United States District Court, M.D. Alabama, Northern Division
MENTAL-HEALTH OPINION AND ORDER
H. THOMPSON UNITED STATES DISTRICT JUDGE.
Robert John Kelly pled guilty on August 28, 2017, to
conspiracy to commit bank fraud and wire fraud, in violation
of 18 U.S.C. § 1349, and possession of stolen mail, in
violation of 18 U.S.C. § 1708. Prior to sentencing, the
government moved for a mental-competency examination, which
was granted. In addition, in light of Kelly's
“lengthy history of severe substance abuse and serious
mental illness, ” the court ordered a presentence
mental-health evaluation pursuant to 18 U.S.C. §
3552(b), “to ensure that defendant Robert John Kelly is
not inappropriately punished for having a disease, to assess
accurately his culpability for the offense, [and] to mete out
any necessary rehabilitative treatment.” United
States v. Kelly, No. 2:17cr131-MHT, 2017 WL 5483169, at
*1-*2 (M.D. Ala. Nov. 15, 2017) (Thompson, J.); see also
United States v. Mosley, 277 F.Supp.3d 1294 (M.D. Ala.
2017) (Thompson, J.). In the resulting evaluation report,
Bureau of Prisons (BOP) Forensic Psychologist Heather H.
Ross, Ph.D., diagnosed Kelly with Severe Stimulant Use
Disorder; Severe Opioid Use Disorder; Severe Alcohol Use
Disorder; Persistent Depressive Disorder; and Antisocial
Personality Disorder. See BOP Psychiatric Report
(doc. no. 497) at 12.
case came up for sentencing on July 27, 2018. After finding
Kelly competent to proceed, the court resolved that he should
be sentenced to a Guidelines sentence of time served
(approximately eight months), followed by placement in a
residential treatment facility, where he is to receive both
substance-abuse and mental-health treatment. The issue of
Kelly's treatment plan, including what facility in which
to place him and how to transfer him directly there from
federal custody to avoid any possibility of relapse, was then
referred to United States Magistrate Judge Susan Russ Walker,
who consulted with defense counsel, counsel for the
government, and the United States Probation Officer.
close consultation with magistrate judge and based on
evidence presented at a supplemental sentencing hearing on
August 3, 2018, the court holds that it will adopt the
following treatment plan.
Residential Placement and Substance-Abuse Treatment
parties and the Probation Department agree that the most
appropriate, currently available placement for Kelly is at
Fellowship House in Birmingham, Alabama. He has been accepted
there for treatment based on the BOP report, and therefore
can be transferred directly from federal custody without any
additional assessment. Once he arrives, he will be assessed
for Medication Assisted Therapy (MAT). The BOP report states
that it appears Kelly has benefitted in the past from MAT
with Suboxone, adding that “it would be most
appropriate to defer any decision to pursue MAT to the
defendant's treatment provider(s).” Psychiatric
Report (doc. no. 497) at 18. However, the court has had prior
experience with a defendant who should have been assessed for
MAT upon arrival at a residential treatment facility, but who
was never actually assessed. Accordingly, the court will
require that the Probation Department file a report with the
court as to whether he has been assessed for, and whether he
is receiving, MAT.
successful completion of residential treatment, Kelly will be
transitioned to outpatient treatment. It is not possible for
the court to know at this time how long the inpatient
component will be, which may depend in part on how he fares
during such treatment. Time in treatment for substance-abuse
disorders is closely correlated with successful results, and
there is strong evidence that 90 days of treatment is the
minimum length necessary to get any positive results from
treatment. See, e.g., Nat'l Inst. Drug Abuse,
Nat'l Inst. Health, Understanding Drug Abuse and
Addiction: What Science Says (Feb. 2016),
/6-duration-treatment; Douglas B. Marlowe, Evidence-Based
Sentencing for Drug Offenders: An Analysis of Prognostic
Risks and Criminogenic Needs, 1 Chapman J. Crim. Just.
167, 169 n.11 (2009). Many experts believe that treatment
should last at least a year, and more if possible.
See U.S. Dept. Health & Human Servs. (HHS), Off.
Surgeon Gen., Facing Addiction in America: the Surgeon
General's Report on Alcohol, Drugs, and Health 4-18
(Nov. 2016) (“In general, patients with serious
substance use disorders are recommended to stay engaged for
at least 1 year in the treatment process ....”). The
court, therefore, recommends that Kelly's treatment,
whether inpatient or outpatient, last as long as possible,
but at least 90 days and preferably a year or longer.
House in Birmingham is equipped to address “dual
diagnoses, ” that is, co-occurring substance-abuse and
mental-health disorders. Kelly will thus be able to receive
mental-health treatment, in addition to drug treatment. The
court will require the Probation Department to verify with
Fellowship House whether he will be able to take any current
medications with him to their facility, and to file a report
to that effect.
Direct Transportation to Avoid Relapse
court previously emphasized at sentencing, it is crucial that
Kelly be transported immediately from jail to inpatient
treatment to avoid the serious dangers of opioid relapse.
“The two weeks immediately after release is a
particularly dangerous period for the formerly incarcerated.
... During this period, the risk of opioid overdose deaths
among former inmates was 40 times higher than the general
population.” Erin Schumaker, Inadequate Prison
Policies Put Former Inmates At Greater Risk of Opioid
Death, Huffington Post (July 31, 2018) (citing Shabbar
I. Ranapurwala et al., Opioid Overdose Mortality Among
Former North Carolina Inmates: 2000-2015, Am. J. Pub.
Health (2018)). It is therefore vital for Kelly's safety
and well-being that he be transported directly from
incarceration to a treatment facility.
end, counsel for Kelly is to arrange transportation for Kelly
from federal custody to Fellowship House under the conditions
stated in open court.
therefore, ORDERED, pursuant to the recommendation of the
magistrate judge and as part of the court's ...