# United States v. Hinckley > District Court, District of Columbia · December 20, 2013 · 40 F. Supp. 3d 8 URL: https://www.frixlaw.com/law-library/cases/2658621 ## Case - **Full name:** UNITED STATES of America v. John W. HINCKLEY, Jr. - **Court:** District Court, District of Columbia - **Decided:** December 20, 2013 - **Citations:** 40 F. Supp. 3d 8; 2013 U.S. Dist. LEXIS 178741; 2013 WL 6699482 - **Precedential status:** Published - **Opinion:** Opinion by Friedman - **Judges:** Judge Paul L. Friedman - **Nature of suit:** Criminal - **Cited by:** 4 later opinions in the Frix Law Library ## Citator (automated) - No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases. - Full citator and citing cases: https://www.frixlaw.com/law-library/cases/2658621 ## How later opinions describe it (automated extraction) - concluding on motion to dismiss that a company’s 12 principal place of business in North America in the chosen state “establishe[d] a sufficient 13 relationship with the state to uphold the choice-of-law provision in the contract” ## Opinion text UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA ___________________________________ ) ) UNITED STATES OF AMERICA ) ) v. ) Criminal No. 81-0306 (PLF) ) JOHN W. HINCKLEY, JR. ) ) ___________________________________ ) 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”). 2 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. 3 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. 4 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. 5 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 6 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. 7 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. 8 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 9 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 10 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 11 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. 12 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. 13 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. 14 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. Tr [Text truncated at 120,000 characters. The full text is on the page linked above.] --- Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/2658621. Public record. Not legal advice.