Title: In Re Noel
Citation: 226 Kan. 536, 601 P.2d 1152
Docket Number: 50,960
State: Kansas
Issuer: Kansas Supreme Court
Date: October 27, 1979

226 Kan. 536 (1979)
601 P.2d 1152
In Re Application of CARROLL E. NOEL, JR., For Release Pursuant to K.S.A. 1978 Supp. 22-3428a.
No. 50,960

Supreme Court of Kansas.
Opinion filed October 27, 1979.
Nick A. Tomasic, Wyandotte district attorney, argued the cause, and Robert T. Stephan, attorney general, and Thomas L. Boeding, assistant Wyandotte district attorney, were with him on the brief for the appellant.
Robert L. Feldt, of Great Bend, argued the cause and was on the brief for the appellee.
The opinion of the court was delivered by
McFARLAND, J.:
Carroll E. Noel, Jr., was charged with murder in the first degree for the 1973 slaying of a United States Postmaster in Wyandotte County, Kansas. In 1974 a jury returned its verdict determining Noel was "not guilty because of insanity" and he was duly committed to the State Security Hospital at Larned, Kansas, pursuant to K.S.A. 22-3428. Subsequently, but pursuant to the same statute, Noel was transferred to the Larned State Hospital. In February, 1979, Noel filed an application pursuant to K.S.A. 1978 Supp. 22-3428a for hearing to determine whether or not he continued to be dangerous to himself or others. The district court found Noel "does not pose a danger to himself or others as long as he is on the prescribed medication," and ordered his discharge from the Larned State Hospital. As a condition of the discharge Noel was ordered transferred to the Osawatomie State Hospital for a period of not to exceed ninety days, during which time the Osawatomie facility was to prepare and implement an appropriate program for Noel's reentry to society (the specific order will be set forth elsewhere in this opinion). The State appeals from this order upon a question reserved, pursuant to K.S.A. 1978 Supp. 22-3602(b)(3). Execution of the order has been stayed pending determination of this appeal.
The issues raised on appeal are complex, broad, and of great importance to the people of Kansas. At issue is the determination of the proper role of courts in deciding whether insanity acquittees *538 should be released and the conditions of release. To facilitate understanding of the issues, we will proceed on the following format:
2. Decision of the district court;
3. Statement of the facts;
4. Statement of the issues; and
5. Discussion and determination of the issues.
STATUTES
K.S.A. 1978 Supp. 22-3428a:
K.S.A. 1978 Supp. 22-3428(3):
DECISION OF THE DISTRICT COURT
The decision was announced in open court on March 16, 1979, immediately following the closing arguments of counsel. The decision, from the transcript, is as follows:
....
....
....
STATEMENT OF FACTS
The evidence before the trial court splits itself into two categories:
1. Pre-commitment data (prior to March, 1974).
2. Post-commitment data (after March, 1974).
The pre-commitment data is summarized as follows:
Noel, a black male, has never married. He was approximately 38 years old at the time of commitment. Prior to the homicide, he was described as a quiet man who apparently had never broken the law, even to the point of acquiring a traffic ticket. Throughout his life he was characterized as a "loner", unable to make friends or trust anyone. These characteristics began in childhood and became more pronounced as the years went by. Feelings of persecution developed, with Noel believing that people were laughing at him, ridiculing him, and plotting against him. In time, the feelings of persecution deepened and became the dominant factor in his life. In 1972 he was working for the United States Post Office in Wyandotte County. By this time his condition had deteriorated to such a degree that outsiders were noticing that something was wrong. In 1972 Noel was complaining to the union steward and other authorities at the post office about plots against him and his sisters. The union steward concluded Noel had a serious psychiatric problem and urged Noel's family to seek psychiatric treatment for him. As a result thereof, in June, 1972, Noel became a patient in the psychiatric ward of a Veterans Administration Hospital.
In the V.A. Hospital Noel's illness was diagnosed as paranoid schizophrenia. Even as early as 1972, the object of Noel's delusions *542 was the United States Postal Service. With tranquilizing medication, Noel's symptoms were controlled. He was discharged from the hospital after a short stay, with instructions to continue taking the medication. Noel stopped taking the medication, apparently, shortly after his discharge. The delusions resurfaced with ever increasing intensity. Noel concluded the post office was going to force his sisters into prostitution; he saw postal trucks and their drivers as being armed with machine guns; and he believed a great postal conspiracy existed to harm him and his sisters. The postmaster, in Noel's mind, became the head of the conspiracy and his chief tormentor. Voices told him he must kill the postmaster to end the danger.
On November 29, 1973, after some two weeks of planning, Noel drove to the Kansas City, Kansas, post office, lawfully parked his car, concealed a long knife on his person, walked into the postmaster's office, and stabbed the postmaster to death (inflicting nine separate wounds). After having completed the task he came to do, he remained in the office and offered no resistance when arrested.
Noel was originally charged with murder in the federal court. Subsequently, this charge was dismissed and he was charged with first degree murder in the state court. While the federal charge was pending, Noel was examined, at federal request, by Dr. William V. McKnelly, Jr. Dr. McKnelly contacted the V.A. Hospital and obtained the data on Noel's prior hospitalization. He testified at the state trial. The doctor concurred with the V.A. diagnosis of paranoid schizophrenia and characterized the V.A.'s release of Noel as a blunder. Dr. McKnelly's testimony was thorough and showed extensive knowledge of Noel's background and condition. The bottom line of the McKnelly opinion is that Noel is and always will be a paranoid schizophrenic; that his is an extreme case of the disease; that Noel's potential for violent acts will remain; and that the disease may be suppressed in a structured setting with a low stress factor and daily appropriate administration of tranquilizing medication.
At trial Noel was found not guilty because of insanity and he was committed to the State Security Hospital at Larned. He was admitted to that facility on March 20, 1974.
The post-commitment data is summarized as follows:
In late 1975 the staff of the State Security Hospital reached the *543 conclusion that Noel was not dangerous to other patients and recommended transfer to Osawatomie State Hospital. About the same time, Noel filed a petition for writ of habeas corpus. Public opinion was aroused and pressure was brought not to make the transfer. By letter of March 12, 1976, Dr. Robert Harder, Director of Social and Rehabilitation Services, of which the state hospital system is a part, squelched the proposed transfer and pointed out to the Larned State Hospital Superintendent the undesirability of such a transfer and the dangers involved if Noel were returned to the community. Noel, as a result of the Harder letter, was transferred from the State Security side of the hospital to the regular Larned State Hospital. This was done pursuant to K.S.A. 22-3428(2), which authorized the chief medical officer of the security hospital to make such a transfer without hearing whenever he concludes the person is not dangerous to other patients. This transfer procedure does not involve a finding that the patient is no longer dangerous to himself or others, as required for discharge, but only that the patient is not dangerous to other patients. The Larned staff at no time in the proceeding recommended any discharge of Noel.
Having stated how Noel went from the security hospital to the regular Larned State Hospital, we will turn to the evidence as to Noel's condition during the committed years.
The principal evidence presented was the report of the Forensic Board of Review, dated February 26, 1979, and prepared for submission to the district court for consideration in the proceeding herein. Dr. John R. Tilton, a clinical psychologist who was Chairman of the Forensic Board of Review of the Larned State Hospital, testified, but the testimony was mainly confined to how the report was prepared, an explanation of the report, board procedures, etc. The only other witness was Ann Parker, a social worker employed by the Larned State Hospital. She was apparently called by defendant to lay the foundation for the admission into evidence of Noel's hospital records (Respondent's Exhibit No. 2). The court admitted the exhibit, but stated:
*544 Immediately following the above statement, counsel made their closing arguments and the court made its oral ruling in the case. The district court had no apparent opportunity to examine the exhibit, nor is it before us, except for the transcript of the testimony of Dr. McKnelly at the jury trial. So that brings us back to the Forensic Board report and the testimony of Dr. Tilton.
Because of its importance, the report is included herein in its entirety (except for the background statement as to murder charge, transfer between institutions, etc.):
Dr. Tilton's direct testimony concluded with the following:
STATEMENT OF ISSUES
The appellant designates a number of issues to be determined *548 on appeal. Looking through form to substance, it is apparent that there is one basic issue and various sub-issues as follows:
DISCUSSION AND DETERMINATION OF THE ISSUES
The basic issue on appeal is whether the district court misperceived the role of the court in the proceeding and, as a result of that fundamental misperception, committed a number of specifically enumerated errors. In order to resolve the basic issue we must first determine the proper role of the court.
The Kansas legislature has varied from time to time in our history as to whether the discharge of an insanity acquittee should be treated as a medical or a legal determination. See e.g., L. 1911, ch. 299, § 5; L. 1915, ch. 339, § 1; K.S.A. 62-1532 (Corrick); K.S.A. 22-3428; In re Timm, 129 Kan. 126, 281 Pac. 863 (1929). In 1976 the question again became a matter for judicial determination. L. 1976, ch. 163, § 23. Under K.S.A. 1978 Supp. 22-3428 and 3428a involved herein (amended by L. 1979, ch. 97, §§ 1, 2, but not relative to the medical versus legal determination), the court is given the responsibility of making the final *549 determination in all proceedings for discharge except where the hospital seeks the discharge and the county or district attorney from the committing county does not object thereto. In such proceedings the court must determine whether the patient continues to be a danger to himself, herself or others.
The State argues that in making this determination the court's prime consideration should be whether that person continues to pose a danger to the public. Kansas law at one time provided that insanity acquittees should not be released by the court unless the asylum superintendent certified that "in his opinion such person is wholly recovered and that no person will be in danger by his discharge." L. 1911, ch. 299, § 5. The language in Kansas cases cited by the State is based upon this 1911 statute. In re Beebe, 92 Kan. 1026, 142 Pac. 269 (1914); In re Clark, 86 Kan. 539, 121 Pac. 492 (1912). See also Hodison v. Rogers, 137 Kan. 950, 22 P.2d 491 (1933); In re Ostatter, Petitioner, 103 Kan. 487, 175 Pac. 377 (1918). In Clark, 86 Kan. at 553, this court said:
The statutes in effect herein (K.S.A. 1978 Supp. 22-3428a and 3428) use the term "others," but the intent to protect the public or community is clearly still within the statute. This is apparent from legislative action taken subsequent to the district court decision in this case. In 1979 HB 2501, amending the statutes herein, the Senate adopted the language "whether or not such person continues to be dangerous to the patient's self or others, including persons in the community in the event the committed person is discharged or conditionally released." The House did not concur with that and other amendments, and the conference committee dropped the emphasized portion, noting:
How, then, does the court proceed to make this determination? Numerous other jurisdictions have been faced with this question. The following is some well reasoned rationale from cases in other jurisdictions:
Hill v. State, 358 So. 2d 190, 206-207, 208 (Fla. App. 1978):
....
State v. Cook, 66 Wis.2d 25, 32, 224 N.W.2d 194, 198 (1974):
State v. Fields, 77 N.J. 282, 307-308, 390 A.2d 574, 587 (1978):
People v. Giles, 192 Colo. 240, 246, 557 P.2d 408 (1976):
Note: In Colorado, release is determined by a jury, but the principle is the same.
In United States v. Ecker, 543 F.2d 178, 183-187 (D.C. Cir.1976), cert. denied 429 U.S. 1063 (1977), the court discussed the standard of review to be applied by the district court in determining the release of an insanity acquittee, which is summarized as follows: In both conditional and unconditional release proceedings, the district court must weigh the evidence in the same manner that it does in deciding matters de novo. The reviewing court, as the trier of fact, must independently weigh and evaluate the evidence. Thus, the weight to be given any expert opinion admitted into evidence is exclusively for the judge, and the judge is not bound to accept the opinion of any expert witness or group of expert witnesses. The hospital's certification that the patient is ready for conditional release should be viewed as an amalgamation of expert opinion which the trial judge must weigh along *552 with all other evidence. The judge's determination can be based on other evidence in the record besides expert testimony, such as the patient's hospital file, the court files and records in the case, and illumination provided by counsel. The policy rationale underlying judicial review of both conditional and unconditional release is to provide for the treatment and cure of the mentally ill in a manner which affords reasonable assurance for public safety; it assures that members of the patient's exceptionally dangerous class are kept under hospital restraint until the district court approves a relaxation of that restraint. Thus, the role of the district court is not simply to review the hospital's decision for unreasonableness, but rather to decide the ultimate question of whether the present status of the patient is such that continued confinement without release is justifiable.
The above are but examples of how other jurisdictions have dealt with the complex question of the proper role of the court in insanity acquittee proceedings.
We conclude the determination of whether the patient continues to be dangerous to himself, herself or others is a legal rather than a medical decision. In any such determination, due consideration must be given to the protection of the public. The court has the obligation to weigh all the evidence in the case, including medical opinions, and reach an independent judgment. A medical opinion as to dangerousness, even if undisputed by other medical opinions, is not conclusive upon the court and must be weighed with the other evidence.
The determination of both dangerousness and the suitability of conditional discharge safeguards (discussed later in this opinion) involves prediction of the patient's future conduct rather than mere characterization of past conduct. Nonetheless, the patient's past conduct is important evidence as to his future conduct. It is appropriate for the court to give substantial weight to the nature and seriousness of the crime committed by the patient and its relationship to his present medical condition. See State v. Fields, 77 N.J. at 307.
Obviously, if the court determines the committed person is no longer dangerous to himself, herself or others, it must order the person discharged. If the court makes an unqualified finding that the committed person continues to be a danger to himself, herself or others, then the person must continue to be committed.
*553 We turn now to the area of conditional releases. The precise language of K.S.A. 1978 Supp. 22-3428(3) is significant and will be repeated with emphasis added:
If the finding is conditional as to the patient's not posing a danger to himself or others, the court is not required to discharge the patient. To discharge or not to discharge is still discretionary with the court. In exercising its discretion, the district court must consider whether any proposed conditions of discharge would truly accomplish their purpose, that is, to safeguard the patient and the public. If the court determines adequate safeguards are not present, then the patient should not be discharged. In any consideration of a reentry plan, the court should look to all aspects of the risks posed by the patient, the patient's condition, and examine every facet of the plan to determine if it will realistically accomplish its purpose. If the court is satisfied that conditional discharge is appropriate, it may order the conditional discharge in accordance with the statutory provisions of K.S.A. 1978 Supp. 22-3428(3).
In the district court's consideration of conditional discharge of the patient, the determination as to dangerousness, whether discharge should or should not be ordered, and whether the conditional safeguards will accomplish their purpose, are all aspects of the same consideration and cannot be separately determined. If conditional discharge is ordered, the court should state with particularity the basis for its conclusion. Throughout any such period of conditional release the court's jurisdiction continues in a similar manner as to persons on probation from criminal convictions.
Before concluding this discussion of the court's proper role, we note that among the 1979 amendments to K.S.A. 1978 Supp. 22-3428(3) is the following:
This should be of assistance to the courts in making these difficult determinations.
We turn now to the basic issue as to whether the district court misperceived its role in the proceedings and, as a result of that fundamental misperception, committed a number of specifically enumerated errors.
The district court's decision appears in its entirety earlier in this opinion and will not be repeated.
We must conclude that the district court did misperceive its role in the proceedings and, as a result of that fundamental misperception, did commit the following errors:
1. The court considered the determination as to "dangerousness" to be medical rather than legal. The only current medical opinion at trial was the amalgamated hospital position (Forensic Review Board's report and the testimony of its chairman) to the effect that Noel was not presently dangerous, with qualification of continued medication. The Forensic Review Board's report goes somewhat further and adds qualifications of suitable environment and lack of stress. The court clearly felt it had no alternative but to accept the medical opinion as to the ultimate fact, and did not weigh any evidence or reach an independent judgment.
2. The court determined the "dangerousness" question and ordered Noel's discharge prior to even considering the conditions to be imposed. As we previously stated, when conditional release is being considered, dangerousness, discharge, and conditional safeguards are all aspects of this consideration and cannot be separated. The court appears to have been unaware of the fact it could have found that Noel did not pose a danger to himself or others as long as he was on the prescribed medication, and it could still have denied discharge by virtue of the conditions being insufficient safeguards.
Dr. McKnelly, the psychiatrist testifying at the murder trial, evaluated Noel when his paranoid schizophrenia was out of control. It has been controlled at the hospital. The Forensic Board of Review evaluating Noel saw him when the medicine and his environment were controlling the disease. The hospital readily *555 admitted that if Noel's special needs were not met he would go out of control again.
The following analogy illustrates the inappropriateness of splitting consideration of dangerousness from consideration of safeguards. Let us suppose a court is called upon to determine whether a shipment of nitroglycerine can be stored in the center of a large city. The experts testify that nitroglycerine is not dangerous as long as it is stored at temperatures below 180° Fahrenheit and is not jiggled. No evidence is admitted as to the conditions under which the nitroglycerine is proposed to be kept, or supervision thereof. It would obviously be error for the court to conclude the explosive presented no risk as long as its needs were met, and to delegate determination of proper conditions to others.
3. The court had no authority to shift the responsibility of fixing conditions of discharge (i.e., reentry program), and of implementing and supervising same, to the Osawatomie State Hospital. If conditional discharge were to be ordered, it had to be on conditions specifically approved by the court. Further, no statutory authority exists for placing Noel under the supervision of a state hospital upon conditional discharge.
4. The court had no authority to divest itself of jurisdiction of Noel during the conditional release, which is the effect of the order.
5. The court ordered the discharge of Noel, with no information whatsoever as to such basics as the circumstances under which he would be living, how he would support himself, or what measures would be taken to assure continuance of the medication.
By virtue of the numerous errors hereinbefore listed, and without further elaboration, we conclude the discharge of Noel was erroneous.
One other issue is raised. The State contends the court erred in failing to assign the burden of proof to Noel. The record is clear that Noel was the moving party. At the beginning of the hearing, Noel's counsel was asked by the court whether he was "prepared to go forward." Counsel responded that he was and called his first witness. There is no evidence that the court placed the burden of proof other than on Noel. The statute herein, K.S.A. 1978 Supp. 22-3428a, is silent as to burden of proof. The statute was amended in 1979, subsequent to the proceedings herein, to provide:
All issues herein have been determined.
Before concluding, however, some additional comments will be made in the hope of preventing a repetition in future cases of some of the basic problems present in this case. We note that whereas K.S.A. 1978 Supp. 22-3428a and 3428 have been amended subsequent to this case, the amendments do not alter the court's role in determining such cases.
As we previously stated, K.S.A. 1978 Supp. 22-3428 applies to hospital-initiated discharge proceedings. Under this statute the court is required to order an independent mental evaluation of the patient. In such a proceeding, presumably both patient and hospital are seeking the patient's discharge and are allied to a certain degree in interest. The independent evaluation gives the court a second medical opinion to weigh along with the other evidence. K.S.A. 1978 Supp. 22-3428a applies to patient-initiated discharge where, presumably, the hospital position and that of the patient are in opposition. In such a proceeding the court, on request of the patient, must order an evaluation. It is the statutory plan that generally the court will have the benefit of a medical opinion other than that of the hospital. Because the case before us was a patient-initiated proceeding (under K.S.A. 1978 Supp. 22-3428a), the mandatory outside evaluation procedures of K.S.A. 1978 Supp. 22-3428 did not apply. The patient requested no outside evaluation, so none was ordered. Accordingly, the court had only one medical opinion on the patient's current mental condition.
The area of insanity acquittee discharge is a highly sensitive issue with the public. The earlier statements herein, relative to the circumstances of Noel's transfer from the State Security Hospital to the civil side of the Larned facility, reflect the sensitivity of the hospital. The Forensic Review Board's report herein was carefully phrased. Noel's potential for being dangerous to others appears throughout. The hospital at no time recommends discharge. The report basically says Noel is not presently dangerous if (1) he takes the prescribed medication; (2) he is in a suitable environment; and (3) he is not subject to stress. The report makes no suggestion of specific conditions to be imposed to safeguard the public.
*557 If Noel's discharge had not been stayed, and if a further act of violence had been committed by Noel, the hospital would have been in an ideal position to respond to public criticism by simply showing from the court's own files:
1. The hospital never recommended Noel's discharge;
3. The court discharged Noel anyway.
It is indeed ironic that the court felt, based solely on the hospital's opinion, that it had no alternative but to discharge Noel. It is incumbent upon courts, for the protection of the public, to give due consideration to all factors in weighing the evidence and making their determinations in all cases such as the case herein.
In uncontested discharges of insanity acquittees, the hospital makes the final determination and is responsible therefor. In contested discharges of insanity acquittees, the court makes the final determination and is responsible therefor. The case before us resulted in the worst of both worlds. The hospital did not determine discharge was appropriate and the court ended up discharging Noel because it felt it was bound by the hospital's position. Accordingly, Noel was discharged with neither hospital nor court satisfied such action was appropriate.
The application to discharge herein was filed on February 14, 1979. K.S.A. 1978 Supp. 22-3428a permits annual filing of such applications by an insanity acquittee. Any new filing of an application by Noel will be governed by the amendments to said statute (L. 1979, ch. 97, § 2), which provide, inter alia:
The judgment is reversed.
FROMME, J., not participating.