Competency Restoration in the State of Hawaii: An object lesson

Karen Franklin’s blog is the premier site for ground-breaking issues in forensic psychology. Always worthwhile and readable, witty and biting, sometimes breathtaking and bold. Her March 9, 2014, post addresses the recent scandal at Napa State Hospital in California, which serves the Northern California incompetent defendant and NGRI population, similar to our Hawaii State Hospital.

In their effort to shorten stays and lighten hospital census, Napa State Hospital enacted a number of shortcuts in their legal restoration program, including rote memorization restoration training using the R-CAI (described as unstandardized and unpublished), and fired a psychologist who insisted on using standardized measures. She was awarded her job back and a million dollar judgment against the hospital, including judgments against the psychiatrist and psychologists who smeared her. Forensic luminaries, Thomas Grisso and Randy Otto, testified on opposite sides.

It is a worthwhile read for anyone interested in competency to stand trial (CST) evaluations submitted to the courts. A couple of years ago, we published our forensic CST report quality study in International Journal of Psychiatry and Law, finding that standards of ordinary community practice were poor.

The use of forensic assessment instruments (FAIs) is a must for quality reports, the most obvious fault in poor quality reports, and is evolving into a standard of care.


Robinson, R., & Acklin, M.W. (2010). Fitness in Paradise: Quality of forensic reports submitted to the Hawaii Judiciary. International Journal of Psychiatry & Law, 33, 131–137, available for free download at

Psychologist whistleblower awarded $1 million; fired after testifying about state hospital’s competency restoration program


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