Wednesday, October 31, 2012

ayres: Competent - Last Day Detail

Summary of last day of Competency Hearing Wednesday October 31, 2012:


Current Status of william hamilton ayres (conservatee of daughter Barbara Ayres of Sacramento) child molestation case:

October 31, 2012: william hamilton ayres has been declared competent. Judge Grandsaert approved the certification from Napa State Hospital that ayres is competent to assist in his own defense against the multiple charges related to his molestation of many young boys.

Bail was set at $900,000.00 and the criminal proceedings have been re-instated. Criminal re-trial is scheduled for March 11, 2013 at 8:45am. Defense attorney McDougall estimates that the trial will take 6 to 9 weeks.

In Court this morning:

Defense attorney Bentley’s closing arguments:

Bentley was brief. He was brash and a bit condescending in his presentation. He spent some time fawning over the “very impressive” testimony of Shyster McDougall and he pointedly referred to the Medina vs California case, and made it sound as if McDougall’s diagnosis of ayres mental condition was the most significant of all opinions.

He told the judge that the defense only has a “low” burden of proof. And he told the judge that he had to decide if the opinion of Dr. McIlnay was more significant that the opinion of Dr. Amanda Gregory, and Dr. Good, and …..(he listed every doctor who stated that ayres showed some degree of incompetence.) and then he did the same for every doctor who didn't claim malingering on their reports.

Bentley concluded (or at least  I stopped taking notes about his angry blathering) by taking some jabs at McIlnay, about how long he had been licensed, etc…


Prosecutor McKowan’s closing arguments:

McKowan’s closing arguments were also very brief. McKowan read the judge very well. She saw that he was impressed with McIlnay, and she hammered some points home about McIlnay: She recapped that McIlnay knew and respected that much was at stake for ayres, and that he didn't take his charge lightly; he focused intently on the PROCESS of arriving at a conclusion, not on what the foregone conclusion should be, or was expected to be.

McKowan pointed out that more significant than the “unique” perspective brought to the case by defense attorney McDougall’s testimony, was the testimony brought by the staff who spent the most time with ayres in a non-clinical setting.  McKowan also pointed out that the new process used by Napa State to have more compartmentalized forensic examination worked very well in this case, that when admitting Doctor (Leppert?) first began to deal with ayres, she realized that there were some red flags in the case, and immediately got the FCLS group (McIlnay’s group) involved in the case in order to deal with some of the staff issues that may arise, due to the already apparent “foregone conclusion” attitude of the evaluating doctors.

McKowan laid into Dr. Sutherland. She noted that he was hostile, evasive, and uncomfortable on the stand, and that he had “Absolutely abdicated his responsibility because of who ayres was” She then contrasted with McIlnay, stating that he’d interviewed every person who had contact with ayres, read hundreds of pages of reports, jail records, etc.

McKowan took a dig at all of the other psychologists as well, she said that Gregory, Warnick, and even to an extent Dr. Good all base their livelihood on the collection of tests that they claim are subtle and sophisticated, and they feel that therefore they are undefeatable tests. McKowan reminded the court that ayres has 50 years of experience as a highly respected psychiatrist and 20 years as a forensic evaluator for the court… (if anyone could defeat the tests, it would be someone like ayres. ) In fact, she said he could easily fake the results.

Then Judge Grandsaert allowed defense attorney Bentley to make his rebuttal statement, but admonished him NOT to address the list of doctors, that he shouldn't assume that the sheer number of doctors constitutes a preponderance of evidence. And he admonished him not to tell the court how the court needs to go about making its decision.

Bentley: Is it more likely that McIlnay is correct, or that all the others were? (Etc… basically doing exactly the first thing the judge just admonished him not to do, but without listing all the names.)

Bentley said that if the judge found the report of (prosecution witness) Dr. Good  to be reliable, then he should find that ayres is not competent and not malingering. (basically doing exactly the second thing the judge just admonished him not to do.) 

It was clear from watching the judge's face that Bentley's mis-steps were NOT lost on the judge.


The judge then immediately issued his decisions:

The judge talked about the Medina case too. Details flew by too fast for me to catch, but basically, his point was that while Medina did acknowledge that a defense attorney is in a unique position to know his client’s mental state, it also acknowledges the complexity of the determination of psychological issues, that psychiatry is based on medical impressions drawn from subjective analysis, etc… basically he threw the Medina case back at Bentley.

Grandsaert acknowledged that the preponderance of the evidence must be upheld. To wit: 

Grandsaert  found that ayres’ conduct and statements made while under observation at Napa State Hospital fly in the face of all claims made about incompetence.

Grandsaert found the results of ALL of the examinations to be unreliable.

Grandsaert stated that the testimony/report of Dr. Good in and of itself was enough to convince him that ayres is competent, and the testimony/report  of Dr. Warnick on it’s own would convince him that ayres is competent, and that the report of Dr. McIlnay on its own would convince him that ayres is competent.

His finding was that ayres is competent and at the very least deliberately exaggerating his symptoms.

Criminal Proceedings were re-instated. 


Bail Determination:

They then moved on to the bail determination. McDougall was in another courtroom on another matter when they started, but the judge said that he felt that the law required him to set bail pretty much immediately, so they proceeded:

Bentley argued that the original bail was $750K (Actually it was higher than that, but was reduced - McKowan pointed this out as well) and he said that ayres’ physical and mental state has clearly deteriorated so much that he needed to have a MUCH lower bail set so that he could be free to see his own doctors and stuff. 

McKowan went large asking for $2M, citing ayres’ long term manipulation of the court, reports from Napa about incidents where he shoved one of the doctors while enraged, the “grooming” behavior, etc. She called his actions a “Gross manipulation.”

Grandsaert stated that he was concerned about the defendant’s willingness to return to court at this point. He noted that ayres made suicide statements while at Napa, and that McIlnay reported that ayres asked him to just “let me go” so that he could go hide somewhere with his wife. (I heard from our observer yesterday that ayres also said that the two of them would change their names and go into hiding)

Grandsaert said that he feels that ayres has a different motivation now than he did before (suicide, fleeing from the law, generally avoiding prosecution, etc...) , and so he set bail at $900K. 

McDougall walked into the courtroom at  the tail end of the bail discussion, and asked the judge to set up a bail hearing at a later time, as he felt that ayres' record of always showing up, with no violations of any kind should have some consideration. That hearing was not set yet. I assume it will come in the not-very-distant future.

The criminal re-trial was scheduled: March 11, 2013. The reason for the delay is that McDougall is on trial until mid December of this year, and he thinks he needs 90 days to prep for the trial, which he estimates will take 6 to 9 weeks.

I don't think the ayres have enough money left to pay for 90 days of prep, let alone 9 weeks of trial. I think we can assume that there will be some push for a plea bargain, or the termination of an attorney for a lower cost option in the near future.


My observation: 

Bentley was a poor choice to handle this matter: he was pushy and Grandsaert didn't like it at all. Our observer from yesterday noted that Bentley’s disdain toward the staff witnesses was palpable even before they took the stand, and it was clear to everyone that Grandsaert found their testimony significant. Bentley clearly expressed derision toward McIlnay, and Grandsaert was clearly very keyed to his report and testimony. Bentley should have picked up on these cues like everyone else in the courtroom did, and tempered his ire. Badly misplayed.

Reactions to the finding:

When ayres entered the courtroom in the morning he was pissed and hangdog looking. he kept his head down the whole time. If his eyes weren’t open, I’d have guessed he was sleeping.

No reaction at all when the judge issued his finding.  I was watching ayres, and didn’t see the idiot supporters, but there was no readily apparent commotion or noise from their little corner, so I assume they were generally flat reactions as well.

The judge spent the better part of his finding very politely, and very subtly rubbing Bentley's face in the mess.


To succeed in other trades, capacity must be shown; in the law, concealment of it will do.
-Mark Twain


Now leave me alone so I can go eat way too much Halloween candy and ponder my shock that the court actually made contact with the real world today, even if only for the moment!


william hamilton ayres was arrested on April 5, 2007 on charges relating to his molestation of many young boys while he was alleging to provide psychiatric care to private patients as well as referrals for evaluation from the juvenile court system in San Mateo County. ayres has been delaying his way through the system free from custody until this latest gambit to skirt prosecution by playing demented for the courts. ayres is currently under the conservatorship of his daughter Barbara Ayres of Sacramento, CA

ayres has had significant interaction over the years with local politicians on boards like the "Children and Families First Commission,"  including the DA who was serving when prosecution began Jim Fox and Assemblyman Rich Gordon. In fact, Gordon nominated ayres for a lifetime achievement award for his "Tireless effort to improve the lives of children." ayres has also been vocally supported during his criminal trial by local head-shrinkers like Bart Blinder, Etta Bryant, Mel Blaustein, Harry Coren, Tom Ciesla, Robert Kimmich, Larry Lurie, Maria Lymberis, Richard Shadoan, Captane Thomson, and Harold Wallach.


Competency Trial: COMPETENT!

In Court: Wednesday October 31, 2012:

ayres was found COMPETENT to defend himself at trial. The judge found that the testimony of Doctor Good, Warnick, and  McIlnay to each be sufficient in and of themselves to find ayres competent.

Judge Grandsaert noted that he is concerned about the defendant's likelyhood to avoid return to court. He noted that ayres made suicide threats and statements to McIlnay that he'd like to be released so that he can run away with his wife and hide.

Bail is set at $900,000.00. McDougall requested a followup bail hearing TBD.

Criminal proceedings reinstated, and trial is (currently) set for 8:45 AM on March 11, 2013.

More to follow... give me a few hours....



william hamilton ayres was arrested on April 5, 2007 on charges relating to his molestation of many young boys while he was alleging to provide psychiatric care to private patients as well as referrals for evaluation from the juvenile court system in San Mateo County. ayres has been delaying his way through the system free from custody until this latest gambit to skirt prosecution by playing demented for the courts. ayres is currently under the conservatorship of his daughter Barbara Ayres of Sacramento, CA

ayres has had significant interaction over the years with local politicians on boards like the "Children and Families First Commission,"  including the DA who was serving when prosecution began Jim Fox and Assemblyman Rich Gordon. In fact, Gordon nominated ayres for a lifetime achievement award for his "Tireless effort to improve the lives of children." ayres has also been vocally supported during his criminal trial by local head-shrinkers like Bart Blinder, Etta Bryant, Mel Blaustein, Harry Coren, Tom Ciesla, Robert Kimmich, Larry Lurie, Maria Lymberis, Richard Shadoan, Captane Thomson, and Harold Wallach.


Tuesday, October 30, 2012

ayres Competency Trial - Day 3

In Court: Tuesday October 30, 2012:

Interesting Development: ayres attempted to groom a developmentally disabled man while in Napa State on multiple occasions ...   Read Merc News (pdf)...

10/31/2012 6am PST Update: 
Decision Expected Today:
The San Mateo Daily Journal is reporting (pdf) that Deputy DA Karen Guidotti says that Judge Grandsaert will ask any follow up questions this morning, and then issue a ruling today. 

Also, see the extensive update immediately below, if you haven't already:

10/31/2012 1:30am PST: Afternoon Update:


In the afternoon,  Dr. George Wilkenson, who testified in ayres’ first competency trial, took the stand.

Previously, Wilkenson had testified that ayres was competent, but that he probably needs some minor accommodations if he's going to testify, like the use of notes as was the case in the criminal trial, or more frequent breaks.

Wilkenson met with ayres four times recently over about eight hours while he was in San Mateo County Jail, the most recent interview was on 10/25/2012. Wilkenson reviewed other reports in the case as well, including Amanda Gregory’s reports, and records from Napa State and from the Jail.

Wilkenson concludes that ayres is competent to defend himself at trial. He finds that ayres did VERY well on the Verbal IQ test, and an “abstract” test, and passed the apraxia test (100% score).

Wilkenson talked about the possibility that ayres has some minor defects with verbal memory areas, but he states, much like Dr. McIlnay, that it’s difficult to tell, as ayres clearly exaggerates his deficits so much.

Wilkenson noted a drastic difference in ayres behavior over a short period of time: On one occasion, ayres seemed profoundly disoriented, but the team monitoring ayres at the county jail reported that only a few weeks prior, he was functioning perfectly normally. When Wilkenson first went to interview ayres at the jail (close to a year after Wilkenson last met with ayres) ayres said “Oh, Hello Dr Wilkenson!” but then acted totally confused.


Dr Wilkenson also recounted several occasions that indicate that ayres is clearly competent:

- He said that ayres like to control the interview, moving to topics that he wants to discuss, but then is cooperative when asked to return to the tasks at hand. Wilkenson concludes that this demonstrates the skills necessary to understand and assist his attorney in a cooperative fashion as would be necessary in court.

- He 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.

- He 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.

Wilkenson discussed a “Rey Test” which is a complex neuropsychological assessment that relies on a complex of different cognitive abilities. Ayres made a series of errors in taking the test that could be indicative of malingering. 


He also talked about Dr. McIlnay’s report: He was very impressed with the report, and called it an “elegant” report, “very balanced.” He noted that it wasn’t just a neuropsychological evaluation, but that it included a “quite powerful analysis” of all of the pertinent case details, and with “everything thought through.” 

This assessment of the McIlnay report enraged defense weasel Bentley. Bentley asked if Wilenson talked to McIlnay or Sutherland. – “No”, he didn’t. 

Bentley pointed out that previously Wilkenson testified that ayres ability to assist in his defense was only marginally adequate, and asked him to confirm that that’s still his assessment. Wilkenson responded that no, he no longer thinks that, and that he thinks that ayres may be malingering, 

Clearly pissed off, Bentley told Wilkenson “You didn’t say that before…” to which Wilkenson replied "No, I think that now though."

Staff Testimony:

The defense attorney clearly objected to the staff being present as witnesses, he didn’t like that they were allowed to testify, and he gave the impression that he had no respect for them at all. He didn’t even bother to cross examine one of the afternoon witnesses. This is probably because their testimony was quite damaging.


Staff first to testify in the afternoon was the Supervising Nurse Sybil James. 

James primary concern is the safety of the patients in her unit. She made several observations about ayres’ behavior while in the unit:

- 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 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. 

Grooming Behaviors:
Finally, over strong defense objections, the prosecutor asked James to describe what she saw happen with an incident that all of the witnesses and lawyers in the courtroom seemed to know about, but the full details of which were not disclosed during testimony: There was an incident that took place between a developmentally disabled man, ayres and a third man. James noticed the developmentally disabled man and the third man behaving suspiciously, and then at a later time, ayres and the third man had the developmentally disabled man positioned between them and there was some suspicious behavior or activity. James described “physical closeness” and “grooming behaviors.” The three men were physically separated by staff, and a police report was filed, and the disabled man was then moved to another unit to protect him. There was not more clarification, and the testimony was allowed only so that it could be considered when it comes time to decide what to do after the judge rules on the competency issue. (In relation to release/incarceration/bail is my guess here...)


A unit social worker (Jacquelyne Green-Gorbey) also took the stand in the afternoon

Green-Gorbey reported that during social group meetings, they would show videos with questions afterwards, and ayres always did fine, and never displayed any signs of confusion. She also stated that while he never demonstrated any problems with memory, whenever there were doctors around, he would complain of memory trouble. 

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.


Last on the stand was the intake RN (Karen Doyle) who was there when ayres was initially admitted. 

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. Doyle even asked him how to spell “Alzheimer’s” and he told her how it’s spelled. Doyle 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. 

Doyle described ayres as arrogant, and said that he asked her “Do you know who I am??” and told her about his sex-ed series, and said that some  republicans didn’t like him because of it. She thought he was making it up, but then learned that he was telling the truth. 

Ayres told her that he was afraid that he’d be harmed because of the nature of the charges against him, and he requested a private room. 

In all, a pretty good afternoon for the Prosecution. 

The judge is reviewing the reports tonight, and the attorneys will do their closing statements tomorrow at 10am. Bentley says he needs about five minutes, and McKowan said she’d need about three hours. Everyone laughed at this.

 I hope Bentey actually only takes five minutes. 



Brief afternoon update: 
In the morning, Dr. Good took the stand first, due to his availability. Dr. Good has met with ayres again to test for malingering. Good has extensive experience in testing for competence and in testifying about such cases. Good stated that of all the cases he's handled this particular case has weighed most heavily on him.

Good states in no uncertain terms that ayres is competent but with some borderline deficit. Good also states in no uncertain terms that ayres is NOT malingering. Prosecutor McKowan asked if this means that if ayres  were to be re-tried, that it must happen expeditiously so that further deficit does not become an issue. . Defense attorney Bentley objected strenuously to this question, but was overruled. Good agreed with McKowan's assessment.

Later in the morning McIlnay took the stand again, and was questioned by Bentley:

Bentley walked McIlnay through each of the reports that he reviewed, (16+ reports) and questioned him about whether he agreed with the conclusions of the reports or not, McIlnay explained why and to what degree he disagreed with most every one of the reports. His testimony seemed firm and authoritative to our observers.

Bentley asked if McIlnay's report was based on lots of assumptions. (Uh... and interviewing the wife and child of the child molester isn't fraught with all kinds of assumptive problems?)  Bentley said that yes, his report was based on assumptions, and as an example, he talked about the fact that none of the others considered ayres' intelligence and education, and that it is important to take that into account in findings of malingering. (Of note: Dr. Good called ayres a "high powered intelligence" and stated that his intelligence was an important factor that he took into account when finding that ayres is competent.)

McIlnay said that it is impossible to discern if ayres is experiencing any cognitive deficits, because of the extent to which he is clearly exaggerating symptoms. 

McIlnay stated that he doesn't take his responsibility lightly, that the reports that he writes will have profound impact on people, and he feels that he has a duty to be accurate and clear. McIlnay took Sutherland to task a bit in this area: he reported that although Sutherland had had a good deal of contact with ayres, there was hardly any written report material from Sutherland about ayres, and he felt that this was problematic. When he went to discuss ayres with Sutherland, McIlnay found that Sutherland had NO CLUE that ayres had been refusing his medication and refusing to use his CPAP machine. (Both of these things may very well be able to reverse any actual minor deficit that ayres be suffering, especially if the deficit is not actually related to dementia.)  

More on the testimony will be added tonight.

During a break, Bentley and McKowan were overheard in discussion: McKowan wanted to discuss "Dangerousness" and Bentley wanted to wait until after the trial. They went back and forth into judge's chambers and then went to talk to Solveig and Barbara. Not entirely clear what this was about, but likely either discussions about incarceration or outpatient release or bail, depending on the outcome of this trial.

Witnesses may wrap up this evening. There are four more prosecution witnesses, sounds like they are Napa staff. This may be rapidly drawing to a conclusion. 




william hamilton ayres was arrested on April 5, 2007 on charges relating to his molestation of many young boys while he was alleging to provide psychiatric care to private patients as well as referrals for evaluation from the juvenile court system in San Mateo County. ayres has been delaying his way through the system free from custody until this latest gambit to skirt prosecution by playing demented for the courts. ayres is currently under the conservatorship of his daughter Barbara Ayres of Sacramento, CA

ayres has had significant interaction over the years with local politicians on boards like the "Children and Families First Commission,"  including the DA who was serving when prosecution began Jim Fox and Assemblyman Rich Gordon. In fact, Gordon nominated ayres for a lifetime achievement award for his "Tireless effort to improve the lives of children." ayres has also been vocally supported during his criminal trial by local head-shrinkers like Bart Blinder, Etta Bryant, Mel Blaustein, Harry Coren, Tom Ciesla, Robert Kimmich, Larry Lurie, Maria Lymberis, Richard Shadoan, Captane Thomson, and Harold Wallach.


Monday, October 29, 2012

ayres Competency Trial - Day 2

In Court: Monday October 29, 2012:

10/30/2012 Update:
News articles available:
The Merc has their story up. (pdf)
The San Mateo Daily Journal has their story up. (pdf) This one is the better of the two.


10/29/2012 Evening Update:

Additional notes about Amanda Gregory's testimony earlier in the day:

Amanda included interviews with Solveig Ayres and Barbara Ayres as part of the process that she used to determine ayres' competency. (Because there's nothing better than input from a biased spouse and child worried about their share of the inheritance to gauge dementia.)

Amanda was not swayed by McIlnay's report, as his report made no reference to the difficulties that ayres was having, and doesn't include findings of dementia.

Prosecutor McKowan made references to a 2005 study about malingering, showing that ALL parts of the testing procedures are available on the internet, and that armed with such information, a person could "pass" tests to detect malingering. Amanda said she lookd at the internet but couldn't find it. (G... G... G... G.... G.... G... G .. Google it!)


More on Shyster McDougall's testimony:

In discussing his fears that he would be fired, McDougall reported that the ayres family bickered and argued over why they had to pay Amanda Gregory and others for their opinions, after Solveig took over the finances.

McDougall was questioned by the other defense attorney Bentley: He asked extensively about the "inuendos" that were made by the Prosecutor about McDougall providing information to ayres about faking dementia. (Oh, no! Certainly not!)

McDougall insists that ayres said that he wanted to go to trial to clear his name. When questioned about staff reports that ayres had said that he didn't want to be restored to competency, because he would be found guilty and have to go to prison, McDougall said that he hadn't heard about any of that. He claims that he did not read THOSE reports, but instead left those to Bentley to read. (So that he wouldn't have to discuss the matter on the stand.) When asked about the opinion that ayres didn't want to be "restored to competency" because he didn't want to go to trial again, McDougall disagreed with the conclusion, and said that it sounded to him like ayres was acting like someone who was tired of being locked up in Napa.

Prosecutor McKowan further hammered on ayres' ability to fake dementia by mentioning that ayres had had several close friends or relatives who had Alzheimer's and therefore would know some of the symptoms very well.

After the afternoon recess, the judge was presented with a binder with all of the reports, and we learned that the defense witnesses have finished, and so the prosecution began calling their witnesses in the afternoon. Dr. Paul Good will be called at some point in the next day or so as well.

First up for the Prosecution was Dr. Shawna Leppert  a Napa Staff Psychologist in the admissions unit. Her job there is evaluation of patients for competency and malingering. She has made more than 150 such evaluations in her time there. She evaluated ayres during the initial month of his stay there, during the period when they actively and aggressively work to "restore" competency if possible.

She said that ayres was unwilling to sit with her for interviews, and declined her proposals to use medications to help restore competency. She reports that at the 28 day evaluation conference with Solveig, Barbara, a staff psychiatrist and a social worker present, when they urged ayres to try some of the programs to help restore competency, he again refused, and at that point asked why he should, that he'd just end up going to prison. Eventually, she got ayres to take the anti-psychotic medication, and said that he was showing some improvement but then after 9 days, he began complaining about side effects, and stopped taking the medication.

Leppert reported that ayres was guarded and defensive, not willing to answer questions, and that he was VERY vocal about his alleged deficits. At one point ayres even told her that he "had a serious lack of capacity to remember anything." (Huh. How about that.)

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.

In another example, Leppert detailed an instance that ayres was playing the board game "Sorry" with another inmate. ayres indicated that he didn't think he'd be able to play, but the game rules were explained to him. He beat the inmate at the game. Later Leppert asked to play with him, and he acted like he wouldn't know how to play, but his game strategy was sound.


The last person to testify for the afternoon was Dr. McIlnay. 
McIlnay is also a forensic doctor, and his specific specialty is also assessment of competency and malingering. He had performed 150 to 200 such evaluations. He states that because of the nature of the institution, there is a fairly high (15% - 20%) instance of people found to be malingering. He also stated however, that the ayres case was presented to him as a "very unlikely to be restored to competence" case.

He stated that he was assigned the case, and that nobody wanted to take the case, as it was likely to be complex and difficult; a whole lot of work. He was told that he needed to produce a report within only a few days, but due to delays from other reports, it took longer than that.

McIlnay reviewed all internal Napa reports as well as all of the reports provided by San Mateo County. He interviewed ayres five times taking about 10 hours to do so. He states that by the third interview he began to suspect malingering due to discrepancies in answers during all of the testing done, and from the reports about ayres' behavior that he was getting from staff. The doctors used a "Global Assessment of Functioning" test at various times, and the inconsistant results were another red flag for McIlnay: Dr. Sutherland tested ayres several times, and he scored 60-65,  then later 40-50 and finally a 30. When Dr. Warnick tested ayres, he scored a 60. Sutherland presented no justification for the scores that were recorded.

McIlnay made no diagnosis of dementia, as the exaggeration was significant enough to cloud any such diagnosis. He also says that ayres is somewhat depressed, but that he doesn't meet ALL of the criteria for a DSM diagnosis of depression.

McIlnay stated that he takes into account the sophistication of the person being evaluated when assessing all components of the person's behavior.

McIlnay also 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 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.


Afternoon Courtroom Notes:
Solveig and Barbara were being very noisy in the back of the courtroom, jabbering like piggies, cell phones buzzing, etc. The Sheriff had to go back to shut them up. While McIlnay was driving the point home about ayres' clear ability to make competent decisions, Barbara got up, stomped out, and threw a cup at the garbage can making a ruckus.

Also at some point someone fell asleep and was snoring, but they woke up just as the sheriff was getting up to tell them to wake the hell up. It was either Fake Blind Hat Guy or the rumply looking reporter dude that was sitting there.


McIlnay testimony continues on Tuesday. Earlier morning proceedings are documented below.




NOON Update:


First up on the stand today was Amanda Gregory who testified in ayres’ previous competency trial.

Amanda has examined ayres 6 or 7 times, for a total of about 25 hours, and has met with McDougall for another 15 hours. Mostly she answered questions with terse yes/no responses. She feels that ayres is incompetent. No surprise there.

The number of hours she has spent with ayres plays into Prosecutor McKowan’s claims that the more time a shrinky-dink spends with a patient, the more sympathetic they are likely to become.

At one point McKowan asked Gregory about her changing the report to indicate that ayres might be malingering, but after the child molester’s attorney challenged McKowan on this point, she realized that she was thinking of Sutherland, who testified on Friday.  (!?)


Also on the stand today was Shyster McDougall, the child molester’s attorney: 

The Shyster testified that he was afraid that he’d be fired because of all of the stuff that he’s legally required to do (which McDougall claims that ayres did not want him to do) because he thinks that ayres is a drooling moron.  Yeah. Because ayres wouldn’t like to have to (continue to) walk free on an incompetence technicality. Whatever the Shyster is sucking down, that’s some pretty high quality shit, and he's trying to share it with the judge…

He talked about Medina vs. California, and about the fact that an attorney is in a unique position to identify when a client is suffering mental deficit. That’s kind of cool actually… attorneys have managed to use bench legislation to turn themselves into medical professionals! I wonder if I could get a lawyer to bench legislate me into a Mars Astronaut - because that would be wicked awesome. 

Anyhow, the meat of the Shyster’s testimony is that ayres tried to pay his Shyster Fee off-schedule a few times, and a few times ayres gave McDougall some lists of doctors that he had already supplied, and that proves that ayres is forgetful. The expert medical professional McDougall didn’t, however, give any opinion about whether or not the stress of possibly dying in prison makes a person more forgetful or not. 

Of note: ayres gave McDougall lists of doctors that he should use to evaluate ayres’ competence as well as lists of pediatricians that McDougall should contact who would testify that it was medically necessary for ayres to give “medical exams.”  Now, a list of local pediatricians who would defend a child molester would be quite an interesting thing to have. Wonder if The Shyster is willing to share some of ayres' suggestions with us?

Court resumes at 1:30pm

Noon TL;DR: Amanda Gregory is still a idiot, and Shyster McDougal was a wittle afwaid that he would be fired by ayres for getting him off on an incompetence technicality.  ayres can produce a list of local pediatricians who would support a child molester.  Prosecutor McKowan posits something that we all know intuitively: that these flakey shrinks are so busy having masturbatory fantasies about the great william ayres and their own shrinky prowess, that they’re unable to see the forest for all the trees -- even when more level-headed folks show them a picture.





william hamilton ayres was arrested on April 5, 2007 on charges relating to his molestation of many young boys while he was alleging to provide psychiatric care to private patients as well as referrals for evaluation from the juvenile court system in San Mateo County. ayres has been delaying his way through the system free from custody until this latest gambit to skirt prosecution by playing demented for the courts. ayres is currently under the conservatorship of his daughter Barbara Ayres of Sacramento, CA

ayres has had significant interaction over the years with local politicians on boards like the "Children and Families First Commission,"  including the DA who was serving when prosecution began Jim Fox and Assemblyman Rich Gordon. In fact, Gordon nominated ayres for a lifetime achievement award for his "Tireless effort to improve the lives of children." ayres has also been vocally supported during his criminal trial by local head-shrinkers like Bart Blinder, Etta Bryant, Mel Blaustein, Harry Coren, Tom Ciesla, Robert Kimmich, Larry Lurie, Maria Lymberis, Richard Shadoan, Captane Thomson, and Harold Wallach.


Saturday, October 27, 2012

ayres Competency Trial D1 - Updates and Press

Yesterday, October 26, 2012 william hamilton ayres was in court for the first day of his latest competency hearing. Detail of this morning's coverage is in the post immediately below this one. This post will briefly detail the afternoon's testimony and press articles.

Dr. Warnick, senior neuropsychologist testified in the afternoon. As she is a defense witness, she obviously has also reported that ayres is demented to some degree. Warnick did not meet with ayres with frequency or regularity, and observers report that she seemed much more objective than the other two who testified earlier in the day -- significantly more objective than the flaky Knoblauch.

Warnick did lots of testing with ayres, and come to the conclusion that while he performs well (even exceptionally well) on most tests, he is suffering mental deficit (Again, in the areas that everyone has been reporting -- the same areas that are most commonly faked by people trying to avoid "malingering" accusations -- the areas that are most difficult for a professional to refute.)

Warnick also stated that ayres is definitely "over-inflating" his memory impairment. When asked by the prosecutor if it was possible that ayres is over-inflating ALL of his impairment, the doctor said that yes, it is possible. (Yet, she stands by the conclusion that she had already drawn: that ayres is suffering deficit in a few areas.)

Warnick had other observations about ayres:

Warnick noted that ayres suffers sleep apnea and thyroid issues that could both contribute or cause the deficits that she is noting. (Earlier reports indicated that ayres was denying treatment for these issues while at Napa -- perhaps we'll see if this holds true later on in the trial...)

Warnick further 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.

Warnick claims that ayres is not feigning dementia (concluding that McIlnay's claim that ayres is malingering is not accurate), and that ayres is over-inflating his memory impairment.

Conclusion for day one: We have a full-on pissing match between doctors at Napa, and it seems like the least flaky of the defense witnesses so far, Dr. Warnick, has done a pretty good job covering her ass.

In the press:

The Mercury News has a blurb up.
Don't bother reading: the guy sat there the whole time, and missed 99% of the significant details.


The San Mateo Daily Journal has an article up (pdf) today as well. Read it.
This is a pretty good article. Durand took her time, and dug a little deeper. Of note, she digs a bit more into some of Knoblauch's testimony (note that the emphasis below is mine):

Under cross-examination, Knoblauch agreed Ayres was consistent in drawing attention to his deficits like memory loss and said he thought he’d be convicted if tried again because society is currently less tolerant of child molestation. 

Knoblauch, who found Ayres sufficiently understood several legal areas required for competency such as plea bargains and listening to his attorney’s advice, concluded he was impaired in “his ability to cope with incarceration pending trial.


Remind me: if I ever get convicted of anything, I need to hire a shrink to say that I'll have a difficult time coping with incarceration, so that they will have some sympathy for me. 

What a fucking waste of oxygen this Knoblauch character is. I assume taxpayer money is being used to pay this asshole... this really has gone too far.


william hamilton ayres was arrested on April 5, 2007 on charges relating to his molestation of many young boys while he was alleging to provide psychiatric care to private patients as well as referrals for evaluation from the juvenile court system in San Mateo County. ayres has been delaying his way through the system free from custody until this latest gambit to skirt prosecution by playing demented for the courts. ayres is currently under the conservatorship of his daughter Barbara Ayres of Sacramento, CA

ayres has had significant interaction over the years with local politicians on boards like the "Children and Families First Commission,"  including the DA who was serving when prosecution began Jim Fox and Assemblyman Rich Gordon. In fact, Gordon nominated ayres for a lifetime achievement award for his "Tireless effort to improve the lives of children." ayres has also been vocally supported during his criminal trial by local head-shrinkers like Bart Blinder, Etta Bryant, Mel Blaustein, Harry Coren, Tom Ciesla, Robert Kimmich, Larry Lurie, Maria Lymberis, Richard Shadoan, Captane Thomson, and Harold Wallach.


Friday, October 26, 2012

ayres Competency Hearing Redux (again)

TODAY, October 26, 2012 william hamilton ayres was in court for his latest competency hearing. This is to be a hearing or trial in front of Judge Grandsaert, and was expected to last about two weeks. There is no jury, only presentation of reports and expert witnesses in front of the judge. The pervert child molester's defense attorney has stated that he will be taking the stand as well, to testify about his observations and alleged statements attributed to him in the Napa State hospital reports.

Recap of this morning's events:


These notes are an as-told-to, and will therefore be somewhat brief (to keep the observer from killing me with my incessant questions and clarifications.)

In the Courtroom: 

The usual group of ayres-turbators are there:  Barbara “Stand still and look stupid” Ayres, the Slattern, Fake Blind Hat Guy, and Granola Hippy-Dippy-Shit Chick.  Robert is still back in Chicago directing bad plays or something. (Hey, pipe down, all you Sonepar USA freaks!)

The child molester has two lawyers representing him: Jonathan McDougall, ayres' regular Shyster, as well as Josh Bentley, who is doing most of the questioning so far. McDougall will be taking the stand, and so Bentley was added to the team to "deepen the scum."

General Background for this morning’s commentary:

Activities at this morning’s hearing, or trial, in front of Judge Grandsaert (not a jury trial) revolved around two of the defense’s witnesses, both of them doctors from Napa State Hospital. Both make statements that ayres is NOT competent to defend himself at trial.

According to discussion in the courtroom this morning, Napa State is in the process of re-vamping some of the policy and procedure relating to the way evaluations are done and reported. Apparently there is some feeling that clinical evaluators can become closer and more sympathetic to the people they are evaluating, and in order to maintain some objectivity, clinical and forensic evaluators are being more compartmentalized with forensic evaluators having less regular contact with patients to help maintain a subjective view.

Reports coming from the institution now are reviewed by more than one doctor (a committee?) rather than just being released directly from any one doctor to anyone outside the institution as apparently happened in the past.   These changes are not due to the ayres situation, but they DO come into play in today’s testimony.

As the hearing started, the prosecutor asked if any member of the Attorney General’s office was present, and then mentioned an executive order to seal the personnel records of the Napa Staff.


On the Stand Today:

The two staff clinical psychologists on the stand today were Dr. Knoblauch and Dr. Sutherland. They were questioned by both the defense shyster and Prosecutor McKowan.

Before the testimony started, Knoblauch approached ayres family  in a friendly manner, seemingly apologetic in his statement to them that he didn't think that "it was going to take all this time.” (Bias much?)

Knoblauch apparently seemed very convinced that ayres is not competent to defend himself, and he apparently felt  that ayres should not have been sent to Napa State to begin with.  Knoblauch met with ayres every day for the time that he was there, sometimes several times a day, but it was noted that he did not take DAILY notes, as (I guess) is customarily the case, instead his notes are sporadic and he filed only a few official reports / monthly reports.

Knoblauch was asked if he knew ayres prior to his incarceration at Napa, and he stated that he did not, but knew someone in San Mateo who knew him fairly well.

Knoblauch feels that ayres has trouble organizing his thoughts. He didn't at any time feel that ayres was faking his dementia.  Reports filed indicate that ayres is mentally performing well in most areas, including his capacity to challenge witnesses. His “capacity to disclose pertinent info is impaired.”  I guess that explains why he can’t just admit that he likes to molest little boys.  

Significantly, there was no change in impairment levels on the second such report, taken at a later time.

Questioning with Knoblauch also touched on the fact that in the Admissions Unit, they are more aggressive with the patients, trying to get them to “health” so that they can testify, and ayres was apparently very belligerent when he was there, but the intensity of his resistance dropped off when he was moved to Knoblauch’s unit.

Knoblauch apparently seemed to bristle at the mention of Dr. McIlnay. (The director, and forensic  psychiatrist.)

New defense attorney Bentley mentioned to the prosecution that “At least Dr. Knoblauch is legitimate...” apparently in reference to Dr. McIlnay.

Courtroom observers report that Knoblauch seemed a bit dull-witted.

Sutherland also contends that ayres is not competent, and apparently wrote a letter reporting this incompetence, but the letter didn't go out, because of the new vetting regulations.

The Director, Forensic Shrink Dr. McIlnay asked for a re-evaluation and commented about findings that ayres was malingering.  utherland says that that didn't change his evaluation that ayres was incompetent, and that he also didn’t think that ayres was malingering, but that he DID change the report to talk about malingering, but not in the sense that malingering is traditionally meant – Sutherland said this about ayres: “ayres is in a very unique situation, he is a psychiatrist of great skill and reputation.”  He feels that ayres wants people to respect him as they once did, and that because his mind is going, ayres perceives that people respect him less (I guess most of his colleagues don’t respect ayres less because he likes to molest young boys then? – shrinks are very troubling….) and therefore he is “faking good.” ...So he’s malingering, but only because he wants people to not treat him like he’s becoming a drooling moron (allegedly).

TL;DR: Napa State Doctors are in the middle of a pissing match, and the touchy-feely shrinks who virtually live with the patients won’t ever see eye-to-eye with the objective forensic shrinks. Testimony from these middling ass-clowns will be a wash.


What did we learn:

Prosecution DID make some very interesting headway:

Discussed today was the fact that there is NO record of any kinds of medical complaints or neurological tests until AFTER the hung jury, and THEN medical records start showing up. (We already knew this, but it’s good to have it put succinctly, I think.)

Malingering:
There apparently is a litany of information available on the internets about how to pass malingering tests, primarily centering around language processing and memory, which are the ONLY symptoms that ayres keeps “failing.”

The doctors complained that ayres would have had little chance to access the internet from Napa, the prosecution pointed out that ayres has been out on bail for years. (DUH. – I swear, I’d have a freaking aneurysm if I ever heard of a shrink that had a lick of common sense – talk about an un-grounded profession...)

ayres was participating in recreational activities, but at NO time did he ever participate in any treatment activities; on multiple occasions ayres made reference to not wanting to be found guilty, etc, as we've mentioned before.

Finally this little nugget: 
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.

So much for diminished capacity. 

There are articles in the press as well, I’ll provide a link if any of them have interesting info. (Where's the beef?)




william hamilton ayres was arrested on April 5, 2007 on charges relating to his molestation of many young boys while he was alleging to provide psychiatric care to private patients as well as referrals for evaluation from the juvenile court system in San Mateo County. ayres has been delaying his way through the system free from custody until this latest gambit to skirt prosecution by playing demented for the courts. ayres is currently under the conservatorship of his daughter Barbara Ayres of Sacramento, CA

ayres has had significant interaction over the years with local politicians on boards like the "Children and Families First Commission,"  including the DA who was serving when prosecution began Jim Fox and Assemblyman Rich Gordon. In fact, Gordon nominated ayres for a lifetime achievement award for his "Tireless effort to improve the lives of children." ayres has also been vocally supported during his criminal trial by local head-shrinkers like Bart Blinder, Etta Bryant, Mel Blaustein, Harry Coren, Tom Ciesla, Robert Kimmich, Larry Lurie, Maria Lymberis, Richard Shadoan, Captane Thomson, and Harold Wallach.


Thursday, October 25, 2012

Reminder: Competency Hearing Tomorrow

REMINDER: TODAY, October 26, 2012 at 9am at the Hall of Justice and Records (400 County Center,Redwood City, CA) william hamilton ayres is slated to start his competency trial. This is to be a hearing or trial in front of Judge Grandsaert, and is expected to last about two weeks. There is no jury, only presentation of reports and expert witnesses in front of the judge. The pervert child molester's defense attorney has stated that he will be taking the stand as well, to testify about his observations and alleged statements attributed to him in the Napa State hospital reports.

If the judge finds ayres to be competent after the hearing, then charges can be reinstated, bail arguments can then be heard, and the prosecution can then attempt criminal re-trial if they so desire. If the judge finds ayres to be incompetent, it's not entirely clear what the next steps will be, but guesses have ranged from return to Napa, to release on his own recognizance , or into the medical conservatorship of his daughter Barbara Ayres of Sacramento, CA. I think it's unlikely that ayres will return to Napa State, as they've already stated that he is competent, and is malingering; lying about his incompetence in order to avoid criminal prosecution.

william hamilton ayres was arrested on April 5, 2007 on charges relating to his molestation of many young boys while he was alleging to provide psychiatric care to private patients as well as referrals for evaluation from the juvenile court system in San Mateo County. ayres has been delaying his way through the system free from custody until this latest gambit to skirt prosecution by playing demented for the courts. ayres has had significant interaction over the years with local politicians on boards like the "Children and Families First Commission,"  including the DA who was serving when prosecution began Jim Fox and Assemblyman Rich Gordon. In fact, Gordon nominated ayres for a lifetime achievement award for his "Tireless effort to improve the lives of children." ayres has also been vocally supported during his criminal trial by local head-shrinkers like Bart Blinder, Etta Bryant, Mel Blaustein, Harry Coren, Tom Ciesla, Robert Kimmich, Larry Lurie, Maria Lymberis, Richard Shadoan, Captane Thomson, and Harold Wallach.


Saturday, October 20, 2012

Surrendered License: Suspicious Timing

An interestingly suspicious development:

We reported earlier that there was a "complaint" filed by the Executive Director of the Medical Board of California, and a decision has now been made: As of October 24, 2012, william hamilton ayres' medical license will be revoked, and he has been ordered to surrender said license, and return his shingle and pocket "I'm a doctor" card. (Note that ayres did not renew his license after 2008.)

The good: If anyone refers to "doctor" ayres, you can now feel free to correct them disdainfully, and you should always make it a point to do so -- "What has gone so horribly awry with the neurons firing off in that pinhead of yours, that you insist on calling child molesting liar ayres a doctor?" will do nicely in a pinch.

The not-so-good: The timing of this is more than just a little bit suspicious. Here is some language from the Surrender and Revocation Decision (Note that the "Respondent" is the child molester ayres, and his "Counsel" is Shyster McDougall):

"Respondent has carefully read, fully discussed with counsel, and understands the charges and allegations [...]"

"Respondent is fully aware of his legal rights in this matter, including the right to a hearing on the charges[...] the right to confront and cross-examine the witnesses against him[...]"

"Respondent voluntarily, knowingly and intelligently waives and gives up each and every right set forth above."

Culpability: Respondent admits the truth of each and every charge and allegation in Accusation No. 03-2007-182894, agrees that cause exists for discipline under section 822 of the Business and Professions Code[...]


You might look at the accusation number and assume that because of the "2007" date that this accusation was based on the criminal charges brought against him, and that he was admitting to molesting young boys. Unfortunately this is not so: Section 822, which ayres is "admitting truthfully" relates to dementia:

If a licensing agency determines that its licentiate's ability to practice his or her profession safely is impared because the licentiate is mentally ill, or physically ill affecting competency, the licensing agency may take action[...]


How convenient that only days before child molester ayres is to appear before judge Grandsaert to contest Napa State Hospital's finding that not only is ayres NOT suffering dementia, but that he has been lying to doctors and the court about dementia to avoid prosecution, he will have had his licensed revoked by the State of California for dementia. AND the record will show that he (with the blessing of his Conservator, daughter Barbara Ayres, and his Shyster attorney) surrendered his license without contest - no doubt at the advice of his attorney. There seems to be no end to the games that the Shyster is willing to play to manipulate the courts.




Surely the timing is no coincidence.

Original Medical Board of California documents. (Our pdf copy)

By the way: Where the fuck is the God Damned press? I guess Wagstaffe didn't prepare a brief for them in the matter, so it's not news...


Friday, October 19, 2012

Reminder: Upcoming Competency Trial

REMINDER: On October 26, 2012 at 9am at the Hall of Justice and Records (400 County Center,Redwood City, CA) william hamilton ayres is slated to start his competency trial. This is to be a hearing or trial in front of Judge Grandsaert, and is expected to last about two weeks. There is no jury, only presentation of reports and expert witnesses in front of the judge. The pervert child molester's defense attorney has stated that he will be taking the stand as well, to testify about his observations and alleged statements attributed to him in the Napa State hospital reports.

If the judge finds ayres to be competent after the hearing, then charges can be reinstated, bail arguments can then be heard, and the prosecution can then attempt criminal re-trial if they so desire. If the judge finds ayres to be incompetent, it's not entirely clear what the next steps will be, but guesses have ranged from return to Napa, to release on his own recognizance , or into the medical conservatorship of his daughter Barbara Ayres of Sacramento, CA. I think it's unlikely that ayres will return to Napa State, as they've already stated that he is competent, and is malingering; lying about his incompetence in order to avoid criminal prosecution.

As of October 18th, we have not heard of any further delay to the proceedings. It's probably less likely that there will be delays, as this time around, ayres is locked up in jail waiting for his attorney to finish his current caseload before the competency issue can be heard.

william hamilton ayres was arrested on April 5, 2007 on charges relating to his molestation of many young boys while he was alleging to provide psychiatric care to private patients as well as referrals for evaluation from the juvenile court system in San Mateo County. ayres has been delaying his way through the system free from custody until this latest gambit to skirt prosecution by playing demented for the courts. ayres has had significant interaction over the years with local politicians on boards like the "Children and Families First Commission,"  including the DA who was serving when prosecution began Jim Fox and Assemblyman Rich Gordon. In fact, Gordon nominated ayres for a lifetime achievement award for his "Tireless effort to improve the lives of children." ayres has also been vocally supported during his criminal trial by local head-shrinkers like Bart Blinder, Etta Bryant, Mel Blaustein, Harry Coren, Tom Ciesla, Robert Kimmich, Larry Lurie, Maria Lymberis, Richard Shadoan, Captane Thomson, and Harold Wallach.