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    PSYCHIATRIC SECURITY REVIEW BOARD

    AT: WHITING FORENSIC INSTITUTE

    DIVISION OF THE CONNECTICUT VALLEY HOSPITAL

    MIDDLETOWN, CONNECTICUT

    DATE: NOVEMBER 4, 2011

    IN RE: KENNETH RUGGLES - Mandatory Review

    (CGS, Section 17a-585)

    AND

    Temporary Leave

    Filed by CVH

    (CGS, Section 17a-587)

    PSYCHIATRIC SECURITY REVIEW BOARD:

    Mark Kirschner, Ph.D., Acting Chairman

    Ellen Lachance, Executive Director

    FOR DMHAS, DIVISION OF FORENSIC SERVICES:

    Dr. Maya Prabhu

    FOR CONNECTICUT VALLEY HOSPITAL:

    Dr. Michael Lah

    FOR GILEAD REHABILITATION CENTER:

    Patricia Burke

    FOR THE STATE:

    Deborah Mabbett, ASA

    FOR KENNETH RUGGLES:

    Monte P. Radler, PD

    ALSO IN ATTENDANCE:

    Kenneth Ruggles

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    Michael Daubart

    POST REPORTING SERVICE

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    . . .Verbatim proceedings of a hearing

    before the Connecticut Psychiatric Security Review Board,

    In Re: Kenneth Ruggles, held on November 4, 2011, at 10:36

    a.m., at the Whiting Forensic Institute, Middletown,

    Connecticut . . .

    ACTING CHAIRMAN DR. MARK KIRSCHNER: Id

    like to call to order the hearing on Kenneth Ruggles.

    Would all persons who are going to testify, please rise

    and raise their right hand to be sworn.

    MS. ELLEN LACHANCE: You may stand.

    (Whereupon, Dr. Maya Prabhu, Dr. Michael

    Lah, Patricia Burke, and all potential witnesses were duly

    sworn in.)

    COURT REPORTER: Thank you.

    ACTING CHAIRMAN KIRSCHNER: Miss Lachance,

    the background information please.

    MS. LACHANCE: The purpose of todays

    hearing is a Mandatory Review of the Status of Kenneth

    Ruggles, pursuant to Connecticut General Statute, Section

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    17a-585; and Temporary Leave filed by Connecticut Valley

    Hospital, pursuant to Connecticut General Statute, Section

    17a-587.

    I have a three-page document marked PSRB

    Exhibit 1 with todays date, which lists all the materials

    that will be considered as evidence for todays

    proceeding.

    ACTING CHAIRMAN KIRSCHNER: Id like to

    bring to the attention of counsel the missing seats up

    here on the Board, that were missing five members

    currently. It will become necessary for members of the

    Board to read the transcript of the hearing so they can

    participate in the deliberations. Are there any

    objections?

    MS. DEBORAH MABBETT: No.

    MR. MONTE P. RADLER: No objection.

    ACTING CHAIRMAN KIRSCHNER: Thank you.

    The first witness please.

    DR. MAYA PRABHU: Good morning. My name

    is Maya Prabhu. Im a consulting forensic psychiatrist

    attached to the Office of the Commission for Mental Health

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    and Addiction Services in the State of Connecticut and I

    act as a consulting forensic psychiatrist for CVH in the

    case of Mr. Kenneth Ruggles.

    In preparation for todays hearing, I

    spoke with Mr. Ruggles on November 1st and 3rd. I also

    spoke to members of his clinical team, which include Dr.

    Shahil Battell (phonetic), his attending psychiatrist, who

    is present, Dr. Justin Winkel, his individual therapist,

    who may yet join us, and various members of his team,

    including his nursing staff, his group supervisors, his

    rehab supervisors, and his prospective TL supervisor. I

    will be describing Mr. Ruggles source in the hospital

    since his last hearing before the Board in March of 2010

    and then review the application for TL.

    Mr. Ruggles has been maintained on Dutcher

    3 South, an enhanced security community reintegration unit

    since his hearing in March 2010. There has been no change

    to his psychiatric diagnosis. On Axis I of the DSM-IV he

    is diagnosed as having schizophrenia, chronic, paranoid

    type, and alcohol abuse. He does not have a diagnosis on

    Axis II. He has been on the antipsychotic medication

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    Olanzapine (Zyprexa) at a dosage of 30 milligrams daily.

    He is compliant with his medications, including those for

    his medical illnesses, which I will describe in a moment.

    You may recall that prior to your last

    hearing with Mr. Ruggles there had been some changes to

    his medications and some changes in Mr. Ruggles behavior.

    However, since then, Mr. Ruggles has been absolutely

    clinically stable, there have been no violent incidences,

    no episodes of aggression, no threats made to other

    people, and his behavior has been socially appropriate.

    He has not written any letters to any government or

    judicial officials or filed any legal petitions in this

    time. He has shown no reoccurrence of the delusions from

    which he had suffered previously, and there has been no

    evidence of persecutory or grandiose thinking.

    He has a number of medical problems to

    which Ill return in one moment, but Ill note that his

    random urines for drugs and alcohol have been negative,

    and his blood serum levels for Olanzapine, his

    antipsychotic medication, are -- are -- are where they are

    to be slightly above perhaps the target high level of 80

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    nanograms per milliliter. His dose is at 89 -- his serum

    levels are 89.6, but he has none of the side effects that

    hes previously reported on higher doses.

    Since June of 2009, Mr. Ruggles has had a

    full Level 4 pass, which allows him to have unsupervised

    access to certain areas of the hospital for five to six

    areas daily -- sorry -- for five to six hours daily. And

    with the current privilege level, he participates in a

    number of staff supervised community trips and multiple

    grounds passes in his own custody. He attends a range of

    psychotherapy groups. He attends supportive psychotherapy

    with -- which is one-to-one therapy with Dr. Winkel, which

    has been increased to 30 minutes weekly. He is in a group

    therapy called the Forensics Group, which is 45 minutes

    weekly. And Dr. Winkel, who is also the therapist for

    that group, notes that Mr. Ruggles has made progress in

    linking his depression, his alcohol use, and his paranoia

    at the time of the crime and to think about how theyve

    contributed to the crime. Mr. Ruggles goes to a substance

    group called Sobriety Skills in which he has also

    discussed the role that alcohol played in his lifestyle

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    prior to the crime. And he attends a number of

    recreational groups, including band, computer skills, has

    been in walking and bowling groups. And I note that the

    walking and recreational groups are also part of the

    integrated treatment plan to manage some of his medical

    illnesses, which Ill talk about as I said in one moment.

    He works in the greenhouse twice a week

    and he attends a self-esteem group at River Valley

    Services, which is one of the community treatment options

    that are being recommended as part of his TL. And he --

    once a month he attends the Gilead Social Group.

    Mr. Ruggles is uniformly described as

    behaving appropriately, as engaging in the groups and the

    activities, and making good use of his passes. He is

    described by -- has been described by most members of his

    team as a model patient.

    I mentioned that he had a number of

    medical illnesses. These are unchanged since the last

    time that you saw him, but I note that he has

    hypothyroidism, for which hes being treated with

    Synthroid; hypertension and hyperlipidemia, for which hes

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    being treated with Zocor, Avalide, Metoprolol, Vasotec,

    and is on a low salt diet. He is -- hes seen by a

    cardiologist once a year and his medical conditions are

    stable.

    On a formal exam, I found Mr. Ruggles to

    be pleasant and cooperative, with appropriate eye contact.

    His speech was quiet, of normal rate and normal tonal

    variations. He told me that his mood was good and I

    didnt see any signs of depression or elation. He told me

    his appetite was fine and that between the walking group

    and the attention that hes trying to pay to his diet,

    that hes lost a little bit of weight over the course of

    the year, which was in fact a medical goal. His sleep was

    adequate. I did not find any evidence that he suffered

    from any abnormal beliefs or that he had any overvalued

    persecutory ideas. I didnt find any evidence of

    delusions, and in particular I didnt find that he had

    worked for the U.S. Government as a government agent. He

    denied any visual or auditory hallucinations, and I didnt

    see him responding to internal stimuli. I didnt find any

    signs that he suffered from suicidal or homicidal

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    ideation. His formal cognitive exam was unremarkable but

    for some slight difficulty interpreting abstract proverbs.

    With regard to his insight, so as has been

    noted on previous PSRB hearings, Mr. Ruggles insight

    around his mental illness and his need for medication

    remain a focus of his treatment. He acknowledges that he

    was paranoid at the time of the crime and that he felt at

    the time that there were certain groups of individuals who

    were out to harm him, including the government and the

    police. He described himself as having been frightened

    and paranoid. However, he refuses to believe that he has

    a mental illness. Indeed in some of his writings he notes

    that he does not believe that mental illness exists at

    all. And he told me that it was not the antipsychotic

    medication that hes on, but rather his spiritual beliefs

    that have been -- and time which have been most helpful in

    contributing to his clinical progress.

    Having said that in describing his lack of

    insight, Mr. Ruggles is willing to take medication as long

    as the clinical team recommends it and as long as it is

    part of the PSRBs recommendations for him. He stated

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    that he intends to follow the PSRBs recommendations and

    noted spontaneously that he would never let such an event

    happen again as he would not carry weapons again and that

    he has no desire to drink and has not had cravings in the

    time that hes been at CVH.

    I asked him whether he thought that the

    crime was part of his being -- was part of him being part

    of a conspiracy or whether he was the target of a

    conspiracy, and he told me that he didnt like thinking

    about that period in his life and that it had been a

    particularly difficult time for him.

    So in my opinion, I think that the best

    risk management of Mr. Ruggles requires both the continued

    treatment of his schizophrenia and his history of alcohol

    abuse, it requires continual monitoring by mental health

    staff of his mental state, and the provision of an

    appropriately structured environment. And Mr. Ruggles has

    acknowledged that the PSRBs recommendations in this are

    key to his compliance.

    As his case is currently being managed and

    as he is currently presenting, I do not think that Mr.

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    Ruggles represents a danger to himself or other people.

    And its the basis of that clinical stability that, as you

    know, there has been a proposed temporary leave

    application submitted to the PSRB.

    The purpose of the temporary leave

    application is to provide for treatment in the community

    at two facilities, River Valley Services and Gilead

    Rehabilitation Center in Middletown. Those are two

    facilities where hes already currently receiving

    treatment. The application provides for treatment in

    these two facilities for up to four days a week and up to

    six hours a day. His TL supervisor, Wendy Blakely is not

    here to day. In her place, as we mentioned, we have

    Patricia Burke from Gilead, who is the program director

    there, and we have a representative from River Valley

    Services, Colleen Milt (phonetic) -- is she -- Im sorry,

    I dont think that shes here --

    A VOICE: (Indiscernible) -- no, Im here

    --

    DR. PRABHU: Sorry. Hello. The groups

    recommended for Mr. Ruggles at River Valley Services

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    include Symptom Management group and continuation of his

    self-esteem group. He will also be attending other

    recovery groups as its deemed clinically appropriate as

    his attendance there and his engagement there is observed.

    He will walk himself unescorted to the facility which is

    located on CVHs campus. At the second facility, Gilead

    Community Services, he will be transported by a Gilead

    van, which is staff supervised, and he will be attending

    an outpatient group, a therapeutic group, and then

    engaging in the clubhouses daily activities, which

    include a community meeting, tasks for the day, lunch and

    cleanup. Both facilities are supervised and Mr. Ruggles

    will be required to check in with unit staff over the

    course of the day. I will note that he will remain on his

    overnights at Dutcher. He will have his medications

    administered by CVH staff and he will remain in one-to-one

    therapy with Dr. Winkel.

    Part 2 of the plan will involve -- has

    involved Mr. Ruggles being placed on the waiting list for

    the Gilead Apartment Housing Program, which is a 24-hour

    supervised boarding type house where six other clients

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    would be present. There is a staff office present in the

    same building. He would attend the Gilead Clubhouse for

    programming or at River Valley Services. And specific

    clinical services will be considered as Mr. Ruggles

    progresses through Part 1 of the TL if it is approved by

    the Board.

    So in conclusion, as Ive noted, Mr.

    Ruggles has not experienced any psychotic decompensation

    or clinical deterioration since his last PSRB hearing.

    Hes remained on the same antipsychotic medication. He

    continues to be in therapy and groups. He is reported to

    be and the staff notes him to be compliant with his

    medications, and this is confirmed by his serum blood

    levels. His insight about his illness remains partial,

    but he has been consistent in expressing a willingness to

    comply with the clinical teams and the PSRBs

    recommendations for him. Thank you.

    ACTING CHAIRMAN KIRSCHNER: Any other

    testimony or just questions and answers? Attorney Radler.

    MR. RADLER: I have no questions.

    MS. MABBETT: I have a few, thank you.

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    Youve indicated with Mr. Ruggles that theres been no

    further motions that have been filed that youre aware of

    with the courts or any type of government facility?

    DR. PRABHU: Yes.

    MS. MABBETT: Okay. And the last motion

    that youre aware of that has been filed, when was that?

    DR. PRABHU: That was in January of 2010.

    MS. MABBETT: Okay. And there was an

    issue I believe that was brought to the Board at that

    time, correct?

    DR. PRABHU: Yes.

    MS. MABBETT: Okay. And -- now Mr.

    Ruggles was very good about keeping a journal. Do you

    know if he still keeps any type of journal?

    DR. PRABHU: I did not ask Mr. Ruggles

    specifically about whether he had a journal. Im not sure

    if any other members of his clinical team are aware of

    whether he had one and continues to keep one. Im sorry,

    I dont know the answer to that, but I can find out and

    let the Board know.

    MS. MABBETT: Okay. And the other thing

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    is my understanding is that he has computer access. Can

    you tell me is it monitored in any way whatsoever

    DR. PRABHU: You mean currently or in the

    proposed TL?

    MS. MABBETT: Currently and in the

    proposed.

    DR. PRABHU: So he -- as part of his

    computer club he does have computer access. It is

    supervised in the sense that Mr. Ruggles cannot get on to

    the computers and roam the internet freely without staff

    supervision. There are the usual CVH blocks which limit

    websites to which hes accessed. And printouts are picked

    up and seen by the staff that are there. He doesnt have

    one-to-one supervision during the computer club, but

    theres always staff present in the room when people are

    in use of the computers is my understanding.

    MS. MABBETT: Okay. So if theres any

    sites that are out there that are sites that violates or

    sites that deal with any type of weapons or guns or

    anything like that, would CVH be made aware of that or is

    that one of the blocks?

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    DR. PRABHU: I -- my understanding is that

    there are blocks built around dangerous sites as well as

    sites of a sexual nature and content. I cant speak

    specifically to the sites that are listed. My

    understanding is that IT would be able to -- would always

    have access to sites that are being reviewed, although I

    dont know if in the same time -- in real time whether

    theyd be able to provide feedback as to what any specific

    person on any computer site is looking at. I may have to

    defer to Dr. Lah or one of the other members of the

    clinical team about that.

    DR. MICHAEL LAH: Michael Lah, Supervising

    Forensics Psychologist on the Whiting Forensic Division.

    The blocks that the hospital has on our

    computers do prevent patients from accessing sexually

    oriented sites, which are easier to kind of identify. I

    think depending on what the site was, things regarding

    weapons and violence and stuff might be blocked, but it

    also is possible that he could access some things that

    might have -- you know, sort of regular retail things

    about weapons or something. But staff do supervise.

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    Theyre always in the area. So depending on what the site

    was, it might be possible for him to have some kind of

    access. But I dont think anything like groups that

    propose, you know, violence or anti-government kinds of

    things, I dont think hed be able to access things like

    that.

    And in the community setting, staff are --

    or my understanding is that staff are always in the room

    when the computers are being used and -- they may not

    constantly be looking at what hes doing, but are always

    there and able to kind of check now and then and see what

    hes doing, how the computer was being used.

    The hospital computers, we do have the

    ability to print out a history of where -- the activity

    where people went. So if there was a question about him

    accessing something, the computer technology folks would

    be able to access and print that out, the history, and be

    able to tell what he was doing on the computer.

    MS. MABBETT: And is that information --

    if the PSRB Board asked for that information, for the

    computer printouts of an individual, would you be -- I

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    mean I dont know -- is it something that you would

    provide to them?

    DR. LAH: We -- whatever the Board

    requests, wed provide if were able to.

    MS. MABBETT: Okay. And then the

    computers access at the other facilities are certainly --

    do they do have any type of blocks or something like that?

    MS. PATRICIA BURKE: This is Patty Burke

    from Gilead Community Services, the rehab center where Mr.

    Ruggles will be attending.

    We do have blocks on our computer systems,

    again its sexual in nature. There are not specific

    blocks related to guns or any kind of violent websites.

    However, having said that, we do routinely print out for

    ourselves a review of internet sites that have been

    accessed and we are available in the room when people are

    on the computers.

    MS. MABBETT: Okay. And again, with you,

    if the PSRB asked for that information from your agency,

    is that something that the PSRB Board would be able to

    access without any type of court orders?

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    MS. BURKE: I can ask our IT department to

    put a -- set up a program on the computers that will give

    the PSRB, if they required it, access to websites that

    have been accessed.

    MS. MABBETT: Thank you. When you were

    talking about the Level 4 and the access that Mr. Ruggles

    has out there on the grounds, has there been any type of

    violations or times that he has not gone from one place to

    the other?

    DR. PRABHU: No. The clinical team has

    reported that he has -- there have been no instances and

    no violations with regard to his use of the passes.

    MS. MABBETT: Okay. And the passes are he

    would go from one facility to the next?

    DR. PRABHU: So hed be able to walk

    unescorted say to Merritt Hall or to the pavilion for

    special events or to, for example, the greenhouse where he

    might have -- where he -- where he works twice a week. And

    he currently attends one group once a week already at

    River Valley Services that hes able to escort himself

    there and back.

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    MS. MABBETT: Okay. And what type of time

    frame are we looking at there? How long does it take him

    to get to and from these? Fifteen minutes --

    DR. PRABHU: Oh --

    MS. MABBETT: -- an hour? I dont know

    --

    DR. PRABHU: Oh, less than that. I mean a

    couple of minutes, five minutes.

    MS. MABBETT: Okay. And then I know that

    he started the services, the community visits to River

    Valley -- to River Valley and out there into the

    community. Could you tell us a little bit about this? I

    mean hours per day, the places that he goes to, and what

    type of activities take place?

    DR. PRABHU: Im sorry, currently?

    MS. MABBETT: Yes.

    DR. PRABHU: So currently with regard to

    River Valley Services, which is on, as I said, the campus

    at CVH, he attends one weekly self-esteem group. He walks

    himself there. He participates in the group. Apparently,

    hes been invited to remain to socialize and to engage

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    with the group a bit more, but hes always expressed an

    anxiety and interest in getting back to the unit.

    He attends events or recreational

    activities at Gilead Clubhouse once a month, and those

    activities have been, as I understand it, sort of whatever

    the club has been doing on that particular day. You can

    tell -- Ill let Gileads representative describe it in a

    little bit more detail, but the activities that he

    currently engages in which take him into the community are

    always staff supervised. So he attends a weekly walk,

    which is staff supervised, which may take him into say a

    bookstore downtown, but again this is staff supervised,

    and were talking a couple of -- a matter of hours, not

    for the entire day, and certainly not unattended

    currently. So in the proposed TL, he would be attending

    Gilead two days a week for a maximum of six hours. He

    would be picked up approximately around 9:00 am and would

    return again by Gilead van by 3:00 p.m. And during that

    time he would be present at the Gilead Clubhouse doing

    activities with staff and with other clients and under

    staff supervision.

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    At River Valley Services he would again be

    attending twice a day and be participating in structured

    groups, again approximately leaving around 9:00 a.m. or in

    time for the first group, and then returning no later than

    3:00.

    MS. MABBETT: Okay. And -- and when I was

    reading the temporary leave, it indicated that for some of

    the community service leaves he could bicycle, he could

    walk. Are you just talking about those activities on CVH

    grounds, because I was with the impression that he could

    do this getting to the Gilead House?

    DR. PRABHU: Well the plan as it is

    currently -- the current plan is that in fact he will be

    picked up by a Gilead van, sorry, which is staff driven,

    and that the van will drop him off again. That is the

    plan as it is currently formulated.

    MS. BURKE: And he will remain with us at

    the clubhouse.

    DR. LAH: Michael Lah again. I think the

    other factors -- there are two phases to the temporary

    leave. And so during the first phase, which is just day

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    treatment, he will be transported as Dr. Prabhu mentioned

    and supervised by staff. During the second phase he will

    have limited ability -- by bicycle and stuff to get from

    his apartment, maybe to come to River Valley to attend

    treatment activities. So he would have some ability to

    kind of transport himself in that regard.

    MS. MABBETT: So that down the road then

    when he would have a bicycle --

    DR. LAH: In the second phase when we

    start the overnights in his apartment, supervised

    apartment.

    MS. MABBETT: Okay. Which we -- is that

    -- because the one I was looking at was talking about

    three months -- this plan is in place for three months.

    Are you talking about perhaps he might be in his own

    apartment after a three-month time span?

    DR. LAH: The first phase is three months.

    And then the day treatment, we would do that at least

    three months depending on his clinical progress. Then we

    would progress to the second phase, assuming that the

    Board had approved that. And then the second phase is

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    also estimated to at least be like a three-month period.

    It could go longer and definitely depending on his

    progress and our assessment of him.

    MS. LACHANCE: Just for clarity, there is

    no application for overnights at this time. This is only

    an application for day. At the point that the hospital

    should they come forward and ask for overnights, that

    would be -- would require another hearing.

    MS. MABBETT: Okay, thank you. That was

    my concern.

    DR. LAH: So --

    DR. PRABHU: Yes, if I could just note the

    understanding of the team is that Part 1, the piece before

    the Board right now will be at least three months. And --

    and the planning for Part 2 would be obviously dependent

    on his clinical progress and his clinical experience, and

    with further discussions with the team and the community

    providers.

    MS. MABBETT: Okay. And one of the other

    questions Ive got is if in fact he should violate any of

    these rules or he should be late, is somebody going to

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    keep track of this, so that -- I believe that the Board

    has that right to know when theres any violation, no

    matter how minor -- are they going to be made aware of it,

    or are we just going to say, oh, it was just a minor, he

    was five minutes late?

    DR. PRABHU: Well, I think it depends a

    little bit on the form of the violation if there is one.

    And in both cases both Gilead and River Valley Services

    have indicated that they would both let the ward and the

    sorry -- Dutcher, as well as his TL supervisor know. So

    both will be keeping track in various ways. I assume on

    the ward there will be a note written. And in the case of

    the TL supervisor, we can ask her to keep a separate

    record if that would be useful to the Board of any

    violations or deviations from the plan.

    MS. MABBETT: And that would be something

    all kept in one or two different places so that we

    wouldnt have to go to several different areas to try to

    locate it?

    DR. PRABHU: Yes, I would think that would

    be --

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    MS. MABBETT: Like a log --

    DR. PRABHU: -- simple to record in a log

    if needed.

    MS. MABBETT: And you also indicated in

    the temporary leave that he could go pretty much anyplace

    in the State of Connecticut as long as it was supervised

    by staff?

    DR. PRABHU: There is a clear caveat hes

    not able to return to the Town of Bethel or the location

    of the crime. And the -- any -- any trips outside of the

    community treatment centers would be staff supervised.

    MS. MABBETT: But -- and youre aware that

    the location of the crime wasnt necessarily where it took

    place, it was where the police officer actually pulled him

    over?

    DR. PRABHU: Yes.

    MS. MABBETT: The crime was ongoing with

    his delusional state. I mean it was -- it could have been

    any police officer, it could have been any area, it could

    have been any government facility that this could have

    taken -- it could have taken place. So why are you just

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    limiting it to that one place, Mansfield Street in Bethel,

    Connecticut? Shouldnt it also include government

    buildings, the Governors mansion, because the Governor

    was at stake at some point in time, and any other

    government facilities thats out there?

    DR. PRABHU: Well this has been the

    restriction on Mr. Ruggles up until this point, and of

    course he has been present in residing at CVH. If the

    Board thinks that it would be appropriate to limit -- to

    further limit the areas in which -- to which he might be

    able to travel, then certainly Im sure that the team and

    Mr. Ruggles would comply with that.

    Mr. Ruggles -- the community -- the types

    of community trips that Im aware of that Gilead and/or

    CVH and/or River Valley Services provide are largely

    recreational, to bookstores, to parks. They dont involve

    trips to government facilities, trips to courts. So, I --

    my understanding of the nature of the trips that theyve

    conducted so far, I dont think would put him at risk of

    visiting the types of facilities that you might have

    concerns about. Nor might I add has Mr. Ruggles

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    expressed any desire to visit any of the types of the

    facilities that you are expressing concerns about.

    MS. MABBETT: And also concerning police

    officers, when hes on any of these community trips at all

    has he come in contact with any police officers? And if

    so, what has been his state?

    DR. PRABHU: I have not seen any mention

    in the records of Mr. Ruggles coming into any contact with

    police officers. Im not sure if anybody else has any

    further information about that.

    I will note that there are of course

    police officers and security on the grounds of CVH whose

    presence Mr. Ruggles has noted and who are certainly

    present there when he is walking on grounds. And I have

    not heard Mr. Ruggles report any difficulties with them

    and Ive not seen any reports in any of his records of any

    altercations with them.

    DR. LAH: As Dr. Prabhu mentioned there

    are police officers on grounds that Mr. Ruggles has

    interacted with and theres never been any problem.

    Its hospital policy whenever -- if he was

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    on a community trip and a police officer asked him his

    name or any kind of contact like that, its our policy to

    inform the Board. Whenever any acquittee has any

    interaction with police officers. So regardless of the

    reason, you know, if he was in the van and somebody else

    rear-ended the van and a police officer asked him his

    name, we would inform the Board that a police officer was

    there for the accident and asked him his name and

    interviewed him. So any contact that acquittees have with

    the Board we inform -- or with the police, we inform the

    Board.

    MS. MABBETT: But isnt that pretty

    important considering the fact that it was police officers

    that were in danger here, it was just a matter of which

    police officer he was going to end up shooting, and

    unfortunately he shot --

    DR. LAH: Yes --

    MS. MABBETT: -- Michael Daubart --

    DR. LAH: -- Im aware of that. But to

    prevent him having access to that, means he would not be

    able to go anywhere in the state because there are police

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    officers everywhere in the state, in every town, in every

    --

    MS. MABBETT: But what Im saying is have

    we watched his interaction with any police officers thats

    been assertive with him at all and watched what he has

    done because thats -- thats part of --

    DR. LAH: Theres --

    MS. MABBETT: -- his delusions?

    DR. LAH: There have been no problems at

    all with his interaction with the officers on grounds and

    hes had no interaction with community police officers.

    MS. MABBETT: Okay, thank you. And the

    medication that hes required to take, will he take that

    medication prior to the day leaves or when he returns?

    When -- when exactly is that medication --

    DR. PRABHU: Actually, he currently takes

    it at night. And hell remain taking it at night.

    MS. MABBETT: Okay. And if Mr. Ruggles on

    one of these walks should disappear or not show up on

    time, when exactly do you notify the authorities? I know

    that you indicated in the temporary leave that you would

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    notify CVH. But when are they required to notify the

    authorities or what steps are taken after or if that

    should happen?

    DR. LAH: We have clear procedures for --

    even with hospital staff supervised trips with patients if

    a patient -- or an acquittee left the area. The first

    call is to the police. They call 911 and inform the

    police. The second call is to the hospital to the

    hospital police. The third call is to the Dutcher nurse

    supervisor, who would inform the treatment team. So 911

    is the first call that staff would make immediately if he

    walked away.

    MS. MABBETT: What time frame are we

    talking about?

    DR. LAH: Minutes.

    MS. MABBETT: So if he was to be at a

    certain location within minutes and he wasnt there, then

    that 911 call would take place?

    DR. LAH: Oh. If he was supposed to leave

    Dutcher and walked to the building on grounds to go to an

    activity at River Valley Services, if he wasnt there

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    within 10 minutes, theyre supposed to call the unit. We

    would immediately notify our police, then staff. We would

    search the grounds. And then after a period of time, the

    procedure is our police if they couldnt find him, would

    then do the teletype communication with statewide, with

    all state and local police. So the response is pretty

    quickly. Our policy is if somebody doesnt come back from

    a grounds pass within five or ten minutes, we initiate the

    escape procedure.

    MS. MABBETT: Okay. In one of the -- we

    had sent a letter back when -- and Im sure its in your

    file someplace -- that there are certain individuals that

    needed to be notified if Mr. Ruggles should disappear,

    such as the police officers that were involved --

    DR. LAH: Yes --

    MS. MABBETT: -- the Governor --

    DR. LAH: Yes --

    MS. MABBETT: -- and all those people that

    we felt could potentially be threatened as a result of

    what he -- the shooting that had occurred --

    DR. LAH: Right. Part of our procedure is

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    also to immediately notify the Executive Director of the

    Board. And then it would be the Boards responsibility to

    inform the victims.

    MS. MABBETT: And when you talk about

    victims, would that be in compliance with the letter that

    the State had previously sent to your facility? And --

    and you may not have that --

    DR. LAH: It would be in compliance with

    the victims of his crime that the Board has on record.

    MS. MABBETT: Okay.

    DR. LAH: So if you had listed the

    Governor, the Governor is not considered a victim of his

    crime --

    MS. MABBETT: No, hes not --

    DR. LAH: -- so we -- they wouldnt -- I

    wouldnt -- Ellen Lachance could answer that, but --

    MS. MABBETT: Alright. And I would be

    concerned about perhaps security at the Governors

    facility or any government facility that might be -- in

    Hartford or in the area to be notified.

    MS. LACHANCE: You can rest assure that we

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    will take no chances in terms of notifying as many people

    as we think is appropriate in each individual case.

    MS. MABBETT: Okay, thank you. And my

    question to you --

    MS. BURKE: Mmm-hmm --

    MS. MABBETT: -- is what exactly will

    happen at your facility?

    MS. BURKE: Were a working clubhouse,

    which means that individuals who attend our programming,

    theres an expectation that they contribute to the working

    of the clubhouse, whether that is working in the culinary

    unit, which Mr. Ruggles has expressed an interest in,

    writing a newsletter potentially, maintenance of the

    building and the grounds, potentially career services when

    thats deemed appropriate. So its relatively structured.

    People can decline to participate obviously, but generally

    we have about a 90 to 95 percent participation rate on a

    daily basis.

    MS. MABBETT: Okay. And then this

    information of his participation is relayed back to CVH

    then and documented?

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    MS. BURKE: It can be, absolutely. Its

    documented in our electronic medical record on a daily

    basis.

    MS. MABBETT: Okay. And then thats

    something again too that the Board could have access to --

    MS. BURKE: Absolutely --

    MS. MABBETT: -- if need be?

    MS. BURKE: Yeah.

    MS. MABBETT: Okay. Okay, thank you.

    Thank you.

    ACTING CHAIRMAN KIRSCHNER: I just have

    one question. I dont know who can answer it, but he

    continues to deny that he has any type of mental illness

    or need for psychiatric treatment, medication, or therapy,

    but yet hes engaged in therapy. What is he working on in

    therapy and whats he talking about?

    DR. PRABHU: Dr. Winkel, who is both his

    individual therapist and the, sorry, group therapist for

    the Forensics Group, reports that he has -- much of the

    discussion are about the events of the prior week, the

    activities, his interactions with staff and/or other

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    patients on the unit. But hes also volunteered

    information about the crime, about his state of mind at

    the crime, his understanding of how his depression and his

    alcohol use and his paranoia, which is his term, had

    contributed to the crime at the time. And hes also

    spoken about how alcohol was a part of his lifestyle prior

    to the crime and how he felt that -- hes described it in

    terms of wishing to emulate other men in his peer group

    and his regrets about how those things contributed to the

    crime. He has spoken about having strong commitments to

    maintaining sobriety. Hes indicated that he has no

    desire to ever drink again, that hes not had cravings.

    So these are the sorts of things that have come up in

    individual as well as group therapy over the last two

    years.

    ACTING CHAIRMAN KIRSCHNER: So does he

    attribute his paranoia and his depression to his alcohol

    use?

    DR. PRABHU: My understanding is that he

    attributes it both more to his -- as he would describe it

    to his spiritual problems, which is his understanding of

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    his mental illness, and that his -- he was -- he had

    difficulties with his faith and his spirituality, and

    those were the reasons for his being unwell. He has been

    consistent in, you know, not acknowledging that he has a

    mental illness and attributing the paranoia for example to

    the mental illness.

    ACTING CHAIRMAN KIRSCHNER: So he can

    acknowledge paranoia and depression, but doesnt classify

    that as any type of mental illness?

    DR. PRABHU: He attributes it to spiritual

    problems rather than to a mental illness, yes.

    ACTING CHAIRMAN KIRSCHNER: So to what

    does he attribute his spiritual growth or change over the

    course of his hospital stay in terms of how his

    spirituality got corrected?

    DR. PRABHU: In fact, we did discuss this

    this week. He attributes it to time, to learning, and to

    renewed commitment to his spiritual beliefs.

    ACTING CHAIRMAN KIRSCHNER: Is he engaged

    in any type of religious activities, spiritual --

    DR. PRABHU: Its actually not listed as

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    part of any of his activities. Im not aware that -- any

    detail about some of the religious events that he may

    partake in on campus or around holidays.

    I would also note that he -- there was a

    significant change in his participation in treatment

    around 2001. You may recall that prior to 2001, he wasnt

    engaged in therapy at all and he wasnt even attending the

    PSRB hearings. However since then, he has been coming to

    hearings and his engagement in therapy has increased from

    what was my understanding a fairly cursory 15 minutes to a

    now weekly 30 minutes. So although Mr. Ruggles has not --

    continues to state that he does not think that he needs

    therapy, he does come to the meetings, he has increased

    his involvement, and I think that probably reflects his

    growing comfort with his therapists and the treatment team

    even if he doesnt recognize the mental illness for what

    it is.

    ACTING CHAIRMAN KIRSCHNER: Is there any

    concern that this spirituality aspect is almost a form of

    another delusional belief system as opposed to an actual

    spiritual type of faith?

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    DR. PRABHU: Right. So in the past when

    he has psychiatrically decompensated, he has been more

    grandiose and more overtly religious, or one might

    actually use the term religiosity to describe the nature

    and the flavor of his speech and his thought or his

    organization. That has not been the case in the last two

    years. There has been no evidence of religiosity or

    grandiosity or of the kinds of disorganization that hes

    seen in the past -- that weve seen in the past.

    ACTING CHAIRMAN KIRSCHNER: Okay, thank

    you. Miss Lachance.

    MS. LACHANCE: Dr. Prabhu, two years ago

    at his last Mandatory Review hearing, Dr. Buchanan had

    testified about the mental status exam that he had

    performed and he asked similar questions as you had

    described you were asking. And at that point Dr. Buchanan

    was testifying and he said that when he asked Mr. Ruggles

    if he thought that there was a conspiracy against him and

    if he currently believed the conspiracy theory that he had

    believed at the time of the crime, and Mr. Ruggles stated

    that he didnt know if it was a conspiracy, but thought it

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    remained a possibility. So that was two years ago. And I

    note that in your mental status exam you asked a very

    similar question. And I recall that you said something

    about -- or akin to his saying he doesnt like to dwell on

    that. Did you push him on that question?

    DR. PRABHU: I did, in particular because

    I was familiar with Dr. Buchanans questions about it.

    And Mr. Ruggles was more conclusive. He didnt leave open

    the possibility that there might have been a conspiracy

    against him. He simply said no and that he recognized

    that he was troubled at the time and that there were other

    things going on at the time. So he didnt even refer as

    hes had in the past, however even though weakly to

    believing that he was part of a conspiracy or a government

    agent.

    MS. LACHANCE: Is there anyone who can

    give us information about how Mr. Ruggles has participated

    or been engaged in the activities that hes participated

    in at River Valley or Gilead up to this point? I know

    its once a month, but can anyone characterize how he has

    -- how his involvement has been?

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    DR. PRABHU: Again, hes uniformly

    described as polite, cooperative, he does what he needs to

    do, he does what hes asked to do, he volunteers for jobs,

    and he performs jobs also around the unit. He cannot be

    described as the most expressive or voluble of the

    patients in the groups, but he does engage the other

    patients and has volunteered observations about their

    treatment and has absorbed feedback from other patients

    about his own engagement for example in Forensics group

    without any difficulty.

    MS. LACHANCE: In 2006 Dr. Zeman conducted

    an evaluation at the request of Attorney Mabbett. And in

    part that evaluation noted the importance of monitoring

    Mr. Ruggles mental state, particularly in light of his

    refusal to believe he has a psychiatric illness and also

    because he maintains a -- maintained then at least a

    belief that he did not require psychiatric medication.

    For the record does he still believe, do you know, that he

    doesnt require psychiatric medication?

    DR. PRABHU: That is his belief, yes.

    MS. LACHANCE: And -- so in light of his

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    decompensation in June of 2009 and the comments that Dr.

    Zeman made about the importance of monitoring his mental

    status, is that something that you would concur would be

    important as well as he transitions?

    DR. PRABHU: Yes, I would. And in fact, I

    note that in addition to the new activities that he will

    be doing, he will maintain his relationship and his

    therapeutic therapy with Dr. Winkel, whos had a long time

    observing the patient, he will still be having his

    overnights -- hell still be returning to the unit every

    night. So again, hell be working with people who have

    observed him for a long period of time. And both the

    staff at Gilead and River Valley Services have described

    themselves as being another set of eyes on the patient.

    And -- so hes never going to have an extended period of

    time where he is not being supervised. So there will be

    both structure and eyes on the patient at all times.

    MS. LACHANCE: In the community who will

    be the primary responsible party for monitoring his mental

    status?

    DR. PRABHU: So -- you mean does he --

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    will he be having a separate supervisor --

    MS. LACHANCE: No, I meant --

    DR. PRABHU: A clinician?

    MS. LACHANCE: Yes. I dont mean

    necessarily to conduct mental status exams in the formal

    way that you do. What I meant is there one party in

    particular whose responsibility is maybe more so than

    others in terms of monitoring his mental state or checking

    with other people who he has interaction with while in the

    community? Is there one person whos responsible for

    that?

    DR. PRABHU: His TL supervisor, Wendy

    Blakely has described her role to me as realizing that her

    job is to keep an eye on him and to elicit feedback from

    other people who have interactions with him about his

    mental status.

    MS. LACHANCE: And what is her clinical

    background?

    COURT REPORTER: One moment please.

    (pause - tape change)

    DR. PRABHU: Im sorry. May I go ahead?

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    Thank you. She is a mental health worker -- Ive just

    been informed by Patty Burke that she has almost completed

    her Masters Degree in social work. Yes, I knew that she

    was a social worker. And shes had about 12 years of

    experience in -- at least 12 years of experience in

    working with mentally ill clients in the community.

    MS. LACHANCE: From a previous hearing we

    heard testimony that River Valley Services at that time,

    which is probably going back two years ago, did not have a

    forensic team or a forensic psychiatrist on their team. Do

    you know if thats still accurate?

    DR. PRABHU: I dont, but I --

    A VOICE: That is accurate.

    DR. PRABHU: It is accurate according to

    Colleen who is here from River Valley.

    MS. LACHANCE: Thank you.

    ACTING CHAIRMAN KIRSCHNER: Thank you. Do

    we have a statement from --

    MR. MICHAEL DAUBART: How do you do,

    Board. My name is Michael Daubart. Im one of the

    victims of this crime as you know. I strongly oppose any

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    reducing or reduction in Mr. Ruggles level.

    I just want to go back and remind the

    Board of what happened here. And as I sit here throughout

    the years listening to the different hearings, we kind of

    forget what actually went on and what the mental state of

    this person was and what he said back then and what hes

    saying today. So if I can just take a moment and remind

    us what happened.

    Mr. Ruggles was -- planned this assault

    and assassination of me for over three months. He had

    followed me and kept a very detailed journal of all of the

    activities that went on in our town. Mr. Ruggles did not

    have a drinking problem at that time. We had run into Mr.

    Ruggles numerous times. I started out as a 21-year-old

    rookie police officer. I asked Mr. Ruggles one day to

    stop handing out literature from the front of the post

    office in violation of post office regulations. He felt

    he could run for governor and that the government was now

    being run by communist agents and he must take over. I

    did a simple act and just asked him to remove himself from

    those stairs. That put me on his hit list as the No. 1

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    person.

    Mr. Ruggles followed me around,

    unbeknownst to me, and I was a pretty sharp police

    officer, I thought. He sat outside my house in the woods.

    He noted what room I was in. He noted what time I came

    and went. He knew what car I drove. Again, we go back to

    his journal. He wrote detailed entries into that journal.

    How did this Board not review his journal at this day is

    beyond me. He still does that. In those journal entries

    he writes how he had put a bomb in my car, how he walked

    up behind me as I stood in line at a grocery store and put

    a 45 caliber gun in my back, and if I had turned around,

    he had to disable me and cripple me before he shot me in

    the head. He wrote about other officers, David

    Bruckinthal (phonetic), Charles Hubb (phonetic). There

    was a group of officers that had stopped him at minor

    times just asking him to remove himself from sidewalks

    that he was handing out -- or on motor vehicles stops.

    They became on his hit list. He had a large hit list.

    As he progressed down the scale and became

    more and more paranoid, all of these things started to

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    come to head. He planned like I said for three months

    when he was going to assassinate me, how he was going to

    tap the back of my police car, causing me to chase him.

    He was not going to stop. He was going to finally pull

    over in front of a day care center so that when he got out

    of the vehicle, I was looking at 60 kids in the front of a

    day care center as I drew my weapon. If I missed, I was

    probably going to hit one of the little kids. If he

    missed, he had set it up very meticulously that behind my

    backdrop was a sand bank, a sand bank. So his misfire

    would hit a sand bank and mine would hit a group of kids.

    His car was booby trapped. So not only was he going to

    take my life, but any of the officers that came afterwards

    if he was killed or not, were also going to be maimed.

    You talk about location. He marked his location. We had

    spent months where he followed us around and set that up.

    And his interaction with police officers, it could have

    been any of us. He wrote in his journal how officers had

    -- if the officer attempted to stop him, he must get out

    and shoot that officer.

    I need this Board to be able to say these

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    things are corrected, this gentleman will not do that

    again. He still feels that his actions are okay. He

    doesnt accept what he has done. One of the critical

    elements we have in parole is that he accepts his crime. I

    dont hear that coming from him. You talk about alcohol

    was a problem. It wasnt when his crime was committed.

    You talk about medication. He refuses to take medications

    most of the time if you were not here. You have to

    guarantee us that when hes in the community, hes going

    to take it. Hes already telling you hes not going to do

    that. You mention about not having any control or review

    of a journal entry. Ive already gone over that. The

    journals are critical to know what he is really thinking

    in his mind.

    His computer access, it appalls me that

    you dont have detailed knowledge of where this man is

    going. He spent hours in the library researching bombs

    and weapons and mass destruction and how to set all of

    these things up, hours upon hours. And you dont have one

    list of where hes gone in the last six months. And

    youre telling me that it might be time to reduce him?

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    I find that hes still a very -- a very

    large threat to society, that releasing him into society

    without these precautions in place is almost guaranteeing

    that he is going to slip back and run into the same

    problems. And this time hes going to kill somebody.

    He stood above me with a shotgun. He shot

    me the first time, disabling my arm. He wrote in his

    journal how he had to do that. That I had a bad habit of

    unzipping my vest as I was pulling into a dinner break.

    And he knew that. He used that against me to disable my

    arm. He shot me the second time square in the chest,

    knocking me back. He shot me a third time, to ensure I

    was going to die. He put the gun to my head for the

    fourth time. And by the grace of God another officer

    showed up and he had to take it off of my head and shoot

    at that officer. I dont know how I survived that day.

    But I ask the Board if you can guarantee thats not going

    to happen, then you can release him. But if you cant

    guarantee that that is not going to happen again, it is

    your duty to keep him under strict supervision and locked

    up. Thats all.

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    MS. LACHANCE: Thank you.

    ACTING CHAIRMAN KIRSCHNER: Thank you.

    MR. DAUBART: Thank you.

    ACTING CHAIRMAN KIRSCHNER: If there are

    no further questions or matters to be brought before the

    Board, then this hearing is closed.

    (Whereupon, the hearing adjourned at 11:25

    a.m.)

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    HEARING RE: KENNETH RUGGLES

    NOVEMBER 4, 2011

    INDEX OF WITNESSES

    PAGE

    DR. MAYA PRABHU

    Direct Testimony 3

    Examination by Ms. Mabbett 12

    Examination by Acting Chairman Kirschner 31

    Examination by Ms. Lachance 35

    DR. MICHAEL LAH

    Examination by Ms. Mabbett 15

    PATRICIA BURKE

    Examination by Ms. Mabbett 16

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