Dementia complicates slaying case

Last modified: 12/4/2011 12:00:00 AM
Almost as soon as a police officer arrived at his Deerfield home last month, Jeffrey Cook confessed to beating his sister to death.

Prosecutors say he explained how he did it - with a baseball bat and sledgehammer - and pointed an officer toward Sandra Griffin's body, which he left under a blue tarp in his backyard.

But Cook may never go to prison. The 55-year-old has early onset Alzheimer's disease, according to family members - a diagnosis that defense attorneys say makes it unlikely he'll be found competent to stand trial.

"There's no way they can assist their attorneys," said Barbara Keshen, a staff attorney with the New Hampshire Civil Liberties Union who represented several people with dementia during her time as a public defender, including an elderly woman accused of beating her sister to death.

"They cannot make the tough decisions you need to make if you are accused of a crime, especially a serious one like homicide," Keshen said.

But where does a defendant with dementia go if considered dangerous? Ordinarily, if a person is found not competent to stand trial on charges alleging a dangerous crime - a serious assault, sexual assault or arson - prosecutors can ask the court to commit him to the state psychiatric hospital.

But the laws allowing prosecutors to seek civil commitments apply to defendants with an intellectual disability, or people with a mental illness that makes them dangerous to themselves or others.

"You can't be civilly committed if your only diagnosis is dementia," said Robert McLeod, CEO of New Hampshire Hospital, which doesn't have any patients with a primary diagnosis of Alzheimer's.

There are no people with Alzheimer's or another form of dementia in the state's secure psychiatric unit, which is run by the prison. The only state facility that has people with dementia who were found not competent to stand trial is the Glencliff Home for the Elderly.

"In the worst-case scenarios, they end up at Glencliff, if there's a bed," said Judge David King, the deputy administrative judge of the state's circuit courts, who oversees involuntary commitments in his role as a probate court judge.

While serious cases, like slayings, involving a defendant with Alzheimer's are rare, "we've certainly seen elderly people who lack capacity and commit crimes," King said. In those circumstances, he said, the court appoints a guardian to seek out the safest, least-restrictive setting for the person in question.

But options are limited, King said. "There's nothing the state hospital can do for Alzheimer's," he said. "There's really no treatment for Alzheimer's. Sometimes those people almost get warehoused."

 Meeting the standards

Determining whether someone is competent to stand trial requires answering two questions: Does the defendant understand the charges against him? And can he assist in his own defense?

Cook's public defender, Joseph Malfitani, said he had concerns about his client's competency but didn't ask the court to undertake that review during a recent hearing. But he can ask for it at any point: Competency considers a person's current mental state, which can change over the course of a case - and even during a trial.

Experts say that for a person with Alzheimer's, a disease that progresses at different speeds but doesn't reverse course, the state's competency standards would be difficult to meet.

"Sometimes, at the very earliest stages, they may be able to participate reasonably well," said Dr. Sanford Auerbach, the director of behavioral neurology at Boston Medical Center. "But after the very, very earliest stages, certainly if there's a memory impairment, that would be a problem."

Alzheimer's, however, involves more than memory loss: A person's problem-solving abilities, judgment and logic are also impaired. "That's going to affect their ability to participate in their own defense," Auerbach said.

An inability to participate in her own defense is what triggered Barbara Keshen to ask the court to consider the competency of Helen Garland, an elderly Hampton woman charged in 2004 with beating her 85-year-old sister to death.

"I just knew we weren't connecting with her," Keshen said. "I know I have a crazy client if they make me crazy, and that was Helen. She was so good at deflecting things."

Garland, who had been her sister's caretaker for nearly a decade, was charged with beating the 85-year-old woman to death. Prosecutors said Garland broke 22 of Alice Keyho's ribs and backhanded her sister hard enough to leave ring imprints on her face, according to news articles from the time.

Keshen thought it would be reasonable for Garland, who was in her 70s, to consider taking a plea bargain, given her age and lack of criminal record.

But "we could never get her to focus in on that discussion," Keshen said. She decided to ask the court to consider Garland's competency, and a forensic psychiatrist concluded that Garland, who had demonstrated signs of dementia, was not able to stand trial.

A judge agreed, and the charges against Garland were dropped. In 2007, she was committed to the state hospital, according to Ed Cross, the public defender who represented Garland after prosecutors argued she was too dangerous to go free.

But Cross, who had argued that Garland wouldn't be dangerous, said he doesn't know what happened to her after that.

"Considering that she would have hardly ever left her home, we just didn't feel she represented a threat to anyone," he said. "By the time I encountered her, she was clearly someone who needed help."

 Violent acts rare

While some Alzheimer's patients do demonstrate aggressive behavior, acts of serious violence are rare, according to advocates.

Most Alzheimer's aggression is reactive and happens during close personal interactions, when a caregiver is helping a person dress or bathe, said Gerald Flaherty, vice president of medical and scientific programs for the Massachusetts-New Hampshire chapter of the Alzheimer's Association.

In those situations, "it's not intentional," Flaherty said.

Flaherty said the behavior demonstrated by Cook was "really not typical" of Alzheimer's. In 23 years, he said, he could just recall two cases of serious violence in Massachusetts involving a defendant with Alzheimer's or dementia, one a man in his early 60s who had been in prison before for violent offenses unrelated to his dementia.

The other, which Flaherty said happened 15 to 20 years ago, involved an elderly man with Alzheimer's accused of killing his wife in the middle of the night with a screwdriver. The man heard noises in the house, got confused and thought there was an intruder, Flaherty said.

In both cases, the men were sent to a state hospital rather than prison, Flaherty said.

No one in the New Hampshire state prison has a diagnosis of Alzheimer's disease, said Helen Hanks, director of medical and forensic services for the Department of Corrections.

But the prison had an inmate with Alzheimer's who recently died, Hanks said. She said the man - a sex offender serving a long sentence who developed the disease in prison - had been most recently housed in the infirmary so that medical staff could monitor him 24 hours a day.

"You don't want them to go missing or forget who they are," Hanks said. Prison officials had been trying to have the man medically paroled to Glencliff based on the costs the department was incurring, but he died before that could happen, Hanks said.

Glencliff has a small number of people with Alzheimer's or dementia who have been found not competent to stand trial or pleaded not guilty due to reason of insanity, said Todd Bickford, the administrator of the state-run nursing home.

The people in that category - Bickford estimated the number in the single digits - also have a mental illness, a past history of mental illness or a diagnosis of physical behaviors in addition to their dementia, he said.

In Bickford's experience, people who fit those criteria are usually first sent to the state hospital to make sure they're stable and undergo a psychiatric assessment.

"We just need to make sure they're going to be safe themselves and to other residents," he said.

(Maddie Hanna can be reached at 369-3321 or

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