Case Document 623 Filed 07/27/16 Page 1 of 103

UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA

 

 



. 

UNITED STATES OF AMERICA 


v. Criminal No. 81-0306 (PLF)



JOHN W. HINCKLEY, JR. 




OPINION

In 1981, John W. Hinckley, Jr. was a profoundly troubled twe11ty-?ve-year?old
young man suffering from active and acute and major depression. His mental
condition had gradually worsened over the preceding years m? beginning as early as 1976 m?
ultimately resulting in a deep obsession with the actress Jodie Foster and the film Taxi Driver.
Mr. Hinckley began to identify with the main character in the ?lm, Travis Bickle, who
unsuccessfully plots to assassinate a presidential candidate in order to win the affections ofa
young woman. At numerous points in the years leading up to 1981, Mr. Hinckley travelled to
Yale University in New Haven, Connecticut seeking to establish contact with Jodie Foster,
leaving notes, letters, and poems at her dormitory and even speaking with her on the phone
several times. After failing in his effort to establish a personal relationship with Ms. Foster, Mr.
Hinckley then sought to impress her through stalking President Jimmy Carter, travelling to
Washington, DC, Columbus, Ohio, and Dayton, Ohio over a three?day period in September of

1980. On October 9, 1980, Mr. Hinckley was arrested with several ?rearms and ammunition in

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his suitcase at the Nashville, Tennessee airport, where President Carter was scheduled to make a
campaign appearance.

After the presidential election in November, 1980, Mr. Hinckley next travelled to
Washington, DC. and began following President-elect Ronald Reagan. On March 30, 1981, after
several more unsuccessful trips to New Haven, Mr. I?Iinckley wrote a letter to Ms. Foster
describing his plan to kill President Reagan in order to impress her. That same day, Mr.
Hinckley attempted to assassinate the President of the United States in the driveway of the
Washington Hilton Hotel, shooting and severely wounding President Reagan, Presidential Press
Secretary James Brady, Secret Service Agent Timothy McCarthy, and Metropolitan Police
Officer Thomas Delahanty. Mr. Brady suffered permanent brain damage and eventually died
from his injuries in 2014. After a seven?week trial before ajury in 1982, Mr. Hinckley was
found not guilty by reason of insanity and committed to St. Elizabeths Hospital. Shortly after his
trial, Mr. Hinckley attempted suicide and continued to suffer from active of serious
mental illness.

Today, more than 34 years later, Mr. Hinckley is 61 years old and suffering from
arthritis, high blood pressure, and various other physical ailments like many men his age. He has
been under the care of St. Elizabeths Hospital for over three decades. Since 1983, when he last
attempted suicide, he has displayed no of active mental illness, exhibited no violent
behavior, shown no interest in weapons, and demonstrated no suicidal ideation. The government
and the Hospital both agree that Mr. Hinckley?s primary diagnoses of disorder not
otherwise Speci?ed and major depression have been in full and sustained remission for well over
twenty years, perhaps more than 27 years. In addition, since 2006, Mr. Hinckley has
successfully completed over 80 unsupervised visits with his family in Williamsburg, Virginia,

full com 1 in I with the Court?s strict conditions, with two minor exce )tiO?S. The rovernment
I

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and its expert, Dr. Raymond Patterson; an independent expert who conducted a comprehensive
risk assessment in this case, Dr. Katherine Murphy; and all of Mr. Hinckley?s treatment
providers both at St. Elizabeths Hospital and in Williamsburg now agree unanimously that
Mr. Hinckley is clinically ready for full-tirne convalescent leave and that, with certain
cenditions, he will not be a danger to himself or others. In the view of most of the experts who
testified before this Court, Mr. I-Iinckley has by now received the maximum benefits possible in
an setting.

After carefully considering the relevant legal authorities, the expert reports, the
testimony presented at the evidentiary hearing held in April of2015, Mr. Hinckley?s entire
history and clinical record over thirty-four years, and the briefs ?led by the parties, the Court will
grant the HOSpital?s proposal for full?time convalescent leave in Williamsburg, Virginia, with
additional and modified conditions as discussed below. A summary of the testimony, the COurt?s
?ndings of fact, analysis of Mr. Hinckley?s risk factors, the Court?s conclusions, and the

conditions that will be required by the Court for convalescent leave are detailed in the remainder

ofthis Opinion.?

 

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 Of?cer Thomas Delahanty; the trial of Mr.
Hinckley pursuant to a thirteen-count indictment; the jury?s ?nding that he was not guilty by
reason of insanity on all counts; Mr. Hinckley?s years at St. Elizabeths Hospital; his successful
use of city privileges under Hospital supervision during those years; decisions of this Court
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 1-103pita1 and Section 501(k) petitions filed by patients. United States v.
Hinckley, 292 F. Supp. 2d 125 (D.D.C. 2003) (?Hinckley United States v. Hincklev, 346 F.
Supp. 2d 155 (D.D.C. 2004) (?I-lincklev United States v. Hincklev, 407 F. Supp. 2d 248
(D.D.C. 2005) (?Hincklev 111?); United States v. I-"Iincklev, 462 F. Supp. 2d 42 (D.D.C. 2006)
(?Hincklev United States v. Hincklev, 493 F. Supp. 2d 65 (D.D.C. 2007) -Iinckley 

3

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TABLE OF CONTENTS

I. BACKGROUND ..5
II. THE PROPOSAL FOR CONVALESCENT LEAVE ..16
THE EVIDENTIARY HEARING ..30
A. Witnesses from St. Etz?zabeths Hospitth ..31

l. Verne Hyde Forsenic Clinical Administrator ..31

2. Dr. Katherine Murphy Forensic ..37

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

B. Witnessesfi?om?Mr. Hinckley?s Witliamsburg Treatment Team ..56
1. Dr. Deborah Giorgi-Guarnieri Treating ..56

2. Mr. Jonathan Weiss Case Manager ..60

C. Witnesses from the Hinckley Famity ..65
D. The Government is Expert Witness: Dr. Raymond F. Patterson ..67
IV. FINDINGS OF FACT ..73
V. DISCUSSION 
A. Mr. Hincktey?s Identified Risk Factors ..77
1. Mr. Hinekley?s Mental Health: Depression, and Personality Disorder ..78

2. Isolation and Mr. Iulinckley?s Integration into the Williamsburg Community ..80

 

United States V. Hinckley, 625 F. Supp. 2d 3 (D.D.C. 2009) and United States
v. Hinckley, 40 F. Supp. 3d 8 (D.D.C. 2013) (?Hinckley V1 

Case Document 623 Filed 07/27/16 Page 5 of 103

3. Mr. Hinckley;s Level oflnsight into his Mental Illness ..82
4. Access to Weapons ..83
5. The Hinckley Family?s Support ..83

6. History of Suicide Attempts ..83

7. Dif?culty in Relationships with Others, Particularly Women ..84

8. Deception, Underreporting, and Need for Monitoring ..86
B. Speci?c Proposals in the Hewett] ?s Letters ..88
1. Full?Time Convalescent Leave ..88

2. The Hospital?s Proposed Treatment Plan and Frequency of Appointments ..90
3. Monitoring, Risk Management, and Accountability ..94
4. Financial Support and Housing ..100
VI. CONCLUSION ..101

I. BACKGROUND
This niatter is before the Court on the proposal of St. Elizabeths Hospital for the
conditional release of John W. Hinckley, Jr. to full-time convalescent leave in Williamsburg,
Virginia, pursuant to 24 DC. Code 501(e) a so?called proposal? or letter.?2 Over
the years, the Hospital has submitted a series of proposals to this Court, seeking to expand the

scope or duration of Mr. Hinckley?s activities outside the grounds of the Hospital. The

 

2 24 DC. Code 501(c) provides that if, ?after a hearing and weighing the
evidence,? the Court ?nds that the patient ?has recovered his sanity and will not in the
reasonable future be dangerous to himself or others? such that ?the condition of such person
warrants his conditional release, the court shall order his release under such conditions as the


39

court shall see ?t . . . .

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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 DC.
Code 501(k) (a so?called 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 petition, if any. After conducting an evidentiary hearing, the
Court has either granted the Hospital?s request invariably with modifications or additional
conditions imposed by the Court or has denied the request. The Hospital?s latest proposal
contemplates full?time ?convalescent leave? in Williamsburg, Virginia w?e in short, the Hospital
proposes fully transferring Mr. Hinckley?s care to a team of mental health professionals in
Williamsburg, with oversight by the Hospital?s Forensic Outpatient Department, permitting Mr.
Hinckley to reside full?time in Williamsburg.

Over the course of the last twelve years, the Court has incrementally expanded
Mr. Hinckley?s privileges outside the HOSpital, always contingent upon careful monitoring and
his and his family?s cempliance with the numerous conditions imposed by the Court. The
Hospital has characterized its requests for gradually expanding Mr. Hinckley?s freedom as a
series of phases, each of which entails greater integration into the world outside the Hospital. In
December 2003, the Court allowed six local one-day visits by Mr. Hinckley with his parents
outside of the con?nes of St. Elizabeths without the supervision of Hospital personnel and within
a 50~mile radius of Washington, DC. so~called ?Phase 1? visits. Beginning in November
2004, after review oi the Phase I visits by the St. Elizabeths Hospital Review Board, the Court
permitted local overnight visits by Mr. Hinckley with his parents in a hotel within a 50?n1ile
radius of Washington, DC. (?Phase visits). Each visit was thoroughly assessed by the

Hospital and Mr. Hinckley?s treatment team before a subsequent visit took place, and a written

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report on each visit was provided to the Court. There were a total of six Phase I visits and eight
Phase 11 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 
visits). See I?Iinckley 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 United States v. I-Iinckley (Aug. 18, 2006) [Dkt No. 229]. In 2007,
the Court permitted six additional Phase 111 visits and expanded the duration of those visits to six
nights. 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 visits under
the same terms and conditions until further order of the Court. See Order at i, United States v.
Hinckley (Aug. 15, 2008) [Dl<t. No. 281]. Mr. Hinckley made at least 24 Phase visits. 
Hinckley v1, 625 F. Supp. 2d at 56.3

In 2009 after an evidentiary hearing that lasted six days the Court
authorized so~called ??Phase visits, which allowed Mr. I?Iinckley to make visits of up to ten
days to Williamsburg. While Phase 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.  Hinekley VI, 625 F. Supp. 2d at 6. To

that end, the Court authorized twelve Phase IV visits, each with a duration often days and nine

 

3 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.
Hinckley IV at 43-44; Order, United States v. I~Iincklev (Nov. 21, 2006) [Dkt. No. 244]. On
January 29, 2008, John Hinckley, Sr. passed away.

7

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nights, and each subject to the successful completion of the previous visit, with a written report
to the Court. Order at 2, United States v. Hinckley (July 20, 2009) [Dkt. No. 311].

During these Phase 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. Order at 1-2, United States v. Hincklev (July 20, 2009) [Dkt. No. 311]. Such
activities included establishing therapeutic relationships with two Williamsburg~area treatment
providers whose services had been arranged for him during his visits a and a
combined individual therapist and case manager. Mr. Hinckley also was permitted to Spend four
hours twice a week performing volunteer work with a local organization, which could increase if
deemed appropriate by the treatment team and his participating employer. lg. at 11?12.

Contingent upon Mr. I-linckley?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. Speci?cally, Mr. Hinckley was allowed up to three
hours of unaccompanied time, twice a week, between the hours of 8:00 am. and 9:00 pm, ?for
speci?c social, recreational, religious, or shopping related activities.? Order at 12-13, gated,
States v. Hinckley (July 20, 2009) [Dkt. N0. 31 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. 15,1. at 4?6. In
particular, the HOSpital was required to provide specific details, including time and place, of the
time Mr. Hinckley was to spend outside the supervision of his family members. 1d. at 3.

Mr. Hinckley also was permitted up to two hours of unaccompanied time twice

daily within the confines ofhis mother?s housing subdivision during specified hours. Order at 2,



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13, United States v. Hincklev (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 tamin member 01' treatment provider with him at all times. 1d. 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 OPS-enabled cell
phone anytime that he was not accompanied by his mother or siblings. 131. at 2. After each visit,
the Hospital was responsible for submitting a detailed report of the visit to the Court, the
government, and Mr. Hinekley?s counsel prior to the next visit. Lg]. at 10.
During each ten-day Phase IV visit, Mr. Hinckley was required to meet at least

once with his Williamsburg-area Dr. John J. Lee. After interviewing and assessing
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. l-Iinckley?s St. Elizabeths HOSpital
treatment team after each visit to discuss the visit and any concerns or issues relating to Mr.
Hinckley or his treatment goals, and to participate by telephone in the meetings of the treatment
team to discuss Mr. I-?Iinckley?s Individual Recovery Plan every three months or as scheduled.
Order at 3-5, United States v. Hincklev (July 20, 2009) [Dkt No. 311].4 Mr. Hinckley also was
ordered to meet at least once during each visit with his Williamsburg?area case manager and
individual therapist, Mr. Carl Beffa. Mr. Beffa was required to communicate after each visit

with Mr. Hinckley?s primary therapist at St. Elizabeths, Dr. Sidney Binks, to discuss and

 

4 Upon Dr. Lee?s departure from the institute where he practiced, he was replaced
in 2010 by Dr. Deborah Giorgi-Guarnieri, a 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) [Dkt No. 312]; Order, United States v. I~Iincklev (Sept. 30, 2010)
[Dkt No. 432]; Hospital?s Revised Letter of December 14, 2012 at 12-13 (?I?iospital?s Dec.
14, 2012 Revised Letter?) [Dkt No. 396].

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collaborate on the course of therapy for Mr. Hinckley. He also was required to complete a
checklist ofobservations, communicate with the treatment team after each visit, and participate
in treatment team meetings in the same manner as Dr. Lee. 1d. 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 isigns of?decon1pensati0n? or deterioration in Mr. Hinckley?s mental
condition during his visits to Williamsburg, no matter how slight, or any indication of danger to
himselfor to others, or of elopement (that is, attempt to escape or abseond), Mr. Hinckley would
immediately be returned to the Hospital. Order at 7, United States v. Hincklev (July 20, 2009)
[Dkt No. 311]. 

Mr. Hinckley began making Phase IV visits in late 2009. He soon began
volunteering two days a week, for four hours each day, at the hospital library of Eastern State
Hospital in Williamsburg. Although Eastern State is a liOSpital, Mr. Hinckley?s
relationship with the institution was and is that of a volunteer employee, not a patient. Beginning
in 20] 2, with the imminent closure of the hospital library due to staf?ng and funding changes,
Mr. Hinckley began volunteering in the cafeteria at Eastern State, where he helped at the cash
register and took orders from patrons. He has received positive reviews from his supervisors in
both volunteering capacities about his work and his interaction with patrons and employees.
HOSpital?s Dec. 14, 2012 Revised Letter at 10?1 1. According to the Hospital, Mr. Hinckley
also made use of his twice-weekly periods of unsupervised time in the community, as well as his
daily periods of unsupervised time within his mother?s subdivision. He obtained his driver?s
license and now operates the Hinckley family?s vehicle during his visits, accompanied by a

family member. l_d. at 19.

10

Case Document 623 Filed 07/27/16 Page Mr. Hinckley had completed twelve ten?day Phase IV visits,
without any reported incidents of misbehavior and in compliance with all of the Court?s speci?c
directives. Upon motion by Mr. Hinckley and the Hospital, the Court entered an interim order
permitting an inde?nite number of additional Phase IV visits under the terms and conditions
speci?ed 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, 
States v. Hinckley (May 13, 2011.). Subsequently, Mr. Hinckley completed an additional 21 ten-
day Phase IV visits  or a total of 33 ten?day Phase IV visits without any reported incidents
of misbehavior and in compliance with all of the Court?s speci?c directives, with two notable
exceptions discussed below.

On two separate dccasions in July 201 1 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. I-linckley reported afterward to his clinical unit administrator at
the HOSpital, Mr. Kevin Shamblee, that he had attended the movie, even describing and
recommending it. See Hinckley VII, 40 F. Supp. 3d at 13, 37, 39-40, 59-450. Mr. Hinckley made
similar misrepresentations to the expert witnesses retained by the government when they later
interviewed him in preparation for the upcoming evidentiary hearing before this Court. See id. at
13, 37, 39-40.

The Secret Service had been monitoring Mr. Hinckley on both occasions, and
their surveillance reports showed his claims to be false. 011 both days, as the Secret Service

reported, Mr. Hinckley arrived at the movie theater and spoke with someone in the ticket booth

11

Case Document 623 Filed 07/27/16 Page ticket. Instead, he spent the remaining hour or two of his unsupervised free
time at a nearby chain bookstore, Barnes Noble, and a fast-food establishment, before being
picked up by his mother to return home. See Hinckley VII, 40 F. Supp. 3d at 13~14, 42. When
confronted with this evidence, Mr. Hinckley later admitted being dishonest about the deviations
from his itineraries. See 1e. at 13?14. These incidents occurred after the Hospital submitted its
July 201 1 letter to the Court, but before the evidentiary hearing held with respect to that
letter. Considerable time was devoted to the incidents during the hearing. See i_d. at 59?61.

The ultimate goal of these Phase IV visits and activities was to determine if Mr.
Hinckley is ready to be released from the Hospital to live independently in Williamsburg with
the support of his mother (so long as she is healthy and alive), his siblings, and and
counseling professionals in the Williamsburg community. See Hinckley V1, 625 F. Supp. 2d
at 6; l-linckley V, 493 F. Supp. 2d at 66. With this goal in mind and after an evidentiary
hearing lasting a total of more than ten full days the Court authorized Mr. Hinckley?s Phase
IV visits to Williamsburg to expand from ten to seventeen days in February 2014. See Hinekley
3111, 40 F. Supp. 3d at 66-71; Order at 1, United States v. Hincklev (Feb. 26, 2014). As has been
the case with every one of Mr. Hinekley?s visits to Williamsburg, Mr. Hinckley was required to
remain under the supervision of his mother or siblings at all times, except when he was
participating in preapproved unsupervised activities. Order at 7, United States v. Hinckley (Feb.
26, 2014). The HOSpital, as always, was required to thoroughly assess each visit before any
subsequent visits took place. 1d. at 1.

In addition to expanding the number of days in Williamsburg, the Court also
expanded Mr. Hinckley?s unsupervised time and various privileges. l-Iinckley V11, 40 F. Supp.
3d at 68?70; Order at 1, United States v. Hincklev (Feb. 26, 2014) [Dkt. No. 455]. On each trip,

Mr. Hinckley was permitted: (1) up to six unsupervised outings outside of his mother?s housing

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subdivision lasting up to four hours, between the hours of 9:00 am. and 9:00 pm; and (2) two
120-minute unaccompanied walks per day within his mother?s subdivision, between the hours of
8:00 am. and 5:00 pm. standard time and 8:00 am. and 9:00 pm. daylight savings time. Order
at 2?3, United States v. Hincklev (Feb. 26, 2014) [Dkt. No. 455]. Mr; Hinckley was further
permitted to volunteer at Eastern State HOSpital or engage in other work or volunteer activities
with the Hospital?s approval. Id. at 2. Mr. I~Iinckley also was given permission to drive the
I-?iinckley family?s car unaccompanied while in Williamsburg as long as he was ?using the
vehicle to travel to destinations where people w[ould] be expecting him, such as to mental health
treatment appointments, approved volunteer and employment activities, as well as to any speci?c
social or educational activities arranged by him and Mr. Weiss.? E. at 1-2.5

The Court, however, continued to require detailed itineraries to be prepared by the
Hospital in advance of each visit. Order at 3, United States v. Hincklev (Feb. 26, 2014) [Dkt.
No. 455]. The Court stated that if the itineraries ?contain the kinds of social and other interactive
activities that show piogress,? the Court would consider a motion to modify the itinerary
requirement at a later date. 151. In addition to the itineraries, Mr. Hinckley was ordered to
continue his practice of maintaining a daily log of his activities while in Williamsburg. 1d,. Mr.
Hinckley also was required to continue carrying a OPS?enabled cell phone anytime his mother or
siblings did not accompany him. 1d. at 6.

Mr. I?Iinckley was permitted to use the Internet during his visits ?only under the
constant supervision of his mother or siblings or with the use of technology or technologies that

can both track his internet use and restrict it to the use of certain sites.? Order at 7, United States

 

5 Mr. Jonathan Weiss is the successor to Mr. Beffa as Mr. l-linckley?s case
manager. See infra at 60-61.

13

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v. Hinckley (Feb. 26:2014). Mr. Hinckley?s use was restricted to particular sites approved by
the Hospital in advance, which were to be included in the itineraries. id.

During each 17-day Phase IV visit, Mr. Hinckley was ordered to meet weekly
with his Williamsburg-area Dr. Deborah Giorgi-Guarnieri. Order at 4, United States
v. Hinckley (Feb. 26,2014). Additional visits were permitted if ?clinically necessary.? 191. At
each appointment, Dr. Giorgi?Guarnieri was required to ?monitor Mr. lwlinckley for any signs of
deterioration or decompensation in his mental condition? and be ?especially alert for anger,
depression, any ideas of elopement, endangerment to self or others, noncompliance
with conditions of release, or rejection of the supervision provided to Mr. Hinckley by his
responsible persons.? id. Dr. Giorgi-Guarnieri also was ordered to assess and monitor the risk
factors identi?ed in the Hospital?s checklists, which she was required to complete and provide to
the Hospital, along with ?written feedback summarizing her contact with Mr. Hinckley,? after
each appointment. 1d,. In addition to these meetings, Dr. Giorgi?Guarnieri was tasked with
participating by telephone in: post-Visit conference calls with the Hospital?s inpatient
treatment team to discuss Mr. I?Iinckley?s progress; and (2) the inpatient treatment team?s
Individual Recovery Plan meetings scheduled every two months for Mr. Hinckley. Dr.
Giorgi-Guarnieri also was charged with verifying that Mr. Hinckley was taking his medications
as prescribed, prescribing any additional medications in the case of an emergency 
situation, and facilitating any acute hospitalization needed in such a situation. 1d. at 4-5.

The Court also approved the substitution of Mr. Jonathan Weiss, a licensed
clinical social worker, for Mr. Beffa as Mr. l-Iinckley?s case manager. Order at 5, United States
v. Hinckley (Feb. 26, 2014). Mr. Weiss was tasked with identifying opportunities to increase
Mr. l-linckley?s ?socialization, enrichment, or mental health support in the Williamsburg

community.? 1d. Mn Weiss was required to monitor Mr. Hinckley?s attendance and progress in

14

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his volunteer and daytime activities and communicate at least once per visit with Mr. Hinckley?s
work supervisors. As with Dr. Giorgi?Guarnieri, Mr. Weiss was required to provide written
feedback to the Hospital after each visit. 1d. Mr. Beffa. continued in his role as Mr. Hinekley?s
individual therapist, with whom Mr. Hinckley was required to meet weekly for both individual
and group therapy during his visits. E. at 5-6. Mr. Beffa also was required to provide the
l?lOSpital with written feedback after each visit. E. at 6.

As of this writing, Mr. Hinckley has completed twenty-seven 17-day visits to
Williamsburg. With the exception of one incident described below, $3 ig?ra at 35?36, 63.
Mr. Hinckley appears to have complied fully with the conditions imposed by the Court. SQ

Patient?s Ex. 1, Hospital?s Dec. 19, 2014 letter at 2?4.

By all accounts, Mr. Hinckley?s socialization has improved dramatically since the
Court?s last Opinion and Order. Mr. Hinckley has participated in numerous activities at the
suggestion of his case manager, Mr. Weiss, including bowling, attending lectures, attending
outdoor musical concerts, and joining a community center for exercise and the ability to take
various classes. Hospital?s Dec. 19, 2014 letter at 2. Mr. Hinckley also has developed
several new social relationships in the Williamsburg community, in particular with two local
photographers. Mr. Hinckley has begun attending regular group meetings with the local chapter
of the National Alliance on Mental Illness 1d. According to the Hospital, Mr.
Hinckley also has demonstrated initiative in deveIOping relationships. For example, he
expressed an interest in developing relationships with certain members of his therapy group. But
establishing social relationships outside the group with group members is prohibited by the
group?s rules so long as Mr. Hinckley continued within that cohort. Therefore, at Mr. Beffa?s

suggestion, Mr. I-iinckley agreed to switch his group therapy time and has since begun

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Case Document 623 Filed 07/27/16 Page 16 of 103

developing relationships with at least two former group members, in addition to individuals he
has met at his NAMI ?meetings. 1d,

Despite diligent efforts by both Mr. Hinckley and Mr. Weiss, Mr. Hinckley has
been unable to secure additional volunteer or paid employment opportunities due to some
resistance within the Williamsburg community. Mr. Hinckley has, however, begun assisting
with landscaping andiyardwork at the local Unitarian Universalist Church. 1d. at 3. Mr.
Hinckley?s efforts to obtain paid employment have been further hindered by his part-time

residence in the area. Q6

11. PROPOSAL FOR CONVALESCENT LEAVE
On December 19, 2014, the Hospital submitted the original version of its current

proposal for full-time convalescent leave for Mr. I?Iinckley. Patient?s Ex. 1, Hospital?s Dec. 19,
2014 Letter to the Court [Dkt No. 494] (the ?Hospital?s Dec. 19, 2014 Letter?). On March
20, 2015, the Hospital ?led a revised letter, Patient?s Ex. 2, Hospital?s March 20, 2015 Letter
to the Court [Dkt No. 516] (the ?Hospital?s March 20, 2015 Revised Letter?), adding eleven
proposed conditions of release to the original eight listed in the December letter. The core of
the Hospital?s proposal is to transition Mr. Hinckley from l7~day visits to residing full-time on
convalescent leave in?Williamsburg, Virginia initially with his mother. Dr. Katherine
Murphy, the forensic who has performed risk assessments in this case,
appropriately refers to this as Phase convalescent leave. Patient?s Ex. 7, Violence Risk

Assessment Update at 61 (Mar. 31, 2015) [Dkt No. 558] (?Murphy Although the

 

6 The Court has recently been advised by letter from St. Elizabeths HOSpital of
June 27, 2016 [Dkt 618] m- that Mr. Hinckley has been offered a paid position at the Unitarian
Universalist Church where he has been volunteering for the past two years. The government has
given its approval for Mr. Hinckley to pursue this paid employment opportunity. See Hospital?s
July 6, 2016 Letter to the Court [Dkt No. 620].

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Hospital previously proposed that the next step in Mr. Hinckley?s integration would be a series
of 24-day visits, the Hospital now believes that 24?day visits would provide only minimal
clinical bene?ts to Mr. Hinckley above the 17-day visits, while continuing to hinder Mr.
Hinckley?s ability to establish residency in the Commonwealth of Virginia, become eligible for
government benefits, obtain paid employment, and otherwise complete his integration into the
I Williamsburg community. See Hospital?s Dec. 19, 2014 Letter at 1?2. The HOSpital
proposes that Mr. Hirickley?s professional services would be provided by a Williamsburg
treatment team consisting of Dr. Giorgi?Guarnieri, Mr. Weiss, and Mr. Beffa as well as a
boardwcerti?ed music therapist, and that overtime Mr. Hinckley would cease meeting with the
Hospital?s inpatient treatment team in the District of Columbia. 1d. at 4~5; Hospital?s March 20,
2015 Revised Letter at 1~2.7 Mr. Hinckley?s case would be overseen and managed by the
Hospital?s newly-created Forensic Outpatient Department, headed by Dr. Nicole Reid Johnson.
The Hospital believes that after countless visits of gradually expanded duration to
Williamsburg over nearly thirteen years, Mr. Hinckley is ready for full-time convalescent leave
with conditions. {its the Hospital explained in its proposal:
Mr. Hinckley has spent several years, since 2006, gradually
integrating into the community in Williamsburg. Over the course of
the past several months, he has undertaken noticeable efforts at
addressing the concerns raised in the December 2013 Opinion

regarding the quality of these efforts. Notably, Mr. Hinckley has
made tremendous efforts to diversify his activities, increase his

 

7 Ms. Elizabeth Haley was Mr. Hinckley?s music therapist until December 2015,
when she relocated to Mississippi. St. Elizabeths HOSpital?s Letter to Court of December 10,
2015 at 4 [Dkt. 591]. So far as the Court knows, neither Mr. Weiss nor anyone else responsible
for Mr. Hinckley?s treatment has yet identified a new music therapist to join the treatment team.
Indeed, the Hospital informed the Court on May 3, 2016 that ?[t]he quest for a Music Therapist
to-replace Ms. Haley has ended. The Williamsburg team was unable to secure another licensed
Music Therapist to work with Mr. Hinckley for the amount the family will be able to afford.?
The Court notes, however, that both the HOSpital and the government included appointments
with a music therapist in their proposed conditions for convalescent leave. Music therapy will be
included by the Court as a condition of release. at 92-93.

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exposure and engagement to others, and has begun to create social
roots from which his further development in this community can
grow. He has not evidenced any signs of decompensation or
increased risk for violent recidivism during this time period. His
attempts at fully integrating into this area continue to be Mr.
Hinckley?s primary focus. it is the Hospital?s opinion that this
process will be more effective for him as a full-time resident in the
area.

Hospital?s Dec. 19, 2014 Letter at 4.
Speci?cally, the Hospital?s Letter of December 2014 and Revised Letter of

March 2015 state that full?time convalescent leave in Williamsburg now is appropriate, with the

following court-imposed conditions:

1. While residing in Williamsburg, VA on [convalescent leave
Mr. Hinckley will receive follow up with
Deborah Giorgi-Guarnieri, MD. She will write his 
prescription which will be ?lled at a pharmacy in Williamsburg.
Dr. Giorgi-Guarnieri will meet with Mr. Hinckley twice per
month for the first three months and no less than 
thereafter.

2. Mr. Hinckley will receive both individual and
group therapy with Carl Beffa, LCSW, on a weekly basis.

3. Mr. Hinckley will continue to receive case management services
from Jonathan Weiss, LCSW. They will meet at least twice per
menth for the ?rst year. Thereafter, case management meetings
will occur no less than once per month.

4. Dr. Giorgi-Guarnieri, Mr. Beffa, Mr. Weiss, and Elizabeth
Haley, MT-BC, will communicate via email or fax with the
Director of Forensic Services of the Forensic Outpatient
Department (FOPD) via a receipt of clinical notes. Mr.
Weiss and/or Dr. Giorgi?Guarnieri will also make telephone
contact with FOPD prior to Mr. Hinckley?s visits to
Washington, DC. The Director of Forensic Services will be
responsible for forwarding these documents to the Court.

5. Mr. I?linckley will utilize the services of a Primary Care
Physician (PCP) which will be identi?ed by his family following
clari?cation of bene?ts. The PCP will be responsible for any
medication for Mr. Hinck?ley?s medical concerns.



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6. For the first six months, the Williamsburg treatment providers,
Dr. Giorgi~Guarnieri, Mr. Beffa, Mr. Weiss and Ms. Haley, will
meet with Mr. Hinckley in person for treatment
planning conferences. Thereafter, at the discretion of the
Williamsburg treatment team, these meetings may occur on a
semi-annual basis, inde?nitely.

7. While residing in Williamsburg on CL, Mr. Hinckley will make
weekly calls to the FOPD.

8. While residing in Williamsburg on CL, Mr. Hinckley will also
be'required to travel to Washington, DC on a basis to
meet with staff members iron: the FOPD for the ?rst (four) 4
months at which time they will review and determine how often
he will need to come to their of?ce for appointments. He may
travel to Washington, DC unaccompanied for these regularly
scheduled appointments.

9. To ensure that Mr. Hinckley has appropriate continuity of care
during his transition to community placement, a current member
of his inpatient treatment team will be present at his regularly
scheduled meetings with the FOPD. This will occur for
the ?rst four (4) months or at the discretion of the FOPD.

10. While residing in Williamsburg on CL, Mr. Hinckley will
continue to attend his scheduled structured activities in addition
to any future employment or alternative constructive activities.



1. Upon receipt of a [court order] for CL to reside in Williamsburg,
Saint Elizabeths Hospital Social Work staff, and Mr. Weiss, will
work with Mr. Hinckley to apply for Social Security and
Virginia Medicaid benefits and any other bene?ts he may be
eligible for leading up to his release.

12. Mr. Hinckley will be allowed to travel unaccompanied and
without supervision for personal, recreational or clinical
purposes. Mr. Hinckley will avoid traveling to government
centers.

13. In the event of a emergency, Dr. Giorgi?Guarnieri
will arrange for emergency hospitalization in the immediate
vicinity. She will coordinate with FOPD to determine if further
assessment and treatment should be undertaken at SEH [Saint
Elizabeths HOSpital 

14. Mr. I-Iinckley shall not travel ?fty miles outside of
Williamsburg, VA without Court approval. He will be permitted

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Case Document 623 Filed 07/27/16 Page 20 of 103

to travel to and from Washington, DC, unaccompanied for the
purpose of meeting with FOPD.

15. Mr. Hinckley?s Media Plan to refrain from seeking or accepting
invitations to give interviews with members of the press should
remain in place.

16. Mr. Hinckley will be permitted to access the Internet, as needed.
If Mr. Hinckley creates any online account for email or social
media services, he is required to share the username and
password to the FOPD as well as his Williamsburg treatment
providers.

17. Mr. Hinckley will submit to drug and alcohol screens
at ?the FOPD, and in Williamsburg at the discretion of Dr.
Giorgi?Guarnieri.

18. Should placement fail due to unavailability of family in the
Williamsburg area, FOPD will work with Mr. Hinckley and the

Williamsburg treatment team for the development of an
alternative placement.

19. Should one of the individually named Williamsburg treatment
providers become unavailable, FOPD will work with the team
to establish a replacement provider as soon as possible.

Hospital?s March 20, 2015 Revised Letter at 1?3.

Mr. Hinckley supports the Hospital?s proposals and has not submitted his own,
separate petition for expanded conditional release privileges under 24 DC. Code 501(k), as he
has sometimes done in the past. See; Patient?s Response to the Government?s Opposition to Saint
Elizabeths Hospital?s Recommendation for Convalescent Leave (Apr. 17, 2015) [Dkt. No. 524]
(?Patient?s Response?).

On April 10, 2015, the government ?led an opposition to the Hospital?s proposal.
The government acknowledges that ?[b]oth Dr. Patterson and Dr. Murphy conclude that Mr.
I?Iinckley is mentally stable, generally compliant with his treatment, and clinically ready to reside
in the community given appropriate conditions.? Government?s Response to St. Elizabeths

Hospital?s Recon?nnendation for an Expansion of Defendant?s Conditional Release at l~2 (Apr.

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Case Document 623 Filed 07/27/16 Page 21 of 103

10, 2015) [Dkt No. 522] lt nevertheless opposes the proposed convalescent leave plan
without signi?cant additional conditions beyond those suggested by the Hospital. 1d. 1n the
government?s view, the Hospital?s plan inadequately addresses: (1) ??nancial sustainability of
Mr. l-vlinckley?s placement in Williamsburg;? (2) ?communication and coordination of duties
between treatment providers in Williamsburg and the District of Columbia,? (3) ?a housing
transition plan [in Williamsburg], and the possible alternative placement in the District of
Columbia should [the] Williamsburg placement become infeasible,? and (4) ?Mr. Hinckley?s
potential accelerated mental deterioration based upon his clinical history.? lg. The government
therefore requests that the Court instead impose the following 35 conditions, some of which
overlap substantially with the Hospital?s proposals:

1. Mr. Hinckley may reside in the community solely with his
mother at her home in Williamsburg, Virginia. If his mother is
not present, Mr. Hinckley may not have an overnight non-family
guest or stay at any location other than his mother?s home. Mr.
Hinckley may only return to the District of Columbia for the
purpose of scheduled visits with the Hospital. While in the
District of Columbia, Mr. Hinckley may not reside or spend the
night at any location other than the Hospital.

2. Prior to placement 011 convalescent leave, the Hospital and
Williamsburg treatment teams shall provide each other, the
Court, both counsel, and the US Secret Service with a list of all
treatment team providers, their telephone numbers and email
addresses. Both treatment teams shall notify all parties of any
changes in the contact information.

3. The Forensic Outpatient Department (FOPD) treatment team
shall include Verne Hyde so long as he is employed by the
Hospital. If Mr. Hyde is no longer employed by the Hospital,
the treatment team shall include at least one of the following
inpatient treatment team members: Dr. Benjamin Adewale,
Denise Brown, or Dr. Sidney Binks.

4. Mr. Hinckley shall maintain weekly telephone contact with Mr.
Hyde, Dr. Nicole Johnson or another designated member of the
Hospital?s FOPD treatment team. For the ?rst three months of
Mr. l?linckley?s outplacement, Mr. Hyde, Dr. Johnson or another
designated member of the FOPD treatment team shall speak

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with Mrs. Joann Hinckley at least once per week. Thereafter,
the OPD treatment team shall maintain telephone contact with
Mrs. I-Iinckley They shall document their contact
with Mr. Hinckley and his mother in Mr. Hinckley?s medical
chart.

5. Prior to his outplacement, Mr. Hinckley shall be ?tted with an
ankle monitoring device, to be supervised by the US. Secret
Service or another United States Government agency or
contractor for the Government. Mr. I-linckley shall consent to
the installation of a tracking devise on his vehicle, which will be
monitored by the US. Secret Service or another United States
Government agency or contractor for the Government. Mr.
I-Iinckley shall provide the FOPD treatment team with this
vehicle?s information, and shall drive no other vehicle without
previously giving that vehicle?s information to the FOPD. Mr.
Hinckley shall also consent to installation of monitoring
software on his computer, which will be monitored by the
United States Secret Service or another United States
Government agency or contractor for the Government. Mr.
Hinckley shall provide the FOPD treatment team with this
computer?s information. Mr. Hinckley shall use no other
computer, laptop, tablet, netbook, phone, or other internet?
enabled device without providing that device?s information to
the FOPD. The FOPD shall immediately notify both parties of
any changes in Mr. Hinckley?s vehicle or electronic devices.

6. Pursuant to this Court?s February 26, 2014 Order, Condition
#17, Mr. Hinckley shall carry a GPS~enabled cell phone when
he is away from his mother?s residence. Mr. Hinckley shall
provide the cell phone company, subscriber information and
phone number of this cell phone to the FOPD. If the number,
cell-phone company, or any subscriber information changes, Mr.
Hinckley must immediately inform the FOPD. FOPD shall
immediately notify both parties of any changes relating to Mr.
Hinckley?s cell phone. Mr. Hinckley shall not use any other
phone at any time except in case of emergency if his cell phone
is not functioning. Mr. Hinckley consents to the United States?
(or any of its agents or contracting designees) obtaining and
using any cell?site or other geopositional data from his cell
phone to determine his location at any point in time.

7. Mr. Hinckley may be permitted to drive unaccompanied only
within a thirty mile radius of Williamsburg, Virginia, unless he
is traveling to Washington, DC. for the purpose of his 
scheduled appointment with his FOPD treatment team. Except
for his scheduled visit to the Hospital in Washington,
119, if Mr. Hinckley desires to travel further than thirty miles

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Case Document 623 Filed 07/27/16 Page 23 of 103

outside of Williamsburg, he must make a request to the FOPD
at least seven business days in advance. The OPD shall notify
the parties in writing with[in] 24 hours of receiving the request.
If the Government files an objection, Mr. Hinckley may not
travel unless approved by the Court.

8. Mr. Hinckley shall notify Mr. Weiss before going to any private
residences.

9. Mr. Hinckley shall not travel to government centers, facilities
and sites, or to areas where the current or former Presidents, Vice
Presidents, members of Congress or the Executive Branch, any
other federal or state political ?gure, or any US. Secret Service
protectee who will be visiting in the District of Columbia,
Williamsburg, or any other area. If Mr. Hinckley enters a
protected area, he shall leave the area immediately if requested
by law enforcement or as soon as he becomes aware that an
above individual is or will be present. On other occasions, Mr.
Hinckley may enter government facilities to attend to personal
business only with prior notice and approval of the FOPD or if
accompanied by a family member or Williamsburg treatment
team member. 

10. The Government shall notify the Court and Hospital if
the data it obtains from the ankle bracelet, cell phone, vehicle or
computer- or internet-usage yields any information showing that
Mr. I-Iinckley has violated any conditions of release.

11. The Department of Behavioral Health through the FOPD shall
be responsible for ensuring that Mr. Hinckley receives
appropriate treatment and medication while residing
in Williamsburg. Mr. I-linckley shall travel to the FOPD at 35 
Street NE, Washington DC, once per month for monitoring of
his mental condition and compliance with the conditions of his
release. He shall meet with the FOPD treatment team and shall
participate in an individual session with Dr.
Binks at the Hospital during that same visit.
Immediately following that appointment, Mr. IMIinckley shall
return directly to his home in Williamsburg, Virginia.

12. FOPD shall notify the U.S. Secret Service, counsel for Mr.
Hinckley and counsel for the Government of the date and time
of ?his scheduled FOPD appointment. They shall provide the
intended travel route and time of departure from Williamsburg,
Virginia. Notice shall be provided at least two weeks prior to
the scheduled appointment by all parties. Mr. Hinckley shall
travel directly to and from the FOPD on the designated route and
may stop only for food and/or gas along the route.

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13. Mr. Hinckley shall participate in structured activities in the
[Williamsburg] community, such as a volunteer position or paid
employment, which are approved by the FOPD treatment team.
He shall be responsible for volunteering and/or working at least
three days each week. Mr. Hinckley shall provide a weekly
schedule of his volunteer/employment activities to Mr. Weiss
and his treatment team at the FOPD. Mr. Hinckley shall consent
to any employer or volunteer organization speaking with any
treatment clinicians involved in his care. Mr. Hinckley shall
notify Mr. Weiss and the FOPD treatment team of any
changes in his place of employment and/or volunteer activities.

14. Mr. Hinckley shall complete a daily log of his activities while
on convalescent leave which shall include his work/volunteer
hours, social contacts/meetings, scheduled appointments with
treatment providers, errands and recreational activities. He shall
bring the log to his appointments at the FOPD for
rev1ew.

15. Dr. Giorgi-Guarnieri will provide treatment and
prescribe medication for Mr. Hinckley at a frequency of at least
once per [week]8 for the ?rst six months of his convalescent
leave. Thereafter, Mr. Hinckley shall meet with her as often as
required but not less than twice per month. Dr. Giorgi-Guarnieri
shall notify the FOPD treatment team of any changes
in Mr. Hinckley?s prescribed medication. Dr.
Giorgi-Guarmeri will monitor Mr. Hinckley for any signs of
deterioration 0r decompensation in his mental condition and will
be especially alert for anger, depression, any ideas of
elopement, endangerment to self or others, noncompliance with
the conditions of release, or rejection of the supervision provided
to Mr. Hinckley by his responsible persons. If any such items
are detected, she will immediately notify designated staff at the
OPD. Dr. Giorgi?Guarnieri will continue to assess and monitor
the risk factors identi?ed in the HOSpital?s checklists, which she
will complete and return to the FOPD and Williamsburg
treatment teams along with written feedback summarizing her
contact with Mr. Hinckley prior to his scheduled FOPD
appointment. Dr. Giorgi-Guarnieri also will participate in
telephone conference calls with the OPD treatment
team and other Williamsburg treatment providers prior to Mr.
Hinckley?s scheduled FOPD appointment. If

 

3 This condition originally stated ?once per month.? On April 21, 2015, the
government filed an amendment clarifying that this was a typographical error and was meant to
state ?once per week.? Government?s Amendment of its April 10, 2015 Response to Saint
Elizabeths Hospital?s Recommendation for an Expansion of Defendant?s Conditional Release at
1-2 (April 21, 2015) lkat. No. 527].

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Case Document 623 Filed 07/27/16 Page 25 of 103

necessary, Dr. Giorgi-Guarnieri will facilitate acute
hospitalization for emergencies. She shall
immediately notify designated members of the FOPD treatment
team ofany emergency. FOPD shall notify the Court
and counsel within 24 business hours.

16. Mr. Jonathan Weiss, a licensed clinical social worker, will
provide case management services to Mr. Hinckley. Mr.
Hinckley shall meet with Mr. Weiss at least twice per month.
Mr. Weiss will make recommendations to Mr. I~Iinckley and the
FOPD treatment team for opportunities to increase Mr.
Hinckley?s socialization, enrichment, or mental health support
in the Williamsburg community. Mr. Weiss will consult with
each of Mr. Hinckley?s work and volunteer supervisors no less
than once a month to con?rm Mr. Hinckley?s attendance and
adequate work performance. These reports shall be integrated
into Mr. Weiss?s progress notes for Mr. Hinckley?s case
management. Prior to Mr. Hinckley?s FOPD
appointment, Mr. Weiss will provide written feedback to the
FOPD and Williamsburg treatment teams, summarizing any
contact with Mr. Hinckley related to case management and
recommendations. He will also participate in telephone
conference calls with the FOPD treatment team and other
Williamsburg treatment providers prior to Mr. Hinckley?s
scheduled FOPD appointment. Mr. Weiss will collect
progress notes from Williamsburg providers and ensure
their delivery to Dr. Johnson every month. Mr. Weiss will also
corroborate Mr. Hinckley?s self-report with the reports of
treatment providers and family members by noting and
addressing any discrepancies.

17. Mr. Carl Beffa will continue to serve as Mr. Hinckley?s
individual and group therapist in the Williamsburg area. Mr.
Hinckley will meet at least once weekly with Mr. Beffa for
individual therapy sessions and at least once weekly for group
therapy sessions. Prior to Mr. I-linckley?s FOPD
appointment, Mr. Beffa will provide written feedback to the
Hospital and Williamsburg treatment team, summarizing his
contact with Mr. I-Iinckley. He will also participate in 
telephone conference calls with the FOPD treatment team, Dr.
Johnson and all Williamsburg treatment providers prior to Mr.
Hinckley?s scheduled FOPD appointment.

18. Mr. Irlinckley shall participate in individual music therapy
sessions at least once per month in Williamsburg, either with
Ms. Elizabeth Haley or another board-certi?ed music therapist.
The music therapist shall agree to maintain contact with
the treatment teams. Prior to Mr. Hinckley?s FOPD

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appointment, the music therapist will provide written feedback
to the FOPD and Williamsburg treatment teams, summarizing
his or her contact with Mr. Hinckley. I?le/ She will report to the
OPD and Williamsburg treatment teams any emergency issues
that may be disclosed during sessions. lie/She will participate
in telephone conference calls with the FOPD treatment
team and other Williamsburg treatment providers prior to Mr.
l'linckley?s scheduled FOPD appointment.

19. Dr. Nicole Johnson of the Hospital shall conduct weekly
telephone calls with Mr. I?linckley to assess the status of risk
factors. She shall prepare a progress note summarizing the
content of weekly phone calls. Dr. Johnson shall consult with
each member of the Williamsburg treatment team and a family
member of Mr. Hinckley?s prior to [the] FOPD visits. Dr.
Johnson shall oversee the preparation of a summary of
Mr. Hinckley?s progress in. Williamsburg. Dr. Johnson shall
submit the progress notes of all Williamsburg treatment
providers along with her summary to the Court and both
counsel every month. Dr. Johnson shall corroborate Mr.
Hinckley?s self-report with the reports of treatment providers
and family members by noting and addressing any
discrepancies.

20. The Williamsburg treatment team, Dr. Giorgi-Guarnieri, Mr.
Weiss, Mr. Beffa, and the music therapist shall meet with Mr.
I~Iinckley in person for treatment planning
conferences. They shall provide a cepy of the treatment plan to
Mr. Hinckley?s FOPD treatment team. At a frequency of not
less than twice per year, the FOPD treatment team shall meet in
person with Mr. Hinckley and the Williamsburg treatment team
in Williamsburg for purposes of treatment planning and
communication of treatment progress, concerns, and goals.

21. Mr. I~Iinck1ey will utilize the services of a Primary Care
Physician (PCP) which will be identified by his family following
clari?cation of bene?ts. The PCP will be reSponsible for any
medication for Mr. Hinckley?s medical concerns.

22. Mr. Hinckley shall comply'with all requests by the Hospital
and/or the FOPD for information relating to any medical and/0r
treatment he may receive by parties in the
community. Any health care provider shall provide all treatment
information and records regarding Mr. Hinckley?s care to the
Hospital or the FOPD upon request.

23. Prior to Mr. Hinckley?s placement on convalescent leave, the
Hospital?s social work staff and Mr. Weiss shall identify all

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Case Document 623 Filed 07/27/16 Page 27 of 103

possible government assistance programs for which Mr.
Hinckley may be eligible and shall work with him to apply for
programs.

24. Mr. Hinckley shall be permitted access to the internet, as needed.
He shall provide a list of all internet enabled devices that he is
able to access to both treatment teams. The FOPD treatment
team shall provide this information to both parties. Mr.
Hinckley shall not become a member of, subscribe to, or make
any postings on any social media site such as Facebook, Twitter,
Instagram, Linkedln or any other social media site. Mr.
Hinckley may have only one email account and shall provide his
username and password to the FOPD treatment team. The
FOPD treatment team shall provide this information to both
parties. The FOPD treatment team shall review Mr. Hinckley?s
email transactions on a basis and discuss any concerns
that may arise during his appointment. Mr. Hinckley
shall not access any website or search for any information
relating to himself, Jodie Foster, President Reagan, James
Brady, Jeanette Wick, presidential assassinations, firearms or
weapons of any kind or any other topics or individuals relating
to his criminal case. The Williamsburg treatment team and/or
the FOPD treatment team shall immediately notify the Court and
counsel of any questionable internet or email activity.

25. The US. Secret Service may examine all of Mr. Hinckley?s
internet-enabled devices. Mr. Hinckley shall permit the
installation of any hardware or software systems which monitors
(real?time and/or historically) record and/or ?lters computer use
and he shall not attempt to remove, tamper with or reverse
engineer, or in any way circumvent the s0ftware. Mr. Hinckley
shall not use any software program or device designed to hide,
alter, or delete records/logs of his computer use, internet
activities or the files stored on his computer, including the use
of steganography, cache/cookie removal software.
Mr. Hinckley shall only utilize the identified internet enabled
devices and will not permit anyone else, other than the U.S.
Secret Service personnel, access to those devices. Mr.
Hinckley?s computer must have a Windows or DOS operating
system. Mr. Hinckley shall not install new hardware or effect
repairs on his computer system without receiving prior
permission from the US. Secret Service. Mr. Hinckley shall
disclose all online accounts including user?names and
passwords, to the US. Secret Service upon request, and shall
also provide telephone/internet service provider billing records
upon demand, as well as proof of the disconnection or
termination of such services. Mr. Hinckley shall execute a

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Case Document 623 Filed 07/27/16 Page 28 of 103

release form allowing the U.S. Secret Service to access account
information directly from his Internet Service Provider. Mr.
Hinckley shall not create or assist directly or indirectly in the
creation of any electronic bulletin board, ISP or any other public
or private network. If password protection is required on Mr.
Hinckley?s system, application or files, such passwords shall be
provided upon request to the U.S. Secret Service. Upon request,
Mr. Hinckley shall permit the U.S. Secret Service to examine
any internal or external storage media, including hard discs, zip
discs, ?oppy diskettes, CD ROMS, optical discs, magnetic tapes,
or any other storage media.

26. Mr. Hinckley may not publicly display by exhibition or sale any
memorabilia, writings, paintings, photographs, art work or
music created by him. He may not participate in any public
musical performance either individually or with a group.

27. If Mr. Hinckley should receive any communication either by
mail, phone or electronic communication relating his offense
and/or notoriety, he shall immediately notify the FOPD
treatment team and shall not respond to the communication.

28. Mr. Hinckley, his mother and his siblings will continue to adhere
to the ?Media Plan to be Utilized for Patient While on
Conditional Release? which provides that any effort to contact
the media, either by Mr. Hinckley or by his mother, in person or
by any other means while Mr. Hinckley is on conditional release,
will constitute a violation of his conditional release. If
approached by media, Mr. Hinckley and the members of his
family will withdraw.

29. If there are any negative incidents regarding the public or media,
Mr. Hinckley, Mrs. Hinckley and/or Mr. Hinckley?s siblings will
immediately return to the home and call a member of Mr.
Hinckley?s Williamsburg treatment team, the FOPD treatment
team, local, law enforcement, and/or the U.S. Secret Service. If
so directed, Mr. Hinckley will be returned to the Hospital.

30. If a I-Iinckley family member becomes aware of any violation of
the conditions of release or any other concerning behavior either
through their own observations or information revealed by Mr.
I--1inckley or his social contacts, they shall immediately notify 
Dr. Giorgi?Guarnieri. If any FOPD or Williamsburg treatment
team member becomes aware of such risk they shall
immediately notify the Court and both parties. If requested, Mr.
Hinckley shall voluntarily return to the Hospital escorted by a
family member, FOPD member or Williamsburg treatment team
member.

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31. Mr. I--Iinckley shall abide by all laws, shall not consume alcohol,
illegal drugs or controlled substances absent prescription, shall
not possess any firearm, weapon or ammunition, and shall not
be arrested for cause. He shall comply with all requests for drug
and/or alcohol screening.

32. If for any reason Mrs. Joann Hinckley is not able to adequately
monitor Mr. Hinckley in her home, Mr. Hinckley shall be
returned to inpatient status at the Hospital. Thereafter, the
HOSpital, FOPD and the Williamsburg team shall work together
to develop an alternative plan for Mr. Hinckley?s conditional
release and shall present the plan in writing to the Court and
counsel for review. The government?s expert(s) may conduct a
full evaluation of Mr. Hinckley and the proposed plan and will
provide an opinion with respect to the plan. A hearing shall be
set to review the plan and Mr. Hinckley may not resume his
conditional release privileges until the conclusion of the hearing
and ruling by the Court.

33. If for any reason Mr. Hinckley or his family cannot continue to
?nance any of the required treatments in Williamsburg as
detailed above, Mr. Hinckley shall be returned to inpatient status
at the HOSpital until further Court Order.

34. If for any reason, a member of the Williamsburg treatment team
becomes temporarily or permanently unavailable, the FOPD
shall immediately notify the Court and counsel. They shall
identify an alternative treatment provider and provide
information about the provider to the Court and counsel. If
clinically indicated, Mr. Hinckley may be returned to inpatient
status until the completion of this process. The government?s
expert(s) may conduct a full evaluation of Mr. Hinckley and the
proposed providers. A hearing shall be set to review the
alternative providers and if Mr. Hinckley has been returned to
inpatient status during this process, he may not resume his
conditional release privileges until the conclusion of the hearing
and ruling by the Court.

35. If Mr. Hinckley?s mental condition deteriorates, or if he violates
the conditions of this release[,] he shall be returned to inpatient
care at the Hospital, with due notification to the Court and
coUnsel. Thereafter, he may not resume convalescent leave
without prior notice to the Court and counsel. If the government
objects to Mr. Hinckley?s return to convalescent leave[,] a
hearing shall be set and he shall remain an inpatient until the
conclusion of said hearing.

Opp. at 5?17.

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Mr. Hinckley?s counsel and the Hospital each ?led a reply to the government?s
opposition on April 17, 2015. Mr. Hinckley agreed with certain of the conditions proposed by
the government but argued that many others are ?unnecessary and counter-therapeutic.?
Patient?s Response at 4. The Hospital responded to the concerns raised by the government and
provided specific responses to each of the government?s 35 proposed conditions, agreeing with
16 of them in whole and eXplaining its reasons for disagreeing with the others in whole or in
part. Patient?s Ex. 4, St. Elizabeths Hospital?s Response to the Government?s Opposition at 4-15

(Apr. 17, 2015) [on No. 526].

THE EVIDENTIARY HEARING

As has been its practice, the Court held an evidentiary hearing on the Hospital?s
letter in order to permit all parties to substantiate and elaborate upon their positions with
respect to the Hospital?s proposal. That hearing, which began on April 22, 2015, included
opening statements by counsel for the government and counsel for Mr. Hinckley, six days of live
testimony, and closing arguments. Counsel for Mr. I-Iinckley called the following witnesses:
(1) Scott Hinckley, Mr. Hinckley?s brother; (2) Diane Sims, Mr. Hinckley?s sister; (3) Mr. Verne
James Hyde, liorensic Clinical Administrator at St. Elizabeths HOSpital, and Mr.
Hinckley?s former music therapist; (4) Dr. Deborah L. Giorgi?Guarnieri, the aforementioned
in private practice in the Williamsburg area who has been Mr. leinckley?s
in that area since 2010; (5) Mr. Jonathan V. Weiss, a licensed clinical social worker
and Mr. leinckley?s Vlfilliamsburg case manager; (6) Dr. Katherine Murphy, former Clinical Staff
at St. Elizabeths Hospital, now in private practice, who once again prepared an
extensive risk assessment report with respect to Mr. Hinckley; and (7) Dr. Nicole Reid Johnson,

Forensic Services Director for the District of Columbia?s Department of Behavioral Health.

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In contrast with prior hearings, counsel for the government called only one
Witness: Dr. Raymond Patterson, a retained as an expert 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 Stateof Maryland. Sadly, its other primary expert over the years, the highly
regarded Dr. Robert Phillips we the former Director of Forensic Services, State of Connecticut
Department of Mental Health, Deputy Medical Director, American Association, and
lecturer at both the University of Maryland School of Law and Yale University School of

Medicine died unexpectedly a year before the evidentiary hearing commenced.9

A. Witnesses ?rom Sr. EZizabeths Hospital
1. Verne Hyde Forensic Clinical Administrator
Mr. Verne Hyde, the Forensic Clinical Administrator at St. Elizabeths
Hospital, testified on behalf of the Hospital and its Forensic Review Board, which oversees the
work of individual patients? treatment teams as they formulate recommendations for conditional
releases. Although Mr. Hyde previously. served as Mr. Hinckley?s music therapist from 2006 to
2012, he transitioned ?to his current role in 2012. Transcript of Hearing at 6-7 (Apr. 22, 2015
pm). His primary responsibility as Forensic Clinical Administrator is to coordinate services and

develop treatment plans for individual patients, write responses in forensic cases, and present the

 

9 Throughout this Opinion, the testimony of witnesses will be cited by references to
the transcript by the date of the testimony and, where appropriate, the morning or afternoon
session, and by page. For example: ?Transcript of Hearing at (Apr. 23, 2015 am)? Each
transcript is available on the public docket of this case. Exhibits will be referred to by the
proponent of the exhibit number the United States [?Gov?t Ex. No. mf]. Mr. Hinckley
[?Patient Ex. No. Hf], or St. Elizabeths Hospital [?Hospital Ex. No. The exhibits, some in
redacted form, also are available on the public docket.

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Forensic Review Board?s recommendations. 1_d. 1? As to Mr. Hinckley, Mr. Hyde ?coordinate[s]
and write[s] Mr. Hinckley?s treatment plans,? ?draft[s] the itineraries? for each of his visits to
Williamsburg, interviews each of Mr. Hinckley?s Williamsburg providers after each visit and
collects and summarizes their clinical notes, and coordinates with the Secret Service as needed.
m. at 7?8.

Mr. Hyde ?rst testified regarding his experience as a music therapist and his now-
terminated therapeutic relationship with Mr. Hinckley. Mr. Hyde is a board-certi?ed music
therapist and is trained to recognize and risk factors of mental illness. Transcript of
Hearing at 840 (Apr. 22, 2015 pm). He testi?ed that Mr. Hinckley?s self-awareness ?in terms
of his regard for what his actions might mean to others, what his relationships are and what they
have been, where his future lies? has ?very much blossom over the past ten years. 3. at 11.
Since terminating the therapeutic relationship, Mr. Hyde continues to meet with Mr. Hinckley on
almost a daily basis when Mr. Hinckley resides at St. Elizabeths. 1d. at 14. Mr. Hyde further
stated that he ?unequivocally? believes that Mr. Hinckley is not a danger to himself or others. 1_d.
at 13?14.

Mr. Hyde was the principal author of the HOSpital?s letter, which was the
result of ?countless? meetings with Mr. Hinckley?s treatment teams at the Hospital and in
Williamsburg. Transcript of Hearing at 17 (Apr. 22, 2015 pm). He stated that the treatment
teams ?rst reviewed the Court?s earlier opinion, previous petitions, and risk assessments, and
Mr. Hinckley?s progress in Williamsburg over the course of numerous meetings and conference
calls. 1_d. at 17-19. Mr. Hyde testi?ed that Mr. Hinckley is a low risk for violent recidivism and

a low risk for relapses, 1g. at 23: he is ?low risk; ?clinically stable,? with his primary Axis I

 

'0 Mr. Kevin Shamblee held this position before Mr. Hyde.

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[diagnoses] ?in full and sustained remission.? m. at 27. The treatment teams determined that the
?[i]npatient setting isunot appropriate for somebody in Mr. Hinckley?s place clinically? and that
an outpatient setting, in Williamsburg in particular, ?is where he?s getting the most therapeutic
bene?t.? id. at 22. Beginning in 2013, following the Court?s last opinion in this matter, the
Hospital has worked to ?create a tight-knit team [in Williamsburg] that knows him well, that
understands the risk factors, and that can leverage the protective factors in his favor? in order to
transition Mr. Hinckley full?time to an outpatient setting in Williamsburg. Id. at 20-22.

As part of the transition, Mr. Hyde testi?ed, his role in coordinating and
overseeing Mr. Hinckley?s treatment would transfer to Dr. Nicole Reid Johnson, Forensic
Services Director for?the District of Columbia?s Department of Behavioral Health. 
Transcript of Hearing at 24 (Apr. 22, 2015 pm). Under the Hospital?s proposal, Mr. Hyde
would no longer be involved in the day?to?day treatment of Mr. I-Iinckley. 536; Hospital?s March
20, 2015 Revised Letter at 1?3. Mr. Hinckley?s treatment would shift entirely to the
Williamsburg treatment team, with outpatient visits with Dr. Johnson in the District of
Columbia. During the return visits to the District of Columbia, Mr. Hinckley initially
would continue to meet with Dr. Sidney Binks, Mr. Hinckley?s treating at St.
Elizabeths since 1999. Transcript of Hearing at 29?31 (Apr. 22, 2015 pm).

Mr. Hyde further testi?ed about many details of the Hospital?s proposal and each
of the 19 proposed conditions and their underlying rationales. For each condition, Mr. Hyde
provided the Hospital?s reasoning and described why it is necessary or helpful for risk
management or for Mr. Hinckley?s continued treatment. Transcript of Hearing at 21?87 (April
22, 2015 p.111). With? respect to a number of the conditions proposed by the Hospital, Mr. Hyde
testi?ed that a certain amount of discretion would be given to Dr. Johnson and the outpatient

department, in consultation with the Williamsburg treatment team, and a certain amount of

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discretion would be reposed in the Williamsburg treatment team. 1d. at 29, 33, 35. Mr. Hyde
testi?ed that such discretion is appropriate because the implementation of conditions of release
are ?clinical decision[s]? that Mr. Hinckley?s providers should be able to tailor to Mr. Hinckley?s
treatment needs as they evolve. at 33. For example, the proposed conditions specify the
frequency of Mr. Hinckley?s visits to Dr. Giorgi-Guarnieri for the first three months, and then
provide only a minimum of one meeting a month thereafter; but they give Dr. Giorgi?Guarnieri
the discretion to determine whether more than one meeting per month is needed. Ld. at 44-46.
Mr. Hyde also explained that Mr. Hinckley?s current regime of 17-day visits to Williamsburg
hinders his integration into the community and limits Mr. Hinckley?s opportunities for paid
employment and volunteer activities. E. at 3668.

As to the summary letters of Mr. Hinckley?s progress which the Hospital has
prepared and the Court has received and reviewed after each of Mr. Hinckley?s visits to
Williamsburg over the last twelve years the Hospital proposes eliminating this step and
simply forwarding the Williamsburg treatment team?s clinical notes to the Court instead.
Transcript of Hearing at 48?51 (Apr. 22, 2015 pm). According to Mr. Hyde, the summary
letters are ?not sustainable? due to the amount of work it takes to prepare them, and they are
?redundant,? at 15, because the letters essentially regurgitate the information contained in the
treatment providers? notes. 1d. at 49?50. Mr. Hyde also testified that the Hospital does not
believe that the summaries are any longer ?clinically relevant? or ?risk relevant.? Transcript of
Hearing at 15 (Apr. 23, 2015 p.111). The HOSpital therefore proposes that Dr. Nicole Reid
Johnson collect the Williamsburg treatment providers? notes, as Mr. Hyde has done for the past
several years, and forward these documents to the Court without an attached summary letter.

Transcript ofHearing at 3233 (Apr. 23, 2015 am).

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Mr. Hyde also testi?ed that the Hospital?s proposed conditions would eliminate
the requirement that the Hospital and Mr. Hinckley prepare advance itineraries of his daily
activities, which Mr. inckley has followed for each of his previous visits to Williamsburg.
Transcript of Hearing at 67~68 (Apr. 22, 2015 Under the Hospital?s proposed conditions,
Mr. Hinckley would be allowed to travel unaccompanied and without supervision without a pre-
determined itinerary, with the exception that he avoid ?government centers,? a term which is left
undefined. in. The Hospital believes the elimination of itineraries is appropriate for
convalescent leave because itineraries ?present a major barrier to him living dynamically and
normally in the community.? id. at 68.

Mr. Hyde stated that Mr. Hinckley?s compliance with the itineraries, since the two
incidents in 201 1, has been ?very, very good? and that he ?has not shirked his reSponsibilities
with that.? Transcript of Hearing at 82 (Apr. 23, 2015 am). With the exception of one ?lapse,?
as Mr. Hyde described it, Mr. Hinckley has complied with his scheduled itineraries and received
permission from Mr. Hyde in advance for any changes. E. at 82?83. The ?lapse? occurred on
January 20, 2015. Mr. Hyde testified that Mr. Hinckley was scheduled to go with his friend,
Bruce Brelsford, a local photographer, to meet with Robert Lerner, a former creative director and
photographer with Look Magazine. m. at 83?84. Mr. Lerner, however, was ill and canceled the
meeting. Mr. Hinckley and Mr. Brelsford instead went to visit a musician, John Tracy, but failed
to notify Mr. Hyde in advance to obtain his approval to the change in itinerary. E. at 84. The
following day, Mr. Hinckley did inform Mr. Hyde of the change. 19,. at 85. In Mr. Hyde?s view,
unlike the incidents in 201 1, when Mr. Hinckley went to a book store instead of to a movie as
required by his itinerary, and then lied to his treaters which Mr. Hyde viewed as deceptive,
Transcript of Hearing at 7881 (Apr. 23, 2015 p.111.) the decision to visit Mr. Tracy, the

musician, instead of Mr. Lerner in January 2015 was not deceptive or manipulative ?given the

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context of the situation.? E. at 79. Rather, it was an exercise of ?poor judgment in the
moment.? 1Q.

Mr. Hyde also discussed Mr. Hinckley?s continued integration into the
community in Williamsburg with the considerable assistance of Mr. Weiss. Transcript of
Hearing at 30-31, 61-62 (Apr. 23, 2015 Unlike the most recent prior hearing in this matter
at which the Hospital?s witnesses acknowledged that Mr. Hinckley had not taken advantage
of opportunities to increase his socialization in Williamsburg Mr. Hyde believes that there has
been a ?marked increase in Mr. Hinckley?s level of engagement,? at 74?75, and that the
switch from Dr. Beffa to Mr. Weiss as Mr. Hinckley?s case manager in Williamsburg has been a
?huge plus.? 151. at 62. For example, Mr. Hinckley has joined a community center and attended
lectures at a museum and a local university. In addition to group therapy with Dr. Beffa, Mr.
l-Iinckley also has begun attending group meetings with the National Alliance on Mental Illness
which is a national organization that supports those living with mental illness and
their families and friends. Id. at 7677. Mr. Hinckley has expanded his use of unaccompanied
time, pursng his new interest in photography, arranging times to meet with different friends, and
exploring employment opportunities. 1g. at 79. Mr. Hinckley has also established friendships
with several members of the Williamsburg community, including Mr. Brelsford, a photographer,
and Mr. Les Solomon, who works at the Unitarian Universalist Church where Mr. Hinckley
volunteers. ta. at 884239.

Mr. Hyde testified that with the conditions proposed in the original December 14,
2014 letter and those contained in the revised March 20, 2015 letter, the Hospital believes
that Mr. I?Iinckley would not be a danger to himself or others. Transcript of Hearing at 44 (Apr.

22, 2015 pm).

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2. Dr. Katherine Murphy Forensic 

Dr. Katherine Murphy has a master?s degree in forensic from the
Chicago School of Professional and a doctorate from American School of
Professional Transcript of Hearing at 5-6 (Apr. 27, 2015 am). Dr. Murphy
formerly was a clinical at St. Elizabeths Hospital. m. at 7-8. She ?rst
conducted a risk assessment of Mr. Hinckley in this case in 2011, with a supplement completed
in 2013, in preparation for the previous evidentiary hearing in this matter. m. at 9. She
conducted an extensive risk assessment update in advance of this evidentiary hearing. Dr.
Murphy was permitted to offer expert testimony at the hearing on the issue of whether Mr.
Hinckley will be a danger to himself or others as a result of mental disease if released on
convalescent release to Williamsburg under the conditions prOposed by the Hospital. E. at 8.

Dr. Murphy testi?ed that she supported the Hospital?s plan for convalescent
leave, so long as certain additional Speci?ed conditions were added, Transcript of Hearing at
13-14, 6667 (Apr. 27, 2015 am), because, in her expert opinion, Mr. Hinckley is ?currently low
risk and would be a low risk of future violence if granted convalescent leave under the speci?ed
conditions.? 191. at 15?; id. at 104. She further testified that she is ?very confident? in this
Opinion. E. at 15. She further believes that ?the risk of relapse is low ofdecompensation
without prolonged isolation and that [Mr. I-linckley] would be readily assessed throughout his
transition by several treatment providers based off of his adjustment to the plan.? E. at 16. If a
relapse did occur, Dr.? Murphy testified that in her opinion it would be gradual, detectable by his
treatment providers, and responsive to pharmacology. 151.; see id. at 57~5 9.

In conducting the risk assessment update, Dr. Murphy interviewed Mr. Hinckley
and all of his treatment providers in Williamsburg and at St. Elizabeths Hospital, among others.

See Murphy Rpt. at 19?48. She also administered several tests of Mr. Hinckley.

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Mr. Hinckley?s results on the ?rst test, the Minnesota Multiphasic Personality Inventory
showed?a ?very similar pro?le that he showed in 201.1 and across multiple
administrations since at least 1995.? Transcript of Hearing at 17 (Apr. 27, 2015 am). This test
showed that Mr. Hinckley ?shows a tendency towards defensiveness,? ?indicating that he tends
to portray himself in an overly favorable light and has some difficulty acknowledging
and problems.? E. The test ?did not show any elevations on the
clinical scales,? ?indicat[ing] that he?s not showing any overt distress, not showing
bizarre ideation, not showing paranoia, [and] not showing remarkable depression.? I_d. at 18.
The two scales where Mr. Hinckley historically has shown some ?slight elevations? over the past
decade or so, Scales  and 4, ?suggest that I-Iinckley] does harbor some degree of anger but
has a dif?cult time communicating and expressing this angerhard-time expressing
this negative emotion.? at 19. Overall, Dr. Murphy testi?ed that Mr. Hinckley is ?not
evidencing significant based off of the MMPI-2 data.? m.

Dr. Murphy next administered the Violence Risk Appraisal Guide 
which ?is an actuarial instrument used to assess violence using statistically driven methods?
Transcript of Hearing at 20 (Apr. 27, 2015 am), comprised of twelve predictor variables.
Murphy Rpt. at 52.  Hinckley?s score on the VRAG did not change in comparison to his
score in 2011. Dr. Murphy testi?ed that this result was expected, however, because the test uses
?static dispositional historical factors,? in other words ?factors [that] don?t change over time.?
Transcript of Hearing at 21 (Apr. 27, 2015 am). This is not surprising because Mr. Hinckley
has been institutionalized at St. Elizabeths for over 30 years, whereas ?the average length of stay
for folks in the original VRAG study was four to ?ve years.? E. In addition, the original VRAG

study looked ?at recidivism when the individual had been transferred to either the community, a

halfway house, or a minimum?security forensic hospital,? and Mr. llinckley ?has been [in]

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minimum security since 1992 and has had open access to the grounds.? 1g. at 22. Mr. Hinckley
scored in the second lowest category, out of nine, indicating a low risk ofviolence. Murphy Rpt.
at 53. Mr. Hinckley?s low test scores ?suggest[] that he?s meaning that his
risk of violence dissipated over time. Transcript of Hearing at 22 (Apr. 27, 2015 am.) Based
on the VRAG results and the caveats discussed above, Dr. Murphy concluded that Mr.
Hinckley?s risk ofviolence is ?decidedly low.? 1d. at 22-23.

in addition to the original VRAG, Dr. Murphy also administered the VRAG
revised, which was published in February of 201 5 based upon research data published in 2013.
Transcript of Hearing at 23 (Apr. 27, 2015 am.) The purpose of the VRAG revised was ?to
deal with some of the caveats that came with the administration of the original m. The
VRAG revised, however, has ?about the same level of predictive accuracy as the VRAG
[original],? in Dr. Murphy?s opinion. m. at 24. Dr. Murphy testi?ed that Mr. Hinckley again
scored in the second lowest category, out of nine, on the VRAG revised, the same score Mr.
Hinckley received on the VRAG original. This score puts Mr. Hinckley ?at a low risk of
violence.? I_d. at 24.

The ?nal test Dr. Murphy administered was the This test ?is a
structured professional judgment tool that relies on empirically~based risk factors.? Transcript of
Hearing at 25 (Apr. 27, 2015 am.) The test incorporates three domains: historical (H), clinical
(C), and risk management (R). The ?rst domain, historical, overlaps substantially with the

VRAG and involves static factors that generally do not change over time. Q. Regarding this

 

?1 Dr. Murphy testi?ed that she administered the updated version of the 
which is ?fundamentally the same? as prior versions. Dr. Murphy stated that the researchers
incorporated updated research, narrowed the definitions of certain risk factors, and made small
additions, such as adding a risk factor on the historical scale for antisociality, which research has
shown ?is the strongest predictor ofviolence.? Transcript of Hearing at 27 (Apr. 27, 2015 am.)

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domain, Dr. Murphy analyzed the historical risk factors that were the most salient at the time of
the offense: at the time, major depression, isolation, [and] narcissistic personality
disorder.? 1d. at 27~2?8. Dr. Murphy testified that ?Mr. Hinckley has responded Well? to
treatment at St. Elizabeths and has been compliant with his medication and therapies. id. at 30.
With the exception of the incident in January of 2015 discussed by Mr. Hyde, Dr. Murphy also
testi?ed that Mr. Hinckley has been ?very diligent in his approach to following through with
what?s been asked ofhim and what are in his court orders.? 1,1. In total, Dr. Murphy concluded
that Mr. Hinckley no longer exhibits signs of and that ?[t]hrough more than 30 years
of monitoring, treatment and data collection, it has become clear that depression and narcissism,
as risk factors of violence in the case of Mr. Hinckley, are inherently mitigated in the absence of
active 1d: at 29-30.?

The clinical domain measures ?clinical risk factors,? including ?a person?s present
adjustment, if there?s any signs of mental illness, any signs of Violent ideation, how they?re
coping with life, what does their support network look like, [and] how they?re responding to
treatment.? Transcript of Hearing at 30 (Apr. 27, 2015 am). Dr. Murphy testified that ?Mr.
Hinckley remains stable,? ?has not shown any ?uctuations in mood,? and ?has not shown any
at all.? E. at 31. Dr. Murphy stated that it was signi?cant that, deSpite
?some stressful circumstances over the last few years,? including the death of James Brady, Mr.
Hinckley has not needed any adjustments to his medication, a fact which shows ?increased

resilience.? 1d,.

 

'2 In her Report, Dr. Murphy noted that is the linchpin to Mr. Hinckley?s
overt expressions of Violence in the past, and Mr. I?Iinckley ?has not exhibited 
for more than two decades.? Murphy Rpt. at 55

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As for future anticipated signi?cant stressors, Dr. Murphy noted that there
obviously will come a time when Mr. I-Iinckley will have to deal emotionally with the loss of his
mother, ?who has been a source of unwavering support.? Murphy Rpt. at 60. Dr. Murphy
envisions Mr. Hinckley ?reacting with sadness, the typical bereavement responses
that one experiences when they lose somebody very important.? Transcript of Hearing at 86
(Apr. 27, 2015 p.111). will be sad. He will grieve,? but, she noted, ?bereavement should
not be confused with depression.? id. In Dr. Murphy?s view, Mr. Hinckley?s manner of grieving
this loss will ?requireclinical attention,? and treatment providers will have to assess Mr.
Hinckley for signs of depression following his mother?s death. Murphy Rpt. at 60. '3 She
testi?ed, however, that ?there will be several treatment providers, and Dr. Giorgi-Guarnieri as
the risk management assessor, who will be looking at this very issue and will be looking at this
issue closely.? Transcript ofHearing at 89 (Apr. 27, 2015 pm). She is con?dent that ?[a]ny
of major depression . . . would be detected? and ?would be addressed.? lg.

Dr. Murphy further testi?ed that Mr. Hinckley has responded well to the addition
of Mr. Weiss as case manager, which has improved Mr. Hinckley?s mood and level of
motivation. Transcript of Hearing at 32 (Apr. 27, 2015 am). She noted that Mr. Weiss has
been a positive addition that has ?brought about a lot of new opportunities for Mr. Hinckley.? 
at 37. Dr. Murphy stated that Mr. Hinckley has not exhibited any signs of isolation or
withdrawal, has relied upon his support system in Williamsburg, has connected with other
individuals on his visits to Williamsburg, and has exercised sound judgment in his relationships.

is. at 32, 34?35. In comparison to a ?typical insanity acquittee . . . coming out of the hospital to

 

?3 The death of Mr. Hinckley?s father was also stressful and a cause for clinical
concern. The record shows, however, that Mr. I~Iinckley?s mood and emotional reaction were
appropriate. See Hinckley VII, 40 F. Supp. 3d at 54; Hinckley VI, 625 F. Supp. 2d at 23.

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reside on convalescent leave,? Whose ?active are far higher than and far more acute
than what Mr. Hinckley shows,? Mr. Hinckley?s are ?quite stable and have been . . .
for a long time.? 1Q. at 33. Dr. Murphy testified that, as to the clinical factors, Mr. Hinckley thus
is ?really ready to move forward at this point.? Ld. at 34.

The ?nal domain, the risk management scale, is a ?future-oriented scale? that
measures ?empirically?rooted risk factors that pay attention to how a person will adjust to
whatever context is being recommended.? Transcript of Hearing at 26 (Apr. 27, 2015 
There are five risk factors considered as part of the risk management scale: future problems with
(1) professional services plans; (2) living situation; (3) personal support; (4) treatment or
supervision; and (5) stress or coping. Murphy Rpt. at 58. ?The recommended time frame for
examining these considerations is the ?near future,? which is specified as a few weeks to several
months following the evaluation.? lg. Dr. Murphy analyzed each of these factors, noting that
?Mr. Hinckley has sufficiently adjusted to the expansion in his conditional release to 17-day
visits, and he followed each of the stipulations outlined in the 2014 Court Order.? 

Dr. Murphy stated that, going forward, ?a few speci?c risk management issues
will need to be addressed on convalescent leave? most prevalently Mr. Hinckley?s history of
unreliable selfwreporting. Murphy Rpt. at 58. While Dr. Murphy noted that Mr. I?Iinckley has
shown improvements in this area, she stated that ?it remains essential that treatment providers
continue to corroborate Hinckley?s reports so that any discrepancies can be 
addressed and resolved.? 1g. Dr. Murphy noted that Mr. Hinckley ?is fortunate that he has
personal support available to him that many insanity acquittees do not,? although she noted that
the Hinckley family?s ?nancial backing ?cannot be guaranteed over the long term,? so ?further
establishing Hinckley] in the community as financially independent from his family should

be the primary case management objective through the next phase of transitionCase Document 623 Filed 07/27/16 Page 43 of 103

stress and coping, Dr. Murphy concluded that Mr. Hinckley ?is currently in a stable position to
manage the[] losses [of his professional and personal relationships at the Hospital] with
resilience? and that, in the event of his mother?s death, ?multiple treatment providers will
actively assess Mr. Hinckley for signs of developing or worsening depression following his
mother?s death.? E. at 60.

Dr. Murphy also testified regarding her assessment of the ten risk factors
particular to Mr. I?Iinckley that have been identi?ed by the Hospital and Dr. Patterson.l4 As to
the first risk factor, depression, Dr. Murphy testified that she has not seen any evidence of
depression and that Mr. I?Iinckley?s diagnosis of major depression is in ?full sustained remission?
and has been for over two decades. Transcript of Hearing at 38 (Apr. 27, 2015 am). She
further testified that she has not seen any evidence of isolation, the second risk factor with Mr.
Hinckley. E. at 38?3 9. In fact, Dr. Murphy noted that Mr. Hinckley is ?very far from anything
that resembles? the isolation that occurred at the time of the offense. id. at 39. Although Mr.
Hinckley ?always has been an introvert? and this will not change Dr. Murphy testified that

1

he has ?met the expectation that both [treatment] teams have put forth for him? as far as

 

?4 These risk factors were identified by the I-ioSpital as related to Mr. Hinckley?s
original offense and his future risk for violence. Patient?s Exhibit 1 from Feb. 2013
Evidentiary Hearing [Dkt. No. 415-?1] (Mr. Shamblee?s Recommendation for an Expansion of
the Current Conditional Release and for Convalescent Leave). These ten risk factors are
included as part of the Hospital?s ?checklist? that each treatment provider completes for each of
Mr. Hinckley?s visits to Williamsburg. Transcript of Hearing at 19 (Apr. 23, 2015 
The risk factors are: (1) depression; (2) isolation; (3) (4) level of insight into mental
illness; (5) personality disorder (Speci?cally, in Mr. I-?linckley?s case, narcissism); (6) access to
weapons; (7) lack of family support; (8) history of suicide attempts; (9) dif?culty in relationships
with friends; and (10) deception. Dr. Patterson agrees that this is the appropriate list of risk
factors, although, as discussed later he now would add an eleventh risk factor. _S_e_e infra at 73.

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becoming integrated into the community. E. at 40. He has shown a brighter affect and more
positive outlook; he is more relaxed, the antithesis ofisolation. at 40-41.15
As to the next risk factor, Dr. Murphy testified that she found no
evidence of and that Mr. Hinckley has been in full, sustained, and stable remission for
more than two decades. Transcript of Hearing at 41 (Apr. 27, 2015 Dr. Murphy also
testified that Mr. Hinckley has been fully compliant with his medication regime, which is
directly relevant to the fourth risk factor, insight into mental illness. m. at 42. Dr. Murphy
stated that Mr. Hinckley?s compliance with his medications, including being proactive ?in being
sure that his medications are readily available for him? in Williamsburg, ?suggests that [insight
into his mental illness] is not a risk factor that elevates his risk in any way and contributes to an
overall risk pro?le that?s low.? in. As to the fifth risk factor Mr. Hinckley?s narcissistic
personality disorder Dr. Murphy agreed that his narcissistic personality disorder is
signi?cantly ?attenuated at present and [has been] for many years.? Q. at 42?43. Dr. Murphy
also testified that there is no evidence of interest in weapons, the sixth risk factor. Q. at 48.
Regarding the seventh risk factor, family support, Dr. Murphy testi?ed that, ?in contrast [to]
many of the insanity acquittees that are coming out of the hospital that have minimal to no
support,? ?Mr. I?Iinckiey?s family has been emotionally supportive, [and] financially supportive.?

M. Mr. I--Iinckley?s mother, Dr. Murphy noted, ?in particular has been unwavering in her support

of Mr. Hinckley.? m. at 49.

 

'5 Dr. Murphy also stated that Mr. Weiss has ?made it clear? that Mr. I-Iinckley?s
previous lack of volunteer opportunities and relationships in Williamsburg which in the past
had been perceived as ?a lack of initiative? we actually was often a result of ?the resistance from
the community down there and how his level of notoriety has impacted this.? Transcript of
Hearing at 37 (Apr. 27, 2015 

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The next risk factor associated with Mr. Hinckley is a history of suicides. Dr.
Murphy testified that Mr. Hinckley has shown no evidence of wanting to hurt himself since his
last suicide attempt in 1983, about a year after his admission to St. Elizabeths Hospital.
Transcript of Hearing at 50-51 (Apr. 27, 2015 am). As to the ninth risk factor, difficulty in
relationships with women, Dr. Murphy testified that this is ?not a risk of violence as it stands
right now,? in part because the relationships he has had in recent years are ?real relationships
with real women,? as opposed to delusional or fantasized relationships in the past. E. at 52. In
Dr. Murphy?s opinion, ?too much emphasis has been placed on this as a risk factor,? and Mr.
Hinckley?s recent response to relationships with women has been ?reasonably mature.? 1d. at
51-52. Dr. Murphy did note, however, that Mr. Hinckley sometimes ?seems to show behaviors
that are consistent with an adolescent level or young-adult level of relationships.? 1d. at 52?53.

Regarding the tenth or final risk factor, deception, Dr. Murphy testi?ed that there
has been no evidence of deception since her last evaluation of Mr. I~linckley. Transcript of
Hearing at 57 (Apr. 27, 2015 am). Dr. Murphy further testi?ed that she does not view the
January 2015 incident, where Mr. Hinckley met with Mr. Tracy instead of with Mr. Lerner, as
his itinerary indicated, as an instance of deception. E. at 5465. Dr. Murphy stated that she
thought Mr. Hinckley ?used poor judgment? on that occasion, but does not believe ?he was
trying to deceive or omit or withhold information.? Q. at 55. Nor does she believe it was an
instance of manipulation. Q. at 56?57. In contrast to the two previous occasions where Mr.
Hinekley has violated his itinerary, Dr. Murphy noted that there is no indication that Mr.
Ivlinckley lied at any point about this incident, and instead appears to have been relatively
forthcoming about it to his treatment providers. Murphy Rpt. at 16-17.

Dr. Murphy further offered her opinion regarding Dr. Patterson?s suggestion that

an eleventh risk factor, ?nancial support, should be added. Transcript of Hearing at 53 (Apr. 27,

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2015 am). She testi?ed that she does not ?view this issue in the same way? And does not
believe lack of financial support should be added as a risk factor. Id. Instead, Dr. Murphy stated
that financial support is ?always inevitably and inherently a component of putting together
outplacement plans.? IQ. In conducting the assessment, Dr. Murphy noted that her
?main objective? is to analyze the risk ?of the 6- to-18-month time frame? and that she does not
believe ?that the fact that the family can?t sustain the same level [of ?nancial support] over time
represents a risk factor.? Id. at 54.

Regarding the HOSpital?s proposal to eliminate Mr. Hinckley?s requirement to
follow daily itineraries, Dr. Murphy testi?ed that she does not ?think [itineraries are] necessary
from a riskwmanagem?ent perspective.? Transcript of Hearing at 61 (Apr. 27, 2015 She
stated that, through Phase IV of Mr. Hinckley?s integration, the itineraries were ?useful to gather
data about how Mr. Hinckley was going to adjust to this increase in freedom,? but that we now
?have enough data . . . to suggest. that he uses . . . his time there [in Williamsburg] responsibly.?
m. at 63?64. Moreover, Dr. Murphy noted that an itinerary ?becomes less realistic? and brings
?a degree of rigidity? that ?can interfere with Mr. Hinckley being more spontaneous,? which
should be encouraged during convalescent leave. E. at 64. In Dr. Murphy?s opinion, itineraries
?don?t ?t the convalescent leave framework.? lg. at 88.

As to  Hinckley?s music therapy, Mr. Murphy testi?ed that it is ?an avenue of
therapy that is useful for Mr. Hinckley that he derives great bene?t from,? but that she does not
see it as ?a critical component to keeping his risk low.? Transcript of Hearing at 7 (Apr. 27,
2015 pm.) She stated that she discussed Mr. Hinckley?s music therapy with Dr. Giorgi?
Guarnieri and that both agreed that music therapy is ?not absolutely critical . . . from a risk
management perspective? such that ?the actual treatment itself isn?t something that is necessary

to keep him at a low risk.? Id. at 8. In fact, Dr. Murphy suggested that ?a clinician who is not

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doing music therapy or trained in music therapy could review his songs.? m. Dr. Murphy noted,
however, that in her opinion music therapy ?should [not] be taken away at this point.? 191. at 9.

Dr. Murphy testified that her proposal involving three phases, with decreased
structure and fewer cenditions over the next several years m? at 48-51 ?steps down
the level of monitoring and supervision in a way that accounts for there being an absence of
itineraries.? Transcript of Hearing at 61 (Apr. 27, 2015 am). For example, instead of an
itinerary prepared in advance, Dr. Murphy recommends requiring Mr. 1--Iinck1ey to maintain a
general calendar or log of what he has done each day that he can present to Mr. Weiss and Dr.
Johnson for discussion about his adjustment. E. at 61 ~62; Transcript of Hearing at 107-08 (Apr.
27, 2015 pm). Dr. Murphy testified that her ?recommendation is not so detailed that he?s
logging all of his activities,? but would require only a general log, particularly regarding changes
to his scheduled activities, that is for ?accountability purposes.? Transcript of Hearing at 87
(Apr. 27, 2015 am). Dr. Murphy believes that such a daily log or calendar, rather than an
advance, detailed itinerary of daily activities, is ?consistent with the level of freedom that [Mr.
I-Iinckley is] ready for.? E. at 86. With such a log or calendar, the ?onus? would be on Mr.
Iv-linckley, and Mr. Weiss would then be responsible for contacting people to con?rm the
activities detailed by Mr. Hinckley in his daily calendar or log. I_c_i. at 63. In her opinion, in view
of Mr. Hinckley?s history of unreliable self-reporting m? an important risk factor Mr. Weiss
and other treatment providers need to continue to corroborate Mr. I-Iinckley?s reports of his
activities and whereabouts. Murphy Rpt. at 58.

Based upon her conclusions from the results of the risk assessment and the
various tests she administered, it is Dr. Murphy?s opinion that Mr. Hinckley is ready for full-time
convalescent leave inWilliamsburg, Virginia. Transcript of Hearing at 66-67 (Apr. 27, 2015

am); Murphy Rpt. at 60?61. In her view, Mr. Hinckley is a low risk of further violence under

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the proposed conditions, with the modi?cations she proposes, and the prospect of relapse is

decidedly low. Transcript of Hearing at 104 (Apr. 27, 2015 am).

Dr. Murphy made a series of recommendations, dividing Phase into three time

periods: (1) the ?rst six months of convalescent leave (?Part (2) the next six to twelve

months (?Part and (3) after eighteen months on convalescent leave (?Part Murphy Rpt.

at 61-65; Transcript of Heating at 68 (Apr. 27, 2015 am). These recommendations largely were

incorporated into the Hospital?s revised conditions in its April 17, 2015 letter. During Part A,

Dr. Murphy recommends the following minimum treatment schedule for Mr. Hinckley:

 

1. ?treatment planning conferences? with the I
Williamsburg treatment team, and Dr. Johnson when available,
to ?review the status of Mr. Hinckley?s risk factors and his
community reintegration efforts;? 1 6

2. ?monitoring checks? with Dr. Johnson and a member
of Mr. Hinckley?s former inpatient treatment team at the
Forensic Outpatient Department in 

3. individual sessions until the conclusion
of Part A with Dr. Binks at the Forensic Outpatient Department
in 

4. Weekly group sessions with Mr. Beffa;

5. weekly NAMI group meetings;

6. Individual therapy with Mr. Beffa three times a month;

7. (twice per month) meetings with Dr. Giorgi?
Guarnieri;

8. Case management meetings with Mr. Weiss at least twice a
month; and

9. meetings with an individual music therapist.

'6 In her written report, Dr. Murphy recommended that ?Dr. Johnson and a member

of the inpatient treatment team should be routinely included (via conference call) in these
conferences.? Murphy Rpt. at 61.

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Transcript of Hearing at 68?74 (Apr. 27, 2015 am); Transcript of Hearing at 47-50, 68-69 (Apr.
27, 2015 p.111); Murphy Rpt. at 61?62. Dr. Murphy acknowledged that this schedule is ?far
above? what is typically recommended for a patient on convalescent leave and opined that this
schedule would provide ample opportunity for Mr. I-linckley?s treatment providers to assess and
monitor his condition and integration. Transcript of Hearing at 75 -76 (Apr. 27, 2015 am).

After six months of convalescent leave, Dr. Murphy testi?ed that she
recommends a ?comprehensive treatment planning conference? with all of Mr. Hinckley?s ?key
providers,? including the Williamsburg treatment team and Dr. Johnson. Transcript of Hearing
at 75 (Apr. 27, 2015 am); see Murphy Rpt. at 62. If all participants in the conference concur
that Mr. lulinckley has met expectations during Part A and is ready to proceed to Part B, Dr.
Murphy recommends that Mr. Hinckley then progress to a somewhat reduced minimum
treatment schedule under Part B. Transcript of Hearing at 75 (Apr. 27, 2015 Murphy Rpt.
at 62. For Part a period of six to twelve months following the initial six month period 
Dr. Murphy stated that she recommends the following minimum treatment schedule for Mr.
Hinekley:

1. ?treatment planning conferences? with the
Williainsburg treatment team;

2. ?monitoring checks? with Dr. Johnson at the Forensic
Outpatient Department in 

3. Weekly group sessions with Mr. Beffa;

4. Individual sessions with Mr. Beffa two times a
month;

5. Weekly NAMI group meetings;
6. Meetings with Dr. Giorgi?Guarnieri at least once a month;
7. meetings with Mr. Weiss at a minimum; and

8. meetings with an individual music therapist.

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Transcript of Hearing at 76?81 (Apr. 27, 2015 am); Transcript of Hearing at 49?52 (Apr. 27,
2015 pm); Murphy Rpt. at 62-63. Mr. I?Iinckley would no longer meet with Dr. Binks once Part
begins.

Dr. noted that, in contrast to the Hospital?s proposal of treatment
planning meetings occurring every other month, she recommends that the meetings continue on a
basis during Part B, because risk management and case management ?become the more
salient foci and objectives of transitioning a patient out? at this point in convalescent leave.
Transcript of Hearing at 77 (Apr. 27, 2015 am). She recommends maintaining 
treatment planning meetings ?because this is the avenue that?s going to address [Mr. Hinckley?s
problem with] self?reporting.? 1d. at 78. She further testi?ed that her proposal involves less
individual therapy in 'Part because it does not ?remain to be the critical component that it was?
M. at 77, and because. Mr. Hinckley, at that point, will have ?reached maximum bene?t [from]
individual on a weekly basis, and it can be tapered down, and group
is emerging as the indicated treatment modality for Mr. Hinckley.? Transcript of
Hearing at 51-52 (Apr. 27, 2015 pm); s99 algg Transcript of Hearing at 78-79 (Apr. 27,
2015 am). Dr. Murphy testified that Dr. Binks and Mr. Beffa agreed with the approach of
decreasing individual therapy and continuing group therapy because ?once [a patient has] started
the group [therapy], that becomes the primary modality of treatment and individual therapy
is used as an adjunct to bolster [group therapy].? Transcript of Hearing at 79 (Apr. 27, 2015


Under both Parts A and of Dr. Murphy?s proposed plan, Mr. Weiss would take
on the role of liaison between the Williamsburg treatment team and Dr. Johnson and the
outpatient department at St. Elizabeths Hospital. Transcript of Hearing at 82 (Apr. 27, 2015

am). He would collect progress notes from treatment providers in Williamsburg, talk to Mr.

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Hinckley?s work supervisors, con?rm Mr. Hinckley?s attendance at work and appointments with
treatment providers, and relay all of this information to Dr. Johnson. IQ. at 82-83; Murphy
Rpt. at 64. Dr. Johnson would review the material provided by Mr. Weiss and conduct collateral
interviews with the Williamsburg treatment providers. Transcript of Hearing at Sit-85 (Apr. 27,
2015 am). Under Dr. Murphy?s proposal, Dr. Johnson would put the material together and draft
a summary of Mr. I-tlinckley?s adjustment and progress in Williamsburg, and provide all
this information to the Court. 151.; alsg Murphy Rpt. at 64.17

Following Part B, Dr. Murphy recommends that an updated risk assessment be
conducted and a comprehensive treatment planning conference be convened to evaluate Mr.

. Hinckley?s adjustment to convalescent leave and assess how to proceed. Murphy Rpt. at 65.
After there is more data, the risk assessor will look at how Mr. Hinckley has done on
convalescent leave in?the last year or so, and then decide what treatment providers he needs to
see going forward and how frequently. Transcript of Hearing at 105-07 (Apr. 27, 2015 am).

Dr. Murphy further testified regarding additional risk management conditions she
recommends. First, she testified that she agrees with the Hospital?s proposal that Mr. Hinckley
be limited to a 50?mile radius of Williamsburg. She testi?ed, however, that she also
recommends that ?if he travels 30 miles out of . . . the center point of the radius . . . that he?s with

a treatment provider? or a family member. Transcript of Hearing at 89, 91 (Apr. 27, 2015 am).

 

17' Dr. Murphy believes that the community reintegration objectives for Parts A and
are as follows: (1) applying for health care entitlements; (2) researching housing options in the
Williamsburg area; (3) obtaining consistent employment; and (4) locating a primary care
physician in Williamsburg. She believes that the and treatment
objectives are: (1) utilizing the support of Mr. Beffa, Dr. Giorgi?Guarnieri and the
group to guide decision~making in intimate relationships, as well as in forming
and maintaining friendships; (2) assisting Mr. Hinckley in identifying and expressing his
emotional responses effectively; (3) continuing to encourage openness and disclosure in a
consistent manner to all those involved in his treatment; and (4) reviewing community
reintegration efforts and changes in routine. Murphy Rpt. at 63.

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This condition would be consistent with the proposal that Mr. I-Iinckley avoid government
centers in Richmond iwhich is within the 50 mile radius, but outside the 30 mile radius). E.

Dr. Murphy testified that requiring a OPS-monitoring ankle bracelet would be
?intrusive and unnecessary in this case.? Transcript of Hearing at 92 (Apr. 27, 2015 am).
Because Mr. Hinckley will be monitored under the conditions proposed by the Hospital, Dr.
Murphy testified that she believes such ?a high level of supervision is inconsistent with [Mr.
Hinckley?s] needs right now.? Id. at 94. In her opinion, an ankle bracelet would also ?further
impede[] his ability to . . . reintegrate as a member of society? because of the stigma and
recognition that would come with an ankle bracelet. E. at 95. Dr. Murphy further noted that
?there hasn?t been any evidence to suggest across [his hospital stay] or during his stays in
Williamsburg that [Mr. Hinckley] is an elOpement risk.? Dr. Murphy testified that she
therefore also does not believe a vehicle tracking device is necessary. Id. at 95. And while Dr.
Murphy recommended that Mr. Hinckley continue to carry as GPS-enabled phone at all times,
she Opposes any restrictions on which phones Mr. Hinckley may or may not use to make calls,
either from his mother?s home or at employment or volunteer work. E. at 100; Transcript of
Hearing at 33 (Apr. 27, 2015 

As to restrictions or monitoring of Mr. Hinckley?s Internet access, Dr. Murphy
testi?ed that she does not believe ?that?s [clinically] indicated right now? because there is no
?data to suggest that Mr. Hinckley is going to use the Internet in some way to commit a crime or
commit a violent crime.? Transcript of Hearing at 96 (Apr. 27, 2015 In her risk
assessment, Dr. Murphy found ?nothing outstanding or noteworthy or red ?ags to suggest that
[Mr. Hinckley] should not be afforded the opportunity to use the Internet,? which is ?a vital part
of existence today.? Id. at 96. Dr. Murphy also testi?ed that there is no reason why this access

should not include information about himself, President Reagan, James Brady, presidential

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assassinations, or other forms ofviolence because such information ?can be used as a
therapeutic tool.? 191,. at 99. As to pornography, Dr. Murphy noted that ?looking at pornography
does not elevate his violence risk,? which ?might be different in a sex offender evaluation, but in
the case of Mr. Ir-Iinckley, [such a restriction] is not a risk-relevant need.? Transcript of Hearing
at 34 (Apr. 27, 2015 pm). Dr. Murphy further noted that Mr. Hinckley has never shown interest
in visiting pornographic websites or websites with the information listed above. Transcript of
Hearing at 99-100 (Apr. 27, 2015 Dr. Murphy therefore opposes the government?s
proposal to restrict and track Mr. Hinckley?s Internet access because it is ?extrapolating into
extreme what-ifs that are outside of his risk factors that have been identified.? E. at 98. Dr.
Murphy, however, does agree with the Hospital?s proposal that Mr. Hinckley report any online
accounts, account details, and passwords to the Forensic Outpatient Department for Dr.
Johnson?s review. Transcript of Hearing at 34 (Apr. 27, 2015 p.111).

Dr. Murphy testi?ed that she opposes any cenditions that Mr. Hinckley be
returned to the Hospital for either a minimis violation of his conditions or if a treatment team
member becomes unavailable to continue Mr. Hinckley?s treatment. Transcript of Hearing at
101-03 (Apr. 27, 2015 am). She testified that issues such as the January 2015 incident ?don?t
necessitate rehospitalization,? which instead should be reserved only for an individual with a

?mental disorder that .makes [them] a risk of violence to [them]self or others.? 1d. at 101.

3. Dr. Nicole Johnson Director of Forensic Outpatient Department

Dr. Nicole R. Johnson, a forensic and currently the Forensic Services
Director for the District of Columbia?s Department of Behavioral Health also referred to as
the Forensic Outpatient Department or FOPD testi?ed regarding her proposed role in the

Hospital?s proposal for convalescent leave. Dr. Johnson began her current position in March of

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2014, prior to which she was an attending at St. Elizabeths for seven years.
Transcript of Hearing at 7-9 (Apr. 28, 2015). The Forensic Outpatient Department monitors
individuals found to be not guilty by reason of insanity ?once they are stabilized in the hospital
and they are no longer posing a danger to themselves or others or the community and they have
sufficiently been restored with their mental health? such that they can be discharged under
certain conditions. 1d. at 7-8. Dr. Johnson is the first person to hold this title before March of
2014, the outpatient oversight duties were handled by ?a collaboration between the individual
staff members that were employed by the Department of Behavioral Health.? 1g. at 8.

Dr. Johnson testi?ed that her department currently monitors 84 individuals on
conditional release residing in the District of Columbia community. Transcript of Hearing at
12-13 (Apr. 28, 2015). She said that in a typical case, her department has ?minimal? contact, if
any, prior to a court order granting conditional release. E. at 14. That process is currently
changing, however, as Dr. Johnson testified that the Hospital is trying to involve her prior to an
individual?s discharge to conditional release. 191. at 15. Generally, once an individual is
discharged to conditional release, responsibility for the patient transfers to the outpatient
department, and the inpatient staff at St. Elizabeths have no further involvement. 

Dr. Johnson testified that she has not attended any of the Williamsburg treatment
team meetings, but that she did attend the Hospital?s review board meetings regarding Mr.
Hinckley. Transcriptof Hearing at 16 (Apr. 28, 2015). She has also spoken with Kevin
Shamblee, VJ. Hyde and Dr. Benjamin Adewale regarding the Hospital?s proposed conditions
and her proposed role. E. at 17. She had met with Mr. Hinckley for the ?rst time approximately
two weeks before the evidentiary hearing. I_d. at 46-47. She testified that she is familiar with
Mr. Hinckley?s identified risk factors and stated that she has ?actually put more work and more

knowledge into Mr. Hinckley?s case at this point in time in his court case than [she had] of

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anyone else that?s come out of the hospital on orders of conditions.? is. at 17~18. Dr. Johnson
stated that she has no concerns regarding her ability to perform her proposed role if Mr. Hinckley
were released on convalescent leave. 1d. at 18.

Dr. Johnson testified that she agrees with the liOSpital?s proposal that Mr.
Hinckley visit the outpatient department in the District of Columbia on a basis and that
she speak with Mr. Hinckley on the phone once a week. Transcript of Hearing at 19, 49 (Apr.
28, 2015). In her opinion, the visits should continue ?until there?s a risk assessment on
file that indicates that less frequent visits would not be detrimental to Hinckley?s] centinued
progress.? 1d. at 19; gee, id. at 21-23. She did, however, express several concerns during her
interview with Dr. Patterson regarding Mr. Hinckley?s convalescent leave. Dr. Johnson
testified that she ?would prefer not to be reSponsible for compiling a report? or
summary, from all the treatment providers in Williamsburg, but would do so if the Court
required it as a condition of convalescent leave. 131,. at 19-20; gee, id. at 70. Dr. Johnson testi?ed
that she would prefer to send the treatment providers? notes directly to the Court and also provide
her own progress notes regarding her weekly phone calls and visits with Mr. Irlinckley.
1d. Another concern was Mr. Hinckley?s ?nancial support. She testi?ed that Dr. Patterson told
her ?that his conversation with [Mr. Hinckley?s] siblings suggested that there was a concern that
in the next one to two years, Mr. Hinckley would no longer have the ?nancial support? he
currently has. 1d. at 24. Dr. Johnson testi?ed, however, that after being informed of the
testimony of Scott Hinckley and Diane Sims, she no longer has that concern. 1d. at 24, 27,
6566; see,  at 65:67.

Dr. Johnson testi?ed that she agrees that Mr. I-Iinckley is ready for convalescent
leave to live in Williamsburg and that she supports the Hospital?s proposed conditions.

Transcript of Hearing at 27~28 (Apr. 28, 2015).



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B. Witnesses?rom Mr. Hinckley?s Treatment Team
1. Dr. Deborah Giorgi?Guarnieri Treating 

Dr. Deborah Giorgi?Guarnieri, who took over as Mr. Hinckley?s
Williamsburg~area 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 and is board?certi?ed in both areas.
Transcript of IWIearing? at 7-8 (Apr. 24, 2015 am). She also has a law degree. Her past work
has included positions as the director of forensic for the Medical College of Virginia
in Williamsburg, the consulting forensic for the Eastern District of Connecticut, and
assistant professor and associate director of forensic residency at Yale
University Medical School. See Hinckley VII, 40 F. Supp. 7 at 29. She treats patients with
diagnoses similar to Mr. Hinckley?s, and she is trained to recognize signs and of
and major depression. Dr. Giorgi?Guarnieri also was involved in the development
of the Hospital?s convalescent leave plan, at least as to the aSpeets that concern her treatment and
visits with Mr. Hinckley. Transcript of Hearing at 58 (Apr. 24, 2015 am).

Dr. Giorgi?Guarnieri testi?ed regarding Mr. Hinekley?s diagnoses and current
condition. She stated that Mr. Hinckley?s Akis I diagnoses are not otherwise
specified, and major depression. Transcript of Hearing at 13 (Apr. 24, 2015 am). She testified
that she is ?fairly con?dent? that both conditions are in full and stable remission and that she has
not seen Mr. Hinckley ?show that would qualify as either a major depressive episode
or that would give him a disorder in the ?ve years that [she has] treated
him.? in. Mr. Hinckley?s Axis II diagnosis is narcissistic personality disorder, which Dr.

Giorgi-Guarnieri agreed is ?signi?cantly attenuated.? 1d. at 14.

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During each of Mr. Hinckley?s 17?day conditional releases to Williamsburg, Dr.
Giorgi?Guarnieri has =met with Mr. Hinckley twice for 45 minutes each. She testi?ed that he has
?always been perfect with [his] medication? and ?has made sure he had his medicine
at all times.? Transcript of Hearing at 15 (Apr. 24, 2015 During each session, Dr. Giorgi-
Guarnieri has evaluated Mr. Hinckley for each of the risk factors that have been identi?ed by the
Hospital. Reviewing the risk factors as itemized in Dr. Patterson?s Report, she testi?ed that she
has not seen any indication of the first, second, third, and sixth risk factors: depression,
isolation, and access to weapons. id. at 16~18. As to the fourth risk factor insight
into mental illness she noted that Mr. Hinckley?s ?insights into his illness have improved in
the five years [she has] treated him.? Id. at 17. As to the ?fth risk factor personality disorder
Dr. Giorgi-Guarnieri testi?ed that his narcissistic personality disorder is signi?cantly
attenuated. 1d. at 17. She has not observed any deceptive or manipulative activity, the tenth risk
factor; Mr. Hipckley has not distorted reality, and he has not sought attention in the community.
I_d. at 18. As to the seventh risk factor, family support, she stated that ?the Hinckleys have been
extremely supportive of John, and that?s a very, very important factor for him to enter into the
communitythe eighth risk factor, Dr. Giorgi-Guarnieri testified that she
has never seen any evidence of Mr. I-Iinckley wanting to hurt himself. id, at 20. Finally, as to
dif?culty in relationships with others, she stated that she carefully monitors Mr. l-linckley?s
relationships and discusses his friendships and romantic relationships during their discussions.
E. at 18.

Dr. Giorgi~Guarnieri agreed with Dr. Patterson?s proposal, detailed in his report,
that an eleventh risk factor should be added regarding Mr. Hinckley?s ?nancial support and
stability. Transcript of Hearing at 20 (Apr. 24, 2015 She stated, however, that in her

opinion ?if the family has committed to their support and there is money there, that that should

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satisfy that particular risk factor? for Mr. Hinckley. E. at 24; id. at 84~85. On the issue of
?nances, she also stated that she accepts Medicare and Medicaid, so that she could continue to
treat Mr. Hinckley if he were to become eligible for assistance under those programs. She noted,
however, that such assistance does not cover forensic costs, such as risk assessments and
preparing for court hearings. Id. at 24-25; seg id. at 32. She further testified that, based on the
testimony of Scott Hinckley and Diane Sims, she is ?satis?ed that the support and the ?nances
are there.? E. at 26; id. at 28?29. She emphasized that if the family?s resources ?require him
to see another physician, [she is] more than willing to transition him to another physician.? 1d. at
25. She testi?ed that [she] think[s] John needs something that he?s not getting, I would let
the outpatient services know immediately.? L91. at 28. Dr. Giorgi?Guarnieri emphasized that she
believes ?nancial support is Mr. Hinckley?s biggest risk factor in the sense that if ?all of a
sudden, there?s no money and John can?t pay for his services and John can?t live in the family
home; then I think we need to send him. back to the hospital and get a new plan in order.? E. at
85. ?But that?s a big what-if.? IQ.

Regarding the incident where Mr. Hinckley visited with a musician, John Tracy,
instead of going with?Mr. Brelsford to see Mr. Lerner, as scheduled on Mr. Hinckley?s itinerary,
Dr. Giorgi-Guarnieri testified that Mr. Hinckley raised the issue in their session that week and
stated that ?he realizes now, he should have let [Mr Hyde] know [in advance].? Transcript of
Hearing at 35-36 (Apr. 24, 2015 am). She noted that she did not ?think John was deliberately
trying to deceive anyOne or trying to put himself out in the media or trying to make money on
something.? Q. at 37. She thought that he ?just saw the opportunity as something he wanted to
do and didn?t think about making contact first.? Dr. Giorgi?Guarnieri testified that
?sometimes when more than one risk factor shows up at the same time, it gets harder for John to

think of everything td do? and that, at those times, Mr. Hinckley ?still needs a little guidance.?

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id. at 37-38. She stated, however, that she did not believe that ?the actual behavior was a risk at
all,? but that ?the only misjudgment he had was he should have called.? 1d. at 38. She also
stated that since that incident, Mr. Hinckley has ?been excellent about letting peeple know.? E.
at 77.

Dr. Giorgi?Guarnieri testi?ed that, in her opinion, the conditions imposed for
convalescent leave should grant her the discretion to meet with Mr. I?Iinckley ?a minimum of
once a month individually and a minimum of once a month in treatment team.? She also would
like the authority to ?see him more often if I need to see him more often.? Transcript of Hearing
at 30 (Apr. 24, 2015 am). As to the Williamsburg treatment team visits, although the Hospital?s
proposal only would require that the treatment team meet together with Mr. Hinckley every other
month, Dr. Giorgi?Guarnieri testi?ed that she would prefer the number of meetings with the
treatment team to be once a month. g1. at 30-31, 46. She stated that this would be her preference
because, in addition to her individual sessions with him, she would like ?a second session either
in a treatment team once a month or by myself with John where I do risk assessment, because I
feel very reSponsible for making sure that . . . the risk factors are in check.? lg. at 46. She
therefore does not ?mind every other month as a minimum,? but ?when he first comes down,
we?re going to do it once a month . . . because I?m going to ask that we do it once a month.? 131.
at 48. And she testified that, if she observed any emergency with Mr. Hinckley, she
would coordinate with the outpatient department at St. Elizabeths to arrange for emergency
hospitalization, ifnecessary. E. at 40.

Dr. Giorgi?Guarnieri also testi?ed that she believes the Williamsburg treatment
team m- consisting of herself, Mr. Weiss, Mr. Beffa, and (until recently) Ms. Haley is stable
and that everyone involved has ?a commitment that?s pretty secure for the next two years. And

in those two years, [they?ll] also be looking at getting [Mr. Hinckley] other benefits.? Transcript

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of Hearing at 33 (Apr. 24, 2015 She stated that ?if one of the four core people were to
change,? the treatment team would work with the Court and the Hospital to ?nd a suitable
replacement and ?make sure John has his support at all times.? m. at 34.18

. As to monitoring of Mr. I?Iinckley while on convalescent leave, Dr.
Giorgi-Guarnieri agreed that a condition requiring Mr. Hinckley to carry a (BPS?enabled phone
?would be very helpful.? Transcript of Hearing at 52 (Apr. 24, 2015 am); gee id. at 54?55. She
disagreed, however, with the government?s proposed condition to require an ankle bracelet,
stating that she has ?not had much luck with that with [patients who have been found not guilty
by reason of insanity]? and she did not ?know if that?s appropriate for an outpatient? because, in
order to qualify for outpatient treatment, ?there?s a certain assessment that?s [already] been done
that you are safe enough to walk around without an ankle bracelet on.? id, at 56-5 7.

I In Dr. Giorgi-Guarnieri?s opinion, Mr. Hinckley is ready for full?time
convalescent leave in Williamsburg and would not present a danger to himself or others under
the conditions proposed by the Hospital. Transcript of Hearing at 12~13, 41 (Apr. 24, 2015
am). She further agreed that Mr. Hinckley?s risk of relapse under the conditions of the plan is

low. 1d. at41.

2. Mr. Jonathan V. Weiss Case Manager
The Court also heard testimony from Mr. Hinckley?s case manager in
Williamsburg, Mr. Jonathan V. Weiss, a licensed clinical social worker in private practice.

Transcript of Hearing at 5 (Apr. 24, 2015 pm). As Mr. Hinckley?s case manager, Mr. Weiss?

 

18 Despite these assurances, the Hospital has reported that, as noted, Low at 17 n.7,
Ms. Haley, the music therapist, is no longer part of the treatment team, no new music therapist
has been identified, and that the Williamsburg treatment team and the HOSpital have ceased their
efforts to find a new music therapist.

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major responsibility is to assist Mr. Hinckley with integrating into the Williamsburg community,
which has included assisting with ?social connections, employment, volunteer services, and . . .
hopefully . . . residential services.? m. at 8. During each of Mr. Hinckley?s 17~day visits to
Williamsburg, Mr. Weiss has met with him five to seven times on average. 1Q. Mr. Weiss noted
that Mr. Hinckley has been very punctual at their meetings and ?usually beats [Mr. Weiss] to
wherever we are to meet.? Id. at 20. Mr. Weiss testi?ed that, since January 2015, the
Williamsburg treatment team has met regularly, at least by phone, to exchange information about
Mr. Hinckley?s treatment and status. Transcript of Hearing at 21 (Apr. 24, 2015 Mr.
Weiss stated that it is his understanding that the treatment team agrees that Mr. Hinckley ?has
been doing an excellent job? and that recently he has been ?more comfortable in meeting new
people and interacting with other people and taking some initiative.? Id. at 22.

Mr. Weiss was integral to Mr. Hinckley obtaining his volunteer position at
Eastern State Hospital. At the hospital, Mr. Hinckley ?works in the canteen, assists patients,
staff . . . with . . . genera] food needs, does some cash register work.? Transcript of Hearing at 9
(Apr. 24, 2015 pm). Mr. l?Iinckley?s supervisors have reported ?very positively? about his work
there. at 10. Within six months prior to the hearing, Mr. Weiss also made contact with the
Unitarian Universalist Church in Williamsburg and set up another volunteer position for Mr.
Hinckley. At the church, Mr. Hinckley works on the grounds with Mr. Les Solomon doing
landscaping, including ?cutting grass, raking leaves, picking up branches, building birdhouses,
[and] assisting in whatever endeavors that they have requested to be performed.? 1d. at 11. Mr.
Weiss also testi?ed that the members of the church have been supportive of Mr. Hinckley?s
involvement there. At the request of the church?s pastor, Mr. Weiss stated that he met with
approximately 40 members of the congregation to explain Mr. Hinckley?s role and that ?a

number of congregants, three or four, came up afterwards, expressed their interest, support for

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John and willingness really to have him engage in more things at the church if he was willing
to.? 131,211: 11?12.

Mr. Weiss further testi?ed about Mr. Hinckley?s recent attendance at regular
meetings with the Williamsburg chapter of the National Alliance on Mental Illness. He
stated that, during Mr. Hinckley?s visits to Williamsburg, he has attended the NAMI meetings I
every Tuesday evening. Transcript of Hearing at 12-13 (Apr. 24, 2015 pm). Mr. Weiss
testified that he believes the meetings have been a very positive experience for Mr. Hinckley and
that ?it?s helped him understand aspects of the community and being an individual with mental
illness living in our community.? 1d. at 14.

Mr. Weiss and Mr. Hinckley engaged in ?extremely limited? efforts to pursue
paid employment for Mr. Hinckley during his l7~day visits. Transcript of Hearing at 14 (Apr.
24, 2015 pm). Mr. Weiss testi?ed that he made several attempts with local businesses, but that
each ?could not work out for different reasons.? 191. Most notably, Mr. Weiss stated that ?the
issue of him being there 17 days a month presented some real barriers to begin with.? 1d. at 15.
The businesses that Mr. Weiss contacted felt it ?wasn?t fair to other employees? if Mr. Hinckley
received special scheduling for only half a month, and that ?they wondered if that might detract
from John being able to assimilate easily into their staff, as well as asking for special
permissions.? 151. at l5. Mr. Weiss also noted that other reasons included ?people?s perceptions
of Mr. Hinckley, erroneous opinions about him and his mental health state.? E. at 16. Because
of these issues, Mr. Weiss decided to hold off on pursing paid employment opportunities any

further until Mr. Hinckley was in Williamsburg on fullutime on convalescent leave. 131. at 15. ?9

 

'9 As noted, however, see supra at 16 n.6, Mr. Hinckley has recently been offered a
paid position at the Unitarian Universalist Church, and the government has no objection to him
accepting the job.

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Mr. Weiss also discussed Mr. Hinckley?s relationships in Williamsburg and his
increased effort to make new friends. Transcript of Hearing at 16 (Apr. 24, 2015 pm). Mr.
Weiss testified that Mr. Hinckley has developed new relationships through group therapy, as
well as connections that Mr. Weiss was able to facilitate. For example, Mr. Weiss testified that
Mr. Hinckley has developed a relationship with a photographer in Williamsburg, Bruce
Brelsford, over the eight months preceding the hearing, and that Mr. Brelsford has introduced
Mr. Hinckley to Robert Lerner, an accomplished retired lead photographer for a national
magazine. id. at 17. Through his group therapy, Mr. Hinckley has also developed a friendship
with Ms. L, whom Mr. Weiss has not met. In Mr. Weiss? opinion, Mr. Hinckley?s willingness to
engage and develop relationships ?has improved tremendously over time.? Q. at 18-19, 27.

As to the January 2015 incident where Mr. Hinckley did not inform Mr. Hyde in
advance of a change in his itinerary, Mr. Weiss stated that he believes ?there?s some
misunderstanding about [the incident] and others might have characterized it as deception, but I
certainly wouldn?t.? Transcript of Hearing at 28 (Apr. 24, 2015 pm). He testi?ed that he
became aware of the issue ?within a day? after Mr. Hinckley ?volunteered the information? to
Mr. Hyde. Mr. Weiss asked about it because he had spoken with Mr. Brelsford, the
photographer who accompanied Mr. Hinckley that day. Mr. Weiss further testified that ?John
was right upfront about the whole thing once it was brought to his attention? and did not attempt
to hide the incident or mislead Mr. Weiss. 1d. at 29. In his View, this incident did not reflect
deception or an intent to deceive. 1d. Despite the fact that Mr. Hinckley erred in net informing
Mr. Hyde before the change in itinerary, Mr. Weiss testi?ed that'he believes the behavior itself
was ?quite appropriate? and ?positive? because Mr. Hinckley ?took initiative to pursue
something in an area that he was interested in? and did so ?with a trusted mentor, somebody that

[Mr. Hinckley] knew Weiss] knew and trusted.? 151..

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Mr. Weiss testified about the ten risk factors particular to Mr. Hinckley identi?ed
by the Hospital and Dr. Patterson in his report. Mr. Weiss said that he has seen in Mr. Hinckley
no indication of depression, deception, isolation, (thought or mood disorder), Mr.
Hinckley?s wanting to harm himself, or narcissistic personality disorder. Transcript ofHearing
at 2325 (Apr. 24, 2015 pm). While acknowledging that there are ?elements of narcissism? in
Mr. Hinckley, Mr. Weiss said this is not ?a major concern in terms of his mental health.? E. at
25. As to family support, Mr, Weiss testi?ed that ?Mrs. Hinckley is extremely supportive,? as
are Mr. Hinckley?s brother and sister. 1d. at 26. Finally, Mr. Weiss testified that he does not
view ?nancial support as a major risk factor, considering the testimony by Scott Hinckley and
Diane Sims, and his knowledge of the available support in Williamsburg and ?conversations with
Ms. [Denise] Brownslohn?s social worker at St. Elizabeths.? E. at 32-33. In addition, Mr.
Weiss stated that it is his ?strong hope and belief that John will be able to be employed and earn
some income himself and get whatever bene?ts . . . that are available to him.? 1d. at 33.

Concerning itineraries, Mr. Weiss testi?ed that he believes it would be ?sensible
for that to continue at least for a year? and then ?as John continues to get more involved that [the
treatment team is] able to decrease? the itineraries. Transcript of Hearing at 43 (Apr. 24, 2015
pm). Mr. Weiss stated that he would prefer if ?there would be some latitude? and ??exibility?
in the itineraries to allow ?minor changes? without prior approval from either the Court or
someone in the District of Columbia. 1g. at 44. He stated, however, that he would ?still want
Mr. Hinckley to let [him] know? of any changes. 1d. at 45.

Mr. Weiss testified that under the convalescent leave plan, he would like to meet
with Mr. Hinckley once a week at ?rst, perhaps decreasing the frequency of meetings as Mr.
Hinckley becomes more integrated into the community. Transcript of Hearing at 51-52 (Apr. 24,

2015 pm). Mr. Weiss also stated that, in his opinion, Mr. Hinckley should live with his mother

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for at least the first ?six months to a year? to ?evaluate how his . . . integration is occurring,? as a
sort of transition stage. 1g. at 53. Mr. Weiss then would begin ?seeking housing after a year to a
year and a halt? if ?all things [are] progressing satisfactorily,? the ultimate goal being
independent living for Mr. Hinckley. 131.20 Mr. Weiss also testi?ed that he would be willing to
collect all the progress notes of all the treatment providers in Williamsburg and deliver them to
Dr. Johnson. 1d. at 39. He would also ?have no problem digesting them and then putting out a
summary? for transmission to Dr. .Johnson and the Court. at 49?50.

Mr. Weiss testi?ed that he agrees with the Hospital ?without any reservation
whatsoever? that Mr. Hinckley is ready for convalescent leave in Williamsburg. Transcript of

Hearing at 7 (Apr. 24, 2015 p.111).

C. Witnessesfrom the Him'kley Famiiy

Mr. Hinckley?s brother and sister, Scott I?Iinckley and Diane Sims, who have
visited Williamsburg during many of Mr. Hinckley?s conditional releases over the years, testi?ed
that Mr. Hinckley helps out with daily chores around his mother?s house, including
housecleaning, cleaning the gutters, laundry, and preparing meals. Scott Hinckley testified that
his relationship with his brother has grown closer over the many years of the conditional
releases. Transcript of Hearing at 38 (Apr. 22, 2015 am).

Scott Hinekley and Diane Sims also testi?ed at length regarding the Hinckley
family?s financial support of Mr. Hinckley, in particular the family?s ability to fund the expenses

that are proposed in the Hospital?s letter. Scott Hinckley testi?ed that the family has

 

20 Both Mr. Weiss and Mr. Hyde told Dr. Patterson in his interviews with them that
they saw the ultimate goal for Mr. Hinckley as being able to live independently in Williamsburg
or its environs. Gov?t Ex. 2, Dr. Raymond F. Patterson?s Independent Forensic 
Evaluation of John W. Hinckley, Jr. at 2728, 55?56 (Apr. 8, 2015) [Dkt No. 552] (?Patterson


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diligently paid all of Mr. Hinckley?s providers and will continue to do so in the future. He
further testi?ed that the family expected Mr. Hinckley would receive government bene?ts in the
future to assist with expenses. The family also hopes that, upon residing in Williamsburg
full?time, Mr. Hinckley will be able to secure paid employment that would also assist with the
expenses.

Scott Hinckley reported that Mr. Hinckley?s mother currently has available
approximately $500,000 in assets, including equity in her home and funds in her Individual
Retirement Account to continue Mr. Hinckley?s treatment. Transcript of Hearing at
42-43 (Apr. 22, 2015 Both siblings stated that they, together with their mother, would
provide reasonable financial support to their brother as needed. In what Scott Hinckley
described as a ?worst?case scenario? wwithout any government assistance, including Medicare,
Medicaid, and state health bene?ts, and without Mr. I-Iinckley obtaining any paid employment m?
he testi?ed that he was con?dent the family could fully support Mr. Hinckley for at least two
years, but that beyond that would be a ?challenge.? E. at 39w41, 65. He did state, however, that
his mother?s funds ?should be enough for four to ?ve years of treatment? even without any
government assistance. 1d. at 79, 90; al? i_d. at 101?102. Scott Hinckley also testified that
the Hospital had provided him with information regarding potential bene?ts Mr. Hinckley may
be eligible for once he is a resident of Virginia and how to apply. 1g, at 6667.

Diane Sims testi?ed regarding the family?s plan in the event that Mr. Hinckley?s
mother became unavailable, either through illness or death. Ms. Sims stated that she would

immediately move to Williamsburg and live with Mr. Hinckley until a permanent living situation



for Mr. Hinckley was approved by St. Elizabeths Hospital and this Court; she could and would
come ?at a moment?s notice.? Transcript of Hearing at 103?04 (Apr. 22, 2015 am). Ms. Sims

also testi?ed regarding Mr. Weiss, describing him as a ?wonderful asset and addition for John.?

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E. at 17. She stated that Mr. Weiss has ?a wonderful sense of the community down there? and
has ?spent a lot of time with [Mr I'linckley] . . . introducing him to new things and to new

people.? I_c_l. at 118.

D. The Government ?3 Expert Witness: Dr. Raymond F. Patterson

The government?s expert witness, Dr. Raymond F. Patterson, who has testified at
numerous prior hearings in this case, was permitted to testify as an expert on the diagnosis and
treatment of mental illness. Transcript of Hearing at 143-44 (Apr. 28, 2015). In preparing his
report, Dr. Patterson interviewed Mr. Hinckley and all of his treatment providers in
Williamsburg and at St. Elizabeths HOSpital. ,Seg Gov?t Ex. 2, Independent Forensic 
Evaluation ofJohn W. Hinckley, Jr. at 2 [Dkt No. 552] (?Patterson Dr. Patterson was in
agreement with Mr. Hinckley?s treatment providers about his diagnoses, and acknowledged that
his Axis I disorders major depressive disorder and disorder not otherwise specified
have long been in full and sustained remission, with no signs of or major clinical
depression for many years. Transcript of Hearing at 147 (Apr. 28, 2015); Transcript of Hearing
at 5 (Apr. 29, 2015 pm.) Mr. Hinckley?s third diagnosis is narcissistic personality disorder.
Transcript of Hearing at 147 (Apr. 28, 2015). Mr. Hinckley is prescribed Risperdal, an
medication, at milligram per day, which is considered a minimal dosage, and
Zoloft, an antidepressant, at 150 milligrams per day, and is in full compliance with his
medication regimen. J_d. at 149; Transcript of Hearing at 69 (Apr. 29, 2015 am); Transcript of
Hearing at 7 (Apr. 29, 2015 pm); see, gist; Patterson Rpt. at 5-6.

Dr. Patterson testi?ed that he now agrees with the Hospital and its witnesses that
Mr. Hinckley is clinically ready for full-time convalescent leave (outpatient placement) in

Williamsburg, Virginia, and that he is a low risk of violence under appropriate conditions.

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Transcript of Hearing at 159-60 (Apr. 28, 2015); Patterson Rpt. at 67-68; Transcript of Hearing
at 81 (Apr. 29, 2015 am). Dr. Patterson opposes the Hospital?s plan for convalescent leave,
however, because, in his view, the conditions proposed by the Hospital lack suf?cient
monitoring and risk management planning necessary to keep the level of risk 10w. Speci?cally,
Dr. Patterson raised three principal objections to the conditions proposed by the Hospital: (1) the
frequency of Mr. I?Iinckley?s meetings with the Williamsburg treatment team should increase,
rather than decrease, on convalescent leave; (2) any changes in conditions should not be left to
the discretion oer. Hinckley?s treatment providers, but instead should be approved by the
Court; and (3) the plan does not contain sufficient mechanisms to monitor Mr. Hinckley?s
activities.

In Dr. Patterson?s opinion, the ?rst twelve months of convalescent leave should
involve intensive monitoring; and an increase, rather than a decrease, in clinical services and risk
management from the levels on Mr. Hinckley?s current 17-day visits. Transcript of Hearing at
180 (Apr. 28, 2015); Transcript of Hearing at 99 (Apr. 29, 2015 Dr. Patterson testi?ed
that he believes this increase is necessary due to ?the relative decrease in Hinckley?s]
involvement at the hospital and the increase in opportunities and risk in the community.?
Transcript of Hearing at 99 (Apr. 29, 2015 am). Any reductions in the frequency of treatment
meetings and monitoring after twelve months then would be based on ?performance measures as
to whether or not that is appropriate,? particularly another full risk assessment, and a further
court order approving the decrease. Transcript of Hearing at 180-81 (Apr. 28, 2015).

Dr. Patterson testified that he believes the Hospital?s proposed treatment schedule
contains too few contacts with both the Williamsburg and the Hospital inpatient treatment teams.
Transcript of Hearing at 154-65 (Apr. 28, 2015). For example, Dr. Patterson stated that, in his

Opinion, Mr. Hinckley should meet with Dr. Giorgi-Guarnieri once per week, which is

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approximately the same frequency as under the conditions of the current 17-day visits. 1d. at
154. He makes this recommendation because ?when you increase the opportunities and the
activities of someone . . . in the community and you perhaps plan to decrease in some ways the
monitoring of those activities . . . it?s very, very important to not decrease the therapeutic
interventions or decrease the monitoring.? lg. Dr. Patterson believes therapeutic interventions
actually should increase ?because you?re already decreasing the hOSpital component.? 1g. at 155.
It is essential, in his view, that the Williamsburg treatment team meet at regular intervals and
work as a team. Transcript of Hearing at 50?51 (Apr. 29, 2015 am). Similarly, Dr. Patterson
recommends that members of the St. Elizabeths Hospital individual inpatient treatment team m?
including Dr. Binks and Dr. Adewale should remain involved in Mr. Hinckley?s case by, for
example, participating with Dr. Johnson in treatment team meetings inde?nitely, until a court
order changes the conditions. E. at 26?28. He does not believe, however, that it is necessary for
the St. Elizabeths treatment providers to continue to meet as a team if convalescent leave is
granted. Id. at 51-52.

Dr. Patterson testi?ed that increased frequency of the Williamsburg treatment
team?s contacts with Mr. Hinckley and more structure and supervision are important because, if
there were any mental deterioration or decompensation, Mr. Hinckley ?traditionally? doesn?t
report Transcript of Hearing at 29-30 (Apr. 29, 2015 am). Dr. Patterson does not
agree that, should Mr. Hinckley decompensate and his risk factors increase, it would be a ?slow
process? and ?readily detectible.? Patterson Rpt. at 68. In Dr. Patterson?s view, Mr. I-iinckley?s
history of failing to accurately self-report therefore makes detection of any decompensation 
and the consequent possible increased risk of danger dif?cult. Transcript of Hearing at 29-30

(Apr. 29, 2015 am).

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Dr. Patterson also opposes Dr. Murphy?s proposal to divide the convalescent
leave plan into the three parts, Part A, Part B, and Part C, and the time frames she proposes for
each part. Transcript?of Hearing at 180-81 (Apr. 28, 2015); Transcript of Hearing at 32-33 (Apr.
29, 2015 pm). Speci?cally, Dr. Patterson objects to any change in conditions that is based upon
such speci?c time frames as opposed to an evaluation of Mr. Hinckley?s performance.

Transcript of Hearing at 32 (Apr. 29, 2015 pm). In his View, there must be a new risk
assessment before each signi?cant change in conditions so that an evaluation can be made of
how Mr. I-Iinckley has performed under the current conditions. Transcript of Hearing at 81-82
(Apr. 29, 2015 am). Dr. Patterson also believes any change must be ordered by the Court,
rather than left to the discretion of Mr. I-iinckley?s treatment providers. Transcript of Hearing at
33 (Apr. 29, 2015 psi).

Because he believes there should be increased structure and monitoring if Mr.
Hinckley is released on convalescent leave, Dr. Patterson testified that he opposes removing
monitoring conditions that are currently in place, including speci?cally itineraries. Transcript of
Hearing at 170-71 (Apr. 28, 2015).21 Dr. Patterson testified that he believes itineraries should
continue in some form in order to monitor Mr. Hinckley?s ?progress or lack thereof? and,
speci?cally, to keep track of Mr. Hinckley?s unsupervised free time in relation to his identi?ed
risk factor of isolation. E. at 172, 169. Itineraries would allow ?the clinicians as well as the risk
assessors to have something to measure his performance against.? 14. at 174. Dr. Patterson

expressed the view that itineraries also are essential to risk management of Mr. Hinckley to

 

2' Despite his concerns regarding monitoring under the Hospital?s plan, Dr.
Patterson testi?ed that he does not agree with the government?s preposals that Mr. Hinckley
wear an ankle bracelet and that a GPS-tracking device be installed on the I?iinckley family?s
vehicles because he does not ?see clinical indications for that.? Transcript of Hearing at 64 (Apr.
29, 2015 pm). He does, however, continue to support the condition that Mr. Hinckley carry
with him a GPS?equipped cell phone as a monitoring tool. 1g. at 57-63.

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supervise his activities and his se1f~reporting of what happened. Transcript of Hearing at 92-93
(Apr. 29, 2015 ant). Dr. Patterson thinks it would be an ?excellent? idea to require Mr.
Hinckley to draft his own itineraries. Transcript of Hearing at 171 (Apr. 28, 2015); Transcript of
Hearing at 39 (Apr. 29, 2015 am.) Dr. Patterson also testified, however, that he thinks the
current level of speci?city required in itineraries is unnecessary for example, if the itinerary
stated that the Hinckley family was going to go out to dinner, Dr. Patterson did not think it was
necessary to include the Speci?c name of the restaurant and address, as the current conditions for
itineraries require. Transcript of Hearing at 49 (Apr. 29, 2015 pm.)

In Dr. Patterson?s opinion, the January 2015 incident where Mr. Hinckley violated
his planned itinerary, was not a mistake and raised serious risk monitoring concerns. Transcript
of Hearing at 174.75 (Apr. 28, 2015). He believes that Mr. Hinckley?s call to Mr. Tracy the day
before indicates that Mr. Hinckley likely intentionally violated the conditions of the court order
and was ?at best bad judgment.? Lei. at 175~76. Dr. Patterson therefore categorizes the incident
as ?deceptive? in addition to being a violation of his scheduled itinerary despite the fact
that Mr. Hinckley did not lie or attempt to hide the incident, as he has on those few previous
occasions where he violated his scheduled itinerary. Transcript of Hearing at 89-91 (Apr. 29,
2015 am.) Dr. Patterson did acknowledge on cross-examination, however, that this incident
was Mr. Hinckley?s only unapproved variation from his itinerary in the two years preceding the
April 2015 hearing, and that he otherwise has been in substantial compliance with his itineraries
and appears to have used his free time responsibly. Transcript of Hearing at 11 (Apr. 29, 2015
pm.)

Dr. Patterson also opposes Mr. Hinckley being given unrestricted access to the
Internet. Transcript of Hearing at 44 (Apr. 29, 2015 am). Dr. Patterson testi?ed that Mr.

Hinckley instead should be able to access only pie-approved websites and ?that there should be a

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mechanism for monitoring his use of the Internet.? Id. at 43. Dr. Patterson stated that his
opposition was two?fold. First, he believes there is information available on the Internet from
which Mr. Hinckley should be restricted from access. Id. at 44, 74. For example, in Dr.
Patterson?s opinion, Mr. Hinckley should not have access to information about presidential
assassinations because it ?relates directly to his pathology.? lg. at 74. And second, Dr. Patterson
is concerned that Mr. Hinckley could publish his music, photographs, paintings, or writings on
the Internet, which should be monitored and require pie?approval from his treatment providers,
including assessment of risk, and because ?the notOriety?fame issue is a part of his pathology.?
Id. at 44; Transcript of Hearing at 94 (Apr. 29, 2015 ?Even the idea of anonymity is a
very elusive thing in these days of Internet discovery.? Id. at 94.

Dr. Patterson acknowledged that Mr. Hinckley?s engagement with the
Williamsburg community has increased and that he has taken greater initiative since the last
hearing in this matter, although he emphasized that Mr. I?Iinckley could have previously engaged
in these efforts but had refused to do so. Transcript of Hearing at 156-67, 170 (Apr. 28, 2015).
In particular, Dr. Patterson pointed to the weekly NAMI meetings. In Dr. Patterson?s opinion,
?[t]here is no reason that while he had ten?day visits, he could not have attended the National
Alliance on Mental Illness.? Transcript of Hearing at 156~57 (Apr. 28, 2015). Dr. Patterson
expressed his continued concern that the Williamsburg community ?has not been welcoming to
Mr. Hinckley over time,? which further impedes his integration. Id. at 156. Dr. Patterson did

acknowledge, however, that Mr. Hinckley?s integration into the community has improved since

Mr. Weiss took over as case manager. m. at 170.22

 

22 This concern regarding barriers to Mr. Hinckley?s integration into the community
had been a principal part of Dr. Patterson?s opposition to the Hospital?s previous proposal to
increase visits from ten days to seventeen days. Hinckley VII, 40 F. Supp. 3d at 35-36.



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As to the I~Iinckley family?s ?nancial support, Dr. Patterson testi?ed that his
primary concern is that Mr. I~Iinckley receive sufficient ?nancial support, either from the family
or from government assistance, to support his clinical, forensic, and housing services needed to
remain in the community. Transcript of Hearing at 75 (Apr. 29, 2015 am.) He stated, however,
that after hearing the testimony of Scott Hinckley and Diane Sims, he now understands ?that the
family is prepared to continue their ?nancial support for Mr. leinckley?s clinical, . . . forensic, as
well as housing needs.? E. at 43. Dr. Patterson testi?ed that his concerns as to ?nancial support

therefore are ?greatly attenuated.? Transcript of Hearing at 44 (Apr. 29, 2015 pm.)

IV. FINDINGS OF FACT

The Hpspital, Mr. Hinckley?s treatment providers, and Dr. Patterson have
identi?ed ten principal risk factors for Mr. I-Iinckley based on the circumstances leading up to the
offense and his conduct at the and on his visits to Williamsburg. These risk factors are:
depression; (2) isolation; (3) (4) level of insight into mental illness; (5) personality
disorder; (6) access to weapons; (7) lack of family support; (8) history of suicide attempts;
(9) difficulty in relationships with others; and (l 0) deception. Because an assessment of these
risk factors is critical to determining whether Mr. I'Iinckley will become a danger to himself or
others in the reasonable future if released on full-time convalescent leave, in contrast with prior
opinions the Court will organize its findings of facts by risk factor.

Based upon the testimony and exhibits offered by counsel for the government and
by counsel for Mr. Hinckley, the Court ?nds that the following facts have been established by a
preponderance of the evidence:

.1. Mr.- I-Iinckley?s current diagnosis is disorder not

otherwise specified (Axis I), in full and sustained remission; major

depression (Axis I), in full and sustained remission; and
narcissistic personality disorder (Axis II).

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Depression

2. Mr. Hinckley?s diagnosis of major depression (Axis I) has been
in full remission for more than twenty years, and perhaps more
than twenty-seven years.

3. Even though his clinical depression is in full and sustained
remission, depression remains a risk factor for Mr. Hinckley. He is
a low risk for decompensation. If Mr. Hinckley were to experience
a relapse of major depression, that relapse would not occur
suddenly, but rather would occur gradually over a period of at least
weeks or months, and would be detectable by his treatment
providers in Williamsburg.

Isolation
4. Although Mr. Hinckley has exhibited no signs of isolation or
withdrawal in recent years, isolation remains a primary risk factor
for Mr. Hinckley, who is by nature an introverted person.
Particularly if Mr. I-iinckley is to reside in Williamsburg full?time
and no longer spend time in the structured environment of St.
Elizabeths Hospital, it would be of concern if he engaged in too
many solitary activities, rather than continuing to take steps to
integrate himself into the Williamsburg community through more
vocational, social, and educational pursuits and through developing
friendships. This issue has become of less concern over the last
three or four years, however, as Mr. Hinckley?s socialization and
community engagement has dramatically improved under the case
management of Mr. Weiss.

5. Mr. Hinckley continues to be guarded, defensive, and

a a .
sometlmes secretive, but he has made Significant progress in
becoming more open with his treatment providers.



6. was the linchpin of Mr. Hinckley?s overt expressions
of violence in the past. Mr. Hinckley?s diagnosis 
disorder not otherwise specified (Axis I), however, now has been
in full remission for more than twenty years, and perhaps more
than twenty~seven years.

7. Mr. Hinckley has exhibited no evidence of 

or ofdelusional thinking and no evidence of obsessive conduct for
at least twenty years and perhaps as many as twenty?seven years.

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Level ofInsz'ght into Mental Illness

8. Mr. Hinckley self?medicates with 1 milligram of RiSperdal, an
medication, and 150 milligrams of Zoloft, an
antidepressant, in addition to medications for physical ailments and
multivitamins. There is no indication that Mr. Hinckley has failed
to take his medications in the recent past or during any of the
authorized releases. In fact, his treatment providers report that Mr.
Hinckley has been fully compliant with his medication regime and
that Mr. Hinckley has been proactive in coordinating with his
providers and the Hospital to ensure that his medications are
available for his visits to Williamsburg. Overall, his insight into
his mental illness is greatly improved in recent years.

Personality Disorder

9. Mr: Hinckley?s narcissistic personality disorder is signi?cantly
attenuated from its previous state. Mr. Hinckley continues to
exhibit of self-importance, but he no longer exhibits the
intense self~absorption and grandiosity that was present during the
19803.

10. Mr. Hinckley?s self-reporting underrepresents his problems
and pathology due to his tendency to minimize problems and avoid
negative aspects of situations and to present himself in an overly
positive light.

Access to Weapons

11. There is no evidence that Mr. Hinckley has had or sought
access to weapons during his visits to Williamsburg or at any time
in the last 34 years.

Lack ofFamity Support
12. Mr. Hinckley currently enjoys signi?cant emotional and
?nancial support from his mother and siblings. The Hinckley
family possesses sufficient ?nancial means to fully support Mr.
Hinckley?s treatment needs in Williamsburg for the foreseeable
future:

History Attempts

13. Mr. Hinckley has exhibited no violent behavior, nor attempted
suicide, in more than thirty-two years.

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Dif?culty in Reiationships with Others

14. Historically, Mr. Hinckley?s relationships with women, his
perceptions of those relationships, and the judgment he sometimes
has exercised concerning such relationships have been inextricably
intertwined with Mr. Hinckley?s mental illness and have been
especially implicated when he has been most clinically
dysfunctional. He has strong affiliative and dependency needs,
and his mood has often ?uctuated based on the status of his
relationships with women. While there have been no mood
?uctuations in recent years, this remains an area of ongoing
clinical concern. Mr. Hinckley continues to require some guidance
and support in navigating interpersonal relationships, and Mr.
Weiss is effectively providing what is required.

Deception

15. Mr. Hinckley has on two occasions in 2011 exhibited
deceptive behavior even though there have been no of
or depression. Deceptiveness may relate to Mr.
Hinckley?s narcissistic personality disorder. In combination with
his guardedness, secretiveness, defensiveness, and lack of
forthrightness at times, deceptiveness makes it more difficult to
monitor Mr. Hinckley?s activities while in Williamsburg,
particularly his unaccompanied time where the monitoring is based
largely on his own self-reporting to his treatment providers. Self-
reporting and the treatment providers? ability to rely on Mr.
Hinckley?s being candid with them will be ever more important.
Despite the fact that Mr. Hinckley has not exhibited any deceptive
behavior in the approximately two years since the Court?s last
Opinion and Order, deceptiveness continues to be a salient issue.

16. On two occasions in 2011, during Mr. Hinckley?s use of his
unsupervised free time in Williamsburg, he deviated from the strict
terms of his pie-approved itineraries by not attending movies, as
scheduled, and instead spending his time at the Barnes Noble
bookstore located in the same shopping center. Mr. Hinckley later
falsely told Hospital staff and other evaluators that he had attended
these movies and made representations about their content and
quality.

17. Oh one occasion in 2015, Mr. Hinekley again deviated from
his pie-approved itinerary by visiting a musician acquaintance as
opposed to a local photographer. Mr. Hinckley was accompanied
that day by Mr. Brelsford, an individual whom Mr. Weiss knows
well. Mr. Hinckley self?reported this deviation to Mr. Hyde the

Case Document 623 Filed 07/27/16 Page 77 of 103

following day and did not lie or deceive his treatment providers or
his family.

18. Mr. Hinckley has never tried to escape from the Hospital or

when on city outings or on unsupervised conditional release

visits with his family. He has participated successfully in well

over 200 Hospital?accompanied outings in the community without

incident. He has also participated successfully in all of the Phase 1,

Phase ll, Phase and Phase IV visits authorized by this Court.

These visits have been therapeutic and bene?cial. He has followed

every condition imposed by the Court in authorizing these visits,

over nearly thirteen years, with the important exception of the

three episodes described above.

After thirty-four years as an inpatient at St. Elizabeths Hospital, and in view of the
foregoing ?ndings, and the successful completion of over 80 Phase and Phase IV visits to
Williamsburg over the last ten years, the Court finds that Mr. Hinckley has received the
maximum benefits possible in the in-patient setting and m? as even Dr. Patterson acknowledged
that he is clinically ready for full~time convalescent leave. On the ultimate mixed question of
law and fact, dangerousness, the Court finds by a preponderance of the evidence that Mr.
I?linckley will not be a danger to himself or to others if released on full?time convalescent leave

to Williamsburg under the conditions proposed by the Hospital, as modi?ed and supplemented

by the Court in this Opinion.

V. DISCUSSION
A. Mr. Hinckley ?s Identi?ed Risk Factors
In assessing the Hospital?s proposal for full-time convalescent leave, the Court
considered each of the ten risk factors identi?ed by the Hospital and Dr. Patterson. Each factor 
will be addressed in turn, with the exception of the first (Depression), third and fifth
(Personality Disorder) risk factors which will be discussed together because they are closely

related.

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1. Mr. Hinckley?s Mental Health: Depression, and Personality Disorder

All of the experts and treatment providers who testi?ed during the evidentiary
hearing agreed that Mr. Hinckley?s Axis I diagnoses namely, his major depression and
disorder are in full and sustained remission and have been for many years. During
this long period of sustained remission more than 27 years, in the Court?s View w? by all
accounts, Mr. Hinckley has shown no signs of delusional thinking or any violent tendencies. His
treatment providers report that while he has experienced some ?uctuations in mood in the past,
including periods of sadness or anxiety in response to dif?cult or stressful life events (including
the death of his father and the death of James Brady m? both of which Mr. Hinckley responded to
appropriately), his emotional health has remained stable. Mr. Hinckley?s narcissistic personality
disorder (Axis II) also is signi?cantly attenuated.

Although the government?s expert witness raised some caveats about this
consensus including the role that Mr. Hinckley?s therapy at St. Elizabeths and medication
have played in keeping his at bay Dr. Patterson agrees with the Hospital and Dr.
Murphy that Mr. Hinckley?s Axis I diagnoses are in full remission. Transcript of Hearing at
159-160 (April 28, 2615). He also agrees that Mr. Hinckley is ready for full-time convalescent
leave. Transcript of Hearing at 4-5 (April 29, 2015 PM).

Thus, as with the government?s opposition to the previous expansion to 17?day
visits, the concerns expressed by the government and its expert about the Hospital?s proposal are
not based so much on Mr. Hinckley?s current mental stability as on the risk that by removing him
from the structured and supportive environment at St. Elizabeths Hospital to a situation lacking a
comparable degree ofoversight, therapeutic intensity, and social interaction, Mr. Hinckley may

once again fall prey first to isolation and perhaps eventually to depression (risk factors for

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dangerousness) which, if undetected, potentially could lead to suicidal thoughts or a
reemergence of That he is presently free of such and has been for many
years, is not seriously questioned.

Dr. Murphy and many of Mr. Hinckley?s treatment providers have noted what an
important supportive role Mr. mother has played over the years, and how close he
and his mother have become. As Dr. Murphy has noted, Mrs. Hinckley?s death, when it occurs,
would undoubtedly be traumatic for Mr. Hinckley, perhaps the most signi?cant loss in his life;
Transcript of Hearing at 86?88 (Apr. 27 p.111). As Mr. Hinckley?s treatment providers and the
Court have observed, however, Mr. Hinckley has handled his other most signi?cant loss the
death of his father in :2008 m- quite well. While the relationship between Mr. Hinckley and his
father historically was a troubled one and the relationship with his mother has always been much
better, Mr. Hinckley?s level of sadness and change of mood on the occasion of his father?s death

were ?appropriate,? see Hinckley VII, 740 F. Supp. 3d at 31, and his emotional health ?remained

 

stable? ?in response tb difficult or stressful life events (including the death of his father).? ta. at
54; see a_l_s2 Hinckley VI, 625 F. Supp. 2d at 23. While the treatment team in Williamsburg will
have to assess Mr. I-Iinckley for signs of depression following his mother?s death, the Court is
confident, based on this prior history, that Mr. I?linckley will not decompensate or become
dangerous at that time and that, as Dr. Murphy found, any of major depression as
opposed to appropriate sadness characteristic of bereavement will be detected and addressed
by the treatment team in Williamsburg.

The Court is persuaded that because Mr. Hinckley?s Axis I diagnoses 

disorder and major depression are in full and sustained remission, and because his

attenuated narcissistic personality disorder is not evidence of potential dangerousness, he will not

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be a danger to himself or others if released on convalescent leave to the Williamsburg

community under the conditions to be imposed by the Court. ?pg infra at 88?10].

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

Over the past seven years, Mr. Hinckley has participated in sixty 10- and 17-day
visits to Williamsburg following, of course, several years of shorter visits. The immediate
therapeutic goal of these ?Phase visits was to acclimate Mr. Hinckley to his mother?s
community and to permit him to focus on social and vocational integration there. Hinckley
VI, 625 F. Supp. 2d at 6; Hinckley VII, 40 F. Supp. 3d at 1 1. The broader aim of Phase IV, a
?transitional stage,? was to determine if Mr. Hinckley is ready to be released from the Hospital to
live independently in his mother?s community. Hinckley V, 493 F. Supp. 2d at 66. The
question before the Court now is whether Mr. Hinckley has suf?ciently achieved that goal such
that he is ready to be released on full-time ?Phase convalescent leave, and, if so, on what
conditions.

Every witness who testi?ed on the matter agreed that Mr. Hinckley has made
signi?cant progress towards integrating himself into the Williamsburg community since the
Court?s last Opinion over two years ago. While the government and its expert maintain that Mr.
Hinckley could have shown more initiative earlier in this process, they acknowledge that Mr.
Weiss has been a very positive addition to the Williamsburg treatment team and that Mr.
Hinckley?s community engagement and socialization have improved.

The record demonstrates that Mr. Hinckley has continued volunteering at Eastern
State Hospital, while also beginning to volunteer at a local Unitarian Universalist Church, where
he has recently been offered a paid position. He has earned praise from his supervisors in both

his volunteer positions. Mr. Hinckley and Mr. Weiss have also diligently pursued additional

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volunteer opportunities, which failed to come to fruition for a variety of reasons. Although Mr.
Hinckley has pursued paid employment, he has been unable until quite recently to secure a paid
position, see at 16 n.6, in large part due to his irregular part?time residence in the area.

Mr. Hinckley has also participated in numerous social, recreational, and
educational activities, both accompanied by his case manager Mr. Weiss and independently by
himself. Mr. Hinckley has gone bowling, attended several lectures, attended outdoor musical
concerts, and joined a local community center to exercise and take classes offered. Mr. Hinckley
has recently begun pursuing photography as a hobby and has explored taking photography
classes. He also has begun regularly attendng group meetings with the local chapter of the
National Alliance on Mental Illness or NAMI. While Mr. Hinckley has continued to face
rejection and reticence in some instances from the Williamsburg community, these activities
Show marked improvement from the last evidentiary hearing in this matter.

In conjunction with increased social, recreational and educational activities, Mr.
I?Iinckley also has made signi?cant strides towards developing friendships in the community and
displayed improved self-initiative. To further his new interest in photography, Mr. Hinckley has
developed a relationship with two local photographers. He also has started socializing with at
least two members of his former therapy group, in addition to several individuals he has met at
his NAMI meetings.

Mr. Hinckley?s progress in this area is in signi?cant contrast with the lack of
progress noted at the prior hearin I, after which the Court raised concerns that ?Mr. I~Iinckley has
not engaged in any additional volunteer activities beyond his work at Eastern State, nor has he
participated in any ongoing social, recreational, or educational activities or even taken the
initiative to identify such activities.? Hinckley VII, 40 F. Supp. 3d at 55. The Court also noted

that has not made any friends in the community.? 151. Mr. Hinckley and his treatment team

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appear to have taken the Court?s words to heart over the last two-and-a-half years. The Court
commends both Mr. Weiss for his aggressive, and seemingly successful, case management to
identify potential Opportunities and Mr. Hinckley for his initiative in following through with the
opportunities identified, as well as pursuing independent interests, such as photography and
music. There has been ?a marked increase in his level of engagement,? Transcript of Hearing at
74 (Apr. 23, 2015 AM) (testimony of VJ. Hyde), and Mr. I-linckley has developed some
friendships in the community. The progress shown has signi?cantly alleviated the Court?s prior
concern that ?allowing Mr. Hinckley to spend the majority of each month in Williamsburg,
without the structure of his St. Elizabeths routine or the daily social and therapeutic interactions
he has there, may foster isolation and, ultimately, depression.? Hinckley VII, 40 F. Supp. 3d at
56. The Court is con?dent that Mr. Hinckley?s progress towards integration and socialization

will continue on full-time convalescent leave.

3. Mr. I-?iinckley?s Level of Insight into his Mental Illness

Dr. Giorgi-Guarnieri reports that Mr. Hinckley?s insights into his mental illness
?have improved? during the last five years and that ?he thinks a lot about whether his behaviors
are considered narcissistic, and he cares very much what the Court and his family say.?
Transcript of Hearing at 17 (Apr. 24, 2015 am). Mr. Hinekley?s treatment providers also report
that he has been fully compliant with his medication regime and that he has been proactive in
coordinating with the Hospital and his providers to ensure he has suf?cient medication for the
duration of his visits to Williamsburg. Dr. Patterson cencluded in his report that ?Mr. Hinckley?s
insight is appropriate regarding and depressive but fair with regard to
narcissistic elements of his personality disorder as he minimizes their importance.? Government

Exhibit 2 at 67 [Dirt No. 552]. Although Mr. Hinckley?s insight into his mental illness remains

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a risk factor that his treatment providers should monitor and assess, the Court is satis?ed that this
risk factor is significantly attenuated and currently does not increase Mr. I-?Iinckley?s risk for

violence.

4. Access to Weapons
There is no evidence that Mr. Hinckley has had access to any weapons at the
Hospital or during his visits to Williamsburg. Nor is there any evidence that Mr. Hinckley has

sought such access or displayed an interest in weapons of any kind.

5. The Hinckley Family?s Support

The Court believes that this risk factor is critical to Mr. Hinckley?s success on
full-time convalescent leave. Mr. Hinckley, however, has enjoyed signi?cant emotional and
?nancial support from his mother and siblings during his visits to Williamsburg. As Dr. Murphy
noted in her report, Mr. Hinckley?s mother has been ?exible and accommodating to Mr.
Hinckley?s treatment needs and has fully complied with the conditions imposed by this Court?s
orders. Murphy Rpt. ?at 59. Both of Mr. Hinckley?s siblings also testified that they have
participated in several of Mr. Hinckley?s visits and that they have grown closer to their brother as
a result. As to financial support, the Court is satis?ed by the testimony of Mr. I~Iinckley?s
siblings that Mr. Hinckley?s treatment needs will be fully supported by the Hinckley family as

needed and that there is no risk in the immediate future that Mr. Hinckley will not receive the

treatment and monitoring ordered by the Court due to ?nancial concerns.

6. History of Suicide Attempts
Mr. Hinckley has not attempted suicide in more than thirty-two years. Neither Dr.

Patterson, Dr. Murphy, nor any of Mr. I-Iinckley?s treatment providers noted any concerns

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regarding suicide attempts at the evidentiary hearing, although it remains a risk factor for Mr.

Hinckley.

7. Difficulty in Relationships with Others, Particularly Women

Unlike in the past, the issue of Mr. Hinckley?s relationships with women was not
as central to the April, 2015 hearing as it has been in prior evidentiary hearings. See, gg,
Hinckley VII, 40 F. Supp. 3d at 61-63; Hinckley VI, 625 F. Supp. 2d at 10, 15; Hinckley V, 493
F. Supp. 2d at 74?76. Neither the government nor its expert raised any new concerns in this area
and, since the last evidentiary hearing, there have been no reported instances of concern or of
inappropriate behavior in Mr. Hinckley?s relationships with women.

To the contrary, Mr. Hinckley has fostered new healthy relationships and there
continues to be no indication of delusion or idealization. Mr. Hinckley developed a friendship
with a woman he met at a NAMI meeting, Ms. L. He saw or spoke with her during a number of
his 17-day visits to Williamsburg. Hospital?s March 13, 2015 Letter to the Court [Dkt No. 514];
Hospital?s October 8, 2015 Letter to the Court [Dkt No. 586]; HOSpital?s April 7, 2016 Letter to
the Court [Dkt. No. 608]. More recently, however, Mr. Hinckley has been trying to distance
himself from Ms. L. because of her drug and alcohol use. Hospital?s May 3, 2016 Letter to the
Court [Dkt No. 612]. As for Ms. CB, a woman whom Mr. Hinckley has known since 2009, the
Hospital noted in its Letter that Mr. Hinckley?s relationship with Ms. CB has had ?ongoing
dif?culties,? particularly regarding her mental health. Mr. Hinckley, however, ?remained an
anchor and advocate for her,? and ?has been willing and able to turn to his clinical providers to
discuss his challenges with her.? Hospital?s December 22, 2014 Letter at 3-4 [Dkt. No. 494].
Mr. Hinckley also has firmly rebuffed Ms. interest in moving to Williamsburg, after the

Hospital strongly discouraged it and Mr. Hinckley himself concluded that it was not a good idea.

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Patterson Rpt. at 53. Mr. Hinckley reported to Dr. Patterson that he has told Ms. CB that they
can continue to communicate over the phone, but ?he will not be coming up to Washington to
see her and that she cannot come to Williamsburg.? Id. at 61-62. More recently, although Mr.
Hinckley continues to speak frequently with Ms. CB by telephone and continues to give her
moral support, see Hospital?s February ll, 2016 Letter to the Court [Dkt No. 598]; Hospital?s
July 6, 2016 Letter to? the Court [Dkt. No. 620], he has made it clear to her that she cannot be a
part of his life in Williamsburg. Murphy Rpt. at 57 (Mr. Hinckley ?has begun to slowly
detach himself from Mrs. as he transitions to \lltilliamsburg).23

In the past, the Court has noted that ?[t]he focus on Mr. Hinckley?s female
relationships . . . can easily become unmoored from the question of whether he is a risk of danger
to himself or others.? Hinckley VII, 40 F. Supp. 3d at 63. ?Significantly, the government?s
experts have expressed concern for years that Mr. Hinekley?s romantic relationships may lead
him to decompensate or become dangerous yet as they acknowledge, deSpite numerous
intense relationships and breakups that Mr. Hinckley has experienced, this has never come to
pass.? E. And ?over these many years there has been no evidence that Mr. Hinckley?s romantic
relationships m? real relationships, not delusional fantasies about movie stars or others have
caused him to be dangerous to himself or others.? Id. It remains the case, however, that past
incidents have ?suggest[ed] that Mr. Hinckley?s interest in women may lead him to exercise bad
judgment or be less than forthright with his treaters.? see generally i_d. at 61-63. Given his

history, the centrality of these relationships to his life, and their potential effect on his stability

 

23 Mr. Hinckley also ?successfully handled? a difficult breakup with a former
romantic partner, Ms. N, who abruptly stopped communicating with Mr. Hinckley and
eventually sent him a ?Dear John? letter in the mail, by ?turning to his support networks and
focusing his attention on his recovery process,? as his treatment providers have encouraged him
to do. Hospital?s Letter at 4.

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and judgment, Mr. Hinckley?s relationships with women therefore will continue to be of interest

to his treatment providers and to the Court.

8.. Deception, Underreporting, and Need for Monitoring

One of the challenges in assessing Mr. Hinckley?s risk of dangerousness is his
tendency to minimize problems and underreport negative feelings to his treatment providers.

This widely acknowledged trait, which is related to Mr. Hinckley?s narcissistic personality 
particularly his need to present himself in a positive light undermines confidence in the ability
to assess the overt signs of his mental health and stability. It also raises the prospect that if Mr. I
Hinckley were to experience resurgent of his or depression, he might not
report them to his Williamsburg treatment providers.

More troubling from a risk management perspective is Mr. I?linckley?s
demonstrated willingness on two occasions in 201 1 we to be deceitful with his treatment
providers and others. On full-?time convalescent leave, it is even more imperative that his treaters
and the Court have con?dence that he will faithfully adhere to the rules that are prescribed for
him an rules that the Hospital believes will mitigate his risk and promote continued stability 
and that he fully and accurately report his activities. With more freedom and flexibility, more
unsupervised time, and less contact with the Hospital, his treatment team in Williamsburg must
trust that Mr. Hinckley is being open, honest, and not deceptive in his self?reporting. Any further
reasons for a continuing lack of certainty that Mr. Hinckley will adhere to the terms of the
Court?s orders or for concluding that he cannot be relied upon honestly to report his activities to
his treatment team would make it difficult to conclude that he can be effectively monitored if
given more freedom. The Court notes, however, that Mr. Hinckley has made great progress in

this area, as there have been no further instances ofdeception since the Court?s last Opinion, and

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Mr. Hinckley appears to have established an open and productive relationship with Mr. Weiss
and his other treatment providers in Williamsburg.

While the Court understands the government and its expert?s concern regarding
Mr. Hinckley?s deviation from his itinerary in January of 2015, the Court agrees with the
Williamsburg treatment team and the Hospital that Mr. Hinckley exercised poor judgment, but
did not engage in deceptive or manipulative behavior. While Mr. Hinckley should have received
prior approval for the? deviation from his itineraI?Y? as required under his conditions of release, he
self?reported it to Mr. Hyde the followmg day and there is no evidence that Mr. Hinckley lied or
minimized the event at any point. This distinction is important because, on the two prior
occasions in 2011, Mr. Hinckley did lie and hide deviations from his itinerary. The January
2015 incident therefore is of far less concern from a risk management perspective than the 2011
incidents. Putting aside the deviation without pie-approval from Mr. Hyde, the Court also notes
that the activity itself was positive Mr. Hinckley was socializing with a new friend, seeking to
develop a relationship with a local musician whom he had contacted on his own initiative, and
exploring one of his recreational interests. Aside from this incident, Mr. Hinckley has complied
fully with his scheduled itineraries since the Court?s last opinion.

The suggestion by Dr. Murphy that Mr. Hinckley maintain a daily log of his
activities and deliver it to Mr. Weiss and Dr. Johnson and that Mr. Weiss corroborate Mr.
Hinckley?s account of his activities with employers, supervisors, and family will encourage Mr.
Hinckley to consistently and accurately report his activities and enable Mr. Weiss to monitor

them. Discussing his activities with Mr. Weiss and Dr. Johnson could also serve a

clinical/therapeutic function.

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B. Specific Proposals in the Hospital ?3 (6) Letters
1. Full?Time Convalescent Leave

The central preposal made by the HOSpital in its Letter is that Mr. Hinckley
should reside full?time in Williamsburg on convalescent leave. Based on the reports of the
experts, the testimony and other evidence presented at the evidentiary hearing, and the entire
record in this case, the Court is con?dent that under appropriate conditions, Mr. Hinckley is
clinically ready for full-time convalescent leave and that he will not be a danger to himself or
others in the reasonable future if released on full?time convalescent leave in Williamsburg.

Mr. I-Iinckley has been making lO?day and 17-day visits to Williamsburg for
approximately seven years, without in any way decompensating or doing anything that might
suggest a risk of danger. He now has made 60 such visits. With the notable exception of the two
movie incidents and the January 2015 incident discussed above, all the evidence shows that he
has obeyed every rule and restriction that has been prescribed for him. He has complied with the
speci?c obligations required of him under the Court?s last Order, including meeting regularly
with his Williamsburg treatment providers and maintaining two volunteer positions. Mr.
Hinckley also has dramatically increased his recreational, social, and educational activities and
developed several new social relationships under the guidance of Mr. Weiss. Mr. Hinckley?s
mental status has remained stable throughout this long period, with no reemergence of 
or clinical depression, both of which have been in full remission for well over two decades. His
track record of stability supports the ?rst recommendation of his treatment providers w- who
uniformly believe that he is ready for convalescent leave that Mr. Hinckley be permitted to
reside full~time in Williamsburg. That recommendation is consistent with the results of a

thorough risk assessment that, utilizing empirically supported methods of predicting

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dangerousness and recidivism, found Mr. Hinckley to present a low risk of danger under the
HOSpital?s plan.

The Court ?nds that any of clinical depression or would
develop gradually and would likely be detectable by his treatment providers in Williamsburg or
by Dr. Johnson during Mr. Hinckley?s visits to the FOPD. The Court also ?nds that Mr.
Hinckley?s medication will continue to serve a protective function in warding off such
The Hospital?s plan for convalescent leave involves numerous contacts with mental
health professionals on a regular basis. Under the conditions that the Court will include in its
Order, in the ?rst six months Mr. I?Iinckley will see Dr. Giorgi-Guarnieri at least twice a month,
Mr. Weiss once per week, and Mr. Beffa twice per week. Unless modified by the Court on
motion of the parties, the Court?s Order will also require that Mr. Hinckley work with a music
therapist once a month. For this six-month period, he will be seen by his mother every day so
long as she remains physically and mentally healthy, as by all accounts she is and by his
siblings during any oi their trips to Virginia. Mrs. Hinckley, Scott Hinckley, and Diane Sims are
all relatively familiar with Mr. Hinckley?s identi?ed risk factors and of mental illness
and have been conscientious custodians for each of his many periods of unsupervised conditional
release for nearly thirteen years. During the ?rst six months of convalescent leave, Mr.
Hinckley also will be?seen each month by Dr. Johnson and Dr. Binks, his long?time treating
at the FOPD in Washington, DC.

Based on Mr. Hinckley?s consistent track record over approximately seven years
of 10- and 17-day visits to Williamsburg, the consensus among his treatment providers about his
stability and readiness for convalescent leave, the results of empirically rooted risk assessments,
and the significant clinical oversight entailed by the Hospital?s proposal, as it will be mortified by

the Court, the Court believes that residing full?time in Williamsburg will not cause Mr. Hinckley

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to be a danger to himself or others. The Court further believes that full-time residence will
promote Mr. Hinckley?s continued integration into the Williamsburg community and his efforts

to obtain paid employment.

The Court notes that its previous concern about the risk of Mr. Hinckley

 

becoming lonely, isolated, and possibly depressed while still present due to Mr. Hinckley?s
risk factors and history has been considerably mitigated. As discussed above, Mr. Hinckley
has made convincing ?efforts towards developing social and vocational ties. He has made several
friends in the cemmunity and participated in frequent social, recreational, and educational

activities, including the pursuit of his interests in music and photography. The Court has every

reason to believe that this progress will continue on full-?time convalescent leave.



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

Given the concerns about Mr. Imlinckley?s potential for decompensation if he were
distanced from the support system now provided at St. Elizabeths, and his tendency towards
solitary activities and,isol.ation, a key question is whether the Hospital?s proposal will provide
a treatment schedule and support network in Williamsburg that will be adequate to manage Mr.
Hinckley?s risk of mental or emotional deterioration.

Under the HOSpital?s proposal?mas re?ected in its March 20, 2015 revised
Letter and its April 17, 2015 Letter Mr. Irlinckley will have a therapeutic team in
Williamsburg made up of four individuals: a new case manager (Mr. Jonathan Weiss), a
(Dr. Deborah GiorgiuGuarnieri), a therapist (Mr. Carl Beffa), and a music therapist.
The members of this ?Williamsburg treatment team? have all now been involved with Mr.
Hinckley?s case for several years. On full-time convalescent leave as proposed by the Hospital,

Mr. I-Iinckley will have regular, frequent appointments in Williamsburg with Dr. Giorgi-

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Guarnieri, Mr. Weiss, Mr. Beffa, and his music therapist. It is also contemplated that Mr.
Hinckley will have additional contact with Mr. Weiss regarding the development of
opportunities for social, recreational, educational, and therapeutic activities in the community
and that he will be accompanied by Mr. Weiss to some of those activities. Mr. I~Iinckley also
will be required to make weekly telephone calls to the FOPD, attend in-person meetings with the
Williamsburg treatment team every month, and travel to Washington, DC. on a basis to
meet with Dr. Johnson at the FOPD. With the exception of a music therapist, the Williamsburg
treatment team now has been stable in its membership for at least three years and each member is
well?acquainted with ,Mr. leinckley?s mental health, history, and identi?ed risk factors. The
Court is confident that the Williamsburg treatment team, in conjunction with the Hospital, the
FOPD, and the Hinckley family, will provide an adequate support system for Mr. Hinckley on
full-time convalescent leave. i

The Hospital proposes the following appointment schedule with Mr. Hinckley?s
treatment providers:

0 Twice per month with Dr. Giorgi-Guarnieri;

I Twice per month with Mr. Weiss;

0 Weekly individual with Mr. Beffa;

- Weekly group with Mr. Beffa;

0 treatment planning conferences with the Williamsburg
treatment team and Mr. Hinckley;

I Once per month with Dr. Johnson at the FOPD in Washington, DC.

"the Court agrees that this schedule will be suf?cient for Mr. Hinckley?s
care and risk management, with three exceptions. First, the Court agrees with Dr.
Murphy?s recommendation that Mr. Hinckley continue meeting with Dr. Bink's for individual

once per month, for the ?rst six months, during Mr. Hinckley?s appointments at

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the FOPD in Washington, DC. Following six months on convalescent leave, Mr. Hinckley?s
therapeutic relationship with Dr. Binks may terminate. Mr. Hinckley therefore need only meet
with Mr. Beffa for individual three times per month, rather than weekly, during
the ?rst six months to avoid overlap during the week of his appointment with Dr. Binks.

Second, the Court continues to believe that ?it is essential . . . that there be
coordination and communication among the Williamsburg providers including meetings at
regular intervals mu so they begin to function as a team.? Hinckley VII, 40 F. Supp. 3d at 58.
Despite this concern expressed in the Court?s Opinion of December 2013 and the agreement of
the importance of this condition by virtually every witness at the evidentiary hearing, the
Williamsburg treatment team only began meeting as a team telephonically in January 2015 and
apparently had met in person just once as a team prior to the April 2015 evidentiary hearing. To
ensure that such communication and coordination among the Williamsburg treatment team
providers occurs regularly, the Court will require that the Williamsburg treatment team meet in
person with Mr. Hinckley to review and discuss Mr. Hinckley?s progress and treatment on a
rather than basis for at least the ?rst year of convalescent leave.

Third, the Court will require Mr. Hinckley to work with a music therapist once
per month, as proposed by both the Hospital and the government. Although the Hospital
informed the Court that it has ceased its search for a new music therapist to replace Ms. Haley,
the Court directs the Williamsburg treatment team to re-open that search and identify a music

therapist to join the treatment team.? If the treatment team is unable to identify a replacement

 

24 Dr. Murphy and Dr. Giorgi-Guarnieri agree that ?it?s not absolutely critical that
[Mr. lelinckley] have individual music therapy from a risk management perspective? despite the
fact that he ?derives great bene?t? from it. Transcript of Hearing at 7?8 (Apr. 27, 2015 pm).
Dr. Murphy expressed her opinion at the time of the evidentiary hearing, however, that music
therapy should not be removed yet. at 9.

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within a reasonable period of time and the Williamsburg treatment team unanimously agrees that
music therapy is unnecessary from a risk management perSpective, the Hospital must file a
motion, with justi?cations, to modify the conditions of convalescent leave to remove this
condition or propose an alternative.

The Court emphasizes that the conditions imposed in this Opinion and
accompanying Order are minimum requirements and encourages Dr. Johnson, Dr.
Giorgi?Guarnieri, Mr. Weiss, or Mr. Beffa to increase the frequency of appointments if, in their
professional judgment, it is clinically indicated or would further assist Mr. Hinckley?s integration
into the Williamsburg community. To that end, the Court will leave to the discretion of each
treatment provider m: in consultation with Dr. Johnson of the FOPD we the authority to increase
the frequency of Mr. Hinckley?s appointments. This, of course, is consistent with the View of
most witnesses at the evidentiary hearing that clinical judgments should largely be left to the
clinical professionals and treatment providers, and that the Court?s involvement should decrease
as Mr. Hinckley successfully completes each part of Phase convalescent leave.

The Court also agrees with the phased approach to convalescent leave
recommended by Dr. Katherine Murphy, as well as with Dr. Patterson?s concern that further
evaluation is required at eagh stage before moving to the next. After the first six months of
convalescent leave mt- what Dr. Murphy described as ?Part the Court will permit the
minimum frequency of appointments with Mr. Hinckley?s providers and the FOPD to decrease
provided that each member of the Williamsburg treatment team and Dr. Johnson agree
that such a reduction is clinically indicated and appropriate for risk management. If each
member of the Williamsburg treatment team and Dr. Johnson so agree, the minimum frequency

of appointments with Dr. Giorgi-Guarnieri may reduce to as opposed to twice 

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O.

and the frequency of individual with Mr. Beffa may reduce to twice as
opposed to weekly.

After a full year to eighteen months on convalescent leave, and consistent with
Dr. Murphy?s recommendations, the Hospital must conduct a further risk assessment before any
further reductions in the frequency of Mr. Hinckley?s appointments will be approved. The Court
does not agree with Dr. Patterson and the government, however, that a full evidentiary hearing
will be required at that point. Instead, if Mr. Hinckley?s progress has continued, the risk
assessment reveals nd new areas of concern, and the Williamsburg treatment team and Dr.
Johnson are in full agreement that a further reduction is warranted, the Court encourages the
Hospital, counsel for Mr. Hinckley, and counsel for the government to meet and come to mutual
agreement regarding a proposed further reduction in the frequency of Mr. Hinckley?s
appointments to be submitted to the Court for approval, along with other changes to the
conditions contained in the Order that accompanies this Opinion that the parties agree are no

longer necessary.

3. Monitoring, Risk Management, and Accountability

The Court agrees with the Hospital that the current regime of rigid itineraries runs
counter to the purposes of convalescent leave and would hinder Mr. Hinckley?s socialization and
integration into the Williamsburg community. The January 2015 incident is in fact a prime
example of the kind of ?exibility needed to encourage the growth of Mr. Hinckley?s social
relationships and ability to pursue educational and vocational opportunities. The Court,
however, continues to believe that accountability, planning, and monitoring will be crucial to the
success of Mr. Hinckley?s integration, as well as important for risk management. Mr. Hinckley

therefore will be required to complete a daily log of his unsupervised activities. This log should

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be far less detailed than the previously?required itineraries and will not be submitted to the Court
for approval. Instead, Mr. Hinckley should contemporaneously log his daily activities, including
the people with whom he spent time, and submit his logs to Mr. Weiss and Dr. Johnson at his
appointments with them. Mr. Weiss should discuss the logs with Mr. I-iinckley during his
appointments, and will be required to make periodic calls and visits to con?rm the veracity and
accuracy of the daily logs. Nevertheless, acknowledging Mr. Weiss? suggestion that it might be
therapeutic for Mr. Hinckley to prepare itineraries fora period of time, see at 64, the Court
will leave to the discretion of Mr. Weiss and other members of the Williamsburg treatment team,
in consultation with Dr. Johnson, the authority to determine whether a ?exible, prospective
itinerary m? in addition to Mr. Hinckley?s daily log we also would have therapeutic bene?ts and,
if so, for how long, or whether, since Mr. I-Iinckley has continued to prepare itineraries
for an additional ?fteen months since Mr. Weiss testi?ed at the evidentiary hearing, the
therapeutic bene?ts already have been achieved.

The Court will not require an ankle bracelet or a vehicle tracking device, as there
is no evidence that Mr. Hinckley is an e10pe1nent risk, despite hundreds of opportunities to elope
during his visits to Williamsburg and trips outside of the Hospital over the last twenty or more
years. As Dr. Giorgi-'Guarnieri indicated, such requirements does not seem appropriate for an
outpatient and are not clinically indicated for Mr. Hinekley for whom the goals of convalescent
leave include more ?exibility and integration into the community. The Court will require,
however, that the make, model and license numbers of any cars Mr. I-Iinckley may drive m?
presumably one of Mrs. I-linckley?s two vehicles be provided to Mr. Weiss and to the FOPD.
Mr. Weiss shall provide this information to the United States Secret Service. If there are any
changes in the vehicles Mr. Hinckley may be driving, the same informatiOn should be so

provided.

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The Court will adopt Dr. Murphy?s recommendation to restrict Mr. Hinckley?s
travel outside of Williamsburg. Mr. Hinckley may not travel further than 30 miles from
Williamsburg without being accompanied by his mother or a sibling or a member of the
Williamsburg treatment team, but never more than 50 miles from Williamsburg. Mr. Hinckley,
however, will be permitted to drive unaccompanied to and from Washington, DC. for his
scheduled appointments at the FOPD.

One of the more hotly contested debates among the parties with respect to
conditions of release has been whether as a condition of convalescent leave Mr. Hinckley should
be required to carry a GPS?enabled cell phone whenever he is away from his mother?s residence.
The government and Dr. Patterson think he should; Mr. Hinckley does not. Dr. Murphy
recommends that Mr. Hinckley continue to carry such a phone at all times but opposes any
restrictions on which phones Mr. Hinckley may or may not use to make calls, either from his
mother?s home or at employment or during his volunteer work. s_upg at 52. Dr. Giorgi~
Guarnieri also believes that it would be ?very helpful? for Mr. Hinckley to carry such a phone as
a condition of release. gee gum at 60. On the other hand, over the years in which the Court has
required Mr. Hinckley to carry a GPS-enabled phone during his visits to Williamsburg, the
government never once sought to obtain any information from the device a fact which raises
questions about the pin?pose of such a requirement. The only utility, it seems to the Court, would
be to monitor Mr. Hinckley?s self?reporting of unaccompanied outings and activities, which will
become more frequent with Mr. Hinckley on full?time convalescent leave. If the government
does not look at such data, however, it is hard to see how such a condition would be helpful from
a risk management and monitoring perspective.

Nevertheless, even though Mr. Hinckley is not an elopement risk and the

government has never sought the GPS data from Mr. Hinckley?s cell phone, the Court will

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require that, at least for the first year of his convalescent leave, Mr. Hinckley carry a
GPS-enabled cell phone whenever he is away from his mother?s residence, and that he provide
the name of the cell phone company, subscriber information, and phone number to the FOPD
and his treatment providers in Williamsburg in light of the recommendations of Drs. Murphy,
Giorgi-Guarnieri, and Patterson. Mr. Weiss shall provide the information to the United States
Secret Service. Mr. Hinckley shall also advise the FOPD and his treatment providers of any
change in the cell phone number, cell phone company, or other subscriber information. Dr.
Johnson and the members of the Williamsburg treatment team will be authorized to access the
GPS data from Mr. Hinckley?s cell phone. The Court also agrees with Dr. Murphy, however,
that, even though Mr. Hinckley will be required to carry a GPS?enabled phone, there should be
no restrictions on which phones Mr. Hinckley may use to make calls, either from his mother?s
home or at employment or volunteer work. Indeed, such a restriction would be
counterproductive to the goals of convalescent leave, as it would impede Mr. Hinckley?s ability
to get a job and to successfully maintain employment. .

Over the years, during which Mr. Hinckley has traveled to Williamsburg on court~
approved Phase arid Phase IV visits, there have been severe restrictions on his use of the
Internet. Dr. Murphy believes these restrictions should be lifted if he is granted full time
convalescent leave in Williamsburg. She does not believe such restrictions are clinically
appropriate and that it might even be therapeutic to allow him to visit sites, for example,
concerning President ?Reagan, presidential assassinations, violence, and even pornography, and
then to discuss his observations and reactions with his treatment providers. Mr. Hyde agrees that
this might be helpful therapeutically. Dr. Patterson strongly disagrees, particularly with Mr.
Hinckley living full time in Williamsburg and the increased freedom he will enjoy to work and

travel throughout the community without supervision and with decreased monitoring. Dr.

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Patterson believes that Mr. Hinckley should continue to be able to access only pro?approved
websites, primarily because there is information available on the Internet to which Mr. Hinckley
should not have access. The Court agrees that, at least for the ?rst six months to a year, Mr.
Hinckley should not access any website or search for any information relating to Mr. Hinckley?s
crimes or his victims, weapons, or hardcore pornography. This condition may be revisited. by
Dr. Giorgi?Guarnieri,? Mr. Weiss, Mr. Beffa and Dr. Johnson after this six to twelve-month
period and may be modi?ed if in their judgment such modi?cation is clinically appropriate. The
Court, the Secret Service, and counsel for the parties shall be advised of any such change.

Dr. Patterson also is concerned that Mr. Hinckley could publish his music,
photographs, paintings or writings on the internet and suggests that any such publication even
if done anonymously should require pre?approval by Mr. Hinckley?s treatment providers in
Williamsburg, including the assessment of risks, particularly because, in Dr. Patterson?s words,
?the notoriety fame issue is a part of his pathology.? Transcript of Hearing at 94 (Apr. 29, 2015
am). Since the evidentiary hearing in April 2015, the Court has been advised that Mr. Hinckley
and Les Solomon are thinking about publishing Mr. Hinckley?s songs on YouTube
anonymously, Hospital?s May 3, 2016 Letter to the Court [Dkt No. 612], and that Mr.
Hinckley has an ongoing interest in exhibiting his music and art work anonymously at future art
shows facilitated by Bruce Brelsford. Hospital?s June 9, 2016 Letter to the Court [Dkt No.
616]; Hospital?s June 27, 2016 Letter to the Court [Dkt. N0. 618]. The Court has further been
advised that, at least preliminarily, the Williamsburg treatment team has agreed that it would be
therapeutic for Mr. Hinckley to engage in such activities anonymously as part of preparing him
toward eventual community reintegration. E. In view of Dr. Patterson?s concerns, however,
the Court will require the treatment providers to ?rst assess any risk involved in such activities,

including the risk involved if the media or public identify Mr. Hinckley?s work keeping in

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mind Dr. Murphy?s salient observation that ?it is essential that the grandiose delusions and fame
seeking behaviors? in the past ?be distinguished from his presently held desire to create and
produce artistic compositions.? Murphy Rpt. at 59. Only after such a risk assessment may Mr.
Hinckley?s Williamsburg treatment providers, in consultation with Dr. Johnson, approve such
activities. Such approval should include some method for monitoring them for risk and
evaluating them clinically and therapeutically. The Court, the Secret Service, and the parties
shall be advised.

Furthermore, Mr. Ivlinckley shall not create any accounts with, or upload content
to, social media websites, including, but not limited to, Facebook, Twitter, Instagram, YouTube,
and Linkedln without unanimous authorization from the Williamsburg treatment team and Dr.
Johnson of the FOPD. Mr. Hinekley also shall not upload any content at all, including music or
photographs, to the Internet, even anonymously, without unanimous authorization from the
Williamsburg treatment team and Dr. Johnson of the FOPD, after assessing the risk of his doing
so in light of his pathology. at 7l~72 (summarizing testimony Dr. Patterson). The
Court will not require the installation of monitoring or tracking software onto Mrs. Hinckley?s
computer or limit which computers Mr. Hinckley may access. There is no evidence that Mr.
Hinckley has misused the Internet or accessed inappropriate or unauthorized websites under his
mother?s supervision during his visits to Williamsburg. The Court, however, will require that
Mr. leinckley (1) provide the username and password for any online accounts, including email
accounts to Mr. Weiss and the (2) refrain from tampering with or erasing any browser?s
Internet history; and (3) permit Dr. Johnson and the Williamsburg treatment team access to any
computer or phone owned by Mr. Hinckley or his mother to review the Internet history at any

time.

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4. Financial Support and Housing

Before the evidentiary hearing, the Court shared Dr. Patterson?s concern that the
Hospital had failed to adequately plan and investigate: (1) the ?nancial support required to
sustain Mr. Hinckley?s required treatment on convalescent leave; and (2) a contingency plan for
the death or unavailability of Mr. Hinckley?s mother, who will be his primary guardian on
convalescent leave. As noted above, the testimony of Mr. Hinckley?s siblings, Scott Hinckley
and Diane Sims, as well as the expert testimony of Dr. Murphy, have assuaged those concerns.
See at 4546, 65?67.

First, the Court is con?dent that the Hinckley family possesses sufficient funds to
continue Mr. Hinckley?s treatment and care as required by this Opinion for the foreseeable
future, and that his mother, brother, and sister are committed to providing the ?nancial support
necessary to do so. The Court understands that Mr. Hinckley will be able to begin applying for
government bene?ts once full?time convalescent leave has been approved and he becomes a
resident of the Commonwealth of Virginia. The Court also hopes that full?time residence in
Williamsburg will enable Mr. Hinckley to obtain paid employment. His ability to obtain
employment and certain government bene?ts ultimately will lessen the ?nancial burden on the
Hinckley family.

Second, the Court will require that Mr. Hinckley reside with his mother in her
home in Williamsburg for at least the first full year of convalescent leave. After a year on
convalescent leave, following the comprehensive risk assessment conducted by the Hospital, Mr.
Hinckley may reside in a separate residence, either alone or with roommates, or in a group home
within a 30?mile radius of Williamsburg, provided that all members of the Williamsburg
treatment team and Dr. Johnson agree and approve the selected living situation. Despite this

one-year restriction, the Court encourages Mr. Weiss to begin exploring housing options for Mr.

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Hinckley if his integration into the community is progressing satisfactorily. in the event that
Mrs. Hinckley becomes unavailable while Mr. Hinckley is still residing with her, the Court will

require that one of Mr. Hinckley?s siblings reside with Mr. I-Iinckley until an alternative living

situation may arranged.

VI. CONCLUSION

Thousands of times every day, judges across this country attempt the dif?cult,
damning task of predicting with confidence what a human being may do in the future. Judges
must do so every time a criminal defendant is sentenced or conditions of pretrial release,
supervised release, or probation are set. This is typically done with considerably less
information, analysis, and expert opinion than this Court has about John W. Hinckley, Jr.
Between the many social workers, case managers, therapists, and
other professionals who have treated John Hinckley since 1982, or independently examined him
as part of the proceedings before this Court since 2003 many of whose work and Opinions
have been dissected by lawyers on direct and cross-examination in open court for over a decade
it is fair to say that the lives of few people have been scrutinized with the care and detail that
John Hinekley?s has been. Indeed, it is difficult for the Court to imagine a more thorough
evidentiary and clinical record on which to base a conclusion as to whether a specific person will
present a danger to himself or others in the reasonable future.

This Court has carefully censidered all of the expert reports of the independent
experts presented by the government, by Mr. inckley, and by the Hospital over the years; the
expert and lay testimony presented at the evidentiary hearing held in April of2015, and the

records of the seven prior evidentiary hearings over which this Court has presided since

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2003; Mr. Hinckley?s entire history and clinical record over his 34 years at St. Elizabeths
Hospital; and the relevant legal authorities and the briefs ?led by the parties.

All of the experts and treatment providers who testi?ed during the evidentiary
hearing, including Dr. Patterson, are in agreement that Mr. Hinckley?s Axis I diagnoses his
major depression and disorder are in full and sustained remission and have been for
more than twenty years. During this long period of sustained remission w? more than 27 years,
in the Court?s View Mr. Hinckley, by all accounts, has shown no signs of 
delusional thinking, or any violent tendencies. After 34 years as an inpatient at St.
Elizabeths Hospital, and in view of the findings of fact set forth in this Opinion and the
successful completion of over 80 unsupervised Visits to Williamsburg over the last ten years, the
Court finds that Mr. Hinckley has received the maximum bene?ts possible in the in?patient
setting, that in-patient treatment is no longer clinically warranted or beneficial, and that as
even Dr. Patterson has acknowledged Mr. Hinckley is clinically ready for full-time
convalescent leave. On the ultimate mixed question of law and fact w- dangerousness the
Court finds by a preponderance of the evidence that Mr. Hinckley presents no danger to himself
or to others in the reasonable future if released on full-time convalescent leave to Williamsburg
under the conditions proposed by the Hospital, as modified and supplemented by the Court in

this Opinion and accompanying Order.

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or the reasons set forth in this Opinion, the Court will grant the Hospital?s
proposal for full?time convalescent leave, rejecting or modifying some of the Hospital?s
proposed conditions and adding others proposed by the government and the expert witnesses, or
devised by the Court itself in View of its ?ndings and conclusions. Speci?cally, the Court will
allow Mr. Hinckley to reside full-time in Williamsburg, Virginia on convalescent leave under the

conditions discussed in this Opinion and memorialized in an Order of the Court issued this same

day.
SO ORDERED.
MN
PAUL L. FRIEDMAN -
DAT E: '7  4 to Umted States Judge

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