Opinion ID: 1993367
Heading Depth: 1
Heading Rank: 16

Heading: court's findings of fact

Text: 1. Background and History. It has been long recognized by many people, including criminologists, penologists, psychiatrists and judges, that there exists a group of offenders whose criminality results from and is related to a definite category of mental abnormality. These offenders have been of particular concern to society because usually they have long histories of persistent antisocial behavior which results from lack of emotional balance and control, and in some cases is accompanied by deficient intelligence. It is clear that these individuals have a tendency to repeat their crimes, and they do not respond nor are they materially influenced by ordinary penological reformative measures as provided in the conventional penal institution. Those studying the subject have recognized that these individuals, even though constituting an acute menace to society because of their criminal acts, are in fact mentally ill and should not be dealt with primarily as criminals and confined in a conventional prison, but should be placed in a special type institution. Such an institution they agree should be staffed with psychiatrists, psychologists, sociologists and social workers, and should also include educational, vocational and recreational facilities and instructors, all of which enables the use of recognized psychiatric and psychological procedures and techniques on an intensive basis, for the purpose of changing and rehabilitating the character and personality make-up of the person, so that upon his release, he will, hopefully, assume a useful role in society. The advocates of this approach are cognizant of the fact that mental illness suffered by these offenders often is exceedingly difficult of cure, and will usually require confinement for considerable duration in order effectively to complete the treatment process. They recommend the use of an indeterminate sentence to an institution such as described above so that the offender's release will be related to a cure of the illness, and not merely to the passage of time. This concept recognizes, also, that some offenders may never be cured, and hence the indeterminate sentence would accomplish the protection of society but result in their confinement for life. After extensive studies, [7] Maryland adopted these concepts in 1951 when the Defective Delinquent Act was passed, and its operative facility, Patuxent Institution was completed and opened on January 1, 1955. The initial cost of the Institution was $3,902,000 and the total cost of the physical plant to the present amounts to $7,579,560. The facility is located about midway between Baltimore and Washington, at Jessup, Maryland, is comprised of ten acres, fenced. Facilities include six guard houses, a multisectioned three-story defective delinquent building, a three-story diagnostic center, a kitchen-dining room, a gymnasium-theater, vocational shops and school area, a hospital (containing laboratory facilities, including electroencephalographic and electrocardiographic rooms, dental offices, examination and treatment rooms), administrative offices, a psychiatric isolation section, as well as other structures and units. The entire complex is interconnected by a ground-level tunnel. Both the defective delinquent building and diagnostic center have tiers of cells containing standard items of furniture. The rated capacity of the Institution is 622 inmates, with the committed inmates being housed in the defective delinquent building, and those in a diagnostic status being confined in the diagnostic center. Additional improvements are planned, which include a warehouse structure, home for maintenance supervisors, school building, chapel, additional shop space, and a half-way house. [8] The testimony discloses that from the Institution's opening in January, 1955, to July 1, 1965, a ten-year period, the Institution admitted 1,483 persons, of whom 1,222 were diagnosed by the staff. [9] Of this number, 826 were recommended by the staff for commitment and original defective delinquent hearings were held. Either the court or jury found 581, or 82 percent, of those individuals to be defective delinquents. Up to July 1, 1965, there have been 347 rehearings under the provisions of the Act, and of that number, 185, or 53 percent, were found still to be defective delinquents. Patuxent's per capita costs have increased from $2,562.00 in the fiscal year 1956 (for 188 patients) to $4,602.00 for the fiscal year ended June 30, 1965 (for 487 patients). Comparison of these per capita costs with those lower costs prevailing in State mental hospitals and in the State's penal and corrective institutions is indicative of Patuxent's increasingly extensive treatment program. The operating budget has increased from $476,467.00 for the fiscal year ending June 30, 1956, to $2,348,428.00 for the fiscal year to end June 30, 1966, with the proposed budget for the fiscal year 1967, heretofore submitted to the Budget Bureau, increasing to $2,917,000.00, with the amount of $54,000.00 being currently allocated to the institutional research program and $157,895.00 to its current educational, vocational, recreational and religious programs. 2. Statutory Definition. The Maryland statutory definition of a Defective Delinquent, as applied by the Maryland Courts, is sufficiently definitive to permit its practical application within constitutional limitations, in that: a. The definition sets forth, in precise non-technical terms, readily understood by the laity, a psychiatrically accepted and recognized mental or personality disorder which can be ascertained or diagnosed with a reasonable degree of unanimity among experienced psychiatrists. (1) In determining whether a person demonstrates persistent aggravated antisocial or criminal behavior such as evidences a propensity toward criminal activity, within the meaning of the statutory definition, such phrase must be accorded a non-technical, non-medical meaning. So viewed, it sets forth a clear, sufficient, readily determinable standard; and may be said to exist where such behavior is destructive and persists in a chronic repetitive pattern; in contradistinction to antisocial behavior which is merely occasional or episodic. The criteria employed in making such determination is the individual's past history and record. (2) In determining whether a person, who has demonstrated persistent aggravated antisocial or criminal behavior exhibits such intellectual deficiency ... as to clearly demonstrate an actual danger to society, such term must be accorded its well-recognized psychiatric-psychological meaning. So considered, it is a classification capable of being diagnosed with a high degree of unanimity by objective and clinical testing, non-mechanically applied, and properly evaluated, with prime consideration given in such evaluation to the person's entire life pattern. [10] (3) In determining whether a person, who has demonstrated persistent aggravated antisocial or criminal behavior, exhibits emotional unbalance ... as to clearly constitute an actual danger to society, within the meaning of the statutory definition, such term, although non-medical in origin, is generally understood by psychiatrists in Maryland and the surrounding area, in the context of its use in the statutory definition, to refer to a definite type of medically recognized psychiatric disorder manifested by deep-seated emotional conflicts which distort the individual's attitude toward society, and of society's attitude toward him, resulting in an uncontrollable desire and need to create hostile acts against society  this distortion or characterological crippling having repetitive characteristics which the individual is incapable of controlling and which, through mental mechanisms, impels him to carry out such antisocial acts; and, so viewed, such term is sufficiently definite that the minds of experts in the field usually agree as to what is meant by such term; and that such condition may exist in a person who is intellectually defective, as well as one who is not. [11] (4) In determining whether a person, who meets the other statutory criteria for inclusion within the definition of a defective delinquent, also demonstrates an actual danger to society, within the ambit of the definition, such term must be accorded its common meaning and, so viewed, such determination is to be made primarily on the basis of the empirical tests of his established behavior  it being factually difficult, in making such determination, to limit consideration to persons whose crimes have constituted only a danger to life or limb of other persons, since there is potential physical danger involved in crimes committed solely against property. b. It is the general behavioral pattern, and the psychological and emotional makeup of the individual, which identifies and delineates him as a defective delinquent under the Maryland Act and it is wholly unnecessary to employ psychiatric terms or labels, such as sociopath or psychopath in order to determine whether a person comes within the statutory definition of a defective delinquent. (1) Although, with rare exceptions, individuals adjudged defective delinquents under the Maryland Act would be drawn from a class designated by some psychiatrists as sociopaths or psychopaths, the Maryland definition is in no way dependent for its validity upon the use of any such psychiatric terms, labels or other naming devices. (2) It seems clear, from the evidence, that so rapid is the progress of learning about the operation and disturbances of the mental function that professional nomenclature has not kept abreast of these developments, and therefore such terms that have been used by psychiatrists and others, as psychopath and sociopath have today no universally accepted meaning by members of the psychiatric profession, and may therefore be meaningless terms, unless the user further defines the type of personality to which he refers, by the use of the word. In fact, the word psychopath was dropped from the nomenclature adopted by the American Psychiatric Association in 1952. However, whether or not psychopath or sociopath are valid psychiatric terms is not vital or significant to the coverage, scope and application of the Maryland definition of a defective delinquent. This is so because the limits of such definition are neither broadened, narrowed, nor in any way controlled by reference to these terms. c. The Maryland definition of a defective delinquent is as definite, and to some more definite, and as easy or easier to apply by most of those concerned than either the M'Naghten or Durham Rules for determining criminal responsibility. b. The Maryland definition of a defective delinquent is as definite and accurate as the long standing civil test in Maryland to determine insanity (i.e., that the individual, because of his mental condition, is a danger to himself or others). e. Criminal behavior, per se, does not make one a defective delinquent under the Maryland definition. f. The defective delinquent is not psychotic and does not suffer from any form of delusions, hallucinations, phobias, obsessions, anxiety states or depressions different in kind from the normal person and therefore psychotics are of necessity excluded from the Maryland definition of a defective delinquent. g. Neither mental nor emotional deficiency, or both, make a person a defective delinquent, as in addition he must have demonstrated persistent aggravated antisocial or criminal behavior clearly constituting an actual danger to society, and have been convicted and sentenced for a particular crime. h. About eighty percent of convicted criminals would not fall within the statutory definition of a defective delinquent, since, unlike defective delinquents, these individuals, though socially disordered, are not, psychiatrically speaking, significantly deviated from what is considered normal and are not hostile to society in the manner characteristic of a defective delinquent. Those within the eighty percentile group are frequently referred to as normal or habitual criminals, these terms being employed to distinguish this majority group of criminals from the minority of about twenty percent who are the defective delinquents sought to be reached by the Act. 3. Application of Procedures. We assume generally as to the seven (7) witness inmates, based on their testimony and an examination of their institutional records, and we find specifically as to Daniels, that the examinations for defective delinquency were conducted in accordance with the statutory requirements, and consistent with procedures now generally accepted medically. The institutional medical team, in examining any individual properly referred to it, employs recognized psychiatric techniques, including, among other things, a psychiatric interview and evaluation in depth, a full battery of psychological tests, full sociological and social work studies, including electroencephalographic studies, review of past history and records, including police, juvenile, penal and hospital records; and, in addition, personal interviews with the accused's family, when feasible, and with the accused, are held. These procedures are the accepted practice in matters involving psychiatric evaluation and the techniques employed in state and private mental hospitals, as well as by private physicians, all of which are essential to any accurate psychiatric diagnosis. Opportunity is afforded to the accused, after full discussion, to dispute any data collected by the institution and, if a material conflict arises, the institution customarily conducts further investigation, and discussion with the inmate. If the disputed matter cannot be resolved, the existence of the conflict is noted on the inmate's institutional record, and evaluation of the individual is made in light of all reliable information, both disputed and otherwise, with due regard being given to the fact that there is a dispute. Diagnosis is usually completed within 90 days of admission to the institution and the psychiatrist who testifies in court must have interviewed the inmate, have participated in the staff conference before making the recommendation for commitment, and be personally familiar with the case. 4. Treatment of Inmates. Patuxent Institution furnishes treatment for inmates and presently experiences no deficiencies in staff, facilities, or finances substantially undermining the efficacy of the institution and the justification for the act, in that: a. The aim of the treatment program at Patuxent is to develop internal controls within the individual in order that he may learn sufficient restraint to become a useful member of society. Otherwise stated, such aim is to enable defective delinquents, through treatment, to control their tensions, and, more specifically, to help the individual gain insight into his behavior, to accept responsibility for himself and others, to adjust with relationship to his peers and authority figures, to tolerate frustration and postpone gratification of instinctional demands. b. The treatment program for defective delinquents has both formal and informal aspects and exists on all levels of communication between the inmates and their institutional environment. Underlying the treatment program is a philosophy which recognizes the desirability for total rehabilitation of the person, rather than mere improvement in his mental or emotional status. In addition to psychotherapeutics such as individual and group therapy, the treatment program, in furtherance of this aim, includes educational, vocational, religious, and recreational programs, together with provision for a highly structured social system, or therapeutic milieu within the institution. The graded tier system which, with its inclusion of tier counseling, is designed to build internal restraint, being based on the hypothesis that rewarding behavior which is socially desirable and personally beneficial to the inmate increases the frequency with which such behavior occurs and reduces the tendency toward antagonistic and undesirable behavior. In short, Patuxent utilizes a medically accepted treatment program adapted to the mental and emotional condition of the inmates. c. Since defective delinquents usually require more than normal incentive to be motivated, cannot easily tolerate lack of discipline, and are deficient in ability to control their conflicts, their effectual treatment can best be carried out in a secure institutional environment, such as provided by Patuxent, with a definite reward and punishment system. Such treatment is not available and cannot feasibly be made available in State mental hospitals or State penal institutions. d. The conventional mental hospital, whether State or private, deals with a distinctly different group of patients than Patuxent, in that within the former institutions are found individuals who, for the most part, have internalized their conflicts and do not act out against society, and thus such institutions can be operated as open hospitals. One of the chief characteristics of the defective delinquent is his inability to internalize these conflicts, resulting in acting out antisocial behavior. Moreover, all committed inmates at Patuxent have been found to be, in varying degrees, a danger to society, thus Patuxent must be operated as a maximum security institution. Experience has shown that when individuals possessing the characteristics of the defective delinquent are confined within mental hospitals, they are disruptive to the normal institutional program. e. Confinement of defective delinquents at Patuxent, rather than in the State mental hospitals, has relieved what formerly was a most difficult situation and has made it possible and desirable for such mental hospitals to develop better open hospital programs for its general population, with greater freedom of movement. f. The penal and correctional institutions under the jurisdiction of the Department of Correction have been ineffectual in developing or providing the specialized treatment and attention which defective delinquents require, and experience has indicated that when individuals possessing the characteristics of the defective delinquent are incarcerated in conventional penal institutions they are disruptive to the normal institutional program. Confinement of defective delinquents at Patuxent, rather than in the State's penal institutions, has enabled such institutions to develop more effective programs for the conventional prison population. g. Both quantitatively and qualitatively, Patuxent's treatment program is more effective for the defective delinquent type person than that provided in the State's penal and correctional institutions. h. The State's penal and correctional institutions are basically without functioning psychiatric treatment programs, [12] and have no program even remotely approximating the graded tier concept in effect at Patuxent. Separation of inmates by tiers, in penal institutions of this State, is based purely on convenience to the operation and security. i. Although treatment at Patuxent is not as intensive in the area of individual psychotherapeutic attention as that provided in private mental hospitals (though usually at prohibitive cost to the average citizen), treatment at Patuxent is superior in its milieu therapy, group therapy and post release programs to that provided by State or private mental hospitals, and is more comprehensive than either. j. The operating budget requests, as well as the fiscal requirements, of Patuxent have been realistically met by the State as demonstrated by the figures heretofore given and the fact that the expenditures have increased year by year. k. Patuxent presently provides effectual treatment for all treatable defective delinquents, including Daniels, denying treatment to none, in that: (1) Patuxent's professional staff is adequate and competent as beginning August 15, 1965, the institution was authorized to employ twelve full-time psychiatrists (9.58 being then employed), nine psychologists (5.5 being then employed), and fourteen social workers (13 being then employed). With 485 patients on August 15, 1965, the professional staff to patient ratio was in full compliance with mental hospital staff standards promulgated by the American Psychiatric Association, and was materially higher than such ratios prevailing in the State penal and correctional institutions and in State mental hospitals in Maryland, as well as elsewhere in the country generally. Additionally, professional services of Patuxent's various advisory boards are available and are of value in the treatment program. (2) Patuxent's Institutional Director, who has held the position since its opening, is a highly competent psychiatrist enjoying an international reputation. (3) Patuxent's professional staff is and has been dedicated and determined to help inmates rehabilitate themselves. The relationship between the professional staff and the inmate population is generally good. (4) The institution makes continuous efforts to recruit qualified professional personnel of high caliber and does maintain salary levels competitive with those of institutions employing a professional staff of similar qualifications. Salary levels for the professional personnel at Patuxent are sufficient to attract and hold qualified personnel. This scale is among the highest of all of the States in the country. (5) All inmates are considered treatable and susceptible of help at Patuxent and the institution uses most of the recognized psychiatric treatment techniques. Upon entry each inmate is especially assigned to a psychiatrist and a social worker. (6) Group therapy, which now enjoys almost universal acceptance, and in which use Patuxent pioneered, is now generally considered by experts to be the most effective form of treatment for defective delinquents. Presently 86% of the committed patients are regularly receiving this form of psychotherapy. All patients are afforded an opportunity to receive such therapy, and non-participation is due either to recent commitment, improper attitude or outright refusal. (7) Individual therapy is also provided at Patuxent on a selective basis, but presently only four inmates are receiving this form of treatment, as experience there has demonstrated that defective delinquents generally do not respond well to this form of therapy. (8) All committed inmates by virtue of the milieu therapy program are in a broad sense constantly receiving treatment. (9) Treatment at Patuxent is effective and the environmental (milieu) therapy, which is different from the State penal institutions, is a substantial contributing factor. During the hearing the impression left with us from the whole testimony of Sas and Aravanis further supports this finding. [13] (10) The indeterminate sentence can be an incentive to treatment and rehabilitation of inmates, having therapeutic value in and of itself by motivating some patients to become amenable to treatment and making clear to all patients that they must participate in the treatment process in order to be helped and released. (11) Though helpful, it is not indispensable to effective treatment at Patuxent that individuals be willing patients. (12) The fact that a member of the treating staff at a mental hospital may, on occasion, be required to testify in court in opposition to his patient's release from confinement, though not ideal, is not generally so disruptive of the physician-patient relationship as to interfere materially with successful treatment; and may, when occurring at an institution such as Patuxent, even have positive value in conditioning the inmate to gain insight into the reality of his situation. Patuxent is moving toward the modern tendency of separating the treating and administrative functions, in that the institutional Director or other administrative psychiatrist now testifies in most cases. (13) As part of the treatment program, it is desirable to record all disciplinary infractions in order to gain insight into the individual's response to treatment, and of his adjustment and socialization within the institution. (14) Twenty percent of Patuxent's population are presently beyond the time of their original sentences. (15) The incidence of successful adjustment in the community, of inmates released on parole demonstrates the effectiveness of the treatment program. The post release experience of patients committed to Patuxent, over a ten-year period, shows that of 581 patients committed to the institution, 155, or 27%, were released with results as follows: Type of Release Number Risk Rate I. Total released 155 Violated 64 41% II. Court Releases without Institutional Board of Review (IBR) recommendation 129 Violated 62 48% A. Above patients never on leave status 104 Violated 56 54% B. Above patients who had been on parole but did not have IBR recommendation 25 Violated 7 28% III. Total Released from Parole 51 Violated 9 18% A. Same as item B in category II above 25 Violated 7 28% B. IBR recommended 26 Violated 2 8% Risk rate is based on the number who violated in a given category. It shows the risk to society when there is a release from Defective-Delinquency of a patient who falls into one of the above categories. (16) Patuxent adopted the live in  work out program and 57 inmates, on July 1, 1965, had participated in this program, with 16 violating its terms and committing new offenses. (17) Patuxent's holiday and weekend leave program has resulted in a total of 148 inmates being given such leave up to July 1, 1965, 57 of whom started in 1965, being three times that of any previous year. Of these, 16 violated the terms of the leave program and 13 committed new offenses. All twenty-nine (29) were returned to the institution. (18) A total of 24 inmates have been recommended by the Institutional Board of Review to the courts for outright release from their status as defective delinquents, nine such recommendations were made in 1965, twice the number as for all previous years of the institution's operation. (19) The Patuxent treatment program includes a parole clinic, providing psychiatric aftercare to parolees. It meets regularly and provides both individual and group therapy for parolees, including family group therapy. (20) Patuxent Institution, and the concept which it embodies, is accomplishing its purpose with increasing effectiveness, both because of the development of the science of psychiatry and from experience with the operation of the institution and dealing with the defective delinquent population there. It has been accorded positive recognition as a progressive institution, both nationally and internationally and among leading criminologists, penologists, psychiatrists and judges. [14] 5. Daniels' Treatment. As applied specifically to the petitioner we find as follows: a. The aim of the treatment program for Daniels has not been necessarily to increase his intellectual performance, but to modify his social adaptabilities and his behavior to his environment, so that he can stay out in society as a functioning person, even though intellectually limited. Patuxent is attempting, through treatment, to have him modify his social behavior so as to handle his problems on a thinking rather than on an impulsive basis. b. A specific educational program is available to and is participated in by Daniels. c. Although Daniels has proven not to respond particularly well to group therapy, he is susceptible of help, through application of a simple reality group therapy program. His institutional record with regard to such therapy is lacking in relation to the results reached. However, we do find that all therapy utilized at Patuxent which is appropriate to his condition is available to him. 6. Irregularities at the Institution. There was considerable testimony of various incidents and conditions at Patuxent which if accepted by us as fact would indicate at least lapses in the treatment program and the efficient operation of the Institution. This testimony, while not wholly rejected, does not show such degree of flagrancy as to have a bearing on the constitutional questions here involved, either generally, or specifically as to Daniels. However, we hope that bringing them to light will be noted by the staff for future guidance and reference. 7. Statistical Evidence. We find that the statistical data as to the construction costs, maintenance and operation, as well as the statistical data relative to the referral diagnosis, commitment, treatment, parole and release of individuals at Patuxent is undisputed and therefore it is accepted as correct.