursuits that have no likelihood of permitting him to make friends or increase the support

system that his treating physicians, and Hinckley himself, view as critical to preventing him from

decompensating.” Opp. at 11. According to the government, as a result of his lack of initiative

and unwillingness to broaden the scope of his activities — even when prompted with specific

suggestions by his treatment providers — Mr. Hinckley has not established the social ties

necessary to alleviate the concern that, should he be conditionally released into his mother’s

community as proposed by the Hospital, he may become isolated, depressed, and ultimately

unstable.

In light of what the government views as Mr. Hinckley’s ongoing deception and

secretiveness, his lack of meaningful integration in Williamsburg, and the potentially

destabilizing influence of his relationships with women, the government faults the Hospital for

failing to devise a detailed plan with sufficient monitoring, oversight, and structured activity to

provide assurances that his risk of decompensation is being adequately managed.

In sum, the government argues, between Mr. Hinckley’s continued demonstration

of troubling risk indicators and the Hospital’s failure to adequately account for those risks, it is

20

“impossible to find, even by a preponderance of the evidence, that Hinckley will not become a

danger to himself or others if he is permitted to transition into the community in his mother’s

hometown.” Opp. at 12. Indeed, the government raises the question of whether the

“experiment” of transitioning Mr. Hinckley to Williamsburg has proven a failure, because, as the

government puts it, “the Hospital appears to be unable to knit together either a web of effective

mental-health providers or meaningful activities that Hinckley can use to integrate himself into

the community.” Id.

III. THE EVIDENTIARY HEARING

As has been its practice, the Court held an evidentiary hearing on the Hospital’s

original (e) letter in order to permit all parties to substantiate and elaborate upon their positions

with respect to the Hospital’s proposal. That hearing included opening statements by counsel for

the government and counsel for Mr. Hinckley, more than ten full days of live testimony (making

this by far the longest hearing that the Court has held in this matter), and closing arguments.

Counsel for Mr. Hinckley called the following witnesses: (1) Dr. Tyler Jones, Director of

Psychiatric Services at St. Elizabeths Hospital and a member of St. Elizabeths Hospital Review

Board, which oversees the development and submission of petitions for conditional release;

(2) Kevin Shamblee, a Clinical Administrator at St. Elizabeths Hospital with responsibilities for

Mr. Hinckley, and the author of the Hospital’s (e) letter and revised (e) letter; (3) Dr. Katherine

Murphy, Clinical Staff Psychologist at St. Elizabeths Hospital, who prepared an extensive risk

assessment with respect to Mr. Hinckley; (4) Dr. Deborah L. Giorgi-Guarnieri, the

aforementioned psychiatrist in private practice in the Williamsburg area who has been Mr.

Hinckley’s psychiatrist in that area since 2010; (5) Carl Beffa, the aforementioned therapist and

social worker in private practice in the Williamsburg area who is Mr. Hinckley’s case manager

21

and individual therapist in that area; (6) Diane Sims, Mr. Hinckley’s sister; (7) Scott Hinckley,

Mr. Hinckley’s brother; and (8) Dr. Paul Montalbano, Deputy Director of the Forensic

Psychology Postdoctoral Fellowship Program at Walter Reed Medical Center, formerly Pretrial

Chief of the Forensic Service Unit at John Howard Pavilion, St. Elizabeths Hospital, who

testified as a rebuttal expert witness for Mr. Hinckley.

Counsel for the government called the following witnesses: (1) Dr. Raymond

Patterson, a psychiatrist retained as an expert witness by the government and the former Medical

Director and former Acting Associate Superintendent at St. Elizabeths Hospital, the former

Commissioner of Mental Health in the District of Columbia, and the former Forensic Director

for the State of Maryland; (2) Dr. Robert Phillips, a psychiatrist retained as an expert witness by

the government and the former Director of Forensic Services, State of Connecticut Department

of Mental Health, Deputy Medical Director, American Psychiatric Association, Adjunct

Professor of Law and Psychiatry at the University of Maryland School of Law, and Visiting

Lecturer in Psychiatry at the Yale University School of Medicine; (3) Anthony Bordeaux,

Special Agent with the United States Secret Service, who testified about his surveillance of Mr.

Hinckley in Williamsburg, Virginia; (4) Jason Clickner, Special Agent with the United States

Secret Service, who testified on the same topic; and (5) Richard Rolfes, an employee of a

bookstore located in Williamsburg, who testified about a 2011 encounter with a customer whom

he identified as Mr. Hinckley.

A. Witnesses for the Hospital and Mr. Hinckley

1. Witnesses from St. Elizabeths Hospital

Dr. Tyler Jones, the Director of Psychiatric Services at St. Elizabeths, testified on

behalf of the Hospital and its Forensic Review Board, which oversees the work of individual

22

patients’ treatment teams as they formulate recommendations for conditional releases. In

addition to describing the work of Mr. Hinckley’s treatment team, Dr. Jones was permitted to

offer expert testimony on the issue of whether Mr. Hinckley will be dangerous to himself or

others as a result of a mental disease under the Hospital’s proposed terms of conditional release.

Dr. Jones testified that in his opinion, to a reasonable degree of medical certainty, Mr. Hinckley

represents a low risk of dangerousness to himself or others if conditionally released under those

terms. Transcript of Hearing at 64-65 (Nov. 30, 2011 a.m.).

Dr. Jones testified about Mr. Hinckley’s psychiatric diagnoses and prescribed

medications. Transcript of Hearing at 13 (Nov. 30, 2011 p.m.). According to Dr. Jones, Mr.

Hinckley is currently diagnosed with two “Axis I” conditions: major depressive disorder

recurrent, in full remission; and psychotic disorder not otherwise specified, also in full remission.

Being in full remission, Dr. Jones explained, “means that there are no signs or symptoms of the

disorder.” Id. at 14. Such conditions, although they no longer present any signs or symptoms,

often continue to be included in a patient’s diagnosis for a variety of reasons, including, as in Mr.

Hinckley’s case, for purposes of ongoing monitoring or prophylactic treatment. Id.

Mr. Hinckley also is diagnosed by the Hospital as having one Axis II condition,

narcissistic personality disorder. While the signs of this disorder are still evident in Mr.

Hinckley, in the Hospital’s opinion the condition is attenuated and by itself represents less of a

risk factor for dangerousness than his Axis I conditions once presented. Transcript of Hearing at

14-15 (Nov. 30, 2011 p.m.).

Since May 1999, Dr. Jones testified, Mr. Hinckley has taken one milligram of

Risperdal daily, which is an antipsychotic medication for the treatment of psychotic disorders but

which is also approved for other purposes. This prescription is in the low range of possible

doses. Transcript of Hearing at 16 (Nov. 30, 2011 p.m.). At the time Mr. Hinckley began taking

23

Risperdal in 1999, his psychotic disorder was already in full remission and Mr. Hinckley had

shown no symptoms of psychosis for many years. According to Dr. Jones, the treatment team

believes that the medication serves a useful prophylactic function: if Mr. Hinckley’s clinical

depression were to return and he were to experience a severe decompensation, the medication

would be helpful in preventing symptoms of psychosis, such as delusions. Id. at 19. In addition,

the class of medications of which Risperdal is a part “has been approved for the use of adjunctive

therapy for depression, that is for cases where one medication doesn’t seem to be doing the full

job.” Id. at 19. In light of these two potential benefits, and because Mr. Hinckley has taken the

medication for many years without experiencing any significant side effects, Mr. Hinckley has

remained on the medication.

Dr. Jones reported that Mr. Hinckley has never failed to take his Risperdal.

Transcript of Hearing at 21-22 (Nov. 30, 2011 p.m.). He further explained that if there were

reason to be concerned about Mr. Hinckley’s compliance with his Risperdal prescription while

living in Williamsburg, he could be given the medication every two weeks by a health

professional in a long-acting injectable form, or he could instead be prescribed a closely related

medication, Invega, which comes in a long-acting injectable form that is given monthly. Id. at

25. In the opinion of the Hospital, however, even if Mr. Hinckley were to stop taking Risperdal

or any similar medication, he would still be at low risk for a return of psychotic symptoms. Id. at

20.

Mr. Hinckley began taking his other medication, Zoloft, in 2005, after reporting

feelings of anxiety to his treating psychiatrist relating to his upcoming transition to spending

more time in Williamsburg. Transcript of Hearing at 23 (Nov. 30, 2011 p.m.). Since then, Dr.

Jones reported, Mr. Hinckley’s dosage has twice been increased in response to “contextual and

appropriate” periods of anxiety. Id. at 23-24. On each occasion, the increase was prompted by

24

Mr. Hinckley’s own request, and Mr. Hinckley has never failed to take his Zoloft. Id. at 24. He

currently takes 125 milligrams of Zoloft in the morning and 25 milligrams in the evening. Id. at

15. Were Mr. Hinckley to abruptly stop taking this medication, his symptoms of anxiety might

gradually reoccur, but this change would be observable by his treatment providers at the Hospital

and in Williamsburg, according to Dr. Jones. Id. at 26. Moreover, an increase in anxiety would

not, in and of itself, make Mr. Hinckley more dangerous. Id.

Dr. Jones further testified about certain details of the Hospital’s proposal and their

underlying rationales. He explained that Mr. Hinckley’s current regime of irregularly scheduled

10-day visits to Williamsburg does not allow him to participate fruitfully in therapeutic groups

there, because his schedule lacks the continuity necessary for him to operate as a functioning part

of any group. Transcript of Hearing at 71, 92 (Nov. 30, 2011 a.m.). According to Dr. Jones, the

10-day visits similarly limit Mr. Hinckley’s opportunities for employment and volunteer

activities, which would help to cultivate self-reliance and confidence on his part, and therefore

more time spent in Williamsburg each month, on a predictable schedule, is essential. Id.

Dr. Jones acknowledged that, in his view, if Mr. Hinckley were to find himself in

Williamsburg without a social support network or a set of structured activities, he would be at

risk for isolation and possibly depression, both of which have been identified as risk factors for

dangerousness on his part. Transcript of Hearing at 19-20 (Dec. 1, 2011 a.m.). He also agreed

that Mr. Hinckley has not taken full advantage of the opportunities available to him in

Williamsburg to increase his socialization — a view consistent with that of Mr. Hinckley’s

treatment team — and that Mr. Hinckley has failed to show an interest in a number of things he

could be doing to foster his integration into the community. Dr. Jones cited several examples in

which a suggestion that was given to Mr. Hinckley to increase his socialization led nowhere —

either because Mr. Hinckley did not follow through with the suggestion or because he was

25

rebuffed from taking part in an activity due to his notoriety. Id. at 24-29. And he acknowledged

that Mr. Hinckley has no male friends in Williamsburg, which the Hospital thinks would be good

for him. Id. at 25.

Despite the concerns that Dr. Jones acknowledged about Mr. Hinckley’s potential

risks of isolation and depression in Williamsburg and his failure to ameliorate these concerns by

attempting to establish viable community ties, Dr. Jones still believes that Mr. Hinckley presents

a low risk of danger under the Hospital’s proposal. Transcript of Hearing at 28 (Nov. 30, 2011

p.m.). He also believes that Mr. Hinckley’s scheduled meetings with his Williamsburg-area

psychiatrist would be frequent enough under the Hospital’s plan to allow her to observe any

symptoms of decompensation on his part. Transcript of Hearing at 72 (Nov. 30, 2011 a.m.).

Further testimony about the Hospital’s proposal was provided by Kevin

Shamblee, who was a clinical administrator at St. Elizabeths, a member of Mr. Hinckley’s

treatment team, and the author of the Hospital’s (e) letter. 6 As someone who coordinated the

activities of patients and their various treatment providers, Mr. Shamblee worked with Mr.

Hinckley on and off since 1995 and steadily from 2001 until recently; he saw Mr. Hinckley on a

daily basis. Mr. Shamblee assists in preparing the itineraries for Mr. Hinckley’s visits to

Williamsburg, and conducts post-outing interviews with his family, treaters, and supervisor after

each visit. Transcript of Hearing at 4, 6-10 (Dec. 8, 2011 a.m.); see also Transcript of Hearing at

33-37 (Feb. 25, 2013).

6

Mr. Shamblee testified at the supplemental evidentiary hearing in February 2013

that he recently had taken a position with the outpatient division of the District of Columbia

Department of Mental Health (which operates St. Elizabeths), but he continues to be Mr.

Hinckley’s clinical administrator and remains involved with planning and evaluating Mr.

Hinckley’s Williamsburg outings. Transcript of Hearing at 33-37 (Feb. 25, 2013).

26

Mr. Shamblee was questioned about the progress that Mr. Hinckley has made

under the current regime of conditional releases and the steps he has taken to become integrated

into the Williamsburg community. He acknowledged that Mr. Hinckley’s itineraries for each

10-day visit have been strikingly repetitive, hewing to a predictable pattern of solitary activities

such as seeing movies, visiting a limited range of stores and restaurants, and taking

unaccompanied walks in his mother’s neighborhood — with few ventures aimed at making

friends, joining social groups, or seeking vocational opportunities beyond his current position at

Eastern State Hospital. Nevertheless, Mr. Shamblee emphasized that when assessing the

progress of a patient who has been hospitalized for 30 years, one should not undervalue the

achievement made by that patient in simply becoming comfortable, for example, working 4-hour

shifts with a volunteer employer or engaging in unaccompanied activities in the community.

Transcript of Hearing at 84 (Dec. 8, 2011 a.m.). Viewed in this light, Mr. Shamblee

characterized Mr. Hinckley’s record as “somewhat of a success.” Id. In the view of the

Hospital, he said, Mr. Hinckley needs more time in Williamsburg than that provided by his

periodic 10-day visits in order to engage in activities that will foster his integration into the

community.

Although Mr. Shamblee testified that the Hospital’s proposal would afford Mr.

Hinckley a level of therapy in Williamsburg similar to that which he now receives at St.

Elizabeths, his testimony revealed that under the proposal Mr. Hinckley would have less frequent

contact with a treating psychiatrist. Presently, Mr. Hinckley meets weekly at St. Elizabeths with

his treating psychiatrist. While this pattern would be replicated during Mr. Hinckley’s 17-day

Williamsburg visits (in which he would meet weekly with Dr. Giorgi-Guarnieri), during each of

the proposed 24-day trips he would see her only once. Even this difference may understate the

magnitude of the proposed change, because although Dr. Benjamin Adewale formally meets with

27

Mr. Hinckley only once a week when Mr. Hinckley is at St. Elizabeths, their mutual presence at

the Hospital and ability to consult on a casual, ad hoc basis allow him to see Mr. Hinckley “quite

a bit more” than Dr. Giorgi-Guarnieri would see him in Williamsburg. Transcript of Hearing at

38-39 (Dec. 8, 2011 a.m.). Although Mr. Shamblee views the proposed once-per-visit meeting

with Dr. Giorgi-Guarnieri as adequate, he pointed out that the Hospital’s proposal gives Dr.

Giorgi-Guarnieri the discretion to increase the frequency of her meetings with Mr. Hinckley as

clinically indicated. Id. at 40.

Mr. Shamblee also testified briefly about the two occasions on which

Mr. Hinckley lied to him about having gone to the movies — as his itinerary provided — when

in fact he did not do so. In a post-visit interview Mr. Shamblee had with Mr. Hinckley after his

July 2011 visit to Williamsburg, Mr. Hinckley recommended the movie Captain America which

he said he had seen while in Williamsburg. Transcript of Hearing at 102 (Dec. 8, 2011 a.m.).

Mr. Shamblee had no idea at the time that Mr. Hinckley was not being truthful with him. Id.

Some months later, Mr. Shamblee and Mr. Hinckley had a similar conversation about Rise of the

Planet of the Apes. “Mr. Hinckley said he saw it. It was a good movie. He would recommend

it.” Id. Mr. Shamblee had no idea Mr. Hinckley was not being truthful on this occasion either.

Id. The dates on which Mr. Hinckley said, falsely, that he had gone to the movies were July 24,

2011 and September 4, 2011, as reported by the Secret Service. See Patient’s Ex. 5 (Hospital

Letter Re: Sanctions) (Mr. Hinckley went to box office on both occasions, but did not purchase

tickets); see also Transcript of Hearing at 3-8 (Nov. 30, 2011 a.m.) (testimony of Dr. Jones).

Dr. Katherine Murphy, a clinical staff psychologist at the Hospital who

participated in the planning of the Hospital’s (e) letter, testified about the violence risk

assessment of Mr. Hinckley that she completed in 2011. She also was permitted to offer expert

testimony on the issue of whether Mr. Hinckley will be a danger to himself or others as a result

28

of mental disease during the conditional releases proposed by the Hospital. Transcript of

Hearing at 7 (Dec. 1, 2011 p.m.).

Dr. Murphy’s risk assessment concludes that under the conditions proposed by the

Hospital, Mr. Hinckley will not likely be a danger to himself or others in the reasonable future:

He is at low risk for a relapse of psychosis and depression without

prolonged social isolation. Should a relapse of symptoms of major

mental illness begin to occur, it would likely be gradual, detected

by treatment providers, and responsive to pharmacology. He has

demonstrated his ability to manage increases in the duration of his

outings without presenting as a risk to himself or others. Mr.

Hinckley should continue to advance to the next levels of freedom

provided that ongoing assessments throughout the transition find

him to remain at a low risk of being dangerous to himself and

others.

Violence Risk Assessment Update (“Murphy Rpt.”) at 55. Dr. Murphy further recommends that

“expansions in freedom should be incremental and contingent upon successful completion of a

progression of treatment objectives,” which “should be designed to assist Mr. Hinckley in

demonstrating further initiative with securing and adjusting to a structured routine in addition to

expanding his personal and professional support system in Williamsburg.” Id.

At the evidentiary hearing, Dr. Murphy elaborated on the psychological tests and

risk assessment tools that she utilized to evaluate Mr. Hinckley’s risk of dangerousness. She

relied in part on the results of two psychological tests: the Wechsler Abbreviated Scale of

Intelligence (“WASI”) and the Minnesota Multiphasic Personality Inventory, Second Edition

(“MMPI-2”). While not directly related to violence, she testified, these instruments are useful

because they measure general personality traits and emotional functioning.

Among the most significant results of these tests, Mr. Hinckley’s profile pattern

on the MMPI-2 remained consistent with previous administrations of the test in prior years.

These results must be viewed with caution, however, as Mr. Hinckley continues to display

29

elevated scores on the so-called “K scale,” a measure of the patient’s defensiveness. This

elevated score highlights Mr. Hinckley’s “reluctance to acknowledge symptoms and problems,

with possible pathology being overshadowed by a need to present himself favorably.” Murphy

Rpt. at 47; see Transcript of Hearing at 108 (Dec. 1, 2011 p.m.). Overall, according to Dr.

Murphy, Mr. Hinckley’s MMPI-2 scores place him within a “stable codetype” characterized by

certain hallmark attributes, including “a tendency to harbor chronic hostility coupled with

marked difficultly expressing negative feelings appropriately.” Murphy Rpt. at 47. Individuals

with this profile pattern “tend to lack insight into the origins and consequences of their actions,

and do not necessarily view their behaviors as problematic when others may. They are

hypersensitive to rejection and criticism, and demand attention and approval from others.” Id.;

see also Transcript of Hearing at 17-18 (Dec. 1, 2011 p.m.). Mr. Hinckley’s score on the K scale

was marginally lower than in recent years, which, consistent with reports from other sources,

“may signal a reduction in Mr. Hinckley’s overall level of defensiveness.” Murphy’s Rpt. at 47.

In addition to discussing the results of these general psychological tests, Dr.

Murphy also administered psychological tests and other assessment measures specifically related

to the risk of violence. She described the results of her administration of the Psychopathy

Checklist – Revised (“PCLR”), a psychological test that she described as the “gold standard” for

evaluating levels of psychopathy — that is, “a personality construct that describes individuals

who are cold, callous, impulsive, hostile, have very little empathy and have antisocial lifestyles,

a strong disregard for the rights of others.” Transcript of Hearing at 22-23 (Dec. 1, 2011 p.m.).

According to Dr. Murphy, research strongly supports the validity of the PCLR in measuring

levels of psychopathy and has shown that psychopathy is “a robust predictor of violence.” Id. at

25. Mr. Hinckley’s score shows a “low level of psychopathy” not associated with high

recidivism rates, which in Dr. Murphy’s view indicates a diminished risk of violence. Id. at

30

25-26. Her scoring of Mr. Hinckley on the PCLR is identical to the score rated by Dr.

Montalbano in 1999 and nearly identical to the score rated by another evaluator in 1997. Id.

at 26. In other words, “multiple evaluators have used this tool to examine the construct of

psychopathy in the context of Mr. Hinckley’s violence risk, [and] multiple evaluators find him to

be in the low level, low range of psychopathy.” Id. at 27.

Dr. Murphy also administered a risk assessment instrument called the Violence

Risk Appraisal Guide (“VRAG”), which is “an actuarial measure used to estimate a probability

of future violence within a specified time period post-release” that “consists of twelve variables

that are mathematically weighted,” after which “a statistical analysis is performed to calculate a

risk estimate.” Transcript of Hearing at 20 (Dec. 1, 2011 p.m.); see Murphy Rpt. at 49. 7 Mr.

Hinckley’s VRAG scores placed him at a “moderate level of risk for future violence over a seven

to ten year period post-release.” Murphy Rpt. at 49. Of individuals within his moderate risk

category, “35% violently recidivated within seven years of release and 48% violently recidivated

within ten years of release.” Id. Dr. Murphy emphasized an important caveat in interpreting the

significance of these numbers: empirically, an individual’s risk of violence heightens between

late adolescence and early adulthood, while it declines after age forty. “Therefore, Mr.

Hinckley’s risk status is tempered by the fact that he was a young age at the time of the offense,

and now is middle-aged.” Id.; see Transcript of Hearing at 22 (Dec. 1, 2011 p.m.) (“[S]o over

7

An “actuarial measure” is one that takes into account “static, historical risk factors

that remain unchanged that are empirically rooted, meaning that they have been validated in the

scientific literature to be predictive of future violence.” Transcript of Hearing at 21 (Dec. 1,

2011 p.m.). In other words, an actuarial measure like the VRAG tracks and weights specific

traits of the subject that research has demonstrated are correlated with future violence. Human

judgment plays a minimal role in rating these factors, many of which are historical factors that

will never change for a particular individual — such as age at the time he or she committed an

offense. Id. In Dr. Murphy’s view, actuarial approaches “have a lot of strong scientific weight

behind them. And in the literature there’s a lot of support for them.” Id.

31

time what the research shows is that individuals who have low levels of psychopathy and are

older, usually over forty . . . show a reduction in aggression.”). 8

Finally, Dr. Murphy utilized the Historical, Clinical, and Risk Management

Violence Risk Scheme (“HCR-20”), a risk assessment instrument which she finds more reliable.

It is designed to guide an evaluation by focusing the inquiry on twenty risk factors that have been

empirically linked to violence, the relative weight of which the evaluator sets based on the

subject’s individual case history. See Transcript of Hearing at 29 (Dec. 1, 2011 p.m.); Murphy

Rpt. at 50-53. 9 Applying historical factors to Mr. Hinckley, for instance, Dr. Murphy’s report

emphasizes that Mr. Hinckley’s particular history of violence — a virtual absence of any

violence punctuated by one episode of severe violence — is empirically correlated with a low

risk of recidivism. Id. at 50. Dr. Murphy’s appraisal of clinical risk factors within the context of

the HCR-20 emphasizes the continued lack of evidence of delusional thinking or depression

rising to the threshold of an Axis I disorder, as well as improvement in Mr. Hinckley’s ability to

cope with disappointment and relationship difficulties, his disclosure and openness with family

members and treatment providers, and his judgment and decision-making capacity. Murphy Rpt.

at 52-53. While noting recurrent signs of narcissism, particularly in the form of a sense of

entitlement, she regards this condition as “attenuated” and cautions that some level of

8

Mr. Hinckley’s rebuttal expert witness, Dr. Paul Montalbano, also noted that in

the original research underlying the VRAG a subject’s ability to reoffend began when the subject

was on an open ward, and “in this particular case that Mr. Hinckley has had an opportunity to re-

offend for well over seven or ten years.” Transcript of Hearing at 94 (Feb. 7, 2012 p.m.).

9

The HCR-20, Dr. Murphy explained, is an example of a “structured professional

judgment” tool that, like an actuarial measure, involves consideration of historical risk factors

that research has linked to violence. But unlike actuarial measures, the HCR-20 also

incorporates “dynamic factors, factors that are changeable and can fluctuate over time,” allowing

consideration of the subject’s current “clinical risk picture.” Transcript of Hearing at 21 (Dec. 1,

2011 p.m.). Compared with actuarial tools, the HCR-20 more directly relies on the professional

judgment of the evaluator in weighing the risk factors.

32

maladaptive thinking and behavior persists across the lifespan of an individual with a personality

disorder, regardless of treatment efforts. “Nevertheless, Mr. Hinckley has remained behaviorally

stable, showed acceptance of his circumstances and handled rejection and loss well.” Id. at 52.

Overall, Dr. Murphy acknowledges that while Mr. Hinckley’s depression is in full

remission, depression is a risk factor for Mr. Hinckley, see Transcript of Hearing at 68 (Dec. 1,

2011 p.m.), and that Mr. Hinckley’s risk of violence “would be heightened by a significant and

dramatic increase in depression, particularly in tandem with psychotic symptoms.” Murphy Rpt.

at 51. And she advises that “increases in freedom should be broken down into subcomponents

that are easily digestible for Mr. Hinckley in the form of realistic and attainable objectives.” Id.

at 54.

When questioned about Mr. Hinckley’s risk factors, Dr. Murphy testified that

deception has not been identified empirically as a risk factor for violence, but that it has been

identified as an individualized risk factor for Mr. Hinckley. Transcript of Hearing at 19 (Dec. 6,

2011 p.m.). She agreed that isolation is also an individualized risk factor for Mr. Hinckley, and

she acknowledged that he has maintained a rigidly consistent routine during his Williamsburg

visits, with little branching out beyond familiar and largely solitary pursuits, resulting in a lack of

social ties in that community. Transcript of Hearing at 80-85, 88-89, 96 (Dec. 1, 2011 p.m.).

She acknowledged that Mr. Hinckley “tends to be an introverted individual” and has not

established friendships in Williamsburg. Id. at 82. She testified, however, that Mr. Hinckley has

complied with “the big therapeutic endeavors” and that he has followed through with “the critical

activities that both treatment teams put a lot of weight on.” Id. at 89. More time in

Williamsburg, she opined, would lend itself to more opportunities to meet people and engage in

social groups. Transcript of Hearing at 7 (Dec. 6, 2011 p.m.). Dr. Murphy testified to being

“very confident” in her opinion, to a reasonable degree of psychological certainty, that

33

Mr. Hinckley will present a low risk of danger to himself or others under the conditional release

terms proposed by the Hospital. Transcript of Hearing at 14 (Dec. 1, 2011 p.m.).

2. Witnesses from Mr. Hinckley’s Williamsburg Treatment Team

Dr. Deborah Giorgi-Guarnieri, who took over as Mr. Hinckley’s Williamsburg-

area psychiatrist in 2010, testified about her treatment of Mr. Hinckley and her views on the

Hospital’s proposal. Dr. Giorgi-Guarnieri, who is in private practice, possesses an extensive

background in both general and forensic psychiatry and is board-certified in both areas. Her past

work has included positions as the director of forensic psychiatry for the Medical College of

Virginia in Williamsburg, the consulting forensic psychiatrist for the Eastern District of

Connecticut, and assistant professor of psychiatry and associate director of forensic psychiatry

residency at Yale University Medical School. Transcript of Hearing at 18-20 (Dec. 5, 2011

a.m.). She treats patients with diagnoses similar to Mr. Hinckley’s, and she is trained to

recognize signs and symptoms of psychosis and major depression. Id. at 55.

Dr. Giorgi-Guarnieri explained the distinction between her role as Mr.

Hinckley’s psychiatrist and the roles of Mr. Beffa as the individual therapist and case manager.

Mr. Beffa provides Mr. Hinckley’s therapy and, as case manager, has been responsible for the

“leg work” necessary to set up and maintain Mr. Hinckley’s support system in Williamsburg. In

contrast, Dr. Giorgi-Guarnieri primarily manages Mr. Hinckley’s medications and monitors him

during evaluation sessions “to make sure there are no symptoms reemerging, and to make sure

that the risk factors that might cause symptoms to reemerge are not present.” Transcript of

Hearing at 40 (Dec. 6, 2011 a.m.). She is aided in the latter endeavor by her background in

forensic psychiatry, where the psychiatrist has “an expanded role” that involves “constantly

assessing risk.” Id. at 40.

34

Currently, Dr. Giorgi-Guarnieri meets with Mr. Hinckley at least once during

each of his 10-day visits to Williamsburg, and, at the time of her testimony at the evidentiary

hearing, she had seen him for about ten sessions. Transcript of Hearing at 27, 84 (Dec. 5, 2011

a.m.). During each session they discuss his progress at the Hospital and in the Williamsburg

community, including discussions for screening purposes of individuals he has been talking with

and his relationships with women. Id. at 29. Dr. Giorgi-Guarnieri also proceeds through a

checklist of risk factors, using her observations of Mr. Hinckley and his responses to her

questions to determine whether and to what degree any of these risk factors is present. Id. at

52-53; see Patient’s Exhibit No. 16 (checklist of risk factors). In Dr. Giorgi-Guarnieri’s view,

weekly visits with Mr. Hinckley are enough to allow her to observe any signs of major

depression or psychosis — “maybe more than enough.” Transcript of Hearing at 55 (Dec. 5,

2011 a.m.). If she were to observe any such signs, she would report them to the treatment team

and could, if necessary, have Mr. Hinckley admitted to a hospital until he could be transferred

back to St. Elizabeths.

Dr. Giorgi-Guarnieri expressed the same understanding about the function and

effect of Mr. Hinckley’s medications as was conveyed by Dr. Jones. If Mr. Hinckley were to

stop taking Zoloft, Dr. Giorgi-Guarnieri testified, he might experience “rebound anxiety or

depression” that would be observable within days. With Risperdal, by contrast, symptoms of

stopping the medication might not be apparent unless his psychosis were to reemerge. Transcript

of Hearing at 58-59 (Dec. 5, 2011 a.m.).

During the time that she has worked with Mr. Hinckley, Dr. Giorgi-Guarnieri

reports, his thoughts have remained “realistic” and “hopeful,” and he has been resilient in the

face of disappointments, such as his rejection from an art class in which he had hoped to

participate. Transcript of Hearing at 54 (Dec. 5, 2011 a.m.). She has observed no signs of

35

decompensation or any symptoms of an Axis I disorder. Although she has observed “traits” of a

narcissistic personality disorder, she reports that Mr. Hinckley “has worked very hard . . . not to

let it affect the way he is functioning.” Id. at 55.

Based on her experience working with Mr. Hinckley, Dr. Giorgi-Guarnieri

believes that the gradual transition proposed by the Hospital from two conditional releases of 17

days to at least six releases of 24 days, followed by convalescent leave, is appropriate.

Transcript of Hearing at 61 (Dec. 5, 2011 a.m.). She expects that increased time in Williamsburg

will open up additional social opportunities for Mr. Hinckley — citing, for instance, community

recreational group activities that meet weekly and that are not open to someone who is in town

no more than one week a month. In her view, for Mr. Hinckley to truly establish himself in the

community in Williamsburg, it is important to “flip” the time that he spends in Williamsburg vis-

à-vis Washington, D.C., so that his job, therapy groups, and social events are all in

Williamsburg, “and he just visits the hospital for a check in.” Id. at 65. Dr. Giorgi-Guarnieri

further expressed the view that it is “important to switch now,” and she agreed that to facilitate

his involvement in local activities his time in Williamsburg should be regularly scheduled. Id. at

64-66, 95.

Dr. Giorgi-Guarnieri does not believe that under the Hospital’s proposal Mr.

Hinckley will become clinically isolated. Transcript of Hearing at 63-64, 66-67 (Dec. 5, 2011

a.m.). She acknowledged that, other than with the possible exceptions of a neighbor and a

coworker at Eastern State Hospital, Mr. Hinckley has not made any friends in Williamsburg, and

she suggested that it would be difficult for him to make a friend not connected to his family or

his work. Id. at 104. Dr. Giorgi-Guarnieri agreed that in the event that Mr. Hinckley’s mother

were to pass away before he had established strong community support, he might experience

isolation and stress similar to that which he faced as a young man prior to his offense. But a key

36

difference, in her view, is that Mr. Hinckley had no psychiatric care at that time. Id. at 66-67.

As someone familiar with the Williamsburg community, Dr. Giorgi-Guarnieri observed that it

can be a difficult place for a single person to move to and become established; nevertheless, she

believes that Williamsburg is the right place for Mr. Hinckley right now. Id. at 79-80.

The Court also heard testimony from Mr. Hinckley’s case manager and individual

therapist in Williamsburg, Mr. Carl Beffa, a clinical social worker in private practice. Transcript

of Hearing at 5-6 (Dec. 5, 2011 p.m.). Mr. Beffa has treated Mr. Hinckley since 2007, and he

meets with Mr. Hinckley twice during each visit to Williamsburg, once for therapy and once for

case management, a role that includes assisting Mr. Hinckley in forming connections with the

community and facilitating his socialization and vocational integration. Id. at 10-11, 25-26.

Like Dr. Giorgi-Guarnieri, Mr. Beffa testified that Mr. Hinckley has maintained a

positive attitude during the course of his Williamsburg releases, has shown resilience in the face

of disappointments, and has exhibited no signs of decompensation or any symptoms of an Axis I

disorder. Transcript of Hearing at 24 (Dec. 5, 2011 p.m.). Mr. Beffa has observed “appropriate”

mood changes on the part of Mr. Hinckley in response to sad events, such as the death of his

father, but he has seen no evidence of distorted thinking. Id. at 25. He agrees that an important

factor behind the resilience Mr. Hinckley has demonstrated is the support provided to him by a

variety of therapists and clinicians at St. Elizabeths, but he also believes that the structure

envisioned for Mr. Hinckley in Williamsburg will provide the necessary therapeutic support —

though he acknowledged that some of this support, such as the encouragement of a supportive

supervisor at his volunteer position, will not involve “the same in-depth quality” as what he

receives at St. Elizabeths. Id. at 67-68, 69. Mr. Beffa shares Dr. Giorgi-Guarnieri’s belief that

Mr. Hinckley will not likely become clinically isolated in Williamsburg. Id. at 48.

37

Mr. Beffa supports the Hospital’s proposal to increase the duration of Mr.

Hinckley’s visits. He envisions the 17-day visits as a transition period allowing Mr. Hinckley to

prepare for the longer 24-day visits, while also serving as a “test” for those longer visits.

Transcript of Hearing at 35 (Dec. 5, 2011 p.m.). Mr. Beffa recommends that the 17- and 24-day

visits occur on a predictable monthly basis, to facilitate employment as well as participation in

therapeutic groups, where it is important to have consistency to develop the therapeutic

relationship. Id. at 35-36.

Mr. Beffa was questioned at length about the efforts Mr. Hinckley has made to

integrate into the Williamsburg community and about his own attempts, as Mr. Hinckley’s case

manager, to facilitate the transition. He discussed Mr. Hinckley’s volunteer work at the Eastern

State Hospital library, reporting that Mr. Hinckley’s supervisor has been extremely enthusiastic

about his work. Transcript of Hearing at 29-30 (Dec. 5, 2011 p.m.). Mr. Beffa emphasized that

in order for Mr. Hinckley to expand his social and vocational opportunities, he would need to be

regularly available in Williamsburg for longer periods of time. Id. at 34. For instance, Mr. Beffa

recounted discussions with the manager of a pet store who had expressed openness to hiring Mr.

Hinckley for a part-time job. In order to apply, however, Mr. Hinckley would need to be in

Williamsburg on a predictable schedule. So too with veterinary clinics that Mr. Beffa

investigated. Id. at 33-34. Likewise, Mr. Beffa discussed local music groups, classes at a

community college, and meetings organized by the National Alliance on Mental Illness that

could present valuable opportunities for Mr. Hinckley — emphasizing that Mr. Hinckley would

need longer periods of unaccompanied time in the community and the freedom to drive alone to

these activities, in order to alleviate the burden of having his mother transport him. Id. at 48.

On cross examination, Mr. Beffa was pressed about Mr. Hinckley’s failure thus

far to make any substantial social connections in Williamsburg, and about whether this failure is

38

attributable more to a lack of initiative than a shortage of time spent in the community. Mr.

Beffa acknowledged that Mr. Hinckley has not pursued a variety of suggestions made by Mr.

Beffa to increase his socialization. Transcript of Hearing at 71-76 (Dec. 5, 2011 p.m.). For

instance, Mr. Beffa suggested that Mr. Hinckley attend a men’s breakfast at his mother’s church,

but Mr. Hinckley did not take the suggestion. Id. at 71-72. Mr. Beffa suggested that Mr.

Hinckley, who enjoys painting landscapes, set up his materials and paint in one of several

outdoor park locations that Mr. Beffa showed him, but this suggestion also went unheeded. Id. at

73-74. Although Mr. Hinckley made contact with a locally based musician from whom he was

interested in taking guitar lessons, that musician subsequently moved away from the

Williamsburg area, and when he later moved back Mr. Hinckley did not take Mr. Beffa’s

suggestion to reestablish contact with him. Id. at 26, 77, 79. In terms of vocational integration,

Mr. Beffa testified that although Mr. Hinckley did pursue volunteer opportunities at Eastern

State Hospital, he has not followed up on any of Mr. Beffa’s other suggestions with respect to

employment. Id. at 95. For instance, Mr. Beffa twice suggested to Mr. Hinckley that he

introduce himself to the pet store manager who had expressed interest in hiring him, to no avail.

Transcript of Hearing at 93 (Dec. 5, 2011 p.m.). Mr. Beffa could not think of a single activity

that Mr. Hinckley had attempted since the last Court hearing to demonstrate his effort to

integrate himself into the Williamsburg community. Id. at 77-78.

Mr. Beffa also admitted to experiencing difficulties securing a volunteer or paid

position for Mr. Hinckley in Williamsburg, and acknowledged instances in which Mr. Hinckley

was rejected from consideration for such positions based on his identity. Transcript of Hearing

at 87-89 (Dec. 5, 2011 p.m.). He agreed that Mr. Hinckley has met resistance from some

quarters of the Williamsburg community, and that he has been working at Eastern State Hospital

because Mr. Beffa was unsuccessful in finding volunteer work elsewhere. Id. at 89, 92.

39

In addition to the discussion about his case management efforts, Mr. Beffa also

came under scrutiny in his role as a therapist, specifically regarding his effectiveness in

monitoring Mr. Hinckley’s risk of dangerousness. Particular focus was paid by the government

on whether Mr. Beffa’s style of therapeutic interaction — largely driven by the patient’s choice

of which topics to discuss rather than probing questions from the therapist — truly keeps him

apprised of Mr. Hinckley’s thoughts and actions. For instance, Mr. Beffa was unaware, and

surprised to learn, that in March of 2011 Mr. Hinckley indicated both to Dr. Murphy and to the

treatment team that he was engaged to a “Ms. CB.” Transcript of Hearing at 61-62 (Dec. 5, 2011

p.m.). 10 Even though he understands that relationships with women are a risk factor for Mr.

Hinckley, id. at 63-64, Mr. Beffa never directly asked Mr. Hinckley whether he had an intimate

relationship with Ms. CB, assuming that Mr. Hinckley would tell him “if he chose to.” Id. at 65.

In fact, Mr. Beffa learned this information from one of the government’s experts, Dr. Patterson.

Id. Mr. Beffa also was surprised to learn that Mr. Hinckley had told Dr. Giorgi-Guarnieri that

his interest in a female employee at Eastern State Hospital was not strictly platonic. Id. at 63.

Mr. Beffa recognizes that issues with women have been identified as one of Mr.

Hinckley’s violence risk factors, and he admitted that it would be helpful to know whether Mr.

Hinckley’s relationship with a particular woman is romantic or not, vowing to ask about such

issues in the future. Transcript of Hearing at 64 (Dec. 5, 2011 p.m.). He testified that he has

viewed his role as a therapist, thus far, as “primarily to establish an ongoing supportive

relationship, and not to be involved in in-depth issues. Because in the 45 minutes, it’s not only

discussing various women’s relationships that he has been involved with, but also in terms of

what else is happening in his life every day at the hospital.” Id. at 63-64.

10

For privacy reasons, full names of Mr. Hinckley’s female acquaintances are not

included in this Opinion.

40

Mr. Beffa also was questioned about his role in independent monitoring of

Mr. Hinckley’s conduct in Williamsburg. Mr. Beffa acknowledged that, as Mr. Hinckley’s case

manager, it is important for him to know whether Mr. Hinckley is following the itineraries for his

conditional release visits, but he also admitted that he does not always ask Mr. Hinckley if he is

complying with the items on his itinerary, promising to do so in the future. Transcript of

Hearing at 82-83 (Dec. 5, 2011 p.m.). Until it was reported by the Secret Service, Mr. Beffa was

not aware that Mr. Hinckley deviated from his itineraries twice in 2011 by failing to attend a

movie and instead visiting a nearby bookstore — nor that Mr. Hinckley later lied to St.

Elizabeths staff and others about this. Id. at 81, 103. (These incidents are discussed below. See

infra at 47, 51-52, 53-58, 85-88.) Mr. Beffa’s testimony revealed that he depends entirely on Mr.

Hinckley’s self-reporting about where he has been and what he has been doing during his

unsupervised free time in the community. Transcript of Hearing at 84, 114-15 (Dec. 5, 2011

p.m.).

3. Witnesses from the Hinckley Family

Mr. Hinckley’s brother and sister, Scott Hinckley and Diane Sims, at least one of

whom has visited Williamsburg during nearly all of Mr. Hinckley’s conditional releases since the

last Court hearing, testified that his mood has improved as a result of these visits and that the

siblings have grown closer. Both reported that Mr. Hinckley is helpful around the family home,

doing chores and housework such as preparing meals. Both testified that they have never

witnessed any behavior during these visits indicating that Mr. Hinckley might be a danger to

himself or others. Neither sibling has any reservations about Mr. Hinckley being given more

unsupervised time in the Williamsburg community or the ability to drive unaccompanied. To the

contrary, they stressed that it would be useful for him to be able to drive himself to his

41

therapeutic appointments and volunteer positions, and that expanded driving privileges would

also increase his opportunities for activities that promote social integration. Nor do Mr.

Hinckley’s siblings have any concerns about their mother’s ability to continue to serve as a

custodian for Mr. Hinckley. The siblings emphasized that they could come to Williamsburg on

short notice in the event of an emergency and that, should their mother pass away, the siblings

could spend more time in Williamsburg to provide support for Mr. Hinckley and, with the

assistance of his treatment providers, help him transition to a new living situation. Transcript of

Hearing at 19-20, 28, 35-39, 57 (Dec. 6, 2011 a.m.) (Diane Sims); Transcript of Hearing at 28,

33-35 (Dec. 6, 2011 p.m.) (Scott Hinckley).

Diane Sims testified that despite certain rejections Mr. Hinckley has experienced

in Williamsburg, such as not being allowed to participate in a social group and in an art class, she

regards the community as welcoming and tolerant. She reported that the family is treated well

when they appear in public at restaurants or stores, and that she has never observed any incidents

of anyone bothering Mr. Hinckley. She feels that Mr. Hinckley already is integrated in

Williamsburg “to a certain extent”: he is happy working at Eastern State Hospital; he is familiar

and comfortable with the town; and he has a high degree of respect for Mr. Beffa and Dr. Giorgi-

Guarnieri. Ms. Sims noted that her brother’s current restrictions, which require his mother to

accompany him for much of his time in public, make it difficult for him to socialize, though she

acknowledged he is free to do things like go to the gym or take a golf lesson within his mother’s

subdivision but has chosen not to do so. Transcript of Hearing at 41-42, 56-57 (Dec. 6, 2011

a.m.).

Scott Hinckley testified that Mr. Hinckley is enthusiastic about his work at

Eastern State Hospital and the positive feedback that he has received. He feels that for Mr.

Hinckley socialization comes more easily through interactions in the workplace, outside of

42

which Mr. Hinckley is generally slow to pick up friends. Based on Mr. Hinckley’s experiences

in Williamsburg, including the support he receives from his local treatment providers and the

satisfaction he receives from his volunteer work, Scott Hinckley believes that at this point in time

Williamsburg is the best place for his brother to be. Transcript of Hearing at 37-39 (Dec. 6, 2011

p.m.). Scott Hinckley also indicated that Mr. Hinckley has never demonstrated any proclivity

toward or interest in violence. He did acknowledge, however, that Mr. Hinckley “does not

volunteer information” and that he could be doing more to integrate himself into the

Williamsburg community. Id. at 42, 46.

B. Witnesses for the Government

1. The Government’s Expert Witnesses

The government’s two expert witnesses, Dr. Raymond Patterson and Dr. Robert

Phillips, were in agreement with Mr. Hinckley’s treatment providers about his diagnoses, and

they both acknowledged that his Axis I disorders —major depressive disorder and psychotic

disorder not otherwise specified — have long been in full remission, with no signs of psychosis

or major clinical depression for many years. 11

The concerns about the Hospital’s proposal expressed by Dr. Patterson and

Dr. Phillips fall into five general categories: (1) Mr. Hinckley may not exhibit signs of

underlying mental or emotional disturbance because of his secretive nature and his narcissistic

tendencies, and so the outward indications of his present stability must be viewed with caution;

11

At the time of the original evidentiary hearing, Dr. Phillips diagnosed Mr.

Hinckley’s major depressive disorder as “mild,” rather than in full remission, although he

acknowledged on cross examination that Mr. Hinckley did not meet the criteria for that diagnosis

under the DSM-IV but only under a proposed change (one ultimately never adopted) for the

soon-to-be-issued DSM-V. By the time of the supplemental evidentiary hearing, Dr. Phillips had

changed this diagnosis back to “in full remission,” consistent with that of the other experts and

his own testimony at prior hearings in this case.

43

(2) Mr. Hinckley’s continued deceptiveness calls into question whether his risk of dangerousness

can be adequately managed by any proposal that relies on his own honesty in self-reporting

about his conduct and his intentions; (3) Mr. Hinckley has not used his Phase IV visits to

meaningfully integrate himself into the Williamsburg community, calling into question why

increasing his time in that community is appropriate and whether it is wise to have him spend

much of each month in a place where he lacks social connections; (4) the Hospital’s proposal

lacks the structure and oversight necessary to ensure that Mr. Hinckley will not become isolated

or clinically depressed, while also failing to provide for sufficient monitoring of his conduct; and

(5) Mr. Hinckley continues to exhibit poor judgment and troubling tendencies in his relationships

with women, making this aspect of his life a potentially destabilizing influence, a risk factor for

decompensating.

Dr. Raymond Patterson, who has testified at numerous prior hearings in this case,

was permitted to offer expert testimony on the diagnosis and treatment of mental illness and on

risk management evaluations. He agrees with the Hospital’s diagnosis of Mr. Hinckley and

acknowledges the lack of any overt indications of dangerousness on his part. Nevertheless, Dr.

Patterson offered a markedly different perspective on the success of Mr. Hinckley’s current visits

to Williamsburg and the wisdom of the Hospital’s plan for an expansion of his privileges.

In Dr. Patterson’s view, Mr. Hinckley’s current regime of visits to Williamsburg

has not significantly advanced its purpose of fostering meaningful integration into that

community. As Dr. Patterson sees it, Mr. Hinckley has done little or nothing to build ties to the

community beyond volunteering at Eastern State Hospital and attending his sessions with Mr.

Beffa and Dr. Giorgi-Guarnieri. Transcript of Hearing at 47-48 (Jan. 25, 2012 a.m.). Dr.

Patterson rejects the notion that Mr. Hinckley’s lack of progress toward integration is attributable

to the short duration of his visits to Williamsburg and the restrictions on his activities during

44

those visits. Instead, Dr. Patterson blames the situation on three factors: (1) an absence of

aggressive case management by Mr. Beffa, particularly a failure to arrange activities for Mr.

Hinckley and push him to participate in those activities; (2) resistance from the Williamsburg

community, which has at times rejected Mr. Hinckley from social groups, vocational

opportunities, and educational pursuits; and (3) a lack of initiative from Mr. Hinckley himself,

including a failure to make productive use of the freedom that he already enjoys by engaging in

activities that might promote his integration into the community. Accordingly, Dr. Patterson

does not agree that the remedy for Mr. Hinckley’s lack of integration is a further expansion of

the time he spends in Williamsburg and the freedom he is afforded during his visits. Id. at 39,

48; Transcript of Hearing at 41-42 (Jan. 24, 2012 a.m.); Patterson Rpt. at 75.

Dr. Patterson also disagrees with the assessment that Mr. Hinckley will represent

a low risk of dangerousness under the terms of the Hospital’s plan. That determination, as Dr.

Patterson sees it, simply cannot be made without more information about how Mr. Hinckley’s

time will be spent in Williamsburg and how he responds to those conditions. The proper clinical

endeavor, Dr. Patterson emphasized, is not one of evaluating Mr. Hinckley’s dangerousness in

isolation, but of managing his risk under specific conditions, which must be observed over time.

Transcript of Hearing at 50 (Jan. 25, 2012 p.m.).

Although Dr. Patterson agrees that Mr. Hinckley’s Axis I disorders have long

been in remission, with an important caveat discussed below, he credits this success primarily to

Mr. Hinckley’s many years at St. Elizabeths, where he has received “about the best psychiatric

care there is to offer in the public mental health system in this country.” Transcript of Hearing at

54 (Jan. 25, 2012 a.m.); see Transcript of Hearing at 84, 88, 95 (Jan. 24, 2012 a.m.). Of concern

to Dr. Patterson is the absence of a similarly comprehensive treatment regime and support

system in Williamsburg. In light of Mr. Hinckley’s case history, there are a number of risk

45

factors about which Dr. Patterson is concerned: Mr. Hinckley’s deceptiveness, his sense of

entitlement, the fact that he minimizes his own responsibility for his actions, and his

relationships with women. Transcript of Hearing at 3-8 (Jan. 25, 2012 p.m.). The risk factor that

Dr. Patterson is most concerned about in light of Mr. Hinckley’s lack of integration into the

Williamsburg community is that Mr. Hinckley may become isolated, which could lead to

depression and potentially a resurgence of his psychotic symptoms. Transcript of Hearing

at 41-42 (Jan. 25, 2012 a.m.). This risk would be magnified if Mr. Hinckley’s mother were to

pass away or otherwise become unavailable during the period of his proposed expanded visits.

Patterson Rpt. at 76.

In Dr. Patterson’s view, the Hospital’s proposal for managing these risks does not

pay adequate heed to key traits of Mr. Hinckley’s personality that could mask the signs of any

decompensation. Particularly significant is Mr. Hinckley’s guardedness — his tendency to

withhold information about his thoughts and feelings unless prodded with direct questions from

his treatment providers. The persistence of this trait undermines Dr. Patterson’s confidence that

any deterioration on Mr. Hinckley’s part would be observed by his treatment providers.

Transcript of Hearing at 60-61 (Jan. 25, 2012 a.m.). Citing Mr. Hinckley’s suicide attempt in the

early 1980s, which took his Hospital caregivers completely by surprise, Dr. Patterson observed

that his own experience with Mr. Hinckley belies the assumption that Mr. Hinckley will

necessarily exhibit outward signs of deterioration. Id. at 61. Also significant to Dr. Patterson is

Mr. Hinckley’s pattern of “deflecting” and “minimizing his own responsibilities for his own

behavior,” a trait related to his narcissism and “sense of entitlement.” Transcript of Hearing at 8

(Jan. 25, 2012 p.m.). According to Dr. Patterson, this ongoing tendency raises concern about

Mr. Hinckley’s willingness to strictly follow rules that are part of his conditional release terms,

an essential requirement of any successful risk management plan.

46

Most troubling, in Dr. Patterson’s view, is Mr. Hinckley’s demonstrated

willingness to deceive his treatment providers and the success with which he is able to do so.

This behavior was on display most recently when Mr. Hinckley told multiple interviewers,

including Dr. Patterson, that on two occasions he had gone to a movie –– consistent with what

was in his itineraries — when in fact on each occasion he had skipped the movie and spent his

time at a nearby bookstore. Transcript of Hearing at 21-22 (Jan. 25, 2012 a.m.). Even more

disturbing to Dr. Patterson is that in lying to one treatment provider about this incident, Kevin

Shamblee, Mr. Hinckley went so far as to “embellish” the lie by rating the movies as good and

recommending that Mr. Shamblee see them. Id. at 22-25 (Mr. Hinckley told same lie to

Dr. Giorgi-Guarnieri, Dr. Patterson, and Dr. Phillips, who also did not perceive that he was being

untruthful); see also supra at 28, 41. Dr. Patterson testified that unlike some people, Mr.

Hinckley is adept at telling convincing untruths, and so “[h]e tells people things and is

convincing when he tells them. . . . [Y]ou don’t know when he is lying.” Transcript of Hearing

at 25 (Jan. 25, 2012 a.m.). To Dr. Patterson, this state of affairs jeopardizes the viability of any

risk management plan that relies on Mr. Hinckley’s own honest reporting of his whereabouts and

conduct.

In light of the foregoing considerations, Dr. Patterson’s biggest objection to the

Hospital’s plan relates to the proposed expansion of Mr. Hinckley’s unsupervised free time in the

community and the absence of independent monitoring of his conduct during that time. Given

Mr. Hinckley’s lack of forthrightness and his ability to deceive his interviewers, Dr. Patterson is

troubled by the extent to which the plan relies on accurate self-reporting of his activities by

Mr. Hinckley. See Patterson Rpt. at 74. He is further troubled that while the Hospital’s proposal

significantly expands the amount of unsupervised free time available to Mr. Hinckley, it

simultaneously diminishes the ability to monitor his behavior — by proposing to replace

47

detailed, pre-approved itineraries with a list or menu of activities from which Mr. Hinckley is

free to choose on any given day and by granting him unaccompanied driving privileges. In fact,

Dr. Patterson recommends eliminating unaccompanied time entirely or restricting it to within his

mother’s neighborhood. Because Mr. Hinckley “has not used the time he has responsibly,”

increasing these hours would simply be adding “more of the same.” Transcript of Hearing at 45,

48 (Jan. 25, 2012 p.m.). Dr. Patterson also recommends against permitting Mr. Hinckley to drive

unaccompanied. Id. at 46.

Dr. Patterson also expressed significant concerns, as he has in the past, about Mr.

Beffa’s performance as an individual therapist and case manager for Mr. Hinckley. As noted,

Dr. Patterson believes that Mr. Beffa has not done enough to facilitate meaningful integration of

Mr. Hinckley into the community. Furthermore, Mr. Hinckley’s guardedness makes it crucial

that his individual therapist take an aggressive and probing approach to their sessions — which

Dr. Patterson believes that Mr. Beffa fails to do. Transcript of Hearing at 43 (Jan. 25, 2012

p.m.). Although Dr. Patterson offers high praise for Dr. Giorgi-Guarnieri’s skill as a psychiatrist,

he notes that “her role in this process would be a secondary one,” as compared with Mr. Beffa,

and that under the Hospital’s plan the frequency of her contact with Mr. Hinckley would be

reduced to one session per month (assuming, that is, that the Court authorizes visits of 24 days

per month). In Dr. Patterson’s view, weekly visits would be sufficient for Dr. Giorgi-Guarnieri

to observe signs of decompensation in Mr. Hinckley, but a shift to monthly visits “would make it

more difficult.” Transcript of Hearing at 34 (Jan. 25, 2012 a.m.).

Dr. Robert Phillips, who also has testified in several prior hearings in this case,

was permitted to offer expert testimony on the diagnosis and treatment of mental disease, on the

assessment of future risk of dangerousness by insanity acquittees and those that pose a risk to the

protectees of the Secret Service, and on the management of risk posed by insanity acquittees.

48

Dr. Phillips does not support the Hospital’s proposal, which in his opinion does not adequately

manage Mr. Hinckley’s risk of dangerousness to himself or others. Transcript of Hearing 83-84

(Jan 30, 2012 a.m.). Compared with previous (e) letters submitted by the Hospital, writes Dr.

Phillips, “this proposal is far broader than prior submissions, yet in my clinical opinion the detail

and specificity presented is customarily inadequate.” Phillips Rpt. at 76.

Dr. Phillips drew attention to possible signs of resurgent depression in Mr.

Hinckley, including weight gain and changes in demeanor. Noting that in recent years Mr.

Hinckley has articulated feelings of depression to treatment providers, he explained that in his

view, part of the reason that Mr. Hinckley remains on the antidepressant medication Zoloft is

that underlying symptoms of depression are being responsive to that treatment. Transcript of

Hearing at 6-8 (Jan. 31, 2012). While Dr. Phillips does not believe these indications should

preclude Mr. Hinckley from moving forward toward expanded freedom, he emphasized that they

need to be considered when evaluating the nature and breadth of the treatment that Mr. Hinckley

will receive in Williamsburg. Such concerns are particularly warranted, he testified, in light of

the emotional stress that will accompany Mr. Hinckley’s proposed transition to that community

— including new challenges in a different environment and the loss of established relationships

in Washington, D.C. — and in view of the fact that Mr. Hinckley has not yet integrated into the

Williamsburg community and has been rebuffed from participating in certain social, educational,

and vocational endeavors there. Id. at 7, 11. These concerns are compounded by Dr. Phillips’

assessment that Mr. Hinckley is not always “honest with his clinicians when they query him

about these things.” Id. at 6.

In Dr. Phillips’ view, the Hospital’s proposal does not set forth a framework of

therapeutic support that is comprehensive enough to address Mr. Hinckley’s risks. He is

particularly concerned that the Hospital’s proposal contemplates much less therapy and contact

49

with treatment providers than Mr. Hinckley currently experiences. Transcript of Hearing at 61

(Jan. 30, 2012 p.m.); Transcript of Hearing at 23, 59 (Jan. 31, 2012). He also echoed Dr.

Patterson’s concerns about Mr. Beffa’s performance as case manager and individual therapist,

while similarly indicating greater comfort with Dr. Giorgi-Guarnieri, whom he recommends Mr.

Hinckley see weekly.

The lack of a defined therapeutic structure is especially problematic to Dr.

Phillips because it fails to adequately manage Mr. Hinckley’s risk of isolation, a risk that is

heightened by Mr. Hinckley’s failure thus far to establish social connections in Williamsburg.

Dr. Phillips acknowledges the success Mr. Hinckley has achieved in his volunteer position and

the value of the connections he has reestablished with his family members. Yet he maintains that

Mr. Hinckley has not built meaningful ties to the Williamsburg community, or even attempted to

do so, as envisioned by his present terms of conditional release:

If we look at his conditional release outings up to now . . . I’m hard

pressed to see that he is engaged in activities that have stretched

the envelope, which is precisely what the hospital has indicated

they want him to do . . . and was the rationale for expanding his

visits to ten days. He has not done anything to increase his

socialization, which is the remedy for isolation. He basically goes

to work for his two hours, two days a week, and he comes back

and takes his walks in the community.

Transcript of Hearing at 63-64 (Jan. 30, 2012 p.m.). A failure to develop social bonds is of

special concern because in the past isolation has been a significant contributor to his dysfunction

and a “gateway” for Mr. Hinckley to a state of “dysphoria, depression, and in an extreme

psychosis.” Id. at 62-63. 12 Mr. Hinckley’s resistance to meeting people and to other endeavors

that might expand his social world therefore is troubling. Id. at 53.

12

This same lack of initiative was noted by Dr. Phillips and Dr. Patterson at the

hearing leading up to this Court’s expansion of privileges to ten days in Williamsburg in 2009.

See Hinckley VI, 625 F. Supp. 2d at 11-12, 18, 20.

50

Dr. Phillips disagrees that Mr. Hinckley’s Phase IV visits can be viewed as

successful merely because he has developed comfort being in public unaccompanied, adhering to

a work schedule, and attending his treatment appointments. Transcript of Hearing at 78-88

(Jan. 30, 2012 p.m.). While acknowledging the reasonableness of some disagreement about how

much Mr. Hinckley could have accomplished given the restrictions of his Phase IV visits, he

believes that more could have been achieved. Id.

Dr. Phillips therefore does not support expanding the length of Mr. Hinckley’s

visits at this time. Instead, he recommends that “many of the goals outlined by the 501(e)

proposal can and should be tested and accomplished within the existing time framework of the

ten-day visits currently authorized by the Court before any expansion of privilege is entertained.”

Phillips Rpt. at 76. For similar reasons, Dr. Phillips does not endorse any increases in Mr.

Hinckley’s unsupervised free time at this point, because Mr. Hinckley has not demonstrated that

he is using it to combat his isolation — as his treatment providers have encouraged him to do and

as was contemplated by the existing plan. Transcript of Hearing at 68 (Jan. 31, 2012). Only if

Mr. Hinckley shows that he is using his time in the community to work toward this goal should

he be given increased time, in Dr. Phillips’ opinion. Id. at 69.

Dr. Phillips also believes that caution is warranted in expanding Mr. Hinckley’s

unsupervised free time because of his narcissistic personality disorder, which in Dr. Phillips’

view manifests itself not only in a sense of entitlement and need for attention but also in an “I’m

going to do what I want to do” attitude that is not conducive to observing rules. Transcript of

Hearing at 19 (Jan. 31, 2012). Disagreeing with the Hospital’s witnesses, Dr. Phillips opined

that this trait heightens Mr. Hinckley’s risk of danger to himself or others, because it may lead

him to disregard expectations that have been put in place to minimize his risk. Id. at 21. As an

example, Dr. Phillips cited Mr. Hinckley’s deceit about not strictly following his itineraries on

51

two occasions by visiting a bookstore instead of attending movies. Significant to Dr. Phillips is

not only that Mr. Hinckley lied to numerous people about this, but also that his response upon

being confronted with these lies was, as Dr. Phillips characterized it, a defensive attempt to

deflect blame from his own misdeeds by accusing others of “nitpicking.” Transcript of Hearing

at 28 (Jan. 30, 2012 p.m.). As Dr. Phillips explains in his report: “There is a reason to expect

strict adherence to the conditions of release from insanity acquittees who are attempting

community transition. Among those reasons is to allow for an opportunity to demonstrate the

ability to perform appropriately and the capacity to comply with predefined mutually identified

expectations.” Phillips Rpt. at 77.

Mr. Hinckley’s prevarication about his whereabouts on two occasions highlights

another area in which Dr. Phillips believes that the Hospital’s proposal falls short: the

management of Mr. Hinckley’s deception. The Hospital’s plan, in Dr. Phillips’ view, relies

excessively on Mr. Hinckley’s self-reports and the corroborative reports of his family members.

Transcript of Hearing at 61-62 (Jan. 31, 2012). Based in part on the two incidents involving the

movies, Dr. Phillips testified that “there needs to be some other mechanism put in place other

than self-report to determine compliance with his itineraries.” Id. at 67. As an example, Dr.

Phillips suggested requiring random spot checks by Mr. Hinckley’s case manager to ensure that

Mr. Hinckley is where he is supposed to be. Id. Without clinical structures in place to

adequately monitor Mr. Hinckley’s unsupervised endeavors, and “because of his demonstrated

lack of candor, misrepresentation of the truth, and cavalier attitude as to the significance of his

actions,” Dr. Phillips “do[es] not believe that adequate risk management oversight currently

exists to support a further expansion of Mr. Hinckley’s privileges as requested at this time.”

Phillips Rpt. at 76-77.

52

By contrast, Dr. Phillips does support the Hospital’s recommendation to permit

Mr. Hinckley to drive the family car unaccompanied, but only upon review and confirmation that

Mr. Hinckley has developed a record of responsible driving thus far and contingent upon an

incremental expansion of his community activities. Phillips Rpt. at 77. And Dr. Phillips

acknowledged that in the dozen years during which Mr. Hinckley has been participating in

conditional releases, he has never engaged in any violent activity nor done anything on any

release that would indicate that he has been a danger to himself or others. Transcript of Hearing

at 106 (Jan. 31, 2012).

2. The Government’s Other Witnesses

a. Secret Service Agents

During the course of 2011, special agents from the United States Secret Service

engaged in surveillance of Mr. Hinckley while he made use of his unsupervised free time in

Williamsburg. Two of the agency’s surveillance reports, which describe Mr. Hinckley’s trips to

a bookstore that he frequents, note instances in which Mr. Hinckley was observed briefly

standing in front of a bookcase containing books on President Reagan and presidential

assassinations, among other topics, though the surveillance reports indicate that Mr. Hinckley did

not touch, pick up or read any of these books. The government brought these reports to the

attention of the Court during the evidentiary hearing and cited them as troubling evidence of Mr.

Hinckley’s continued interests. Two of the Secret Service agents who observed Mr. Hinckley

and prepared these surveillance reports were called to testify about the two episodes. 13

13

One of these incidents occurred on July 24, 2011, the same day Mr. Hinckley

failed to attend a movie as contemplated by his itinerary, and later lied about it to Mr. Shamblee

and others. The other incident occurred on October 16, 2011, when Mr. Hinckley did attend a

movie, consistent with his itinerary, but also visited the Barnes & Noble bookstore.

53

Special Agent Anthony Bordeaux testified about surveillance that he conducted of

Mr. Hinckley on July 24, 2011. During the surveillance, Agent Bordeaux took contemporaneous

notes on his Blackberry device, then later compiled a surveillance report based on these notes.

Transcript of Hearing at 113 (Jan. 23, 2012 p.m.); see Patient’s Ex. 25. On that day, Agent

Bordeaux, who had conducted surveillance of Mr. Hinckley many times, established surveillance

with another agent at the shopping center where, according to Mr. Hinckley’s itinerary for that

day, he would be arriving to attend a movie. Transcript of Hearing at 70-71, 86 (Jan. 23, 2012

p.m.). The agents first observed Mr. Hinckley around 1:30 p.m., approaching the movie theater.

Mr. Hinckley “walked up to the ticket window and spoke with an employee at the movie theater

but did not buy a ticket at that time.” Id. at 73. Agent Bordeaux could not hear the conversation

and does not know what was discussed. Id. at 97. Mr. Hinckley then left through the front of the

movie theater and walked to the bookstore in the same shopping center, with the agents

following him inside. Id. at 73. Agent Bordeaux’s surveillance report describes the ensuing

events as follows:

Inside the bookstore the subject was observed stopping and

looking at bookshelves in several different sections to include

Bargain Books about American History, True Crime, American

History [sic]. In these areas the subject was not observed picking

up and looking at any specific books. One item of note is the

subject stopped for a time and looked at the shelves in the

American History area that contain several books about President

Reagan and his attempted assassination.

Patient’s Ex. 9 at 1; see Transcript of Hearing at 99-100 (Jan. 23, 2012 p.m.).

At the evidentiary hearing, Agent Bordeaux elaborated on this portion of the

surveillance report. As he explained, it was a “large bookstore,” and Mr. Hinckley “perused

different aisles in the bookstore, just walking, as anyone would, browsing at books.” Transcript

of Hearing at 74 (Jan. 23, 2012 p.m.). “There came a time when Mr. Hinckley stopped at one

54

particular section in the American history area at one particular bookcase and dwelled there

longer than he had at any other time when he was perusing the shelves. And it drew my attention

. . . to him.” Id. at 74. At the time that Mr. Hinckley stood in front of this bookcase, Agent

Bordeaux was standing about ten to twelve feet away, behind Mr. Hinckley and to his left, so

that he was “looking at his back and a little bit of the left side of his body.” Id. at 76. The agent

did not make note of exactly how long Mr. Hinckley stood in front of the bookcase. Id. at 103.

There were many other books on the shelves besides the books on President Reagan and

assassinations, and Agent Bordeaux could not tell if Mr. Hinckley was focused on any book in

particular. Id. at 77-78, 100-101, 123. As indicated in the surveillance report, Mr. Hinckley did

not pick up any books from the shelves or touch any books. Id. at 77, 99; see id. at 100 (“I said

he looked at shelves. I didn’t say he looked at several books.”).

As soon as Mr. Hinckley left the vicinity of the bookcase, and while the other

agent kept Mr. Hinckley under surveillance, Agent Bordeaux walked to the area where Mr.

Hinckley had been standing and looked at the bookcase. Transcript of Hearing at 75-77 (Jan. 23,

2012 p.m.). He then used a camera phone “to take a quick video of books that were on the

bookshelf that I had seen him standing in front of.” Id. at 78. Government’s Exhibit 5B, a still

photo captured from this video, shows the middle three shelves on the bookcase. While these

were the shelves that Mr. Hinckley seemed to focus on, according to Agent Bordeaux, the agent

also testified that another reason he chose to create a still shot of these particular shelves was that

“obviously, there were books that I felt applied directly to what we were there for.” Id. at 83,

121-22.

After Mr. Hinckley left the bookcase, he went to other sections in the store, and

lingered for 30 more minutes, looking at other book sections as wells as music CDs and fitness

DVDs, according to Agent Bordeaux. Transcript of Hearing at 79, 106 (Jan. 23, 2012 p.m.). As

55

the agent noted in his surveillance report: “During his time in the bookstore, the subject browsed

the magazine section and was observed looking at various magazines referencing art and

literature. . . . The subject was also observed looking at rock music CD’s and one book in

particular, The British Invasion: The Music, the Times, the Era, by Barry Miles.” Patient’s Ex. 9

at 1; see also Transcript of Hearing at 107 (Jan. 23, 2012 p.m.). Mr. Hinckley also purchased a

greeting card. Transcript of Hearing at 80 (Jan. 23, 2012 p.m.). He then left the bookstore,

“walked towards the movie theater, sat on a bench which is in the courtyard area out in front of

the movie theater, and appeared to fill out the greeting card.” Id. at 80. After that, he “walked

into the lobby of the movie theater and waited inside of the glass doors. And his mother arrived

shortly thereafter, and he left in her vehicle.” Id. at 81. Mr. Hinckley’s mother arrived at 2:30

p.m., just over an hour after the agents first observed Mr. Hinckley. Id. Agent Bordeaux

acknowledged that the weather was hot that day — it was late July — and affirmed that the

movie theater lobby was air conditioned, agreeing with Mr. Hinckley’s counsel that it would

make sense to wait inside the air-conditioned lobby rather than outside in the heat. Id. at 111.

Special Agent Jason Clickner testified about surveillance that he conducted of Mr.

Hinckley on October 16, 2011. Agent Clickner similarly took contemporaneous notes that he

later incorporated into a surveillance memorandum. Transcript of Hearing at 25 (Jan. 23, 2012

a.m.). On that day in October, Mr. Hinckley was scheduled to attend a movie at 1:30 p.m. in the

same shopping center, but Agent Clickner and his partner arrived early to familiarize themselves

with the area and surrounding buildings. Id. at 10, 32. Just after 1:00 p.m., Agent Clickner was

inside the nearby bookstore when he observed Mr. Hinckley enter the store and walk directly

into his line of sight. Id. at 14, 32-33. The agent noted in his surveillance report:

The Subject was observed near the section of “world history” and

“new history.” When the Subject approached the area designated

as “new history,” he appeared to be focused on the center row of

56

books of the five row book shelf. The Subject appeared to be

momentarily fixated on the middle of the third row of books.

Patient’s Ex. 22 at 1; see Transcript of Hearing at 14 (Jan. 23, 2012 a.m.). Agent Clickner was

about ten feet away from Mr. Hinckley at the time, looking at his right side profile. Transcript of

Hearing at 15 (Jan. 23, 2012 a.m.). Mr. Hinckley did not touch or pick up any of the books. Id.

at 15, 48, 57.

Agent Clickner testified that although Mr. Hinckley clearly was looking toward

the center of the bookcase, he could not see whether Mr. Hinckley was focused on any particular

book, or even a particular shelf. Transcript of Hearing at 15-16, 47-48, 58 (Jan. 23, 2012 a.m.).

In the agent’s estimation, Mr. Hinckley stood in front of the bookcase for 15 to 20 seconds,

before continuing down the aisle of books. At the time, Agent Clickner did not know what was

on the bookshelves that he observed Mr. Hinckley standing in front of, but the agent testified that

“the manner in which he seemed to be locked on that center shelf . . . grabbed my attention,”

prompting him to later investigate what was on those bookshelves. Id. at 16, 20, 46.

Mr. Hinckley spent 30 more minutes in the bookstore, including some time spent

“looking at a display of Beatles books.” Patient’s Ex. 22 at 1. He ultimately purchased “a book

about Elvis Presley and a book about Bob Dylan.” Id.; Transcript of Hearing at 17 (Jan. 23,

2012 a.m.). After leaving the bookstore, Mr. Hinckley went to the movie theater, purchased a

ticket, and went inside to see the movie Moneyball. Transcript of Hearing at 58-59 (Jan. 23,

2012 a.m.).

After a few minutes passed, Agent Clickner returned to the bookstore, wrote

down the titles of the books on the middle shelf, and used a camera phone to photograph the

books that were on the bookcase, because he was “somewhat concerned based on the material”

of the books on the middle shelf. Transcript of Hearing at 17-18 (Jan. 23, 2012 a.m.); see

57

Patient’s Ex. 22. Government Exhibits 7A and 7B are two of the photographs that he took,

showing the middle three shelves on the bookcase. Transcript of Hearing at 21, 62 (Jan. 23,

2012 a.m.). Among the books on the middle shelf was one about the assassination of President

McKinley in 1901 and one about the assassination of President Kennedy. Id. at 48-58. The

agent acknowledged that many of the books, even on the middle bookshelf, presented no cause

for concern. Id. at 48.

The potential significance of the observations made by Agent Bordeaux and

Agent Clickner is discussed later in this Opinion. See infra at 93-96.

b. Bookstore Employee

The government also called as a witness an employee of the bookstore that Mr.

Hinckley patronizes, Mr. Richard Rolfes, who testified about a 2011 encounter with a customer

whom Rolfes later identified as Mr. Hinckley.

Mr. Rolfes began working as a customer service representative at a Barnes &

Noble bookstore in Williamsburg in early June 2011, shortly after his graduation from college.

Transcript of Hearing at 5 (Jan. 23, 2012 p.m.). While he was at work in early December 2011

— a few days after the opening statements in the evidentiary hearing in this case — a manager

related to him that she had heard on the radio that John Hinckley shopped at their bookstore. Mr.

Rolfes’ manager also told him that the news report “said that [Mr. Hinckley] had been looking

for books on the subject of Presidential assassinations.” Id. at 9, 33, 43. 14 Upon hearing this,

14

This inaccurate radio report, also widely reported in newspapers in the

Williamsburg area and elsewhere, apparently was based on the inaccurate statements made by

the government in its opening statement in this case on November 30, 2011, statements that were

not supported by the Secret Service agents’ reports or their subsequent testimony discussed

above. See Transcript of Hearing at 56-66 (Dec. 1, 2011 a.m.) (discussion of basis for

government’s opening statement); Transcript of Hearing at 3-13 (Dec. 5, 2011 a.m.) (same). As

the Court noted after first seeing Patient’s Exhibit 9, Agent Bordeaux’s report of the July 24,

58

Mr. Rolfes testified, he immediately recalled a conversation he had several months earlier with a

customer who had asked about books on presidential assassinations. That conversation, for

reasons described below, had “stuck out” in Mr. Rolfes’ mind, and he wondered if Mr. Hinckley

had been the customer whom he had assisted. Mr. Rolfes testified: “So I went on the computer,

went to the Wikipedia page and saw a picture and was like, I think that was the guy.” Id. at 9.

The photograph he saw was from Mr. Hinckley’s 1981 arrest. Id. at 34-35. Mr. Rolfes then told

his manager about the encounter and his belief that the customer was Mr. Hinckley. Id. at 12.

About two days later, Mr. Rolfes was approached at work by a manager who told

him that two agents from the Secret Service wished to speak with him. The agents showed him

two photographs of Mr. Hinckley and asked if he had ever helped the person in the photographs.

Mr. Rolfes told them that he had. After this meeting, a government prosecutor and another

Secret Service agent contacted Mr. Rolfes by telephone, and in short order he was subpoenaed

by the government to appear to testify at the evidentiary hearing before this Court. Transcript of

Hearing at 6, 13-14 (Jan. 23, 2012 p.m.).

Mr. Rolfes testified that sometime in late summer or early fall, he saw a customer

in the store’s history section and offered to provide assistance. The customer asked him “if there

were any new books about the Kennedy assassination.” Transcript of Hearing at 6-7 (Jan. 23,

2012 p.m.). The two men were standing next to a bookshelf containing just such a book,

Betrayal in Dallas, to which Mr. Rolfes directed the customer’s attention. According to Mr.

Rolfes, the customer then “asked about books generally on the topic of Presidential

assassinations.” Id. at 7. Mr. Rolfes explained that any such books would be in the same section

2011 incident “says nothing about McKinley, it says nothing about Kennedy, and it doesn’t even

say that he looked at books about President Reagan and his attempted assassination. It says only

that he looked at shelves in the American History area and that the shelves in the American

History area contain books about President Reagan and his attempted assassination.” Transcript

of Hearing at 9 (Dec. 5, 2011 a.m.).

59

where they were standing, and that he could help locate anything specific that the customer had

in mind. The customer asked no further questions, and the conversation ended. Mr. Rolfes then

proceeded to a different part of the store and did not see the customer again. Id. at 8.

When asked why this particular conversation stood out in his memory, even

though it occurred several months before he heard about John Hinckley, Mr. Rolfes responded

that the topic of presidential assassinations was a “taboo subject” about which it was rare to

receive questions. Transcript of Hearing at 18-19 (Jan. 23, 2012 p.m.); see id. at 28. “Usually

when people ask for that subject [presidential assassinations] they are asking for a particular

book or . . . seem to be a little wary of asking . . . whereas this customer just kind of threw it out

there . . . he just seemed not so shy about asking that question.” Id. at 18. While other customers

have asked for books on the assassinations of specific presidents, Mr. Rolfes said this was the

only customer whom he had ever encountered who asked for books about presidential

assassinations generally. Id. at 28. Mr. Rolfes also noted the customer’s very “neutral,

detached,” and “kind of odd” demeanor. “Physically it made me very uncomfortable . . . . The

customer didn’t seem very engaged, even though he was asking me questions . . . . [He] seemed

very detached from the conversation we were having.” Id. at 19. The customer also stood

unusually close to him, making Mr. Rolfes feel “very uncomfortable.” Id. After that day, Mr.

Rolfes testified, he would recall the encounter every time he passed the section of the bookstore

where the two men had been standing or saw a particular book they had discussed. As he

explained: “It stuck in my mind. It’s definitely a unique feeling I got from helping that customer

that was different from helping any other customer.” Id. at 20.

Cross examination revealed considerable uncertainty in Mr. Rolfes’ recollection

of the incident about which he testified. Mr. Rolfes acknowledged that during the roughly four

months between his conversation with the customer and his identification of Mr. Hinckley from

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photographs in December, he had assisted between 5,000 and 10,000 other customers.

Transcript of Hearing at 22-31 (Jan. 23, 2012 p.m.). He further acknowledged that the

Williamsburg Barnes & Noble store receives many customer inquiries about American history

materials, including “a fair amount” of requests for books on the Kennedy assassination. Id. at

26; see also id. at 40-43. Mr. Rolfes could not remember what clothing the customer was

wearing, and he testified that when he first spoke with Secret Service agents he told them that the

customer had worn glasses. Id. at 15, 45-47. As he explained: “I had thought I remembered

glasses, but then right after I said that out loud I realized that, no, I was mistaken.” Id. at 15,

45-47. He also acknowledged that, when speaking with the Secret Service agents, he had used

the phrase “fairly sure” when asked whether he was certain that his identification of Mr.

Hinckley was correct — he testified, however, that by “fairly sure” he meant “that I was sure.”

Id. at 44. Mr. Rolfes also testified, as he had stated in his earlier interviews, that his encounter

with the customer took place in the evening somewhere between 6:00 p.m. and 10:00 p.m. Id.

at 48, 54. He was surprised by the accurate proffer of Mr. Hinckley’s counsel that Mr. Hinckley

never shopped alone at those hours during his visits to Williamsburg. Id. at 48-49.

Additional uncertainty emerged on cross examination about the month in which

this incident took place. Mr. Rolfes testified that he told the Secret Service agents, just as he

later testified in court, that it had occurred in late summer or early fall. Transcript of Hearing at

6, 22 (Jan. 23, 2012 p.m.). When the agents asked whether the encounter could have taken place

around August, he told them yes. In a subsequent interview with Mr. Hinckley’s counsel,

however, Mr. Rolfes said that the encounter definitely happened in August. Id. at 23. While on

the witness stand before this Court, he stated more than once that the encounter did in fact take

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place in August. Id. at 22-23, 31-32, 46, 48. 15 When Mr. Hinckley’s counsel proffered that

Mr. Hinckley never shopped alone in the evening between 6:00 p.m. and 10:00 p.m. and was not

in Williamsburg at all during August of 2011 — which is true — Mr. Rolfes agreed that if this

were correct it would make his identification of Mr. Hinckley less than certain. Id. at 48-49.

The final exchange between Mr. Hinckley’s counsel and Mr. Rolfes on cross examination was as

follows:

Q. [I]f he was not there in August . . . [a]nd he was not there

between 6:00 and 10:00, you would have to be a hundred percent

certain that it wasn’t him; isn’t that true?

A. Yes.

Id. at 49.

On redirect, government counsel suggested to Mr. Rolfes that he had

“consistently said that this took place in late summer or early fall,” rather than during a specific

month, to which Mr. Rolfes agreed. Transcript of Hearing at 54 (Jan. 23, 2012 p.m.). Mr.

15

The following colloquy took place between Mr. Rolfes and counsel for Mr.

Hinckley:

Q. Well, do you remember an occasion speaking with me and two

of my colleagues . . . ?

A. Yes.

Q. And do you remember telling us that it was August, as a matter

of fact, maybe early August. You do remember saying that?

A. Yes.

Q. Now, indeed, you told the Secret Service agent, as reflected in

its memo, “Rolfes stated that sometime in late August 2011 he was

working inside.” Do you remember that?

A. Yes.

Q. All right. Now, does that refresh your recollection that it was

August and not in September?

A. Yes.

Q. All right. So we are sure now it’s August, it’s not September; is

that correct?

A. Yes.

Transcript of Hearing at 23 (Jan. 23, 2012 p.m.).

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Rolfes stated that, in testifying that the incident took place in August, he was wrong about the

month of the encounter, but not about his identification of Mr. Hinckley. Id. at 56. Mr. Rolfes

did maintain on redirect that the encounter took place between 6:00 p.m. and 10:00 p.m. Id. at

54. He explained that when he was pressed by Mr. Hinckley’s counsel during cross examination

about the seeming impossibility of his having interacted with Mr. Hinckley in August, he did not

withdraw his earlier statement about the month of the incident because “I kind of felt like I had

already said it, so I couldn’t back out of that one . . . . I had already said it [was] August, and so

I felt like if I said I wasn’t sure about that, then I would look, I don’t know.” Id. at 56. 16

The potential significance of Mr. Rolfes’ testimony is discussed later in this

Opinion. See infra at 93-96. Suffice it to say that the Court finds his recollection of the incident

about which he testified wholly unreliable and gives it no credence.

16

During recross examination by Mr. Hinckley’s counsel, the following colloquy

took place:

Q. Now, in response to my questions during the interviews [over

the telephone], when [the incident] was . . . you do recall saying it

was in August?

A. Yes.

Q. And you felt like having said that to me then, you couldn’t

retreat from that now?

A. Yes.

Q. Well, do you feel trapped into saying something you don’t want

to say because someone has already — because you have already

staked out a position?

A. I mean — yes.

Q. You do. All right.

Transcript of Hearing at 58 (Jan. 23, 2012 p.m.). On recross, the witness was also asked if he

were to assume that Mr. Hinckley was not in Williamsburg in August and further assume that he

was never in the bookstore between 6:00 p.m. and 9:00 p.m., “would you want to back out [of]

your identification?” The witness responded: “I would want to.” Id. at 61-62.

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C. Mr. Hinckley’s Rebuttal Expert Witness

Dr. Paul Montalbano, who has testified in previous hearings in this case, was

called as a rebuttal witness by Mr. Hinckley and was permitted to offer expert testimony on the

assessment of risk with respect to Mr. Hinckley’s danger to himself or others. He supports the

Hospital’s proposal, agreeing that under its plan “Mr. Hinckley is at low risk for

decompensation” and that “should a relapse begin to unfold, it would likely be gradual and

detectable.” Montalbano Rpt. at 58. Dr. Montalbano believes that “the carefully planned

incremental increases in freedom by the hospital would continue to provide therapeutic benefit,”

and that the concerns expressed by Dr. Patterson and Dr. Phillips “can be adequately managed

without significant risk being posed.” Id.; see Transcript of Hearing at 28 (Feb. 7, 2012 a.m.).

In describing the methodology underlying the risk assessment and report that he

prepared on Mr. Hinckley, Dr. Montalbano explained that, in his view, a goal of forensic

assessments is to identify points where different methods and sources of data support the same

hypothesis. For this reason, he strives to integrate multiple methodologies when conducting a

comprehensive risk assessment, including actuarial and structured professional judgment

approaches (the same methods used by Dr. Murphy in her risk assessment). Transcript of

Hearing at 19-21 (Feb. 7, 2012 a.m.). Actuarial data, while valuable, is limited in usefulness by

its “static” nature, because many of the factors about the individual being assessed do not vary

from year to year. The benefit of the structured professional judgment methodology, Dr.

Montalbano explained, is that it incorporates both static and dynamic factors, leading to

“different scores at different points in time, so you can measure whether the risk is increasing or

decreasing.” Id. at 25. Clinical judgment remains central when using an assessment tool of this

sort, because the ultimate assigning of a risk label — low, moderate, or high — is left up to the

evaluator. Id. at 26; Transcript of Hearing at 101 (Feb. 7, 2012 p.m.). In addition to these two

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approaches, Dr. Montalbano also incorporates what he termed the individualized assessment of

risk. That method entails a case-specific inquiry into a particular subject’s history of violent

episodes and an attempt to ascertain which variables were present at those times. This approach

“helps identify factors that might be targeted for intervention or amelioration.” Transcript of

Hearing at 17 (Feb. 7, 2012 a.m.).

Dr. Montalbano expressed reservations about the methodology employed by the

government’s expert witnesses, Dr. Patterson and Dr. Phillips. He characterized their approach

as a blending of the individualized assessment of risk with a fourth method, unstructured clinical

judgment. In the latter approach, according to Dr. Montalbano, “essentially the evaluator is free

to look at the data, come to whatever conclusions he or she wants, and then formulate a risk.”

Transcript of Hearing at 17 (Feb. 7, 2012 a.m.); see id. at 20-21. In his view, exclusive reliance

on this methodology may lead to skewed results. According to Dr. Montalbano, studies indicate

that “structured professional judgment and actuarial tools significantly outperform unstructured

clinical judgment in the prediction of risk.” Id. at 19. And based on his review of the literature,

he testified: “I don’t think using totally unstructured clinical judgment . . . really has much

scientific support.” Id. As he explained:

With unstructured clinical judgment the evaluator essentially has

free reign to gather information in any way he or she sees fit, to

combine the information in any way he wants to weigh the

importance of any given factor as much as he or she wants, to

attach any label to the information that he or she wants. And the

unstructured method, I believe, research demonstrates is more

prone to bias and error.

Id. at 21.

Similar problems, in Dr. Montalbano’s view, arise from an exclusive reliance on

the individualized assessment of risk, which also may give “too much free reign to the evaluator”

and allow “more bias and error,” because the choice of which risk factors to emphasize, how

65

much weight to give them, and what risk label to select are all left up to the evaluator. Transcript

of Hearing at 22 (Feb. 7, 2012 a.m.). According to Dr. Montalbano, while the literature shows

this method to be useful in identifying risk factors that can be targeted for treatment and risk

reduction, “it is not as well suited for the prediction of risk for a given individual.” Id. at 23.

Among other flaws, the individualized approach fosters a “confirmation bias” or “adversary

allegiance” in which evaluators place undue weight on observations that comport with what the

evaluator already believes and expects to see. Id. at 71-74. By contrast, “a structured approach,

either structured professional judgment or an actuarial approach, tends to be a safeguard against

bias.” Id. at 73. 17

Having compared the psychological tests administered to Mr. Hinckley in 2011

with other administrations of those tests going back to the 1980s, Dr. Montalbano noted that the

results, while largely consistent, indicated a “significant reduction in psychopathology” since the

early 1980s, when Mr. Hinckley’s results were “significantly elevated for a number of clinical

scales like depression, things that would indicate thought disturbance.” Transcript of Hearing at

39 (Feb. 7, 2012 a.m.). By contrast, none of those clinical scales now appear to be elevated,

which “[w]ould suggest an overall significant reduction in psychopathology.” Id. at 39-40. That

finding is confirmed by “behavioral observations and interviews and other sources of data. It’s

17

To illustrate the pitfalls of using individualized analysis as a predictive tool, Dr.

Montalbano cited Dr. Patterson’s concern, during a previous hearing, over behavior by Mr.

Hinckley toward a St. Elizabeths staff member in the 1990s that Dr. Patterson characterized as

“disturbingly similar” to his behavior toward Jodie Foster before his offense. According to Dr.

Montalbano, however, Mr. Hinckley’s interaction with this staff member was that of a real

relationship, rather than a delusional fixation; when Mr. Hinckley was directed not to maintain

contact with her, he complied, and these events did not produce any decompensation on his part.

Dr. Montalbano sees Dr. Patterson’s interpretation of these events as an example of confirmation

bias. Transcript of Hearing at 69-71 (Feb. 7, 2012 a.m.).

66

confirmed by the fact that people say his Axis I disorders [have] been in full sustained remission

for many years. So the data fits together.” Id. at 42.

Dr. Montalbano cautioned that one must keep in mind Mr. Hinckley’s tendency to

under-report problems, a trait evident in his consistent elevation on the so-called “K scale” of the

MMPI-2 assessment tool, which indicates that Mr. Hinckley “is defensive and guarded,” “strives

to present himself in an overly favorable light,” “tends to deny, minimize or avoid unacceptable

feelings or impulses,” Transcript of Hearing at 37 (Feb. 7, 2012 a.m.), and demonstrates an

unwillingness to acknowledge problems. Transcript of Hearing at 89-91 (Feb. 7, 2012 p.m.).

Dr. Montalbano further explained that Mr. Hinckley’s results on the MMPI-2 are consistent with

a profile pattern characterized by “some underlying hostility which is expressed indirectly.”

Transcript of Hearing at 37-38 (Feb. 7, 2012 a.m.). But like Dr. Murphy, Dr. Montalbano agreed

that Mr. Hinckley’s score on the PCLR — which he believes to be a reliable predictor of

violence in community settings — puts Mr. Hinckley in the low range of psychopathy, and that

the consistency in this score over many years with three different administrators indicates that

the results are reliable. Id. at 34, 39-40.

Dr. Montalbano agreed that Mr. Hinckley’s Axis I diagnoses are in full remission,

and they have been so for two decades or more. Transcript of Hearing at 42-43 (Feb. 7, 2012

a.m.). Although some fluctuations in Mr. Hinckley’s mental status have been observable

throughout the years, characterized at times by moodiness, irritability, and sadness, Dr.

Montalbano has seen nothing to indicate significant clinical depression or psychosis. Id. at 42.

While overall his mood is good, there are fluctuations “depending on what’s going on in his

relationships [with women] or with the Court.” Id. at 51; see Transcript of Hearing at 114

(Feb. 7, 2012 p.m.); Transcript of Hearing at 68 (Feb. 7, 2012 a.m.) (there are fluctuations

“depending on what is going on in the relationship, but that has not resulted in

67

decompensation”). His mood improves when he gets increased freedom through his visits to

Williamsburg. Transcript of Hearing at 85 (Feb. 7, 2012 a.m.). He has “a strong yearning for

freedom.” Transcript of Hearing at 114 (Feb. 7, 2012 p.m.). In sum, Dr. Montalbano believes

that the mental conditions that characterized Mr. Hinckley in 1981 are “either significantly

reduced or absent by and large.” Transcript of Hearing at 54 (Feb. 7, 2012 a.m.).

While Dr. Montalbano views depression as an important, “if not primary” risk

factor for Mr. Hinckley, he emphasizes the “clear evidence that he has not been significantly

clinically depressed for decades” and notes that Mr. Hinckley’s visits to Williamsburg have

helped to ameliorate this risk factor. Transcript of Hearing at 54-55 (Feb. 7, 2012 a.m.). Based

“on what numerous hospital staffs, numerous evaluators, numerous mental health professionals

have consistently observed for 20 years,” Dr. Montalbano believes that Mr. Hinckley is “simply

not likely” to relapse into major depression under the Hospital’s plan, and that he represents a

low risk for decompensation. Transcript of Hearing at 45-46 (Feb. 7, 2012 p.m.). Moreover,

Dr. Montalbano testified that Mr. Hinckley has shown a willingness to share feelings of

depression, irritation, and moodiness with his treatment providers, and that signs of deterioration

may also manifest themselves in observable behavioral indicators like increased sleep or weight

gain. Id. at 96-97. In Dr. Montalbano’s view, therefore, a significant change in his mental status

would likely be noticed by his Williamsburg and St. Elizabeths treatment providers. Transcript

of Hearing at 89-90 (Feb. 7, 2012 a.m.); see also Transcript of Hearing at 96-97, 117 (Feb. 7,

2012 p.m.).

Despite Mr. Hinckley’s low risk of decompensation, Dr. Montalbano agrees that

he should nevertheless be treated as a high-risk case, due to the unique nature of his offense

(“[t]he high profile nature of the case”) and the unreliability of his self-reporting. Transcript of

Hearing at 83-84 (Feb. 7, 2012 a.m.). The latter consideration in particular calls for putting

68

mechanisms in place to ensure “adequate and realistic amount of supervision” of Mr. Hinckley’s

activities and his mental state. Id. at 84. Dr. Montalbano agrees, therefore, that Mr. Hinckley

needs “ongoing monitoring” and recommends “gathering information from multiple sources,

having adequate supervision and monitoring, so that everything is not simply contingent on his

self-report.” Transcript of Hearing at 60 (Feb. 7, 2012 p.m.). In this regard, Mr. Hinckley’s

lying about going to the movies is significant not because it has any direct link to dangerousness,

but because his honest self-reporting of compliance with his conditions of release is an important

component of the ability to supervise and monitor him while in Williamsburg. Id. at 68-71.

IV. THE SUPPLEMENTAL EVIDENTIARY HEARING

After the Hospital submitted its revised (e) letter in December 2012, setting forth

a modified proposal for expanding Mr. Hinckley’s terms of conditional release, and after the

government’s experts were afforded a chance to complete supplemental expert reports

responding to that modified proposal, the Court held a supplemental evidentiary hearing over

three days in late February 2013, over a year after the conclusion of the first hearing. The

purpose of the supplemental hearing was to explore the ramifications of the changes the Hospital

had made to its proposal, particularly in view of the withdrawal of Colonial Behavioral Health,

People’s Place, and to discuss any updates in Mr. Hinckley’s status that had occurred during the

previous year. Counsel for Mr. Hinckley called two witnesses from the Hospital, Mr. Shamblee

and Dr. Murphy, and the government called its two expert witnesses, Dr. Patterson and Dr.

Phillips.

Mr. Shamblee testified about the modifications to the Hospital’s proposal and the

reasoning behind them. He also discussed Mr. Hinckley’s progress over the previous year. Mr.

Shamblee represented that during this period Mr. Hinckley complied with all rules and

69

requirements placed upon him, both in Williamsburg and at St. Elizabeths, without exception.

Transcript of Hearing at 86-89 (Feb. 25, 2013). He described Mr. Hinckley’s new volunteer

work in the cafeteria at Eastern State Hospital (a substitution for his former position in that

hospital’s library, which was being phased out for funding and personnel reasons), reporting that

Mr. Hinckley has acted appropriately in this new position, in a bustling environment that requires

extensive interaction with coworkers and patrons, without adverse incidents of any kind. Id. at

101-04. He also discussed the Hospital’s decision to substitute Mr. Jonathan Weiss for Mr.

Beffa as Mr. Hinckley’s case manager in Williamsburg, while retaining Mr. Beffa in his role as

Mr. Hinckley’s individual therapist. Id. at 56-62. 18 During the previous year, according to Mr.

Shamblee, Mr. Hinckley’s mental and emotional state has remained stable with no indications of

clinical depression, and he has done nothing inappropriate in the Williamsburg community or

shown any signs of being dangerous to himse

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