On appeal from the Superior Court, Law Division, Essex County (A-882-83T5; A-1648-83T5) and Bergen County (A-5165-82T5).
Matthews, J. H. Coleman and Gaulkin.
[196 NJSuper Page 37] These are appeals by three former defendants found not guilty by reason of insanity (NGI) of their respective crimes
and thereafter committed to institutions. Each defendant appeals from the determination of his latest Krol*fn1 hearing denying him transfer to a lesser restrictive environment than that which he presently enjoys.
On March 18, 1982, J.L.J. was found not guilty by reason of insanity of arson, murder and aggravated assault occurring on April 15, 1981. On March 18, 1982, the court ordered J.L.J. committed pursuant to State v. Krol, 68 N.J. 236 (1975), State v. Fields, 77 N.J. 282 (1978) and N.J.S.A. 2C:4-8.
J.L.J. was confined to the Forensic Unit (Vroom Building) of Trenton Psychiatric Hospital until August 12, 1982. He was then transferred to the Intensive Treatment Unit at the hospital, where he continued to be confined under a succeeding court order dated February 3, 1983.
On July 15, 1983, a hearing was held to review J.L.J.'s commitment to the Intensive Treatment Unit at the Trenton Psychiatric Hospital. The State presented Dr. Howard S. Blechman, the psychiatrist in charge of appellant's unit to testify as to J.L.J.'s condition. J.L.J. presented Dr. Seymour Kuvin, an independently retained psychiatrist, to testify on his behalf.
Dr. Blechman testified that he has been familiar with appellant since August 1982 and has talked with appellant many times. J.L.J. was diagnosed as showing no overt signs of psychosis, having a history of paranoid schizophrenia in fair remission, and having a history of alcohol and marijuana abuse. He was characterized as being a very low profile individual who rarely speaks. He is difficult to interview and only answers direct questions, with minimal response. When answers are given, they are often vague or inconsistent with previous information. Dr. Blechman also testified that appellant's insight is
fair at best, possibly impaired, and expresses a flatness of affect.
J.L.J. is receiving 50 milligrams of Prolixin Decanoate, a long acting anti-psychotic agent, often used for the treatment of schizophrenia, every two weeks. He also receives 100 milligrams of Tofranil, an anti-depressant, at bedtime and 2 milligrams twice a day of Cogentin, to ease the side effects of the Prolixin. If taken off of this program of medication, Dr. Blechman testified that the statistical chance of recurrence of acute schizophrenic breakdown would be quite high, within a few weeks or a few months.
In regards to theraputic programs, Dr. Blechman stated that J.L.J. is unmotivated and his responsiveness is minimal. He does not go to all available programs and must be prodded and reminded to attend those he does attend. His main problem was deemed not to be bad behavior, but rather that he is unmotivated to do positive things, he only goes through the motions.
Dr. Blechman was uncertain as to whether he would be a danger to society. However, Dr. Blechman would not recommend that J.L.J. be released from the facility into the community. J.L.J. now has level 3 privileges, and would normally be recommended to the less restrictive level 4 shortly.*fn2 The judge had ordered that J.L.J. be given no greater level of privileges unless he received a written report from the staff requesting such an increase and could review the same. The I.T.U. staff seemed reluctant to move formally in the face of a court order when the patient himself, who "never makes waves," doesn't ask for it. Dr. Blechman requested that the court allow the
I.T.U. staff to grant level 4 or 5 privileges when the staff felt it was warranted, or to transfer J.L.J. to the Tri-County Unit with a less intensive level of treatment.
Dr. Kuvin has known J.L.J. since 1981, prior to his criminal trial, and has met with him three times. He found no evidence of present schizophrenia; J.L.J.'s thought associations were intact, although his answers were terse. Although he wouldn't volunteer information or maintain a conversation, his replies were concrete. J.L.J.'s insight as to how he affected others appeared to be intact, but generally speaking, he was expressionless.
Dr. Kuvin agreed with counsel's characterization of J.L.J. as one who would do something if taken by the hand and told 'do this.' He did not believe J.L.J. to be a danger to himself or others, and stated that his present restrictions are a waste of time, money and effort. Dr. Kuvin recommended that he be discharged under close supervision or transferred to an open ward at the Tri-County Unit.
On the basis of the proofs and testimony before the court, the judge found by a preponderance of the evidence that there had been no material changes in J.L.J.'s mental condition, or the degree of potential dangerousness which would warrant a relaxing of the present restraints upon his liberty. The judge also ordered that the same level of privileges be continued and that no greater levels be allowed until written request by the hospital staff.
J.D.M. was found not guilty by reason of insanity of automobile theft on March 5, 1979 and ordered committed to Greystone Park Psychiatric Hospital. At periodic review hearings on June 20, 1979, October 24, 1979, and May 6, 1980 he was returned to Greystone.
A further Krol hearing was conducted on May 29, 1981, and by order of June 15, 1981 J.D.M. was placed in the least restrictive level of Program C at Greystone, pending approval
and acceptance in a transitional residence, to which he would be conditionally released.
As a result of a June 1982 hearing, J.D.M.'s commitment was ordered continued and he was to enjoy all privileges he had had prior to the hearing.
On October 7, 1982, on the advice of his treating physician, J.D.M. filed a notice of motion for an order granting off-grounds employment privileges. The motion was later withdrawn on the advice of the same physician.
J.D.M.'s most recent Krol hearing was held June 16, 1983. J.D.M.'s clinical psychiatrist, Dr. Paul Valvo, was the only witness to testify. Dr. Valvo has been his psychiatrist for four to five years, and has contact with J.D.M. on a daily basis.
Dr. Valvo testified that J.D.M. is a chronic schizophrenic in partial remission. He is nervous but friendly when interacting with other people. His ability to handle stress has improved to the point where he accepts any restrictions imposed on him and cooperates with his treatment team. Dr. Valvo noted that J.D.M. usually obeyed any rules or restrictions imposed, but at times did not have the clear judgment to understand that he should not leave the premises, even to go next door for a pizza. J.D.M.'s actions do not result from evil intentions, but because he does not know any better.
Dr. Valvo testified that J.D.M. does not present a danger either to himself or to others, and that he has not shown any aggressive or violent behavior. Presently, J.D.M. receives injections of Prolixin Decanoate, an anti-psychotic. Without the drug, Dr. Valvo testified, J.D.M.'s behavior would regress and he might "engage in something irresponsible like he did before," i.e., stealing a car.
J.D.M. is currently in a transitional unit at Greystone Park with off-grounds employment privileges, and periodically visits the Community Mental Health Center. His doctors had moved for an order allowing this in October 1982, but after an incident in ...