ayres Competency Press Wrap-Up

FishWrapper Round-Up:
There are several articles in the paper now about Judge Grandsaert’s conclusion that william ayres, child molester and malingerer (conservatee of daughter Barbara Ayres of Sacramento) is competent to defend himself at trial against charges that he molested many young boys.

Ultimately, Judge Grandsaert indicated that one of the most significant factors in his determination was that ayres’ actions and statements while incarcerated at Napa State Hospital flew in the face of any claims that were being made about his competence.  Grandsaert also expressed dissatisfaction with the quality of the majority of the evaluation reports produced by doctors inside and outside Napa State Hospital.

Here is a summary of these behaviors and statements taken from articles in the press as well as from this blog, also included are some unusual behaviors by the psychological “professionals” involved in evaluating ayres:

From The San Mateo Daily Journal, Ayres found competent, 2012-11-01(pdf):

Dr. Shawn Leppert said Ayres told her early on they would not be working together in treatment because the decision that he would remain diagnosed as incompetent was made prior to his hospitalization.

Leppert later testified Ayres was very vocal about his memory loss but that she observed different behavior when he was playing games or seeking snacks as a reward for attending therapy.

From The San Mateo Daily Journal, Doctor claims Ayres exaggerated dementia, 2012-10-30 (pdf):

Dr. Shawna Leppert, a staff psychologist at Napa State Hospital, said William Hamilton Ayres was guarded and resistant during an interview when she brought up his case and told her “we’re not going to work together” because the outcome of his hospitalization was already determined.

Ayres did have some degree of dementia, said Leppert, but she noted discrepancies between his claims of memory loss and what she actually observed. For example, she testified, Ayres would say things like “I don’t think I’m going to understand that” or immediately claim to forget her name and role but later demonstrate the ability to retain new information by playing and even winning games against her and another patient.

At Napa, Ayres, like other committed patients, was expected to participate in treatment aimed at restoring his competency, such as medication, therapy and discussions about his case. Ayres initially refused to take an anti-psychotic drug used as a mood stabilizer and, when his wife encouraged him to try, he asked “Why? So I can go back to prison?” Leppert said.

From the Mercury News, William Ayres case: Defense team questions experience of expert witness, 2012-10-31 (pdf)

McIlnay said his review showed the men who treated Ayres, psychologist Thomas Knoblauch and psychiatrist Dr. Scott Sutherland, had decided early on that their patient could not be restored to competency and made little effort to engage him in activities designed to restore him to competency.

Sutherland's testimony on Friday that he had made "an alliance" with Ayres also made McIlnay uneasy. "The impression was, 'Case closed -- we're just helping this guy to stay comfortable until he can go somewhere else,'

When McIlnay confronted Ayres with his findings in June as he was wrapping up his investigation, Ayres' response was lucid, bolstering McIlnay's confidence in his assessment. "This is a major shift on behalf of the organization," McIlnay recalled Ayres saying. To the psychologist, the patient's remark demonstrated an understanding of Napa's evaluation process and Ayres' standing in it.

The [nursing] supervisor, Sybil James, told the court that on more than one occasion Ayres had to be removed from the company of another inmate out of concerns he might be "grooming" him, a term used for the process by which sexual offenders prepare a potential victim for abuse. James said she and other staffers noticed Ayres spending time alone with the man, who is developmentally disabled. The man had previously been involved in an undescribed incident with another man that resulted in the filing of a police report. The developmentally disabled man was eventually moved to a different unit of the hospital for his safety.

From The Mercury News, Peninsula child psychiatrist to be tried again for molesting patients, judge says, 2012-10-31 (pdf)

The nurse who filled out Ayres' admission forms at Napa, said he spelled Alzheimer's" for her when she couldn't remember how.

When Ayres returned to Napa from a court hearing in San Mateo County, he asked a nursing supervisor if he still had the same room and then walked right to it.

Ayres immediately recognized and greeted by name a psychiatrist he hadn't seen in over a year. The psychiatrist testified: "I think it slipped, that he remembered my name, frankly."

In setting the bail at $900,000, Grandsaert noted his concerns about Ayres "returning to court and his safety." The judge cited Ayres' statement that he would like to "hide" with his wife or kill himself as opposed to go to trial. 

Grandsaert also noted a worry that Ayres could try to "manipulate" witnesses in order to avoid prosecution.

From The Chronicle, Ayres to be retried on molest charges, 2012-11-01 (pdf):

Grandsaert "really felt like the system had been gamed" by Ayres, said Assistant District Attorney Karen Guidotti.

And finally, from our own courtroom observers:
Day 3:

Dr. Wilkenson: 
Wilkenson reported that ayres complained to him about a medical problem while in San Mateo County Jail. He suggested that ayres write a request to deal with the issue. Later he found out that ayres did write a request and the problem was successfully resolved.

Wilkenson talked about a time that ayres recounted overhearing McKowan talking loudly to a witness during the criminal trial, and he extensively reported the detail that they were discussing, even to the point that he drew the conclusion that she was coaching the witness against him.

Supervising Nurse Sybil James:
She noted that ayres behaved differently when doctors were around: when they were present, he would make statements like “I don’t know what I’m supposed to do.” But he did not behave in this manner when doctors were not present.

She recounted an occasion when the patients were having a heated argument about what channels to watch on the television, some wanted Spanish, some English, etc… James reports that ayres proposed a sharing method that would help resolve the matter, and it was implemented successfully by the staff.

James noted that on several occasions, ayres was counseling patients, telling them what medications they should be taking and recommending treatment. James had to remind the staff about the safety of this kind of interaction, and about the “special treatment” that ayres seemed to be getting.

Most troubling, James noted that ayres was being treated “specially” by all of the doctors on the unit, and she was clearly troubled by this inappropriate behavior, as it threatened the safety of her unit. She noted that one day, defense attorney McDougall just appeared on the unit, something that is NOT allowed and is never done. 

Social Worker Jacquelyne Green-Gorbey: 
After the July 25th 2012 hearing in which it was revealed that ayres was found to be competent, and that he would be booted out of Napa and transferred to jail within 10 days, ayres was enraged. He had a tantrum when the driver parked the car when they got back to Napa State. He held on to a post and wouldn't let go, then he fell and insisted that he broke his hip. He complained about his injury whenever anyone would listen, but then he engaged in group physical activities without complaint in the mean time. 

ayres told Green-Gorbey that Dr. Sutherland told him that it was a foregone conclusion that ayres would be found incompetent, and that it would just be a matter of finding some retirement home for him. Ayres told her that he didn’t understand the report’s conclusion that he was competent, and that he didn't know how he was going to pay bail.

Intake Nurse Karen Doyle:
On intake, ayres supplied all of the correct information about what medicines he was taking, what the correct doses were, along with the problems he was having and related surgeries and procedures. ALL FROM MEMORY. She even asked him how to spell “Alzheimer’s” and he told her how it’s spelled. The nurse commented that she didn't think she’d be able to do that for her own medical history; that she’d need her medical history card.

Day 2:

Dr. Shawna Leppert: 
Leppert tried to get ayres to participate in an incentive program in which they get a card that entitles them to some kind of extra snack or treat if they get the card signed by participating in one of the group restoration sessions or other treatment processes. ayres was told that if he forgot the card when he went to a session, he could get it and bring it later for a signature. ayres told her that he didn't understand the process. He did go to a session and forgot his card. Without reminder, he later brought the card to have it signed. Leppert says this is proof that ayres' is retaining short term memory.

Dr. John McIlnay: 
McIlnay recounted an episode when ayres was very frustrated about staffing levels, and ayres was feeling afraid and unsafe, and so he went to the head nurse and explained his frustrations, and suggested changes. The head nurse had noticed the problem as well, and so she implemented some changes within a day or so. When ayres noticed that the changes had been made, he sought her out to thank her for fixing the problem. McIlnay stated that this CLEARLY indicates that ayres was very clear-minded about identifying the problem, identifying solutions, understanding the system to know who to go to to make sure that the changes were made, and that the had no memory issues remembering what the problem was, and who to thank when the problem was fixed.

Day 1:

Dr. Erin Warnick:
Warnick noted that ayres was "unpleasant" and irritable, he had no concern over failure of tests. (Which flies in the face of flaky Knoblauch's testimony that ayres was malingering out of a sense of pride.) She also states that ayres has "poor emotional control," "poor behavioral control," and "poor judgement." She reports that he is verbally disinhibitive, ranting (more than 15 minutes of ranting at one point) and that he broke his pencil at one point during a fit of rage.

More from Day 1:

Dr. Scott Sutherland:
Sutherland said this about ayres: “ayres is in a very unique situation, he is a psychiatrist of great skill and reputation."

General Comment:
ayres was not under forced order to take any medications, but the Napa docs did contact his Stanford doctor to convince him to take Risperdal, (An anti-psychotic, NOT a drug for dementia) but soon, ayres was complaining bitterly to nurses about being dizzy and weak, and so he whipped out the drug information sheet talking about side effects, and got them stop giving them to him.

In all, ayres provided to the court a great deal of data to counter any and all claims of dementia, and when you heap the clear bias and sheer reverence that these shrinks had for ayres on top of ayres' hubris, you can see why Grandsaert had no hesitation in ruling as he did.

For good measure here are a few more recent articles about the competency finding:

Foster City Patch (pdf)
Associated Press (pdf)
Boston.com (pdf)


One More Thing:

There was also a conservatorship hearing (ayres' daughter Barbara Ayres  is his conservator) on Wednesday, October 31, 2012 scheduled for the hour before the start of the competency trial for the day. I went there to see what that was going on with that, but that hearing did not start until after I had to run across the hall to go over to the competency trial, so I missed it.

According to the online data, it appears to have been final paperwork detail that the probate lawyer malingered on until just the day before the hearing to file. (Lots of malingering going on in with all of these legal folk, it seems...)

Looks like that whole conservatorship thing is wrapped up now.

I suppose that if ayres is ever released, Barbara will get to follow him around all day, making sure he doesn't molest any little boys. (At least, that's what she'd better be planning on doing.)