Filed
`
`D.C. Superior Court
`04/12/2024 15:37PM
`Clerk of the Court
`
`
` DBH‘
`
`« DEPARTMENT OFage
`she
`
`WSS senaviowa. HEALTH
`
`Mark J. Chastang, MPA, MBA, FACHE
`ChiefExecutive Officer
`D.C. Department ofBehavioral Health
`Saint Elizabeths Hospital
`
`April 12, 2024
`
`Our Reference:
`Your Reference:
`
`DBH/SEH/GD/SK/vm
`Criminal Case Numbers
`
`Report By:
`
`Judge Fisher:
`
`Graham Danzer, Psy.D.
`Shilpa Krishnan, Ph. D.
`
`Sade Barnes (#924889)
`2019 CMD 006540; 2019 CMD 006881;
`2019 CMD 009792; 2019 CMD 012633;
`2024 CMD 001018
`PDID#: 528135
`
`Wewishto bring your attention to the case of Ms. Sade Barnes (DOB: October 12, 1987). She
`was admitted to Saint Elizabeths Hospital (SEH) as Mentally Incompetent underthe provisions of
`Title 24, Section 531.05(a)(2) of the D.C. Code. This report is intendedto establish the evidentiary
`basis for the current opinion that she remains incompetent to proceed, restorable in the future, and
`in need of ongoing hospitalization to restore her competency.
`
`though was consistently
`she was initially ordered to outpatient restoration,
`In summary,
`noncompliant with The Outpatient Competency Restoration Program (OCRP), and did not attend
`most scheduled evaluations. She was then ordered for inpatient restoration (March 14, 2024). She
`was then re-admitted to SEH (March 21, 2024), as her third forensic admission to this facility.
`Fuller details of her earlier, competency-related history will be summarizedlater in this report.
`
`SOURCES OF INFORMATION:
`
`e
`e
`
`Interview with Ms. Barnes conducted on April 9, 2024, which lasted about 45 minutes.
`Superior Court of the District of Columbia - Criminal Division:
`o Orders for Preliminary Screening to Determine Defendant’s Competency (March
`15, 2022; February 7, 2024).
`o Orders finding defendant Mentally Incompetent and ordering outpatient (February
`13, 2024) and inpatient competency restoration (dated March 14, 2024).
`
`

`

`Barnes, Sade
`
`The Clerk, Criminal Division, Special Proceedings
`The Superior Court of the District of Columbia
`
`2
`
`o Arrest reports related to charges now in question (May 11 and 19, 2019; July 24,
`2019; February 1, 2024) and associated Information (May 13 and 20, 2019; July
`25, 2019; October 2, 2019; February 2, 2024).
`e DC Department of Behavioral Health competency screening and evaluation reports (May
`6, 2021; March 31, 2022; May 22, 2022: June 23, 2022; July 28, 2022; August 25, 2022:
`October 3, 2022; June 20 and 22, 2023; August 1, 2023; March 4, 2024).
`e Review of medical/psychiatric records from:
`o The Central Detention Facility (CDF).
`o Saint Elizabeths Hospital (SEH).
`e Consulted with defense counsel, Kevin Robertson, over the phone (for approximately 15
`minutes; on April 10, 2024).
`
`WARNINGSON LIMITS OF CONFIDENTIALITY/PRIVILEGE:
`
`On April 9, 2024, I, Graham Danzer, Psy.D., Licensed Clinical/Forensic Psychologist evaluated
`Ms. Barnes
`for
`the
`purpose
`of
`determining
`her
`competency
`to
`stand
`trial.
`Also present in the evaluation was Shilpa Krishnan, Ph. D., Deputy Director, Forensic Services
`Division. Prior to the interview, I informed her of the nature and purpose of the evaluation. She
`was made aware that any information she shared would not be confidential, could be
`communicated to the Court, and could influence a determination of her competency. Ms. Barnes
`expressed a rudimentary, though marginally adequate understanding of these limits (1.e., she
`showed some difficulty understanding that defense counsel, the state attorney, and The Judge
`would receive copies of this report, though she answered “no” when asked whether the evaluation
`wasconfidential). She agreed to participate in the evaluation.
`
`RELEVANT HISTORY:
`
`(2016-2018): Suggestive of a relatively positive
`Remote Competency Restoration-Related History
`prognosis for restoration, Ms. Barnes twice appeared restored to competencyafter relatively short
`hospitalization and treatment episodes. She was at SEH from September 14, 2016, to October 13,
`2016, and again from October 9, 2018, to November9, 2018 (about one month each). In the 2016
`admission, she was diagnosedto the effect of Unspecified Bipolar and Other Related Disorder. In
`the 2018 admission, she was diagnosed to the effect of Unspecified Schizophrenia Spectrum and
`Other Psychotic Disorder. During both SEH admissions, she wasprescribed oral and injectable
`regimens of Haldol
`(an antipsychotic). She appeared positively responsive despite only
`intermittent compliance. Consistent with records indicating apparent benefit from Haldol, an SEH
`psychiatrist note indicated, “she says she benefited from Haldol most, ‘Haldol keeps me calm."
`
`ay 2019-January 2024): Following Ms.
`Subsequent Competency Restoration-Related Histor
`Barnes’ first of arrests now in question (May 13, 2019), there were initial efforts to enroll her in
`mental health treatment (July 8, 2019; November 20, 2019). This was followed by recurring reports
`of noncompliance, repeated failures to appear in Court, and bench warrants issued (July 24, 2019;
`August 8, 2019; December3 and 16, 2019). This was followed bya relatively prolonged period of
`whatappeared to be improved compliance (through December 16, 2019, to December9, 2021).
`
`

`

`Barnes, Sade
`
`The Clerk, Criminal Division, Special Proceedings
`The Superior Court of the District of Columbia
`
`3
`
`The Court ordered an initial competency screening (March 15, 2022). Ms. Barnes wasinitially
`screened by Elizabeth Teegarden, Ph.D. (report dated March 31, 2022). Dr. Teegarden opined Ms.
`Barnes was incompetent primarily due to thought disorganization and cognitive impairment. A full
`evaluation of competency was recommended. Lia N. Rohlehr, Ph.D., ABPP, subsequently
`authored a report and addendum (dated May 6 and 22, 2022). In both reports, Dr. Rohlehr opined
`Ms. Barnes incompetent primarily due to impaired rational understanding. Ms. Barnes did not
`appear to meetcriteria for inpatient hospitalization and restoration (at that time). The Court then
`issued an order for Outpatient Competency Restoration (May 27, 2022). There were eight
`subsequent DBH-restoration progress reports (June 23, 2022; July 28, 2022; August 25, 2022;
`October 3, 2022; June 22, 2023; August 1, 2023; January 12, 2024). These eight reports
`collectively indicated Ms. Barnes had been makinglittle-to-no progress towards competency. Lack
`of progress appeared primarily due to non-attendance in OCRP and with scheduled evaluations.
`
`Recent Competency _Restoration-Related History _(February-March_ 2024): Ms. Barnes was
`initially determined Mentally Incompetent and ordered to outpatient restoration (February 13,
`2024). Melanie Bailey, Psy.D. authored the most recent DBH report (dated March 4, 2024). Dr.
`Bailey reported that an opinion on Ms. Barnes’ competency could not be offered because Ms.
`Barnes did not attend the scheduled evaluation. Dr. Bailey raised the possibility that inpatient
`restoration may be necessary to restore her competency. Around which time, and after her most
`recent of arrests now in question, defense counsel questioned Ms. Barnes’ competency onthe basis
`of “odd or bizarre behavior or manifestation of a chronic mental disorder,” (as noted in a
`preliminary screening order dated February 7, 2024). Also, aroundthis time,jail records indicated
`Ms. Barnes had shownsigns of severe mental illness (e.g., paranoia, non-reality-based thinking,
`poor reality testing, significant mood lability/mood swings). Due to further noncompliance,
`including not attending the evaluation with Dr. Bailey, she was returned to jail and ordered for
`inpatient restoration (March 14, 2024). She wasthen (re)admitted to SEH on March 21, 2024.
`
`MENTAL STATUS/CURRENT LEVEL OF FUNCTIONING:
`
`Diagnosis and Treatment: Ms. Barnes is currently diagnosed by her SEH psychiatric provider to
`the effect of Unspecified Schizophrenia Spectrum and Other Psychotic Disorder. She is being
`treated with an intramuscular/injectable psychotropic medication regimen of Haldol(i.e., the same
`antipsychotic that appeared to assist with restoration at SEH in 2016 and 2018). Ms. Barnesalso
`receives a daily oral regimen of Benadryl (to assist with sleep and antipsychotic side effects).
`
`Mental Status: Ms. Barnes met with the undersigned on April 9, 2024. Sheinitially presented as
`pleasant and cooperative. However, her mood and facial expressions ranged widely and wereat
`times inappropriate to the subject of inquiry (i.e., labile mood; inappropriate affect). At other times,
`she showed signs of mild agitation and probable paranoia. During a formal mental status
`examination, she showedfuller awareness of her surroundings andsituation (i.e., appeared fully
`oriented). On mental status examination tasks of increasing difficulty, her performance suggested
`impaired attention, concentration, and reasoning. Her motor movements were within normal limits,
`though her memory-related capacities and her hygiene were marginal.
`
`

`

`Barnes, Sade
`
`The Clerk, Criminal Division, Special Proceedings
`The Superior Court of the District of Columbia
`
`4
`
`Ms. Barnes’ responses to simpler, lower stress questions were most often logical, relevant, and
`organized. In response to higher stress and more complicated questions, she frequently made
`irrational, delusional, nonsensical, incomprehensible, and irrelevant statements. Her expressed
`thinking was frequently circumstantial and tangential. Notably, thought disorganization appeared
`more pronounced, persisting, and severe as the interview wenton.
`
`In addition, Ms. Barnes’ insight and judgment appeared questionable. She reported having a
`mental disorder and needing treatment. However, she has a longer standing history of being
`noncompliant with treatment and psychiatrically decompensated in the community (which she
`appeared to minimize). She repeatedly voiced strong motivation to expedite her discharge from
`SEH and appeared motivated to answer questions in a manner that would appear to superficially
`support this aim (i.e., desirable answers, positive impression management). Comparably, she
`initially presented as pleasant and deferential, though becameincreasingly irritable and paranoid
`as the interview went on, especially when she was presented with records and information that
`were suggestive of mental illness and a need for treatment.
`
`SEH Staff Notes: Upon SEH(re)admission, Ms. Barnes presented as cooperative, thoughirritable,
`apparently responding to internal stimulus, with indications of low insight into mental illness and
`need for treatment, and makingbizarre, delusional, and irrelevant statements. Overthe last (about)
`month of hospitalization, staff notes indicated recurring periods when she presented with poor
`hygiene, and further episodes ofirritability, hostility, paranoia, and internal preoccupation. She
`frequently made delusional statements (at times with bizarre, paranoid, grandiose, and sexualized
`themes). There were also reports of disorganized, bizarre, impulsive, and threatening behavior. An
`elopement attempt was documented (March 21, 2024). Staff notes suggest marginal psychiatric
`and behavioral improvementoverthe last (about) week, most likely due to improved psychotropic
`medication compliance. Ms. Barnes has also presented to her unit psychologist as eager to meet
`and participatory in restoration-focused treatment.
`
`ABILITIES RELEVANT TO COMPETENCY TO PROCEED:
`
`Factual Understanding of the Proceedings: During the current interview, Ms. Barnes showedshe
`most likely has adequate factual understanding of the proceedings against her. During legally-
`related inquiry, she showed working knowledge of the roles and functions of the defense and
`prosecuting attorneys andtriers-of-fact. She also showed working knowledgeofthe different pleas
`a defendant can enter, the pros and cons of considering/accepting plea offers, common terms of
`probation, and the possibility of facing incarceration if she were to be convicted. She offered a
`blanket denial of the entirety of one case, though showed ample knowledgeofthe factual basis for
`her other arrests in question. She identified a plausible range of penalties one could (theoretically)
`face if convicted on the charges she is now facing.
`
`Rational Understanding of the Proceedings: During the current interview, Ms. Barnes showed she
`has inadequate rational understanding of the proceedings against her. She maderational statements
`when asked about possible defense witnesses and wasable to identify who might be called as
`witnesses against her. However, when she was asked about possible penalties she could
`
`

`

`Barnes, Sade
`
`The Clerk, Criminal Division, Special Proceedings
`The Superior Court of the District of Columbia
`
`5
`
`realistically face if convicted, and to appraise the alleged evidence against her, she madeirrational,
`delusional, and contradictory statements. For example, she reported there is a 0% chance that she
`will be convicted, “because I have a good attorney.” When askedto identify a potential benefit of
`electing to testify, she said, “don’t get me lying.” When presented with hypothetical plea bargains,
`her responses were vague and contradictory. While she reported a favorable view of defense
`counsel’s efforts on her behalf, she reported thinking she should follow defense counsel’s advice
`because defense counsel “has the burden of proof. Even the prosecuting attorney has the burden
`of proof.” Thereafter, she made otherirrational statements. Impairment in key areas appears
`primarily due to insufficiently treated/remediated psychotic disorder of record.
`
`Ability to Consult with Counsel: Ms. Barnes appears to lack adequate capacity to consult with
`defense counsel with a reasonable degree of rational understanding. While she answered simpler
`and lower stress questions in a generally logical and organized manner, she made increasingly
`nonsensical, delusional,
`incomprehensible, and irrelevant statements in response to more
`complicated, higher stress questions. She showedhigherlevels of thought disorganization and non-
`reality-based thinking as the interview went on, as was comparable to what defense counsel told
`me abouther presentation during attorney-client communications. As detailed earlier, she voiced
`a favorable view of counsel’s efforts on her behalf, though appeared overly expectant of a highly
`self-favorable legal outcome. While she made multiple rational statements aboutthe state’s alleged
`evidence against her, her elaborations contained delusional and irrelevant content. Thus, she would
`most likely communicate in a highly problematic manner if/when defense counsel presented her
`with less desirable legal options or advisement. Under such circumstances, Ms. Barnes would
`likely appear increasingly paranoid, agitated, and prone to non-reality-based communication (as
`indicated in SEH staff notes and in the current interview with the undersigned). In effect, Ms.
`Barnes appears unable to assist counsel in the preparation of a legal defense, unable to make fuller
`use of counsel’s resources, and unable to make rational legal decisions. As before, impairmentin
`key areas appears primarily dueto insufficiently remediated/treated psychotic disorder.
`
`CLINICAL OPINION AND RECOMMENDATIONS:
`
`In the District of Columbia, a defendant is considered incompetentto stand trial when “as a result
`of a mental disease or defect, a defendant does not have sufficient present ability to consult with
`his or her lawyer with a reasonable degree of rational understanding or does not havea rational, as
`well as a factual, understanding of the proceedings against him or her.” D.C. Code § 24-531.01(5).
`
`Ms. Sade Barneshas a clear and longer standing history of mental illness and treatment. She has
`consistently presented with severe mood and psychotic symptoms. She has most often been
`noncompliant with treatment efforts in the community, though compliant and relatively more
`responsive to inpatient treatment efforts. She was repeatedly restored to competency after being
`hospitalized for about a month in 2016 and 2018, which is about how long she has now beenat
`SEH.She has probably madeless recent progress towards competency, as comparedto her prior
`admissions, because of the progression/worsening of severe mental disorder and persisting
`noncompliance. Overall, there appears to be sufficient data to conclude that Ms. Barnes has a
`mental disease or defect within the parameters of D.C. Code § 24-531.01(5).
`
`

`

`Barnes, Sade
`
`The Clerk, Criminal Division, Special Proceedings
`The Superior Court of the District of Columbia
`
`Ms. Barnes appears to possess adequate factual understanding of the legal proceedings against her.
`This is likely due to relative familiarity with the criminal justice system and sufficient rational and
`adaptive capacities to retain knowledge. However,
`she answered open-ended and more
`complicated legally-focused questions in a clearly non-reality-based, irrelevant, disorganized, and
`delusional manner. During which time, she also showed impaired attention, reasoning, and
`judgment. When she was asked higher stress legal questions, she showed vulnerability to
`psychiatrically decompensating. The
`sum total of which suggests
`inadequate rational
`understanding of the proceedings and inability to consult with counsel with a reasonable degree of
`rational understanding. Thus, it is concluded that Ms. Barnes most likely remains incompetent to
`stand trial secondary to insufficiently treated/remediated psychotic disorder of record.
`
`There remainsa substantial probability Ms. Barnes will attain competencein the foreseeable future
`or make substantial progress toward that goal. While she remains symptomatic, she has only been
`hospitalized for about a month. She has shownsigns of marginal improvement over the past week.
`Her recent improvement appears associated with benefit from the same prescribed antipsychotic
`that appeared to assist with restoring her competency when she wasat SEH in 2016 and 2018. Due
`to apparent progression of severe mental illness, a somewhat longer treatment episode may be
`necessary to restore her competency to face current charges. Alternatively, there is no currently
`available evidence suggesting she is likely to be intellectually incapable of making substantial
`progress towards attaining competency.
`
`At this time, the inpatient setting is necessary in order to provide appropriate treatment. Prior
`history suggests Ms. Barnesis very unlikely to comply with an order for outpatient treatment. If
`returned to the community, she would mostlikely refuse psychotropic medications and not attend
`evaluations or restoration sessions. As a result, she would most
`likely decompensate and
`constructively lose the incremental gains she has recently made towards competency.
`
`The opinions and information presented in this report are subject to the limitations of the data
`available. The current opinion regarding Ms. Barnes’ competency andrestorability could change
`ifadditional information becomeavailable. For‘any questions regarding this report, please contact
`
`Graham Danzer, Psy.D., at 202-597-2918 or g
`:
`
`
`Authored by,
`
`Reviewed by:
`
`NbekhoreAD
`Hehe|a0
`
`Graham Danzer, Psy.D.
`Licensed Clinical Psychologist
`Forensic Services Division
`DC Department of Behavioral Health
`
`Shilpa Krishnan, Ph.D.
`Deputy Director
`Forensic Services Division
`DC Department of Behavioral Health
`
`