Vermont Legislature SmartTranscripts:

[Committee Assistant/IT Support (Unidentified)]: We are live. Hi. Good morning. It is February 24. It's a

[Sen. Nader Hashim (Chair)]: judiciary, and we are taking our best one ninety three. We have a new version. We'll be getting a walk through from Eric as well as a, there was a request for some, general walkthrough of what it means to have the state have the burden to prove something compared to the defendant. So, Eric, the floor is yours.

[Eric Fitzpatrick (Office of Legislative Counsel)]: Oh, thank you. Good morning, everybody. Eric, it's Patrick with the office of legislative council here, as the chair said, to walk the committee through a proposed new draft of the amendment the committee strike on s one ninety three, the forensic facility bill. Should just the committee recall when you looked at last looked at this last week, there was some proposed language provided by sort of the working group led by the Department of Mental Health and the state's attorneys. Remember, that was sort of the last version. So this amendment that you're looking at now incorporates some of those suggestions and I think tries to incorporate some of what the committee was talking about when it was reviewing those suggestions. But that's not to say that this is I may have got some of that a little bit wrong. So feel free to correct me as we go through. We meant this or that. And in fact, some of the highlighted language, as with the last time, it's sort of a placeholder in the sense of it's an issue that the committee is still thinking about. But I can point those out as we go along too. So with that background,

[Unidentified Committee Member/Staff]: a quick walk through.

[Eric Fitzpatrick (Office of Legislative Counsel)]: Again, the changes between this draft and the previous are highlighted in yellow. So you see right there on page one, remember, this is the competency piece of it. You can get into the forensic facility either by through the competency approach, which is someone's found incompetent to stand trial or not guilty by reason of insanity. But that's the NGRI is further along in the bill. The first one you come to is the competency piece. So you see so in this case, this is when a person gets transferred to the French facility after they've been charged with a life sentence offense and found it competent to stand trial. So those things are the same, one and four, and a slight amendment to subdivision three, their line 15. That's just a clarification suggested by and the others that person wouldn't end up in this facility if they're already hospitalized either through the civil or the criminal process. And that's the highlight of magnitude of line 15. That's just a cross reference to the criminal process. But then the one proposed new criteria is line 13, subdivision two. And that's something that the chair suggested. It's a possible approach to the issue. I know the committee has been discussing this and thinking about it, which is, what happens if a how does this interact with the hope without bail situation? And so this is a possible way to do that, which is to have this apply. And I say this, I mean someone being transferred to the forensic facility on the basis of competency. They have to have been held without bail

[Sen. Nader Hashim (Chair)]: as well. And just to add to that, Eric, the 7,553 statute applies to all life offenses, right?

[Eric Fitzpatrick (Office of Legislative Counsel)]: Right. Yep. Exactly.

[Sen. Nader Hashim (Chair)]: So, if somebody is charged with an offense punishable by life, they are likely to be held without bail already, right?

[Unidentified Committee Member/Staff]: Yeah, I

[Sen. Nader Hashim (Chair)]: think that's right. Yep. Yeah. Just wanna make sure that's clear. Yeah. Sure.

[Eric Fitzpatrick (Office of Legislative Counsel)]: So that's the only modification on that page. So it's been been a little reorganization. You start to see bottom of page one. Move on to page two. I broke that up to to be a little more readable. So the idea here is that sort of thinking about it in big picture for a second. Once a person is transferred to the facility, that's what this language deals with. But what happens then? Well, if you look at line 19, page one, they will be evaluated for competency either every six months or upon the determination of the clinical services director that they're likely competent to stand trial. So that's no change.

[Unidentified Committee Member/Staff]: But that's sort of that's the way it works.

[Eric Fitzpatrick (Office of Legislative Counsel)]: So you get committed. And then you're going to be reevaluated either every six months. Or if the clinical services director thinks that your competency is looking better, you can stand trial. That's the existing thing. So proposed new language over on page two starts sort

[Unidentified Committee Member/Staff]: of towards the middle.

[Eric Fitzpatrick (Office of Legislative Counsel)]: This is to address a suggestion that came in the previous draft from stakeholders, DMH, states attorneys, those folks. They wanted something person's competency could not be restored. So what would happen in that situation? And so they had provided a general reference that, well, if there's a finding the person's competency can't be restored, then the procedures from the insanity defense piece would apply. And that was the general statement. So what I've tried to do here is to be more specific about how that would work. So just in the big picture for a second, what this proposes is, remember I just said, so in your if you haven't been found unlikely to have your competency restored, we just went through, you get a reevaluation every six months or the clinical services director could do it sooner if they think that you're gonna be confident. So that's the way it works. Generally. Here, if they find that your your competency is unlikely to be restored, the big difference is then you only get the you can only petition. Right? If you're the person, you do the petition to get reevaluated every one every year. So it's a longer period of time if if you've been found the standard is if you've been found that your competency is not likely to be restored. You see that? So that's kind of the difference. If you got if you go that track, in other words, because you've been finding that your competency isn't likely to be restored, then you get the and that's over on page three, line 12 to 14.

[Unidentified Committee Member/Staff]: That's this.

[Eric Fitzpatrick (Office of Legislative Counsel)]: Yeah. And you'll see that language. It's familiar from the exam. PCR looked at that in that context. If the petition is denied under this subdivision, this this proceeding that applies to the person whose competency is unlikely to be restored, then you can't file again until a year later. So that's how the every year as opposed to every six months works.

[Sen. Nader Hashim (Chair)]: I'm curious about the potential for dual track here in the very rare circumstance that somebody's charged with a life defense charge, but they're not held without bail and they're not competent, would this still cause them to be committed? The way I read it is that it would. I'm just wondering if that's right.

[Eric Fitzpatrick (Office of Legislative Counsel)]: I think that the new language on line one I'm sorry, page one, line 13, that's the way I'm reading that is that's a criteria. So if they're not helping out the other than this forensic facility commitment piece wouldn't apply to them. That may or may not be what you want, but I think that would be the result.

[Sen. Nader Hashim (Chair)]: Yeah. I'm just trying to think of the okay. Alright. Well, hold on one second. So Okay. And keep going. Your your call. Can you record it so that we can make sure that it's I'm doing that now. You are?

[Eric Fitzpatrick (Office of Legislative Counsel)]: Okay. Recording

[Unidentified Committee Member/Staff]: in prom

[Sen. Nader Hashim (Chair)]: Alright. Great. Confirm. Yeah. Okay. So now we're recording, and we can post it later. I know what I was saying, but we'll figure it out then.

[Eric Fitzpatrick (Office of Legislative Counsel)]: Right. Yeah. I mean, it's a good point. I don't know. It's a practical matter how often that would happen, whether somebody would get

[Unidentified Committee Member/Staff]: they wouldn't be held without bail in that situation.

[Sen. Nader Hashim (Chair)]: But there's still the criteria for dangerousness under if you're going to be holding somebody to restore their competency. It can't just be to restore competency. There also has to be the element of dangerousness,

[Eric Fitzpatrick (Office of Legislative Counsel)]: right? Yeah. Heard the forensic authority even applied.

[Sen. Nader Hashim (Chair)]: Yeah. Yeah. And so if so that wouldn't apply if you're not being held without bail because there wouldn't be that same element of dangerousness. If it wasn't found in the old left bail hearing aid, I don't see how it could be found. Competency restoration. That's an yeah.

[Eric Fitzpatrick (Office of Legislative Counsel)]: The the competency restoration although, now that I think of it, the the the dangerousness, that piece is only applicable in the not inclusive of every reason and sanity context. So for competency, it's actually just the question is whether the person has regained competency or not. So they stay at the facility until they restore the competency, they get service, or until there's a final disposition of the charges. They receive services similarly until they're discharged. Until the restorative competency of this final disposition. So in this context, the competency context, there isn't that requirement of that you have in the sanity context of suffering from

[Sen. Nader Hashim (Chair)]: a condition that would create

[Eric Fitzpatrick (Office of Legislative Counsel)]: a substantial risk of bodily injury to another person.

[Sen. Nader Hashim (Chair)]: I think we may need to create some language so that we're not creating this other pathway that doesn't make any sense in the off chance it actually gets to a court. Specifically, the pathway in which somebody is not held without bail, but they're also found not competent to stand trial. And they pose a substantial risk of injury

[Eric Fitzpatrick (Office of Legislative Counsel)]: to the

[Sen. Nader Hashim (Chair)]: public based on whatever the mental illness may be.

[Eric Fitzpatrick (Office of Legislative Counsel)]: Right. It could be that you could if anything, the the how the new criteria on page one line 13, the hold without bail, interacts with this. That might be something you'd wanna hear from from the prosecution defense witnesses as well. But aside from that point, if I'm understanding correct, you could do you know, could be has

[Unidentified Committee Member/Staff]: been held without bail, or if they're not held without bail, they pose the

[Unidentified Committee Member]: you know, they have

[Eric Fitzpatrick (Office of Legislative Counsel)]: a qualifying condition They pose what you just said. That language you kind of cross referenced the standard language about having a qualifying condition that could result in or does result in substantial risk of bodily injury to somebody. So that way, if for some reason, they were there was a decision not to hold the person without bail, there would still be an avenue

[Unidentified Committee Member/Staff]: for that person to go to the

[Eric Fitzpatrick (Office of Legislative Counsel)]: facility. So I'll note that. So we just went through this other track, the track of what happens when because on page two, lines 12 to 14, this is a request that was made last time, as I mentioned, by and others that they want to set up a situation where there could be an opinion on whether a person's competency would likely be restored. So this is new in that sense. And so this does create such an option. And then as I mentioned that if the court

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: finds that the person

[Eric Fitzpatrick (Office of Legislative Counsel)]: is likely to competent to stand trial, well, then they, of course,

[Unidentified Committee Member/Staff]: they notify the state's attorney so

[Eric Fitzpatrick (Office of Legislative Counsel)]: the proceeds can can continue. But on line 16, if they do find by clearing convincing evidence that the person cannot be restored to competency, then they stay in this other track, which means you can only ask for a reevaluation every year instead of every six months.

[Unidentified Committee Member]: So the standard there, clear and convincing. Mhmm. I'm assuming that would essentially be critical important to the examiner and say, do you you find your opinion? Because court would be relying entirely on the evaluations. Right? So whether the clear and convincing standard has been met would really come from testimony from the medical health profession.

[Unidentified Committee Member/Staff]: I think that you're right that it would be based on that testimony, but the clear and convincing is a legal statement. It would be up to the court and say, based on the evidence that I've seen from the evaluation.

[Unidentified Committee Member]: I'm just thinking it's such a, seemingly, such a subjective thing and a thing where you're talking about a highly fluid situation. So it seems like the court would be put in maybe multiple opinions too, right? They could. Yeah, certainly possible. I mean, it makes sense. I'm just wondering to practice how you'd hit that higher standard, but it would just be the testimony from the evaluators had to flag that. Correct. Exactly. Right. Mhmm. Yep.

[Unidentified Committee Member/Staff]: So that's how that competency restoration would work. The next sort of change, which you see in multiple places, starts on page three, line 16 to 17. This is some language that was also requested by the group of folks that have been helping out with this. And that is that prior to use, you remember the committee wanted to go in the direction of the person who would stay at the facility and continue to have services until either they've been restored to competency or charges have been dismissed. So this is just more of a potential challenge to say, rather than charges have been dismissed, there's been a final disposition of the case. But you see that's case. Whatever way that court case might finally be disposed, they would continue to get services and be treated out of facility until one of those two things happen. Over on page four, lines, over on page five, or basically line 12, page four of line five, this is the involuntary medication piece. What this does is essentially describe when voluntary medication could be approved by the court. And you see there's four criteria, 1.4 over 50, those are all criteria taken from the United States Supreme Court, sell it, if it's The United States. That's where that standard comes from, constitutional standard, as to what findings the COVID have to make in order to order a voluntary application. That takes us over to page five. This is the issue, excuse me, you see line two, sorry, section two. This has to do with the dismissal when a person has been found incompetent for the case has remained inactive for a certain period of time. Remember, only issue outstanding there is should that case be dismissed with or without prejudice. That's lines 89. So I just highlighted that just to sort of flag it for the committee that that's something that somebody was still talking about. Another technical change, bottom of page five, which you've seen before, so we're on page six. This is, well,

[Unidentified Committee Member]: this

[Unidentified Committee Member/Staff]: is the issue, again, highlighted just because it's still outstanding. You'll see on page six, nine, 13 to 14, what's going on here is that the and this were in the not guilty by reason of insanity track. So a person who's been found not guilty by reason of insanity, and the the offense involves a potential life sentence. The person goes to the forensic facility for forty days, and within that forty days, there has to be a hearing with the court, orders the person committed, this is line 13, unless the person establishes by clear and convincing evidence. Now remember, this is highlighted because this is the issue that's essentially still outstanding for the Committee one hundred one, which is really two parts to that question. Do you shift the burden to the person to prove it? Question one. Question two is, well, if so, what should the standard be? Preponderance or clear interventions? So that sort of nutshells where the committee was last time about what is the policy decision you wanna make in that situation. Is it the director, the preponderance of the evidence is the standard use in most civil cases. Generally means, quoting, while not sufficient to free the mind wholly from all reasonable doubt, it's still worth convincing than the opposing evidence and is sufficient to incline a fair impartial line to one side of the issue So rather than the 50 one-forty nine, it's sometimes said. A balance of the scales in favor of one side as opposed to the other. Queer and convincing evidence means evidence indicating that the thing to be proved is highly probable or reasonably certain. I

[Unidentified Committee Member]: think I asked the version of this before, but I'll ask it again. So if we shift the burden to the person, ninety nine out of a hundred cases, that's their lawyer. So how would they prove a negative? In other words, how they prove that they're no longer suffering and that they withdraw to create a substantial risk

[Unidentified Committee Member/Staff]: to a clear and convincing statute? I think kind of similar to what you were mentioning before, you're gonna want medical testimony about their medical condition.

[Unidentified Committee Member]: And those would have to be very forceful statements that the person was not at risk in order to get to clear and convincing.

[Unidentified Committee Member/Staff]: Somewhere between beyond a reasonable doubt and preponderance. Exactly. So yes, more convincing than preponderance, not as convincing as beyond a reasonable doubt. Okay. Because without

[Unidentified Committee Member]: putting too far a point on it, it seems like we're describing a situation that would almost never happen, where we shift the burden to the person who has mental, you know, qualifying conditions, and then they need to prove or their employer needs to prove to a clear and convincing standard that they don't have those conditions and they're not a risk. And, you know, the fact that it's unlikely doesn't mean we shouldn't include it, but I just have a hard time seeing how in practice that's ever gonna pan out. But anyway, it doesn't mean they'll give them, it's just.

[Unidentified Committee Member/Staff]: You might be getting some witness testimony might shed some light on that better than I could. Great. Eric,

[Sen. Nader Hashim (Chair)]: on the civil commitment that we have now, it's the stake that has the burden? Correct.

[Unidentified Committee Member/Staff]: Yeah, and cramping as it goes. So, also for a moment, you'll see right in that same subdivision that the mental disease or defect language has been proposed with the change into qualifying condition. Remember, that's also a request from the Department of Mental Health so that it's not just a mental disease or defect. So I, just so we can take a quick turn to see what that means, I was defined on page 10. If you look at page 10, lines nine to 13, the proposed language for qualifying condition, I restructured a little bit so that there's a strong, there's a clear connection between the condition and the finding of incompetency for an ocular disease of insanity. So it does expand the conditions for which a person could be at the facility, but you see if you look at the way the language is phrased, any condition whether mental, congenital, traumatic, however required to be both, or any other circumstance that resulted in the person being determined incompetent to stand trial or not guilty by reason of insanity. So it's not just sort of some condition standing on it. So it has to have been the reason for finding of incompetency or not guilty by reason of insanity. And remember the other requirement for a person being committed to the forensic facility, even if that piece is established, it's a qualified citizen that resulted in competency of NGRI, still has to be finding that the person's release will create a substantial risk of bottoming if they're to another person. So, it could be a person who's incompetent, but if they're not at risk of dangers to somebody else, then they still wouldn't qualify for the substance. That makes sense? That's how that works? All right. So let's turn back. So now we're just about done, actually. So go back to page six. And really, we're gonna see some of the same changes repeated multiple times. Let me just say, if anything goes, the change I just described, expanding dental disease with defects of disqualifying condition. And as well, just highlighting the issue per decision, see it again on page six, over again on page seven, it's the clear and convincing evidence. Blue bears and burgees. Just highlighting that it's here in the lots. So whenever it is, the committee briefs are completed on that, we'll make that adjustment. Page seven, more technical stuff for the changes here, just clarifying that it's the state's attorney, not the commissioner of corrections who files a petition with the court. If there's a finding that the person no longer has the qualifying condition, then it creates a risk of bodily injury. Commissioner, corrections, on page eight, provides all reports to the S. A, and they're the one who filed them with the court. Really, I'll wrap to that page, and over onto page nine, it just continues We have those of the same change language. New piece, page nine, line 17 to 19 having to do with the victim's ability to express views. Remember, this was also a proposal that you looked at last time from the group that's working on this. So in a hearing on this section, 50 may express their views concerning the offense, their their preferences for the purpose of persons placed them in care, and court may consider the testimonies. Over on page 10, we already went through this. That's the definition of qualifying condition. And a couple of, last two pieces are on page 11, subsection C, lines eight to 11. You see this is adding, and this is, I think the committee had concluded that the person should have legal representation. Person in this situation should have an attorney. So the language here said that they're entitled to have counsel appointed from Vermont Legal Aid. Again, committee can decide where that person should come from, but for purposes of this, it says Vermont Legal Aid. And and BLA is the organization that provides representation now for persons in the civil commitment context after after they admit you'll hear your kind of finding the competency is my good stuff. It's insane when the question comes up, whether the person's dangerous and should be committed, legal aid does. So it's you for the contact Happy New Year. On

[Unidentified Committee Member]: page 11, Eric? Yep. Lines 12 through 13, there's a shall, so the Commissioner of Corrections shall consult the Commissioner of Mental Health when performing the duty required by Ms. Chittenden from operating the facility. That seems to me like an ongoing, you know, if you have the same Commissioner for two years and they're operating the facility, what is the mandatory consultation? Is it Because it's not required by the chapter for this case. It's while they're operating the facility. So it

[Unidentified Committee Member/Staff]: Yeah, it really, this was, and it got really into some placeholder language flag the that the committee was talking about is, should this be, you know, DOC or DMH kind of thing?

[Unidentified Committee Member]: But should we say shall consult regularly, or? Yeah, sure. So yeah, that's a good And then they can determine when, what regular this is?

[Unidentified Committee Member/Staff]: Yeah, leave it up to them.

[Unidentified Committee Member]: Because, by way, you could imagine them sending an email the first day and then never talking to anybody. We did our consultations. Right. Or yeah. I I don't think would be a bad idea to bring bring it on some

[Unidentified Committee Member/Staff]: Yeah. Yep.

[Unidentified Committee Member]: We got to switch gears here in a minute or stop at Sandy Raven who He wants to testify. Was your question answered about the burden shifting? Well, don't think we should follow the following the decision on that.

[Sen. Nader Hashim (Chair)]: No. I thought you had what what it means to have the state Oh, yeah. Yeah.

[Unidentified Committee Member]: I'm sure that they were testifying on if one day out here is concerned about defense and more probability what it would be asked for the company's opinion. But then, I want to say, person up to person, I don't really interpret that as meaning, the individual. I mean, it's the defense who asked for the competency, hearing, evaluation, or arrest, the individual will be standing there with his or her attorney. Right. So I don't really look at it as replacing them individually. Right, I

[Unidentified Committee Member/Staff]: think the person is, they're entitled to have counsel appointed, generally speaking, it's gonna be a judge.

[Unidentified Committee Member]: Okay.

[Unidentified Committee Member/Staff]: Thank you, Eric. Yeah. Sorry.

[Sen. Nader Hashim (Chair)]: Are you gonna be sticking around, do you

[Unidentified Committee Member]: have to

[Unidentified Committee Member/Staff]: take up your No. Can't remember. Is it are

[Sen. Nader Hashim (Chair)]: you switching gears to the We're still on 193

[Unidentified Committee Member]: with the doctor here in a minute. Oh, that's right, Glenn. Yeah.

[Unidentified Committee Member/Staff]: Look. There she is.

[Unidentified Committee Member]: Alright. Good morning. Hi, good morning.

[Sen. Nader Hashim (Chair)]: Hear us?

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: Yes, I can hear you.

[Unidentified Committee Member/Staff]: Hi,

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: good morning. Yes, I

[Sen. Nader Hashim (Chair)]: I can hear you.

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: Can you hear Can you

[Unidentified Committee Member/Staff]: are you able to hear me? IT.

[Sen. Nader Hashim (Chair)]: Yeah. They were just in here. I can see that we are getting the audio through her. It's on her end.

[Unidentified Committee Member]: It's clearly on our Oh, really? Let me get them back. One minute. Let me just find out when this is all done. Think they're absolutely are we on? No. We're still we're still live trying to figure out.

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: I'm able to hear you. Are you not hearing me?

[Unidentified Committee Member]: Okay,

[Unidentified Committee Member/Staff]: so she can hear us, but we can't hear her.

[Unidentified Committee Member]: I could try resetting that camera as soon as it'll work.

[Unidentified Committee Member/Staff]: Okay. So since you can

[Sen. Nader Hashim (Chair)]: hear us, our committee assistant's gonna reset the camera to see if

[Unidentified Committee Member]: that fixes things and maybe we'll.

[Committee Assistant/IT Support (Unidentified)]: Speaking now.

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: K. Hi. Can you hear me now?

[Sen. Nader Hashim (Chair)]: Yes. No. We can't hear you. You can hear us?

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: Yes. I can.

[Eric Fitzpatrick (Office of Legislative Counsel)]: Fantastic. Oh, nice job, Henry.

[Sen. Nader Hashim (Chair)]: Great. Thank you, Edward. Thank you.

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: I don't see you anymore, though. It just says Room 1.

[Sen. Nader Hashim (Chair)]: Okay. I think it's restarting. Oh, there

[Sen. Nader Hashim (Chair)]: we are.

[Unidentified Committee Member]: Great. Okay.

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: Excellent. I've got any

[Sen. Nader Hashim (Chair)]: idea what's that when it comes.

[Sen. Nader Hashim (Chair)]: Okay. Alright. Thank you. Sorry about

[Unidentified Committee Member/Staff]: the technical issues that have happened for a little bit here.

[Sen. Nader Hashim (Chair)]: So thanks for coming in. We're talking about S-one Hundred 93 and you requested to pass goodbye and you could please introduce yourself and then the floor is yours.

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: Thank you so much. My name is Doctor. Simkaravan.

[Unidentified Committee Member/Staff]: Oh, okay. Lost.

[Unidentified Committee Member]: That's why it's wrong.

[Sen. Nader Hashim (Chair)]: This is broken. We have to go back to the TV.

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: Okay, I will wait then. Let me know when I should go ahead. One second, try again. Okay, very good. Well, good morning. My name I'll

[Unidentified Committee Member]: just restart it and we'll deal with whatever camera angles. Yeah, we can just keep it. I'm switching. Yeah.

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: Can you hear me now? Is this all right? Oh, very good. Okay. Good morning. My name is Doctor. Sinha Ravin. Thank you so much for having me here to talk about S-one 193. I'll tell you a little bit about myself and then my thoughts on the proposed legislation, and then I'm happy to engage in conversation and answer any questions that might support your work.

[Sen. Nader Hashim (Chair)]: Second. We lost you again.

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: Can you hear me now?

[Eric Fitzpatrick (Office of Legislative Counsel)]: Yes. Yes.

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: Okay, very good. Let me know if I should repeat myself or if you lose some audio. So again, I'm Doctor. Simkharavan. Thank you so much for having me here to talk about S-one 193. I'll share some of my thoughts on the proposed legislation and tell you a little bit about myself and my background and then engage in any conversation or questions that would help support your work. So I am an adult and forensic psychiatrist. I specialize in the intersection of mental health and law, and particularly on the care of individuals who experience serious mental illness and have criminal justice involvement. I'm chief medical officer at Howard Center for the last five years and serve on faculty at Yale University School of Medicine in the Division of Law and Psychiatry. I very much appreciate the work you are doing and want to thank you for taking up forensic mental health infrastructure and specifically competency restoration. I'll share some thoughts and my reading of the literature on competency restoration. So, I wanted to comment on competency restoration for individuals accused of serious crimes such as S-one 193 proposes to establish, and competency restoration for individuals who have been charged with offenses punishable by a life sentence. Research suggests that efforts to restore competence to stand trial are generally successful. A meta analytic review of 68 studies spanning from 1968 to 2008 indicated that approximately eighty one percent of individuals were restored competence successfully. And in that study, usually this was done within ninety to one hundred and twenty days. The success rate of competence restoration varied by context of restoration with those undergoing restoration in hospital settings more likely to be restored than those in community settings. And there were a number of reasons for that. People in community settings were actually more likely to be successfully transferred to diversion programs and thus not restored. And many people in community settings also face barriers to restoration, barriers associated with poverty, such as housing insecurity, transportation barriers, and so forth, which made it make it difficult to participate in community based restoration programs. On another topic that's addressed in S-one 193, the topic of those found not guilty by reason of insanity, who I understand are referred to as equities in the language of S-one 193. Monitoring of equities by the Commissioner of Corrections for non adherence to conditions of release would address some of the gaps and concerns that are experienced with the, that many of us experience with the current ONH or order of non hospitalization system. And that it is very difficult to effectively oversee individuals within the current ONH mechanism if they do not choose to engage in treatment. And the proposed mechanism for this limited group of individuals who are eligible punishment of life sentence, this would address that concern, that it's very hard to effectively treat individuals on orders of non hospitalization when they do not wish to or are not able to engage. So the proposed change in oversight may successfully address places where there are current gaps in our current structure. I had a few other comments for consideration. One is the area of individuals who are not competent and deemed to be not restorable. And research in this area notes the importance of addressing at the outset those individuals who are determined to be not competent and not able to be restored, and considering a disposition for these individuals with a designated process and resources specifically for risk assessment. It's also important to consider special considerations for individuals with intellectual disabilities and competence restoration, as well as cognitive disorders such as dementias and the competence restoration process. So not everyone found competent to stand trial has mental health needs. People with organic brain disorders, intellectual and developmental disabilities can frequently be found not competent to stand trial and can be successfully supported through competency restoration. And my last comment is on page seven, lines 16 through 19 of S-one 193, it's noted that all forensic facility records would be unavailable for public inspection. It's important for clinical treatment teams both in hospitals and in community settings to review medical records to effectively treat an individual and to assess risk. And records that clinical treatment teams need to care for people include those records that are produced at a forensic facility, those treatment records, and also psychiatric evaluations, including competency evaluations and criminal responsibility or insanity evaluations.

[Sen. Nader Hashim (Chair)]: Okay, I just wanted to mention, we might be looking at different versions of the bill.

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: Oh, okay.

[Sen. Nader Hashim (Chair)]: The new version, I believe it was just last night, that is should be posted on our page this morning. But, actually, would you mind just emailing

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: I have not I have not seen that. So this must be from a prior version.

[Sen. Nader Hashim (Chair)]: Right now, and you should get that any moment.

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: Thank you.

[Sen. Nader Hashim (Chair)]: And at the top, it should say draft 2.1 February 22 one 01:01PM.

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: Thank you.

[Eric Fitzpatrick (Office of Legislative Counsel)]: With this draft, the confidentiality piece that doctor is referring to is on page 11, line six lines four and seven. Thank you. Yeah.

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: So those are, you know, if I can help assist in in your work further. Thank you.

[Sen. Nader Hashim (Chair)]: Thank you. I think regarding what is on for our copy, page 11, lines four through seven, can you just provide us with what you think the best way is to phrase that language, please?

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: Sure. I'm going to read what I have. And if the language is the same, I have page seven sixteen through 19. So that's item B. Any record related to a person placed at the forensic facility shall be exempt from public inspection and copying under the Public Records Act and shall be kept confidential, except that records shall be made available to the parties in the underlying criminal case upon request. My thought would be to add, in addition to the parties in the underlying criminal case upon request, clinical treaters or clinical team members in I think it's fine to be broad, but both individuals, clinicians in inpatient or hospital settings and in community settings would need to review both the records produced at the forensic facility and court evaluations, competency restoration reports, or criminal responsibility reports to effectively do their work. I'm happy to give a little more thought to precise language on that, but I didn't prepare it in advance.

[Sen. Nader Hashim (Chair)]: Great. Thank you. We have our legislative counsel here, Garrett Fitzpatrick, who, if you do have additional language, you're welcome to correspond with him and our committee can discuss it. But committee, any initial thoughts on that? I'm not opposed to changing it to match what the doctor is referring to. Okay. So if if you want to, just coordinate with Eric Fitzpatrick and, you know, what you think best language might be, and then ledge counsel can review it and then bring it back to us in the near future. Bradley. Any other questions or comments with doctor? No.

[Eric Fitzpatrick (Office of Legislative Counsel)]: Okay. I

[Sen. Nader Hashim (Chair)]: think one one question I do have, I'm not sure the best way to articulate it, but it kinda goes to what may or may not happen at one of these hearings. And this also may somewhat fall into the health and welfare jurisdiction. But trying to prove that somebody is no longer a substantial risk injury to the public. And can you provide a bit more information and context as to how something like that would be proven after somebody is going through a competency restoration process?

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: If you could share more about when in my experience, a forensic psychiatrist or a team of forensic mental health professionals will undertake to do a formal risk assessment. I don't know if that would really prove that an individual is no longer a risk, but what we typically do is look historically, examine medical records, talk to collateral, look at legal records, and look at what factors support that individual and diminish their risk of violence in the community and what factors might exacerbate it and both look at and both make recommendations about what their risk is and then what measures can be put into place? It sounds like you're asking about transition from a controlled setting to a community setting, if I'm right. And then what can be put into place in the community to support that individual to support safety? And usually supporting safety most often are also the same supports that help that individual do well in the community and fulfill their own goals. So typically, a risk assessment does not say absolutely that someone is or is not a risk in the community, but talks about what kind of risk they may pose and how to diminish that, mitigate risk, support the individual, and what kind of factors might increase their risk of violence or risk to themselves in the community.

[Eric Fitzpatrick (Office of Legislative Counsel)]: Thank you.

[Sen. Nader Hashim (Chair)]: Any other questions? Okay, doctor. Thank you very much for your time. And sorry again about the technical issues there at the beginning. But when you get copy 2.1 and you have the time to look it over, we're also welcome to receive any comments you might have. If you want to send them to the committee assistant and the committee, we'll review them and take it from there.

[Dr. Simha Ravven (Howard Center CMO; Yale Law & Psychiatry)]: Great. Thank you so much.

[Sen. Nader Hashim (Chair)]: Eric, the remaining decision points were evidence threshold, who has the burden, with or without prejudice. And am I missing anything else?

[Eric Fitzpatrick (Office of Legislative Counsel)]: I think those are the main ones that I have. Oh, guess the sort of did you want to have any sort of the consultation or what sort of interaction, if any, between Department of Corrections and Department of Mental Health or put it all under agency of human services? Was there any kind interaction or consultation. That's what the sort of placeholder language is that I put in on page 11. But maybe that's would be okay with the center group was saying. Maybe clarify that that's regular consultation. Maybe that maybe that would cover it. But that's the only other one that I was thinking that may or may not be outstanding for the case.

[Sen. Nader Hashim (Chair)]: Yeah. I mean, DOC is under AHS, so it would be really.

[Eric Fitzpatrick (Office of Legislative Counsel)]: I think it's as you said, it's the who do you want to bear the burden? What do you want the standard of proof to be? And you want the dismissal to be with or without prejudice. Those are the three that kind of jump out to me

[Sen. Nader Hashim (Chair)]: as points of of discussion. Maybe I'm missing something. No. I think I think that goes goes away. Alright. Committee, we we got a couple of minutes, and then we can take a five minute break before eleven. Do we wanna touch on any of these topics or save it for a later

[Unidentified Committee Member]: Okay. That'd great. And then

[Sen. Nader Hashim (Chair)]: So we'll have 10AM, and we'll make decisions on those decision points that day. Yep. And that's after we hear from Jack. Any other witnesses that we may want to hear from ninety three on Thursday morning after Eric?

[Eric Fitzpatrick (Office of Legislative Counsel)]: Do you want me to kinda clean up? So we're looking at this draft with still a fair amount of yellow, which we could keep, but I'm just thinking that I could clean up a bunch of this yellow, leave in place the highlighting of burden approved, standard of review, which may or shall, since those are the kind of remaining decision points.

[Sen. Nader Hashim (Chair)]: I think that that would be helpful.

[Eric Fitzpatrick (Office of Legislative Counsel)]: Right. Okay. Take a couple of pages out.

[Sen. Nader Hashim (Chair)]: Okay. Thank you, Eric. Yep.

[Unidentified Committee Member/Staff]: You bet.

[Eric Fitzpatrick (Office of Legislative Counsel)]: I can hear you.

[Sen. Nader Hashim (Chair)]: Sure. We can go off. We'll take a break for five minutes and come back at