Dissection of the prongs of ALI. A retrospective assessment of criminal responsibility by the psychiatric staff of the Clifton T. Perkins Hospital Center.

The staff of the Clifton T. Perkins Hospital Center has systematically reassessed the impact of the proposed modification of the ALI test removing the second prong. Findings of this retrospective survey reveal few changes in the composite staff opinions reported by the hospital but many variations in the opinions of individual psychiatrists when rating the prongs independently. The effect of these changes in Maryland (while difficult to anticipate) might be an increase in litigation. The resulting fiscal impact, therefore, not only could affect the Division of Corrections but also could increase court costs. The data suggest that rather than limiting psychiatric testimony and ensuring that only the sickest patients are exculpated, the proposed truncation of ALI may have paradoxical consequences. There may be more frequent battles of the experts based on less rigorous science and potential exclusion of affective psychosis from appropriate access to the defense of insanity. While the study methods and sample size prohibit reliable conclusions concerning the likelihood of these consequences in vivo, the issues raised strongly support a need for further investigation before a relatively well-functioning legal framework is changed in favor of the untested rubric of the proposed modifications of ALI.