It's been 35 years since Richard Greist's rampage in East Coventry Township.

On May 10, 1978, Greist, then 27, stabbed and killed his pregnant wife and pulled the unborn child she was carrying from her womb, stabbed his 6-year-old daughter in the eye, and slashed his grandmother's throat.

At his trial in 1980, he was found not guilty by reason of insanity and committed to Norristown State Hospital, where he has remained. And after a judge's ruling Tuesday, that's where Greist, now 61, will stay for at least another year.

The seven-page opinion by Chester County Court Judge Edward Griffith offers a few glimpses into Greist's life in the hospital.

Greist's psychiatrists testified that he has made progress in the last several years and has demonstrated "greater self-awareness, expressions of sadness and remorse," according to the opinion.

His psychiatrist for the last six years, Ira Brenner, has said he was encouraged by Greist's progress and recommended that he be placed in a "less restrictive program," according to the opinion.

But, Griffith wrote, for the last two years Greist has refused to meet with a state-appointed psychiatrist for annual evaluations. That doctor, Barbara Ziv, testified she believed Greist would "decompensate" in a less restrictive environment and added that she felt he was engaging in therapy with Brenner only on a superficial level.

For Greist's annual commitment hearing, hospital staff requested that he be granted expanded privileges for unsupervised trips off hospital grounds. They also asked the court for permission to "explore community placement" - which, Griffith said in his opinion, would boil down to a plan for his eventual release.

Griffith did allow Greist some off-grounds privileges. He will be allowed to leave the hospital unsupervised for 12-hour stretches once a month, and for a 24-hour stretch every third month. He'll also be allowed to attend church, unsupervised, every Sunday at the West Norristown Kingdom Hall of Jehovah's Witnesses for three hours.

But Griffith declined to address any kind of permanent release - and maintained that Greist's continued psychological issues require him to remain at Norristown for the next year, when he'll face another commitment hearing.

"Mr. Greist remains severely mentally disabled and in need of treatment. We have considered a less restrictive placement [...] but find that Mr. Greist is still in need of the therapeutic structure that hospitalization provides," Griffith wrote.

And, Griffith added, Greist is still forbidden from having any contact with his daughters, who are now middle-aged.

Since his commitment, Greist has married twice - to a nurse at the hospital who later committed suicide, and to a woman from New Zealand he met in a chat room for Jehovah's Witnesses.

"He's a darling," she told a judge during a 2005 commitment hearing.

His daughters testified at that same hearing after learning that hospital staff were recommending that Greist be transferred to a group home.

They spoke of their long road to recovery and said that progress would have been undone had Greist been released.

Contact Aubrey Whelan at 610-313-8112, at awhelan@philly.com or on Twitter at @aubreyjwhelan.