Clifton T. Perkins Hospital in Jessup, Maryland is a sprawling, nondescript building, surrounded by forests and located on forty five acres. The forensic psychiatric hospital has grown in size since its construction in nineteen fifty nine. Today, the nearly three hundred bed facility is mostly home to patients who are charged with a violent felony and have been either deemed incompetent to stand trial or not criminally responsible, or an inmate
too mentally ill to be in prison. One of those patients is Catherine Hoggell.
She's a patient at this point and not a prisoner.
Troy Turner is right, Perkins, as it's known, isn't a prison, but the mostly maximum security hospital would sure feel like one of you lived there. Maximum security patients can have limited ability to roam the building and grounds, and all patient buildings are surrounded by security fences. Even with this focus on security, last year, Perkins made the news after a union representing workers at the hospital claim that assaults
on both patients and staff had become routine. But despite the conditions the restrictions on Catherine's movement, Troy Turner, the father of the two children Catherine is accused of killing. Doesn't think Perkins is where his ex partner should be.
I think that she should be punished to the greatest extent that the law would allow. I think that she should stand trial like anyone who murders two children should stand trial. And I think that she should go to jail and go to prison.
In earlier episodes, we talked about the complications police can run into when they are investigating a crime, especially when missing children are involved, that they have to balance the rights of the suspect with the urgency of solving the crime. And in Catherine's case, it was even more complicated because of her mental illness as police tried to find out where she had taken her children, three year old Sarah and two year old Jacob. But that added complication doesn't
stop once a person is arrested. It just continues as they make their way through the justice system, and there is a sense that it's at this point, as the accused is forced to answer for their crimes, that justice will be meted out. But that's not how things have gone in this case. For nine years, Troy has been living at the intersection of these systems as he contests Catherine's incompetency and advocates for what he considers justice for
his children. He wants Catherine found competent to stand trial. He wants the evidence against her presented in a courtroom. I'm Bethcaras and this is Unrestorable, an original podcast from Anonymous content and iHeartRadio.
We come from this very puritan kind of heritage in our culture, and we're very punitive.
This again, is tes Neil, a forensic psychologist at Iowa State University who researches how the justice system copes with the mentally ill.
We have just an extraordinarily high rate of incarceration in this country and a kind of political narrative that we are tough on crime and we want to make sure that people don't get away with things. Then we also have this still pretty stigmatizing view of mental illness.
I agree with Tess. For eight years as a prosecutor in New York City, I was on the front lines of this problem. Our prisons are full of people who are mentally ill. In fact, the National Alliance on Mental Illness says that two million people with mental illnesses are admitted to US jails each year. Is not in jail.
She's in a hospital, and until she can be declared healthy enough to help her defense attorney, she's not going to have to defend herself against criminal charges before a judge or jury or face the threat of a prison sentence. And for Troy, that's the only way to get any justice. But you have to wonder why, why isn't being locked up in a maximum security institution where your freedom is
definitely restricted. Why isn't that a form of justice, especially since it's very clear that Catherine does suffer from mental health issues.
You know, I know, one of the questions raised by this case in other cases involving competency, is whether the criminal justice system adequately protects us from the mentally ill.
My co host Sarah Trelevin was with me when we interviewed tes Neil.
But there's also clearly another question to be asked about whether the criminal justice system serves the interests of and protects the mentally ill themselves. What do you think about the balance of those two ideas.
So, on the one hand, lawyers and the system has this kind of foundational assumption of how the process works, that we're in an adversarial system, and the way we work is that each party gets to offer their best version of the facts with a narrative, and I get to provide their evidence, and the truth will out right. So through that process, whatever the truth is, it's going
to come to the fore. But when you have a situation where somebody is not a great advocate for themselves, whether it be because of mental illness or other reasons, sometimes that attorney is in a difficult philosophical ethical dilemma between whether they're advocating for what the client is asking for, which may not be in their best interests as a human being, right, and so like, maybe they do need treatment, maybe they are mentally ill, and so there's definitely parentalistic
legal representation where maybe that's in the best interest of the but it's not consistent with the system of justice as we have designed it. And so that's a hard problem and it's not solved.
This hard problem is not new. The insanity defense has been used in the US since at least the mid nineteenth century. Since then, the laws have been reformed and case law has been codified. But remember, Catherine is not asserting an insanity defense. She can't do that or won't do that until she's before a judge preparing for trial, and she has to be found competent before that can happen.
For years, Catherine appeared before judges who accepted reports from doctors that she was responding to medication and could likely become competent in the foreseeable future. After all, that was the goal to restore her to competence so she could go to trial. This distinction, this idea that one cannot be tried one cannot help with one's own defense, comes
from a nineteen sixty U. S. Supreme Court decision. It involved a man with a history of mental illness named Milton Richard Dusky, who was found guilty of the attempted rape of a young girl and sentenced to forty five years. He appealed. In ordering a new competency hearing, the US Supreme Court laid out the test that is still used today. A defendant must properly understand the proceedings against him and possess the present ability to assist counsel in his defense.
Dusky was retried, reconvicted, and his new sentence reduced to twenty years.
Incompetence is a present state.
This is Catherine's lawyer, David Felson.
Someone is incompetent now, which means that they can't make for the for whatever reason, can't make the various decisions necessary to assist in their defense, or that they understand what's going on in court. We don't try those people for any crime because they can't defend themselves. They don't know what's going on. Relative to the legal process.
Rules around mentally ill criminals continue to evolve, and in nineteen seventy two, the US Supreme Court held that you cannot hold someone for an indefinite amount of time in the hopes of restoring one's competency.
There's a statute that now limits and I think most states have in this, but there's a limited period of time that you have to restore somebody to confidence.
John McCarthy is the state's attorney in Montgomery County, Maryland.
That timeframe has been more severely limited in Maryland in more recent times. For instance, it used to be ten years, now it's five years. On felonies.
For misdemeanors, it's three, which is why Catherine has been held for so many years now. She was initially held on misdemeanor charges for almost three years, but before that, three year window had expired, a grand jury indicted her for murder, and the state dismissed the lesser charges. Catherine was soon found incompetent to stand trial again, and that started a five year clock which has loomed ever since. And this is where Troy finds himself.
We're going, okay, we have this slock ticking.
If Catherine cannot be restored to competence, then she will either be civilly committed if a judge finds her to be a danger to herself or others, or released, but she will not face murder charges for now because those will be dismissed.
It's hard to kind of look at her and know what she did and know that she might be accountable for, you know, and that there's a good chance that she'll never be held accountable the way the system's working right now. And I'm just looking at her, going this is crazy, and there's nothing that we can do about it at this point right now.
But it has to be made clear. Catherine is an outlier. Most defendants who are found incompetent are restored and end up in a courtroom. Most of them do not run out the clock.
The best estimate we have is that something like seventy five percent of people will be restored within I think a year, and typically that is through taking psychotropic medication. And typically it's even faster than a year. Typically it's within six months because medication typically works, you know, within a month or two.
For Troy, the father of Sarah and Jacob, the man who nine years ago lost his two youngest children and still today has no idea where they are or what happened to them, none of this sits well with him.
She manipulated the system. She manipulated the staff at Perkins. The nursing knows the nurse say that she knows that they The nurses are like, she's manipulating you guys. Basically they are writing to the purpose doctors that they're being manipulated as she's lying and just doesn't matter.
According to Troy and other members of the family, Catherine has been almost brazen about her plans to remain incompetent long enough to see the murder charges against her dismissed. Do you think it's possible for someone to fake incompetency, and I mean just anybody.
I think it's possible.
Sure, I'm speaking with Catherine's attorney David Felson.
I mean not in this case, not with these symptoms, not for this period of time, not under these circumstances, not taking these medications, not getting these therapies. But could somebody fake it? Sure, Beth, you could fake it.
I asked Catherine's lawyer to describe the symptoms he's talking about. He wouldn't go into great detail, but told me he had represented her in the past for a minor traffic infraction, and the contrast between Catherine then and when he met her right after her arrest in twenty fourteen was profound. That there was a clear disconnect between the circumstances that she found herself in and the way she would react
to people. That Catherine's eyes were darting around the room, that she spoke in hushed tones, and that she was obviously paranoid and delusional. Her hair was so messy it looked like she had been living on the street for days. Catherine knew she was facing murder charges because that part of competency she passed. I mean she understood it.
Yeah, we conceded that, yes, Catherine is not stupid. I think that most people have a profound misconception of incompetency to stand trial. They think of incompetency when they hear that word. Their initial vision is someone who is incoherent, unable to communicate, sitting in the corner of a room, drooling, banging their head against the wall, and looking at imaginary butterflies and soiling themselves. That person would clearly be incompetent.
But that is not the only definition of incompetence, and competence to stand trial is a much more complicated, nuanced circumstance.
And here again we bump into the intersection of two competing systems.
It's a perennial question in forensic cases like this, where there's some question of mental illness, it's intersecting with the legal issue.
It's something that test Neil has spent a lot of time thinking about.
Malingering is when somebody is thinking some kind of mental illness in an effort to have their criminal charges dismiss. When clinicians are trying to assess from a one of the things you're trying to assess for is well, what's the motivation?
Troy says he definitely knows Catherine's motivation.
She knows is action.
What's going on there?
And I'm not saying that, you know, just as the father of these kids who wants justice. I'm saying that as someone who knows her, who has spoken with her since she has been locked up. You know, at times, and she doesn't appear to be any less cognizant of the situation than she was whenever she was explaining the entire system to me and telling me a rundown of how long she has to wait and be incompetent to get out.
It's a complicated problem. The medical system Catherine is in is actively trying to get her healthy, healthy enough to stand trial. But that system is supported by doctors and nurses, and it raises questions about doing no harm. Should mental health professionals help make incompetent people well just so the system can prosecute them.
What are the ethics of treating somebody a human being to then enable the legal system to prosecute that person.
It gets even more complicated when you consider the death penalty. Catherine is not facing the death penalty. It was abolished in Maryland in twenty thirteen, only one year before Catherine is accused of killing her kids, But the American Psychiatric Association has weighed in on the question of restoring someone's competency. If there is a threat of execution, that person.
Has to be restored to competency before they can be executed. The American Psychiatric Association has come out very firmly against physicians being involved in that process. They have said it is against the hippocratic oath. It is unethical for a psychiatrist to provide treatment in that situation, to aid a person to restore their confidence to become competent for execution.
But it's still a thorny ethical problem because sometimes people who are very psych practically ill are suffering, and so there's also this hippocratic oath problem of not helping the person when they are suffering. So it gets very complicated at these intersection of systems, especially in that situation.
And again, while Catherine is not facing the death penalty, Troy does believe that the doctors at Perkins are protecting her, helping her maintain incompetency rather than treating her.
There is no therapy for them at Perkins until they are competent. So if you're profoundly mentally I don't know how they expect to bring your competence or have you get better if they're not giving you therapy. That makes no sense to me.
At Catherine's latest competency hearing, the evaluating doctor from Perkins testified that Catherine was not in one on one therapy since that's usually reserved for patients who have resolved their legal situation. We reached out to the Maryland Department of Health to find out more about why an ist patient, that is, someone incompetent to stay trial at Perkins might not receive one on one therapy and an effort to restore them to competency. We were told that it depends
on the patient and their treatment plan. But Lucy and Parsley, an attorney with disability Rights Maryland, has a different take. Based on her experience. She believes Perkins may actually discourage individual therapy for patients being restored to competency.
Perkins believes that the individual might say or do something with respect to their case that might cause the staff to be subpoenaed and testify against them, and they don't want to do anything that could put the person at more risk of being convicted.
Parsley is troubled by this lack of therapy.
We see people who are really suffering because many.
Of them have experienced traumas in their life.
They're not getting trauma therapy, they're not getting PTSD therapy, they're you know, getting medication if they would agree to take it in the hospitals, but they're also kept on the most restrictive levels in the hospitals.
This illustrates that complicated intersection of the justice system and the treatment of the mentally ill, and a conflict even with those presumably on the same side. It's so interesting because your organization, Disability Rights Maryland is interested in the individual and getting them the care they need if they're suffering, like you say, from trauma, but they're not getting that
proper care. But the hospital Perkins also feels like they're doing something in the best interests of the patient by withholding treatment so that they're not prosecuted.
Yeah, I think that is probably true.
But to Troy, this is all irrelevant. The real truth of the matter is Troy does not believe Catherine is incompetent at all. He believed that she is in fact well aware of the situation and is waiting things out, and he says she's being very deliberate about it.
So on one side, you have inconfident, it goes to treatment, it goes down.
Troy is describing a sort of drawing that Catherine made. It was on a handout that Perkins gave Patience to explain the legal process. At the very top, there's a cartoonish drawing of a police officer blowing a whistle, his baton raised in the air like he's chasing down a suspect. Just below there's a drawing of an inmate wearing the classic striped prison guard, looking dejected behind bars in a concrete cell. Troy wants me to notice what Catherine added.
If you look on there, even in terms of incoonfident, where it says not guilty, and there's a home she actually wrote streets on there, and then you have where being convicted, Lisa Jell NCR leads to where you would be home by then as an incompetent person.
NCR stands for not criminally responsible, what we commonly know as not guilty by reason of insanity. For the pathways that lead Catherine out of jail and eventually out of Perkins. Katherine has drawn a cute little house, a curl of smoke coming from the chimney.
It's literally just laid out as instructions. Here's how you get home at some point.
According to this drawing, the paths are clear. Being found competent and then guilty leads to prison. Remaining incompetent and receiving ongoing treatment. Never facing the court system leads to that cute cartoon house look.
When they give you a diagram, literally give you a diagram that basically says paths they get out of jail and a path to go to prison.
It doesn't sit well with Montgomery County State's Attorney John McCarthy either.
And they explain to you on a diagram that she color codes that was an exhibited and she discussed it with her husband. She knew exactly which road would keep her out of jail.
What are the some of the signs that that practitioners look for that someone is malingering. What would be a tell.
Just behavioral consistency across time and across context and situation. So what's the person acting like in their conversations and behaviors with family members and friends if they're in custody, What is their behavior like in custody? What are the treatment providers who are seeing them in that environment? And the people who are seeing them on the unit all the time, What are their notes like on a daily basis.
If you find consistency that the person is struggling across all of those domains, that's much more compelling than if they're only having a problem when you're interviewing them. There's really good kind of psychometrically solved, scientifically based tools measures that we have as clinicians that can that can tap into the lingering like it's been studied quite a lot. We know what it looks like typically from people who
are genuinely ill and people who are faking ill. The only people who are really successful at lingering would be somebody who's very sophisticated about what mental illness genuinely looks like.
And yet, is it possible for somebody to appear lucid, to appear like a good advocate for herself, to appear self interested and capable of strategic thought, and still be not competent to stand trial for serious charges?
Yes, I can give an example. Sometimes delusional disorder is a it's a type of psychotic disorder, but it doesn't have the same presentation as like a schizophrenia or something would have. So with a delusional disorder. A person doesn't have hallucinations. You don't see things that aren't there, they don't hear things that aren't there. So their main symptom with a delusional disorder is some kind of circumscribe fixed false belief, some belief that they truly think is real
that is objectively not true. If that's significant enough, it can really derail things and really like mess up people's lives, and those are hard to treat sometimes, like psychotropic medication
can't always treat that well. So if a person is very sophisticated, a smart human being who's like doing just fine in life, but they have this like resistant and intrusive and problematic delusional disorder, that can that can be a situation where the person might be lucid and this person could be perfectly capable of doing almost everything else
in a life. That could be a reason why somebody might be found incompetent and might not be restorable, because delusional disorder can be pretty resistant to treatment.
Sometimes, is it customary for an evaluator of competency to talk to the friends and family of that individual to get their perspective on whether the individual is malingering?
Yeah, although Again, it depends on the seriousness of the case. It depends on the training of the evaluator, It depends on how good of a job they're doing. So in a system that is incentivizing quick and sloppy work, which sometimes is the case. If there's a contract, for example, for the evaluators, and they get paid by the case and nobody is paying attention to the quality of what's coming in, then the incentive is no, you don't do
any of that. You talk to the person for fifteen minutes, you write a shoddy report sometimes and submit it, and you get your pay. That's a bad way to design a system. It's also a bad way to do practice. But it does happen. But certainly it is the case that if somebody's doing a good job with an evaluation like this, that they will talk to collateral sources, certainly professional collateral sources, but often also non professional collateral sources like friends and family members.
So would you be surprised if in a case family members had signed f David saying that they suspected a patient of malingering, that evaluators did not talk to those family members.
If they knew about.
It in all the years that Catherine has been held at Perkins. The doctors there never spoke to Troy, even though he says he's called the hospital at least ten to fifteen times over the years in an attempt to speak with them. Lindsay, Catherine's mother, says that she too hasn't been interviewed by Perkins. In an affidavit Lindsay signed back in twenty fifteen, she said Catherine understands precisely what is going on in her case, and she is trying
to work the system to her advantage. She has recently explained to me that if she is found to be competent, she will go to jail. In my most recent conversations with Catherine, she has been as clear headed as I have ever known her to be. It's understandable why family members like Katherine's aunt leeb Levins, who also signed an affidavit, are suspicious of Catherine and her incompetent status. She asks questions about me and our family members and tells me
her opinions about them. She is quick witted and responsive. She knows what she is doing. She is just choosing to act like she doesn't. These doubts about Catherine's behavior, create an even more complicated situation for Catherine's own mother.
The point that Troy made that the most important here is that Katherine is afraid of being charged further and going back to jail. She's now finally realizing that she does have a middle illness. She feels safe at Perkins. She wants to stay at Perkins.
Lindsay Hoggle is addressing reporters in twenty fifteen, not long after another hearing where Catherine was found incompetent.
She's very capable of being competent, whether she's taking antipsychotic drugs or not.
She's not taken the right mix.
Yet she understands the situation. The problem is she doesn't want to go to jails.
As simple as that.
But it's not that simple. In fact, years after making that statement, Lindsay has become more circumspect about her daughter. It was clear when Sarah and I visited her more than eight years after her grandkids had gone missing.
It probably wasn't worded correctly that My whole point about her being manipulative is that people with that serious mental illness learn to be manipulative because you've alienated everybody that's close to you and so you have to find a street smart way to survive. That's the reality of it.
Lindsay indicated that at the time she signed the affidavit and made those statements to the me, she was furious with Catherine because she wouldn't tell anyone what she did with the kids.
I mean early on, you know, I signed an Affidavid, and you know I was very angry at the time too, just that we're in this situation. I don't know that you can fake incompetence in her world.
I don't know.
You know, there's been, you know, conversations she's faking middle illness. No, I can tell you no. If anything, she has to be able to envision a safe place for her to be, and in my mind, I don't think she has one right now. I mean, Perkins is safe, I guess if you use that. But I don't think she's faking in competence.
Do you have any regrets about writing that after, David.
You know, I've kind of come to terms with everything that I've done and just gone, you know what, you make good choices, bad choices, And yeah, I don't really regret it.
She upset with you about the AFT, David.
Livid Lindsey is uniquely torn between loving her daughter and missing her grandchildren, between accepting that many of her daughter's actions have been directed by mental illness while acknowledging that Catherine is capable of taking more responsibility. She grapples every day with ambivalence about what justice could mean in this case, but the bottom line is that she wants Catherine to receive better treatment, not punishment.
I think she could be competent intent trial. I think she's capable of that. I would hope that that's not where this goes after eight years. Yes, I would like her to have one on one therapy she asked for that. We're still calling treatment medication only, and if that's what you depend on for recovery, there's really little hope because the medications aren't great. And so, yes, I think she's recoverable.
I think there's a difference between ability to meaningly assist with counsel and willingness to do it.
State's Attorney John McCarthy does not believe Catherine Hoggle is incompetent.
She had the ability to assist counsel, but she wasn't willing to do it because it didn't serve her ultimate goal.
If Catherine were to be declared restored and competent, if she were to face the charges of murdering her who small children, she'd have to decide on a defense, and the most obvious one not criminally responsible. There's plenty of evidence that Catherine suffered from serious mental health problems her entire life, but she'd have to admit that, yes, she killed her children. You can't claim that you are not criminally responsible if you don't also admit that you did the deed.
You know, the doctors that we consulted basically indicated One of the reasons that particularly mothers who cling to insanity or incompetency is because if you actually become competent, where you begin to be able to look at what you've done, the horror of what you have done in taking the lives of your own children is too unbearable to allow
yourself to ever recognize you actually did this thing. So they cling to the incompetency because it's what protects them from having to come to grips with what they've ultimately done. She was desperate not to become competent, and you know, she was terrified of going back to jail and being tried for the murder of her children.
For the last eight years, Troy has done little else but advocate for Sarah and Jacob. He's pushed for Catherine's case to go to trial, but as long as she was declared incompetent, it was impossible. But in summer twenty twenty two that just might change. A judge has indicated he no longer wants to rely on reports from the doctors at Perkins. He wants to assess Catherine's competence himself. That's next time Unrestorable.
You know, we still have a long way to go, and there's still a very good chance that come December the charges will get dropped. But we have a chance to try to at least fight for Sarah and Jacob and fight for what should be happening.
Unrestorable is executive produced and hosted by me Beth Carris and Sarah Trelevin. Our story editor is Kathleen Goldhar, Mixing and sound design by Mitchell Stewart. For anonymous content, Jessica Grimshaw is our executive producer, Jennifer Sears is our executive in charge of production, and Nick Janiez is our legal counsel for iHeart executive producer Christina Everett and supervising producer Abu Zapfhar