Maine man sent to South Carolina psychiatric hospital pending release from state custody

AUGUSTA – A Maine man found not criminally responsible for stabbing his neighbor will soon be released from state custody after 12 years of psychiatric treatment without his mental health being fully improved, according to doctors.

Judge Daniel Billings will preside over a hearing in West Bath District Court in July 2023. Brianna Soukup/Staff Photographer

On Friday, Chief Judge Daniel Billings ordered 50-year-old Malcolm Moore to be returned to Maine and released from prison, agreeing with doctors who said Moore suffers from a personality disorder that is best treated outside of an inpatient system.

Billings pointed out the rarity of this case.

“It's unusual for someone to be released directly from the hospital,” Billings said during Friday's hearing in Kennebec County Superior Court. He added that this was especially unusual because Moore was transferred to Columbia Regional Care Center two years ago because he was violent toward staff at Riverview Psychiatric Center in Maine.

Matthew Davis, Riverview's clinical director, said the facility is a “last resort” that has been used since 2017 for a dozen patients “who have been deemed not criminally responsible and have previously demonstrated high levels of violence.” The state has spent millions of dollars sending people to Columbia and is still reviewing next year's contract.

Davis said Moore has injured and assaulted several staff members and patients over the years, placing a strain on staff and interfering with the treatment of other residents, including those also housed there under court orders.

Moore has been in the care of the Maine Department of Health and Human Services since 2012. Before his transfer, he was treated at Riverview.

Nevertheless, Riverview doctors agreed with Moore's public defender on Friday that he should be released from their care and released into the community.

“I don't want the court to get the impression that we are releasing this wild, dangerous animal,” said Dr. Lorraine Zamudio, head of Riverview's psychology department.

She acknowledged that Moore has assaulted staff and other patients, but said she believes he will be less violent in the community because he has the opportunity to escape stressors he couldn't escape at Riverview or Columbia. She also said he has matured.

“Mr. Moore has learned a lot of tools,” Zamudio said, including coping skills. “He doesn't necessarily use them all the time, but he can use them.”

Billings finally agreed.

“The court cannot find that there is no significant risk here,” he said.

But that wasn't what Moore had to prove – he just had to show that his mental state had changed and that any risks he posed to the community because of his mental illness were being addressed.

“I urge you to engage with social work at the hospital to arrange all of this,” Billings told Moore, who had tears in his eyes at the judge's decision. He watched the more than five-hour hearing Friday in silence via Zoom from the South Carolina facility.

Clinicians testify

Some of the four Riverview psychiatrists who treated Moore told Billings they doubt Moore was ever truly violent because of his schizophrenia. A judge noted this in 2012 when he was found not criminally responsible and transferred to Riverview's care.

Moore still says he hears voices and suffers from paranoia, Sarah Miller, the director of State Forensic Services, testified Friday, but Moore recently told her his voices were harmless and he had learned to live with them.

Dr. Carolyn Criss said Moore was evaluated by four psychiatrists and two psychologists after his arrest for the stabbing, but none of them agreed with the schizophrenia diagnosis later mentioned in court records.

“This is not something the hospital approved,” she said.

Dr. Mary Tibbetts, a psychiatrist who treated Moore in 2018, said auditory hallucinations and paranoia are not unique to schizophrenia and that a person's statement that they “hear voices” can have different meanings.

Criss, Tibbetts and two others told the judge that they believe his most troubling behavior – including several attacks on staff – was due to a personality disorder rather than what they consider to be “serious mental illness.”

The doctors suspected that he was suffering from borderline personality disorder, which is more difficult to treat in inpatient treatment than more serious psychotic illnesses such as schizophrenia.

Davis, who wrote a report last month advocating Moore's release, said he believed Moore's condition could worsen while at Riverview and that Moore would benefit from treatment in which he enjoys more autonomy.

Davis said that all of the schizophrenia symptoms Moore reported in 2012 are now stable and there is not much that can be done about his personality disorders.

He said Riverview has tried various methods to help Moore over the past 12 years, including medication, consulting with psychological experts, and individual and group therapy.

Much of Moore's treatment involved “significant input” from Moore himself, including treatment plans offered to him while he was in South Carolina.

Davis said he participated in several video calls during Moore's first stay at Columbia Regional Care Center two years ago. Moore seemed motivated to return to Maine and committed to new treatment at Riverview — but when he returned, he quickly became combative again, Davis said, and they sent him back.

“It was clear that we were not the right environment for him,” he said.

STILL A DANGER

Davis said Moore's case was “atypical” and “complex.” Moore's charges were serious, he added, “but not nearly as serious as many patients” who were discharged earlier.

A prosecutor who argued against Moore's release was concerned about the fact that Moore has been in an institution for 12 years. Without supervision, after all that time, there's no way of knowing how successful Moore will be..

She referred to an argument Moore had with another patient at Columbia Regional Care Center a few weeks ago.

Billings said it was highly unusual for Riverview to support the discharge of a patient like Moore, who had been found not responsible, directly from the hospital without supervision.

Davis said it was the first time he'd made this type of request since he started in 2019. (The hospital is helping Moore find housing and regain access to public benefits such as Medicare and Social Security, as well as outpatient treatment if he wants.)

Moore must be transferred from Columbia Regional Care back to Maine and will spend a short time at Riverview before his official release.

Moore's attorney Hank Hainke said after the hearing that this was the best outcome for his client.

Hainke was particularly outspoken about Moore's placement in South Carolina, as well as that of other Maine patients. He said Moore was unable to access the kind of therapy in South Carolina that would truly treat his personality disorder.

Hainke said Moore is entitled to treatment, “unfortunately he has a disease that is not treatable in our system.”

“I think there is no doubt that the hospital tried to control this violent and antisocial behavior. And they failed,” he said.

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