During a rare insanity trial for the man who killed five Capital Gazette employees, an Anne Arundel County juror passed Judge Michael Wachs a note on the second day of testimony.
“If the defendant is not found criminally responsible, what happens then?” it read.
Wachs told the jury more information will come before deliberations. The jury’s verdict — insane or not — will either send the gunman to a hospital ward with the possibility of release or behind prison bars for life.
Prosecutors are seeking at least five life sentences without the possibility of parole. He’s already pled guilty and been convicted of murdering Gerald Fischman, Rob Hiaasen, John McNamara, Rebecca Smith and Wendi Winters.
But Jarrod Ramos, 41, also pleaded not criminally responsible, Maryland’s version of the insanity defense. Ramos’ attorneys have to convince 12 jurors it is more likely than not his mental disorders prevented him from understanding his crimes were illegal or from stopping himself from committing them.
If found to be insane, Ramos faces commitment at Clifton T. Perkins Hospital Center, the state’s maximum-security psychiatric hospital in Jessup. Almost all Perkins’ patients are accused or convicted of committing violent felonies.
Unlike a prison sentence where the countdown until release can be exact, the time it takes a sick patient to become mentally stable enough for discharge depends on the person. There is no time limit.
People found not criminally responsible are patients, not prisoners. Severe mental illnesses that led to criminal behavior are treated by clinicians. Over the course of a years-long commitment, patients earn privileges and can leave the facility on day trips or for work if they’re deemed not to be a danger.
Patients are hospitalized at Perkins for an average of five to seven years, said Stephanie Reid, a licensed clinical social worker who’s worked at the facility for nearly 15 year and is a representative of the union American Federation of State, County and Municipal Employees. The Capital spoke with the state health department and four current and former Perkins clinicians about day-to-day life in the hospital.
While that typically translates to about as long as their prison sentences would’ve been, there are exceptions, said Larry Fitch, a lawyer who oversaw the Maryland Department of Health’s Behavioral Health Administration’s Office of Forensic Services for almost two decades.
“Someone may raise (a not criminally responsible defense) for a charge where they might only spend six months in jail, and spend two or three years in the hospital,” Fitch said. “And other people might raise it for a very serious charge and be out in a year for an offense that could result in a life sentence.”
Three categories of patients are treated at Perkins: pre-trial defendants who are too sick for a detention center but return to jail once they’re stable; people who don’t comprehend their legal case and are under evaluation or deemed incompetent to stand trial; and people adjudicated as so mentally impaired at the time of their crime they are not criminally responsible.
Before his trial, Ramos was evaluated at Perkins and found competent to stand trial. He’s sat in a county jail since.
On the ward
At the maximum-security hospital, patients are tightly monitored by a range of mental health professionals. A barbed wire fence surrounds the hospital that has 10 wings and a large grass yard.
Security officers are stationed on every maximum ward of the hospital, compared to lower security psychiatric hospitals where officers typically patrol a campus. Patients are expected to participate in their treatment, including group therapy, and some people are risk-assessed daily.
As of June, 145 patients declared “not criminally responsible” are at Perkins, according to the state health department.
The center has the capacity to evaluate and treat 298 patients but has an average daily population of 269 residents, according to a 2020 legislative audit. In fiscal year 2019, its expenditures totaled approximately $73.4 million.
Most wards at Perkins are maximum-security and have around 30 patients in private and dorm-style rooms. Wards are locked, but rooms are not. Private rooms are earned for good behavior or assigned to patients in poor health who need one-on-one supervision. Around 11 staff members work directly on a ward: two psychiatrists, a psychologist, six nurses and two security officers, according to the health department.
The General Assembly approved the hospital’s creation in 1959. Perkins is named after a psychiatrist who reformed conditions at public hospitals and fought to desegregate psychiatric hospitals in Maryland, according to the state health department.
All newly committed Perkins patients start out in maximum-security wards. From there, patients gradually transition to units with lesser levels of security by climbing to higher rungs in a behavioral and clinical stability ladder.
Patients with higher clinical status can receive items like food care packages or move within the hospital without a staff escort, such as a walk to the snack or barber shop. Patients at top levels can make money working laundry, maintenance and other jobs. They can participate in art therapy, gardening therapy, and other activities.
“We try to come up with ways to really encourage the patients who are really following all of the rules,” said Reid, the social worker.
Stable patients who consistently cooperate in treatment, such as taking medication, spend months without being violent or aggressive, and establish good relationships with family or mental health providers are considered safe to the public and themselves. They may begin their transition back to the community.
A person can also be transferred from Perkins to one of six other lower level security psychiatric hospitals in Maryland, such as Spring Grove in Catonsville or Springfield in Sykesville.
Transitioning out
Once in a transitional unit patients can prepare for release by leaving the hospital for short, supervised day trips. They can get dinner with family, go to the movies with staff, and eventually stay overnight with family and leave the hospital for job interviews. These freedoms help individuals reintegrate into society after years of commitment.
If a person does well in this phase, a court hearing before an administrative judge is ordered.
During the hearing, a patient, their clinical team and their family can testify. So can crime victims. State prosecutors and defense attorneys can question witnesses.
An administrative judge then recommends whether to deny or accept the patient’s request and hospital’s opinion. The district or circuit court judge who originally issued the hospital commitment receives the report and makes a ruling, which can be appealed. Patients also have the right to an annual court hearing.
Still, it takes years to get out of Perkins. A violent outburst or relapse in symptoms can send a person back to maximum-security, the beginning of the rehabilitation system.
“There are so many factors that influence the length of time that a patient would be hospitalized,” Reid said. “We typically want them to understand their illness, understand their symptoms, understand how the crime occurred and how to prevent that from happening in the future.”
Even then, patients determined by both hospital staff and a judge to no longer be dangerous because of a mental disorder are typically closely supervised after release. People who leave hospital commitment are often placed on “conditional release” and supervised for a maximum of five years by employees of the state Community Forensic Aftercare Program. The court can renew the conditions after five years.
The conditions of their release can require a person to live in supervised housing, rather than return to a family home or their own home.
If a person’s mental illness worsens after release and they violate their conditions, they can voluntarily go to the hospital or be returned on a court-ordered hospital warrant. But the rate that people on conditional release commit another crime is low, said Fitch, the former state director of forensic services.
In a five-year period where the Office of Forensic Services collected data, the yearly re-arrest rate of people on conditional release averaged 2.5% compared to Maryland’s general population re-arrest rate at 5.5% from 2007 to 2011, according to the behavioral health administration.
“If you’re a lucky one, in a way, who’s found (not criminally responsible) then you land in a system that makes sure you get all the best supports,” Fitch said. “You stay a little longer, it’s a little stricter and more onerous … your freedoms are curtailed when you’re out, you’ve got to comply with all these conditions, but as a consequence you do pretty well.”
“I don’t think people understand that.”
