VALE, Ore. — In 2016, Oregon officials freed Anthony Montwheeler from the Oregon State Hospital, accepting his argument that he had faked mental illness for nearly 20 years to avoid prison.

Last week, an Oregon judge ruled that Montwheeler, 50, was not competent to stand trial for an assault and two murders that prosecutors say he committed just weeks after his release. The judge ordered him returned to the hospital for treatment of depression brought on by the charges against him.

The Montwheeler case has raised broader questions about Oregon’s handling of people charged with crimes and judged not guilty by reason of insanity, questions ProPublica and the Malheur Enterprise are examining in a yearlong project.

Records show that Montwheeler was allowed to leave the hospital despite warnings from a psychologist that there was a significant risk he would attack relatives or friends.

On Jan. 9, 2017, prosecutors charge, Montwheeler kidnapped Annita Harmon, one of his ex-wives, and stabbed her to death at a gas station. A clerk who witnessed the attack called the police, who then chased Montwheeler’s pickup truck down Oregon Highway 201. Authorities say Montwheeler swerved into the oncoming lane and collided head-on with an SUV, killing David Bates and seriously injuring his wife, Jessica. Harmon was a mother of two children; Bates was a father of five.

The ruling by Circuit Court Judge Thomas Ryan came after a state doctor who had examined Montwheeler testified that while he continues to exaggerate his condition, he is suffering from sufficiently serious “adjustment disorder” to prevent him from effectively participating in his own defense.

Ryan’s decision angered many in this rural farming community who had hoped to see Montwheeler held criminally accountable for his actions.

“He lied to the state to get out of the hospital, and now he’s lying to get out of murder,” said Susan Harmon, the mother of Montwheeler’s ex-wife Annita. Harmon said she is frustrated with the repeated delays that have pushed a trial to late 2019.

The case drew national attention last year after the Enterprise reported on Montwheeler’s claims of faking his illness, his subsequent release and the alleged attacks in January 2017.

The Oregon Psychiatric Security Review Board, which had supervised Montwheeler for 19 years, sued the newspaper to block the release of public documents regarding his time under state supervision as public pressure built for explanations about why the man was free. Gov. Kate Brown of Oregon stepped in to order the records released and the lawsuit dropped.

The state board has since said it had no information on the recidivism of discharged clients. The five-member panel appointed by the governor supervises about 600 people deemed not guilty because of insanity who are sent for treatment instead of prison.

Under Oregon law, the board is required to balance “the protection of society and the welfare of the (criminally insane) person.”

The recent court hearings on the Montwheeler case cast new light on the complexities of that challenge.

Dr. Octavio Choi, a board-certified forensic psychiatrist and director of the Oregon State Hospital’s Forensic Evaluation Service, prepared a 37-page report on Montwheeler’s mental state and sent it to the court in January 2018. It was kept confidential until last week, when Ryan ordered it disclosed at the request of the Enterprise.

The report concluded that Montwheeler needed hospital care before he could assist in his own defense. Choi wrote that he had based his conclusion on a six-hour interview of Montwheeler in September 2017 and thousands of pages of mental health and legal records.

Choi found that Montwheeler had “attempted to exaggerate impairment for the purpose of a favorable outcome,” presumably so he would be sent to the hospital. He cast doubt on Montwheeler’s claim that he was hearing voices, noting that he told the review board in 2016 that he had lied about having such hallucinations. Montwheeler, Choi wrote, “provided highly inconsistent accounts” of those voices and when they started. When pressed about the voices, Montwheeler “became quite angry at this evaluator,” the report says.

Choi catalogued Montwheeler’s previous diagnoses by state doctors. At present, he wrote, there was no sign of active symptoms of bipolar disorder, post-traumatic stress disorder, delusional disorder or any other psychotic condition.

He testified last Monday that Montwheeler might have those conditions, or had them in the past, but that he couldn’t be certain because of “the unreliability of Mr. Montwheeler’s self-reported history.” Without additional documented symptoms from mental health experts, Choi said, he couldn’t trust Montwheeler’s descriptions “at face value.”

He said Montwheeler did have adjustment disorder with depressed mood, which Choi described in court as “mild to moderate depression.”

That disorder, Choi told the judge, “significantly impaired” his ability to make rational decisions about his defense.

He explained in court that he tested Montwheeler’s ability to learn new concepts and evaluated his capacity to consider the pros and cons of choices, both of which he judged insufficient. Such skills are important for deciding legal strategies in his case, such as weighing a plea bargain against the risks of a trial.

“Usually, there’s no clear, no-brainer path,” Choi said. “One could quibble: When he says he doesn’t know or doesn’t understand, is that reliable or not?”

He said that Montwheeler’s condition is “highly treatable,” and that three to six months at the state hospital could restore his mental competency, allowing the criminal case to move forward.

“He should properly be considered highly dangerous and thus would be inappropriate for community-based restoration,” Choi wrote.

He offered no evaluation of whether the past diagnoses were made in error. Choi did emphasize in the report and in testimony that the events of the last three years led him to give little weight to any symptoms described by Montwheeler.

In court, Choi said psychiatrists “are not mind readers” and cautioned against using his current opinion to question the original insanity finding in 1997 and Montwheeler’s 2016 discharge from the state hospital.

Montwheeler’s odyssey with the state’s criminal-insanity system began in 1996 when he was accused of the kidnapping of his then-wife and 3-year-old son, and threatening to kill them and himself. In jail for the crime, he attempted to kill himself and talked about demons. He pleaded not guilty by reason of insanity.

From the beginning, opinions differed about whether he met the criteria.

A state psychiatrist concluded that Montwheeler was depressed because of his circumstances, but that he did not have any other mental illness and did not qualify for the insanity defense.

A private psychologist disagreed. He said Montwheeler had told him he heard voices: his mother, who was killed by his father, and a man he saw die during his military service. He also described other symptoms that the psychologist said meant he suffered from bipolar disorder. The judge sided with the defense witness, deemed Montwheeler criminally insane and placed him into the review board’s custody for up to 70 years.

At a 2016 hearing before state officials, Montwheeler said his lawyer in the kidnapping case gave him a copy of a psychiatrist’s diagnostic manual that he used to feign insanity. His lawyer did not reply to a request for comment.

Montwheeler lived at the state hospital four times over the next 19 years, but he was otherwise allowed to live in the community while being overseen by the Psychiatric Security Review Board. During that time, he was convicted of several crimes, including felony aggravated theft. He last returned to the state hospital in 2014 after two years in prison.

In the years before he was released, state officials once again wanted to move Montwheeler out of the hospital, but only to a secure location away from “his family or active crime victims.” A state psychologist had warned the board that family members would be likely targets should he become violent again. Montwheeler objected and asserted for the first time that he had been fooling doctors for almost 20 years.

“I’ve been using the system, and I’m done,” he told the review board in December 2016. “I basically made that up to make myself sound crazy. I didn’t hear anything, I was just saying that’s what I was hearing.”

The Psychiatric Security Review Board is required to discharge anyone who no longer medically qualifies for its jurisdiction, regardless of the danger to the public. The board freed him.

Officials at the state hospital and the state board have refused to discuss their handling of Montwheeler, citing patient confidentiality, and haven’t undertaken any review of their actions. Relatives of the victims have notified the state they intend to sue for negligence in releasing Montwheeler.

Alison Bort, the Psychiatric Security Review Board’s director since June, said the audio recording of Montwheeler’s appearance before the board nearly two years ago is revealing.

“He lied about it. He malingered. That’s his testimony: that he didn’t actually have a mental disorder,” she said. “I think it was devastating to everybody in that that was the decision that had to be made. … I think if there was anyway the board could’ve held unto him, they would have.

“He was dangerous, but not because of a qualifying mental disorder,” she said.

That was the conclusion of Dr. Mukesh Mittal, who recommended Montwheeler be released from the state hospital. The psychiatrist spoke publicly for the first time last week about why he concluded Montwheeler was telling the truth when he said he had faked mental illness.

Mittal testified in court on Tuesday that he cared for Montwheeler in a controlled setting from 2014 to 2016.

“There was never any indication he was experiencing active symptoms, and he revealed to me that he was taking the medication just to keep up the reasonable deception,” Mittal said, noting the man didn’t take any psychiatric medications for the last year of his hospitalization. “It would be very difficult to hide (a serious illness) for two years.”

One of Montwheeler’s attorneys, Nicolas Ortiz, challenged past diagnoses. He asked if his client’s post-traumatic stress disorder might have just been in remission.

Mittal conceded that the disorder can be inactive for years, but he questioned the validity of that previous diagnosis, noting the Department of Veterans Affairs made no mention of it when he was honorably discharged from the Marines.

“I’m not limiting my diagnosis to the two years he spent under my care,” he said. “I am considering the 20 years he spent under the PSRB’s jurisdiction.”

Under questioning, Mittal said his opinion from two years ago wouldn’t be of value in determining Montwheeler’s fitness for trial. He didn’t dispute Choi’s conclusions.

At times through the hearing, Ryan knotted his hands and pressed his chin into them as he thought.

“This is a close case. I have serious concerns about the defendant’s potential for malingering,” he said. “But on balance I don’t believe I have a basis to contest. And I do agree with Dr. Choi’s report, and I am going to find the defendant unable to aid and assist. And I will be sending him to the hospital for treatment.”

At the back of the courtroom, the audience stirred. The mother of Annita Harmon sat near relatives of David Bates. The group had regularly exchanged hugs and shed tears during breaks in the proceedings. At Ryan’s announcement, the group shifted and some softly cursed. They told the prosecutor that it was unfair they had to wait so long for a court to weigh Montwheeler’s guilt. Malheur County District Attorney Dave Goldthorpe assured them that justice would come.

“The legal system is going to work as it’s designed to work,” he later told a reporter. “I believe he’s competent to stand trial now based on my reading of the report, but it’s the judge’s ultimate decision to make. And that’s what he did.”

The prosecutors, defense attorneys and judge consulted their calendars to decide when to meet to consider next steps in the criminal case. They settled on Jan. 4, 2019.

Susan Harmon leaned over in the wooden pew and spoke with quiet force: “That will be almost exactly two years since he killed her.”