Ohio Admission Rule Following a Not Guilty by Reason of Insanity Verdict

Ohio Admission Rule Following a Not Guilty by Reason of Insanity Verdict governed what could happen after an insanity acquittal: the person was to be treated as mentally ill, not as a criminal, and sent to the least restrictive setting consistent with safety to himself and others. Its importance in William Stanley Milligan’s case lay in separating the verdict from the question of where he should receive care. It made treatment placement a matter for the probate court and turned the search for a suitable hospital into a practical and legal issue before trial was complete.

Purpose and Legal Effect

The law was due to take effect on December 1, 1978, shortly before Milligan’s trial, which was scheduled for December 4. Previously, insanity verdicts had resulted in defendants being sent to Lima. Under the new rule, a person acquitted by reason of insanity would instead be treated as a mentally ill patient, with commitment to a state institution under probate-court jurisdiction. The least-restrictive-environment standard made safety and treatment relevant to placement, rather than treating the insanity verdict itself as a direction to send someone to a particular institution.

The rule concerned disposition after an insanity verdict; it did not resolve whether Milligan could participate in his defense or determine his mental state when the charged acts occurred. Earlier, clinical psychologist Willis C. Driscoll had assessed Milligan’s present capacity and concluded that he could not adequately understand events or assist in his own defense. That evaluation prompted a separate legal dispute over a court-ordered examination by the forensic unit of Southwest Community Mental Health Center. The distinction matters: questions about participation in proceedings, criminal responsibility at the time of the offenses, and treatment after acquittal each shaped a different stage of the case.

Planning for Treatment Before the Verdict

Because Milligan would be the first person affected by the new law, his attorneys believed the probate court might choose a placement other than Lima if the defense could show that another state hospital offered appropriate treatment. Harding Hospital was ruled out because of its expense. Dr. Cornelia Wilbur identified the Athens Mental Health Center, less than seventy-five miles from Columbus, as a possible alternative and recommended its medical director, Dr. David Caul, who had treated multiple-personality cases.

The possible placement was brought into pretrial discussions. The prosecution requested a meeting with Probate Judge Richard B. Metcalf to clarify how the new law would work; Judge Jay Flowers arranged it, and the parties expected to discuss both the evidence that could be admitted by stipulation and where Milligan might be sent if found not guilty by reason of insanity. The defense contacted Dr. Caul to ask whether he would accept Milligan and attend the meeting. He said he would consider accepting him, subject to consultation with hospital and state officials, and agreed to travel to Columbus. The search for a treatment setting thus began before the verdict, because the new rule made the likely destination a question the court would need to address.

Application in Milligan’s Case

At trial, Judge Flowers dismissed the first rape count, citing a lack of corroborating evidence and the absence of a similar modus operandi. On the remaining counts, the medical evidence was stipulated. The judge found that the doctors agreed Milligan had been mentally ill at the time of the offenses, had been unable to distinguish right from wrong, and had lacked the ability to refrain from the acts. With no contrary evidence, he found Milligan not guilty by reason of insanity on counts two through ten.

That decision activated the placement problem the new law had made consequential. The verdict was not itself a finding that Milligan should simply be sent to the institution used for earlier insanity cases; the rule called for treatment as a mentally ill person and placement in a setting consistent with safety. The defense’s effort to identify Athens as an alternative therefore formed part of the legal and clinical preparation surrounding the verdict, although the cited account does not establish that the pretrial discussion alone determined his eventual placement.

Continuing Judicial Assessment

A later court finding in 1979 described Milligan as mentally ill, diagnosed his condition as multiple personality, and ordered hospitalization. The findings cited substantial risk of physical harm to himself, including evidence of suicide threats, and risk to others, including recent violent behavior; they also stated that he would benefit from hospital treatment and needed it. These findings show how judicial review of hospitalization could turn on condition, risk, and treatment need. They should not be confused with the earlier insanity verdict: the verdict addressed responsibility for the charged acts, while the later findings addressed the basis for court-ordered hospitalization.

The rule’s significance in the case was therefore procedural as well as therapeutic. It made the post-verdict system answer a question that an acquittal alone could not settle: what form of care was appropriate, and how restrictive did the setting need to be in light of safety? By placing commitment under probate-court jurisdiction and specifying the least-restrictive-environment standard, the law gave that question a framework distinct from criminal punishment.