REDWOOD CITY -- Is William Ayres' once-brilliant mind crippled by dementia? Or has he been faking symptoms of the disease to escape prosecution on child molestation charges?
Those questions are at the core of a competency hearing that began Friday in San Mateo County Superior Court, where the former child psychiatrist has returned after spending nine months in Napa State Hospital for treatment and evaluation. A jury hung in 2009 on charges that Ayres sexually abused five young boys in his care.
The hearing got under way with a notable twist: Three clinicians who evaluated Ayres at Napa defended their assessment that he has Alzheimer's-related dementia, contradicting the institution's official stance that the 80-year-old former child psychiatrist is mentally fit to stand trial.
The hospital based its decision on the report of forensic psychologist John McIlnay, who documented discrepancies between Ayres' behavior around clinicians and interactions with other staff.
But Thomas Knoblauch, a psychologist who saw Ayres every day from December to July, said he was not swayed by McIlnay's report. He said he never seriously considered the possibility that Ayres was faking his memory problems and difficulty in coming up with words.
"At no point did I ever feel that I was being played," said Knoblauch, who also testified that Ayres often appeared disoriented and had trouble organizing his thoughts.
Dr. Scott Sutherland, a Napa psychiatrist who saw Ayres frequently, also stood by his conclusion that Ayres' mind is deteriorating. He said he was vigilant about potential malingering, and he's never encountered a patient who is capable of faking mental illness or deterioration for long periods of time.
"They all have a tell," said Sutherland, adding, "There's nobody good enough to do this 24/7, month after month, year after year."
After reading McIlnay's report, Sutherland said he added a secondary diagnosis of malingering to his assessment of Ayres, but he reached a vastly different conclusion. He asserts the former president of the American Academy of Child and Adolescent Psychiatry, long accustomed to being treated with respect, would sometimes try to put up a false front of health.
"He would pretend to be a lot better than he was," Sutherland said, "so he would appear to be the person he had always been."
Deputy district attorney Melissa McKowan suggested Ayres, given his background, would have known how to respond to tests designed to ferret out malingering. She cited professional literature showing that successful malingerers typically feign simple symptoms that are difficult to disprove, such as problems with memory and word-finding.
Reading from Napa doctors' reports, McKowan said Ayres took part in recreational activities such as chess, bingo and dancing but never participated in group activities aimed at restoring mental health. He often refused medication, from anti-psychotic drug Resperdal to fish-oil pills and eye drops, she said.
In a report completed early in his stay, doctors noted Ayres had said, "Why should I agree to these treatments -- just so I can go to prison?"
But Erin Warnick, a psychological specialist at Napa, testified that she stands by a neuropsychological evaluation she conducted in April that found Ayres suffers from dementia. She acknowledged Ayres tends to exaggerate his symptoms of memory loss but not to the degree that it would change her diagnosis.
The hearing resumes Monday morning with further testimony from witnesses for the defense, which has the burden of proving Ayres is incompetent. There is no jury for the hearing. Judge John Grandsaert will make a ruling on Ayres' competency.
Contact Aaron Kinney at 650-348-4357. Follow him at Twitter.com/kinneytimes.com