IN THE UNITED STATES COURT OF APPEALS
FOR THE FIFTH CIRCUIT
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NO. 93-1106
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UNITED STATES OF AMERICA,
Plaintiff-Appellee,
versus
ROBERT ALLEN JACKSON,
Defendant-Appellant.
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Appeal from the United States District Court
for the Northern District of Texas
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(April 19, 1994)
Before HENDERSON,* SMITH, AND EMILIO M. GARZA, Circuit Judges.
HENDERSON, Circuit Judge:
_______________________________________
* Circuit Judge of the Eleventh Circuit, sitting by designation.
Robert Allen Jackson appeals from an order of the United
States District Court for the Northern District of Texas denying
his request for conditional release from his commitment pursuant to
the provisions of 18 U.S.C. § 4243(a) to a "suitable facility," and
directing that he be entrusted to the custody of the Attorney
General under 18 U.S.C. § 4243(e).1 We affirm.
I. BACKGROUND
After robbing a bank teller at gunpoint, Jackson was charged
with violating 18 U.S.C. § 2113 (a) and (d) (bank robbery), 18
U.S.C. § 924(c)(1) (using or carrying a firearm during and in
relation to a crime of violence) and 18 U.S.C. § 922(g)(1)
(possession of a firearm by a convicted felon). He was
subsequently diagnosed as suffering from paranoid schizophrenia and
was acquitted of the charges by reason of insanity. In compliance
with 18 U.S.C. § 4243(a),2 the district court then ordered that he
be hospitalized for a determination of whether his release would
create a substantial risk of bodily injury to the person or
property of another due to his mental condition.
This assessment took place at the United States Medical Center
for Federal Prisoners in Springfield, Missouri ("Medical Center").
1
The district court's order is a final appealable order within
the meaning of 28 U.S.C. § 1291. See United States v. Clark, 893
F.2d 1277, 1280 n.3 (11th Cir.), cert. denied, 494 U.S. 1090, 110
S.Ct. 1833, 108 L.Ed.2d 962 (1990).
2
Section 4243(a) directs that "[i]f a person is found not
guilty only by reason of insanity at the time of the offense
charged, he shall be committed to a suitable facility until such
time as he is eligible for release pursuant to subsection (e)." 18
U.S.C. § 4243(a). Subsection (e) requires commitment to the
custody of the Attorney General if, after a hearing, the court
fails to find that his "release would not create a substantial risk
of bodily injury to another person or serious damage of property of
another due to a present mental disease or defect." 18 U.S.C.
§ 4243(e).
2
According to a report prepared for the court by a review panel
consisting of staff psychologists David L. Reuterfors, David F.
Mrad and Christina A. Pietz, Jackson began hearing the voice of
someone he referred to as "Buddy" during a 1989 state incarceration
in Texas for a convenience store robbery. He became suspicious of
others, whom he perceived were trying to threaten or poison him,
and was prone to outbursts of intense anger, which sometimes
resulted in physical altercations. After his release, he continued
to suffer from auditory hallucinations. He claimed that "Buddy"
commanded him to purchase the gun he used in the bank robbery and
to rob the bank.
Jackson has been hospitalized three times for mental health
evaluations. His initial examination at the Medical Center
occurred between December 12, 1991 and January 24, 1992 to
determine his competency to stand trial. During this period, the
staff observed him actively responding to auditory hallucinations
on numerous occasions. When confronted about his behavior, he
became increasingly hostile and at one point, broke out a window
pane in his cell. He was placed in locked status after throwing an
inmate, who had resisted his sexual advances, against a wall. He
indicated to the staff that the voice directed his actions. This
behavior led to a diagnosis of chronic schizophrenia, paranoid
type. The Medical Center staff concluded at that time that Jackson
was unable to understand the nature of the charges against him or
to assist properly in his own defense.
3
He was readmitted to the Medical Center on April 9, 1992, in
an effort to determine if his competency had been restored and was
again placed in locked status for observation. His auditory
hallucinations were reduced and eventually eliminated after he
began taking Mellaril, a psychotropic medication. He was
cooperative with the staff and moved to a less restrictive
environment. By the end of this period of hospitalization on July
15, 1992, he had stopped exhibiting a thought disorder and his
schizophrenia was considered to be in remission. It was after this
admission for observation that he was found not guilty by reason of
insanity on August 6, 1992, of the criminal charges alleged in the
indictment. He was then returned to the Medical Center for another
examination.
This third admission, during which time Jackson continued to
take Mellaril, was for the purpose of assessing his dangerousness
as mandated by § 4243. The review panel reported to the court that
it was "highly likely" that Jackson's violent behavior stemmed from
paranoid delusions. (R1-111). It also opined that he presented a
risk of danger to others due to his mental illness, which could be
viewed as "substantial" if he were not properly monitored upon
release to outpatient psychiatric treatment. (Id. at 113).
Nevertheless, the panel recommended that he be released from
confinement, conditioned upon such outpatient treatment, because
"when medicated, his condition improves such that he can function
appropriately without incident." (Id.). The panel also observed,
however, that:
4
Jackson was unable to understand the
relationship of the lessening of his psychotic
symptoms to his taking medication. Mr.
Jackson never provided an adequate response to
what actions he would take if his psychotic
symptoms reappeared. Again, this suggested
Mr. Jackson was not quite willing to accept he
indeed had a mental illness.
During questions designed to understand his
history of potentially dangerous behavior, Mr.
Jackson candidly explained incidents where he
acted violently. However, Mr. Jackson was not
quite willing to admit that his behavior was
connected to his mental illness. He was
willing, however, to admit that he had
experienced some difficulties with "Buddy,"
and he referenced the recent bank robbery.
In summary, Mr. Jackson presented himself as
an individual who demonstrated limited insight
into his mental illness and was not willing to
admit a need for continued psychiatric care
which would include psychotropic medication.
(Id. at 112). The panel stressed that, if he were released, it
would be necessary to continually monitor Jackson's compliance with
recommended treatment because those who suffer from schizophrenia
sometimes discontinue their medication due to its episodic nature.
(Id. at 113).
After the foregoing report was prepared, Jackson was accused
of another attempt to sexually assault a fellow inmate. The
government then moved for a supplemental psychiatric examination.
Jackson opposed the motion, stating that the Medical Center staff
was aware of the allegations, but continued to recommend that he be
released with proper supervision. The court denied the
government's request and scheduled a hearing as required by 18
U.S.C. § 4243(c).
5
At the hearing, Dr. Pietz testified on Jackson's behalf. She
explained that schizophrenia is a lifelong illness, which can be
controlled only with the proper dosage of psychotropic medication.
She added though that, even after a patient has been stabilized,
the medication can become ineffective - that it can work on one day
and not another. She acknowledged that Jackson's violent episodes
were triggered at times by paranoid delusions and that he continued
to be dangerous, as evidenced by the alleged post-evaluation attack
on the other inmate. In her opinion, however, Jackson's ongoing
dangerousness was not due to his mental illness, which was in
remission, but was the result of an untreatable antisocial
personality. She indicated that, although another dangerousness
evaluation was not conducted after this last violent episode, she
and the Medical Center staff continued to follow Jackson's
condition and maintained their belief that his schizophrenia was in
remission. Dr. Pietz also testified that Jackson had a good
history with respect to taking psychotropic medication, but she
indicated that his medical record revealed he had refused at some
point to take Motrin, a medication which had been prescribed to him
for pain.
After considering the foregoing information, the district
court determined that Jackson failed to prove by clear and
convincing evidence that he was eligible for release. In reaching
this conclusion, the court took into account the fact that he had
not been reevaluated for dangerousness after the second alleged
sexual assault. The court noted that the diagnosis of
6
schizophrenia was based in part on a similar violent episode and
found, contrary to Dr. Pietz's opinion, that this behavior could
indicate an erroneous evaluation of remission or a reemergence of
mental illness. The court also observed that the panel's statement
that Jackson could function without incident when medicated no
longer held true. Without another evaluation, the court was
unwilling to release Jackson as being no longer a danger to the
community due to a mental illness. In addition, the court found
that even if Jackson's illness were in remission, he failed to show
by clear and convincing evidence that such remission would be
maintained through compliance with his medication regimen. Having
found that Jackson failed to carry his burden of proof, the court
ordered that he be committed to the custody of the Attorney General
pursuant to 18 U.S.C. § 4243(e).
II. DISCUSSION
We are first confronted with the appropriate standard of
review to apply to the district court's order. The government
maintains that this appeal turns on factual findings which must be
affirmed unless clearly erroneous. Jackson argued in his brief
that we are faced with a mixed question of law and fact subject to
de novo review. At oral argument, however, he retreated from this
position and stated that he agreed with the government. Only one
other circuit has definitively answered this question before us.
See United States v. Steil, 916 F.2d 485, 487-88 (8th Cir. 1990)
(holding that the clearly erroneous standard applies to review a
district court's determination of dangerousness under § 4243). We
7
now join the Eighth Circuit Court of Appeals and hold that the
district court's conclusion that Jackson failed to prove he was
entitled to release is a finding of fact which can be reversed only
if clearly erroneous.
Under § 4243(d), it was Jackson's burden to prove "by clear
and convincing evidence that his release would not create a
substantial risk of bodily injury to another person or serious
damage of property of another due to a present mental disease or
defect."3 18 U.S.C. § 4243(d).
Clear and convincing evidence is "that weight
of proof which 'produces in the mind of the
trier of fact a firm belief or conviction as
to the truth of the allegations sought to be
established, evidence so clear, direct and
weighty and convincing as to enable the fact
finder to come to a clear conviction, without
hesitancy, of the truth of the precise facts'
of the case."
United States v. Barton, 992 F.2d 66, 69 n.6 (5th Cir. 1993)
(quoting In re Medrano, 956 F.2d 101, 102 (5th Cir. 1992) and
Cruzan v. Director, Mo. Dept. of Health, 497 U.S. 261, 285 n.11,
110 S.Ct. 2841, 2855 n.11, 111 L.Ed.2d 224, 246 n.11 (1990)). We
have no trouble finding that the district court was not clearly
3
The "clear and convincing evidence" standard is invoked when
the underlying offense of a person found not guilty by reason of
insanity is "an offense involving bodily injury to, or serious
damage to the property of, another person, or involving a
substantial risk of such injury or damage." 18 U.S.C. § 4243(d).
In all other instances, an acquittee must prove his lack of
dangerousness by a preponderance of the evidence. Id. Jackson's
criminal behavior, which included armed bank robbery, involved a
substantial risk of injury or damage to the person or property of
another.
8
erroneous in concluding that Jackson failed to carry his burden of
proof.
Jackson concedes that his release would pose a threat to the
safety of others. He claims he is entitled to be discharged,
however, because the evidence shows that his current dangerousness
stems from an antisocial personality rather than schizophrenia and
that he can be held legally only if his violent behavior is "due to
a present mental disease or defect." The district court was
justified, however, in rejecting the panel's opinion that Jackson's
mental illness was in remission.
"Fact finders are entitled to make credibility determinations
about witnesses, even expert witnesses. '[T]he questions of the
credibility and weight of expert opinion testimony are for the
trier of facts, . . . such testimony is ordinarily not conclusive
even where it is uncontradicted.'" Id. at 69 (quoting Mims v.
United States, 375 F.2d 135, 140 (5th Cir. 1967)). As the district
court noted, Jackson's post-evaluation behavior included a violent
encounter similar in kind to the assault he perpetrated during his
first hospitalization. The court correctly attached no weight,
therefore, to the panel's determination that he can "function
without incident" when medicated. Dr. Pietz testified at the
hearing that she believed the latter assault was the result of
Jackson's antisocial personality rather than a recurrence of
auditory hallucinations because he failed to display other symptoms
of schizophrenia, such as disorganized thinking, mistrust of others
and inadequate hygiene. Even so, Dr. Pietz also acknowledged that
9
the psychotropic medication, upon which Jackson's alleged remission
is entirely dependent, can work one day and not another. We cannot
say, on the record before us, that the district court clearly erred
in concluding that the diagnosis of remission was faulty, or that
the second assault could have been caused by a reemergence of
mental illness.
We find no merit in Jackson's contention that the court
improperly ignored Dr. Pietz's testimony that another dangerousness
evaluation was unnecessary because she and the Medical Center staff
continued to monitor his condition after the second assault.
Instead, the court discounted her medical opinion that the assault
was unconnected to his psychosis. Moreover, his argument that
there was no evidence that his schizophrenia was not in remission
misses the mark. The burden of proof was on him to show that he
was no longer dangerous due to a mental illness. For the court to
reject Dr. Pietz's opinion, the government was not required "to
offer rebuttal evidence in the form of its own expert witnesses or
otherwise." Id. at 70.
In addition, the panel agreed that Jackson lacked the
necessary insight into his illness to connect the lessening of his
symptoms to complying with his medical regimen. Although Jackson's
mother stated that she would oversee his treatment at home, there
is no assurance in the record that he would continue to take his
medication once released. Section 4243 does not require that
Jackson be released simply because there are mechanisms whereby he
could be closely monitored on an outpatient basis.
10
Finally, Jackson's reliance upon Foucha v. Louisiana, 504 U.S.
, 112 S.Ct. 1780, 118 L.Ed.2d 437 (1992), is misplaced. In
Foucha, the Supreme Court found unconstitutional a Louisiana
statute that permitted the indefinite detention of an insanity
acquittee who was no longer mentally ill, unless he could prove he
was no longer dangerous. In so doing, the Court reiterated its
prior holding that "'[t]he committed acquittee is entitled to
release when he has recovered his sanity or is no longer
dangerous[.]'" See Foucha at , 112 S.Ct. at 1784, 118 L.Ed.2d
at 446 (quoting Jones v. United States, 463 U.S. 354, 368, 103
S.Ct. 3043, 3052, 77 L.Ed.2d 694, 708 (1983)) (emphasis added). In
Foucha, the acquittee was not mentally ill at the time of his
dangerousness assessment. See id. at , 112 S.Ct. at 1785, 1788-
89, 118 L.Ed. 2d at 447, 452. By contrast, Jackson failed to prove
that his violent tendencies were unrelated to his psychosis.
III. CONCLUSION
The district court did not clearly err in finding that Jackson
failed to carry his burden of proof under § 4243. We, therefore,
AFFIRM the judgment of the district court denying his conditional
release and committing him to the custody of the Attorney General.
11