In October 2005, five months after Thomas Simich Jr. was charged with fatally shooting his sister and brother-in-law, psychiatrist Christine Martone took the stand in a Beaver County courtroom and called him unfit for trial.
According to a transcript, Dr. Martone said Mr. Simich had paranoid schizophrenia, was "preoccupied with Russia and Germany," believed he was the Russian czar and a polygamist, and claimed to receive messages from a cassette tape in his head.
President Judge John McBride asked whether psychiatric treatment one day might render Mr. Simich well enough to stand trial, and Dr. Martone replied, "I can't make any promises."
Nine years later, the case remains in limbo, and Mr. Simich, now 54, is still in treatment, one of hundreds of Pennsylvanians at any given time with mental illnesses so severe that their criminal cases involve sometimes-lengthy detours to state hospitals.
As of Jan. 31, 24.3 percent of those in the seven state hospitals -- 380 of 1,562 people -- arrived there via the justice system.
Mr. Simich was one of 30 receiving treatment aimed at making them competent for trial. Another 335 were in care after being adjudicated "guilty but mentally ill," and 15 were hospitalized after being adjudicated "not guilty by reason of insanity," according to the state Department of Public Welfare, which did not provide details about individual cases.
"Competency" refers to a defendant's ability to understand charges and help an attorney prepare a defense. "Guilty but mentally ill" means the defendant had a diminished understanding of his or her conduct -- but was not legally insane -- when the criminal activity occurred. "Not guilty by reason of insanity" means that defendants were so ill that they didn't know what they were doing or understand that it was wrong.
While police, prosecutors, psychiatrists and mental health advocates contend that the closure of state hospitals around the country has shunted untold numbers of mentally ill people into jails and prisons, the Simich case illustrates a different dynamic: Many of the remaining state hospital beds are occupied not by general psychiatric patients but people ordered into care by criminal court judges, who sometimes must monitor their treatment for years.
E. Fuller Torrey, a nationally known psychiatrist and founder of the Virginia-based Treatment Advocacy Center, said he was surprised that more of Pennsylvania's beds aren't used by people with justice-system involvement. "If it is only a quarter, it is relatively low compared with other states," he said.
Not enough beds?
Some psychiatrists and others claim that deinstitutionalization, including the December 2008 closure of Mayview State Hospital in South Fayette, has gone too far and that state hospital beds are a necessary resource for the persistently and seriously mentally ill. Richard Kuppelweiser, former Mayview CEO, said general psychiatric patients sometimes had to wait longer for an admission because a person ordered into care by a criminal court judge jumped the line.
Of the 380 justice-system patients in Pennsylvania's state hospitals at the end of January, 221 were in "forensic" units with special restrictions. The rest were housed in general or young-offender units, according to DPW. It costs the state as much as $923 a day to care for a person in a forensic unit.
Other justice-system patients have been in treatment longer than Mr. Simich, who, Beaver County District Attorney Anthony Berosh said, is in the forensic unit at Torrance State Hospital in Westmoreland County. James Derbish, now 46, has been in state hospitals since he was declared incompetent to stand trial for the 1999 murder of his 78-year-old Knoxville grandmother.
Peter Savich, now 59, has been in treatment since 1998, when he was declared incompetent to stand trial on charges of setting a fatal house fire in Washington County.
"His prognosis remains poor," Daleep Rathore, a psychiatrist, and Marcia Hepner, chief forensic executive at Torrance, said in a 2012 report. "He is showing a high risk of recidivism."
By pre-empting a trial or prison sentence, a defendant's extended hospitalization can frustrate victims and their families. "I really feel he got away with murder. ... He got off good," Virginia Bergman, 77, of Palm Bay, Fla., said of Mr. Simich.
Her son, Steven, was married to Mr. Simich's sister, Marilyn. The couple, 46 and 43, respectively, were killed May 2, 2005, at the Simich family home in Freedom. Mr. Simich reportedly confessed to the murders, which Mrs. Bergman said she believes were triggered at least partly by plans to relocate her son's in-laws.
After the murders, Mrs. Bergman said, she helped to settle the Florida couple's estate and look after their four teenage and adult children. "I did not have to be a mother but I was, like, over them," she said, noting the children, one of whom was given the tragic news after being awakened at boarding school, still struggle with the loss of their parents.
Judging who's competent
Competency exams -- the first step in determining whether a person is fit for trial or eligible for an insanity defense -- have become a justice-system staple. Nationwide, about 60,000 are performed each year, with about 12,000 defendants ruled incompetent, according to figures posted by the National Judicial College in Reno, Nev.
But those numbers may be low, said Karen Bailey, director of forensic services for Georgia's Department of Behavioral Health and Development Disabilities, who helped the judicial college develop a model process for managing competency cases.
In Allegheny County last year, 1,635 defendants were referred for competency evaluations, said Dr. Martone, who is chief psychiatrist for the Allegheny County Behavioral Assessment Unit and consults on cases in other counties. Of those, 135 were found incompetent, at least for brief periods.
"More and more are not getting restored" to competency, she said.
At a judge's discretion, a person adjudicated "guilty but mentally ill" may be sent to prison or a hospital. The hospital stay could last for the duration of the person's sentence -- or longer if authorities believe additional treatment is warranted and pursue a civil commitment after the sentence expires, said Allegheny County Judge John Zottola, who has worked for improved coordination of the justice and mental health systems.
Those adjudicated "not guilty by reason of insanity" have to remain in care until doctors and officials sign off on their recovery. In York County, for example, James Callahan, now 40, was found not guilty by reason of insanity in the 2002 bow-and-arrow death of his brother, Michael. He remains in a state hospital, Kyle King, spokesman for the York district attorney's office, said.
For those receiving treatment toward competency, hospital stays cannot exceed the sentencing guidelines for their crimes, though authorities can pursue a civil commitment to keep a person in treatment longer, Judge Zottola said.
According to December data from DPW, 181 patients in forensic units had been there fewer than two years, while 40 had been there longer than two years. The majority of patients in the civil units had been there longer than two years.
Mr. Kuppelweiser said some patients under court supervision improve enough to be moved to community programs.
Troy Hill, now 25, spent more than four years on the forensic and civil sides of Torrance after he was charged in 2007 with fatally stabbing one half-brother and wounding another. In 2011, a judge agreed to move Mr. Hill to a community program after Lisa Middleman, homicide counsel in the Allegheny County public defender's office, cited his medical progress and cooperative behavior.
Patrick Kavanaugh, charged in 1993 with beating his mother to death with a staircase baluster at the family's Bellevue home, spent about 15 years at Mayview before a judge agreed to transfer him to a community treatment program.
Mr. Kavanaugh, 40, has never been declared competent for trial. He is scheduled for a status hearing Wednesday before President Judge Jeffrey Manning.
"He's doing all right where he's at," said Mr. Kavanaugh's aunt, Patty Wivell, 78, of Ambridge. She said she and her husband, Ed, continue to visit Mr. Kavanaugh, 40, regularly because she believes her sister would want that. She said he's otherwise had few visitors since the crime, "which was really a shock to us."
Joe Smydo: firstname.lastname@example.org or 412-263-1548.