AUGUSTA — A Maine man who was found not criminally responsible for stabbing his neighbor will soon be discharged from state custody after 12 years of psychiatric treatment that doctors say couldn’t fully address his mental health problems.

Superior Court Justice Daniel Billings presides during a hearing at West Bath District Court in July 2023. Brianna Soukup/Staff Photographer

Superior Court Justice Daniel Billings on Friday ordered 50-year-old Malcolm Moore, who is currently being held at a controversial psychiatric center in South Carolina, be returned to Maine and released from custody, agreeing with doctors who say that Moore suffers from a personality disorder that is best treated outside of the in-patient system.

Billings noted that it’s a rare case.

“Someone moving directly from the hospital to discharge is unusual,” Billings said during Friday’s hearing in Kennebec County Superior Court. He added that it’s particularly unusual, given that two years ago Moore was moved to Columbia Regional Care Center because he was violent with staff at Maine’s Riverview Psychiatric Center.

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

Davis said that Moore has injured and assaulted multiple employees and patients over the years, behavior that has taken a toll on staff and disrupted other residents’ treatment, including those who also are there by court order.

Moore has been in the custody of the Maine Department of Health and Human Services following the non-fatal stabbing in 2012. He was receiving treatment at Riverview before his transfer.

Yet, Riverview doctors agreed on Friday with Moore’s court-appointed attorney on Friday that he should be discharged from their care and released into the community.

“I don’t want the court to be under the impression that we’re letting out this wild, dangerous animal,” said Dr. Lorraine Zamudio, director of psychology at Riverview.

She acknowledged Moore’s attacks on staff and other patients but said she believes he’ll be less violent in the community, with the option to walk away from stressors that he can’t escape in Riverview or Columbia. She also suggested he’s grown more mature.

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

But that’s not what Moore had to prove – he only had to show that his mental state has changed and that any risks he posed to the community as a result of his mental illness were addressed.

Billings ultimately agreed, noting, however, that “the court is unable to find that there’s not a substantial risk here.”

“I strongly urge you to engage with social work at the hospital to get all this in place,” Billings told Moore, who teared up at the judge’s decision. He silently watched Friday’s more than five-hour hearing over Zoom from the South Carolina facility.

CLINICIANS TESTIFY

Some of the four Riverview psychiatrists who have treated Moore told Billings that they question whether Moore was ever really violent as a result of schizophrenia, which is what a judge determined in 2012 when he was found not criminally responsible and committed to Riverview’s care.

Moore still says he hears voices and experiences paranoia, Director of State Forensic Services Sarah Miller testified Friday, but Moore recently told her his voices are benign and he’s learned to live with them.

Dr. Carolyn Criss said Moore was seen by four psychiatrists and two psychologists after he was arrested for the stabbing, none of whom agreed with a schizophrenia diagnosis that was later reported in court records.

“That’s not something that the hospital endorsed,” she said.

Dr. Mary Tibbetts, a psychiatrist who treated Moore in 2018, said auditory hallucinations and paranoia aren’t exclusive to schizophrenia, and that when a person says they “hear voices” it can have different meanings.

Criss, Tibbetts and two other clinicians told the judge that they believe his most concerning behavior – including multiple assaults on staff – seemed to stem more from a personality disorder than what they consider a “major mental illness.”

The clinicians suggested that he has borderline personality disorder, which is harder to treat in an in-patient setting than a psychotic illness, like schizophrenia.

Davis, who authored a report last month endorsing Moore’s discharge, believes being at Riverview might make Moore worse and that Moore would benefit from a treatment where he has more autonomy.

Davis said any schizophrenia-related symptoms that Moore reported in 2012 are stable now, and there’s not much else they can do for his personality disorders.

He said that Riverview tried an assortment of methods to help Moore over the last 12 years, including medication, consulting psychological experts, individual therapy and group therapy.

Much of Moore’s treatment has come with “considerable input” from Moore himself, including treatment plans that were offered while he was in South Carolina.

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

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

STILL A DANGER

Davis said Moore’s case is “atypical” and “complex.” Moore’s charge was serious, he added, “but not nearly as serious as many patients” who have been discharged sooner.

An attorney for the state argued against Moore’s release, saying that after 12 years of being institutionalized there’s no way of knowing how successful Moore will be without oversight.

She pointed to a fight Moore got into with another patient at Columbia Regional Care Center just a few weeks ago.

Billings said it was highly unusual for Riverview to endorse discharging a patient like Moore, who has been found not criminally responsible, straight from the hospital with no supervision.

Davis said it was his first time making this kind of request since he started in 2019. The hospital is helping Moore find housing and reconnect with public benefits, like Medicare and Social Security, as well as outpatient treatment if he wants it.

Moore will have to be transferred from Columbia Regional Care back to Maine, and he’ll spend a brief period at Riverview before he’s officially released.

Moore’s lawyer, Hank Hainke, said after the hearing that this is the best outcome for his client.

Hainke has been especially outspoken about Moore’s placement in South Carolina, as well as that of other Maine patients. He said Moore has not been able to access in South Carolina the kind of therapy-based treatment that would truly address his personality disorder.

Hainke said Moore was entitled to treatment, “unfortunately, he has an illness that is not treatable by our system.”

“The hospital, I don’t think there’s any doubt they’ve been trying to get this violent behavior, this anti-social behavior, under control. And they haven’t been able to,” he said.