Wanda G. Gillis v. Dale C. Cameron, Superintendent, St. Elizabeths Hospital

BAZELON, Chief Judge.

On October 7,1958, appellant was found of unsound mind and committed to St. Elizabeths Hospital, a public mental hospital in the District of Columbia (Mental Health Case No. 1473-58). On November 23, 1958, she left the Hospital without permission and returned to her home in New York. On December 8, 1958, while she was still in New York, the Hospital recorded that appellant was discharged as “improved.” Four years later, in December 1962, she returned to the District of Columbia and called at the office of the Vice President of the United States. As a result of her behavior at that time civil commitment proceedings were again instituted against her (Mental Health Case No. 2454-62). Before their completion, but after appellant had demanded a jury trial under D.C.Code § 21-312 (1961), the Commission on Mental Health moved to dismiss the proceedings on the ground that the previous civil commitment order of 1958 was still in effect and a legal basis for her present detention. The District Court granted the motion and appellant filed the instant habeas corpus petition alleging that her present detention is unlawful because the 1958 order is no longer in effect. After a hearing, the District Court dismissed the petition and this appeal followed.

The District Court’s holding that appellant’s present detention in St. Elizabeths Hospital is legal was based on two points. First, the court held that her discharge as “improved” in 1958 did not terminate the earlier commitment order. Second, the court held that appellant could be recommitted without further hearing because an adjudication of unsoundness.of mind, entered at the same time as 'the 1958 commitment order, was still, in effect. We shall discuss these points in order.

At the hearing below, Dr. Harris, Acting Superintendent of St. Elizabeths, testified that there are four categories under which patients are discharged from the Hospital: “recovered,” “social recovery,” “improved” and “unimproved.” In addition, the Hospital releases patients on parole.¹

. Discharge of patients under the classification “improved” is a generally accepted practice. The hospital attaches no conditions to the release of 'patients so discharged." Therefore a discharge as “improved:’ must be regarded as legally final. Lindman & McIntyre, eds.,'The Mentally Disabled and the Law 227 (1961) (The Report of the American Bar Foundation on the Rights of the Mentally Ill). Consequently, as other jurisdictions have decided, a new commitment proceeding must be held to compel a patient’s return to the hospital. Hatton v. State Board of Control, 146 Tex. 160, 166, 204 S.W.2d 390, 393 (1947); Byers v. Solier, 16 Wyo. 232, 250, 93 P. 59, 64, 14 L.R.A.,N.S., 468 (1907); ² Lindman & McIntyre, ibid.

Adoption of a contrary rule for this jurisdiction would, to employ language from Lynch v. Overholser, 369 U.S. 705, 714, 82 S.Ct. 1063, 1069, 8 L.Ed.2d 211 (1962), be “quite out of keeping with the congressional policy that underlies the elaborate procedural precautions included in the civil commitment provisions [which seem intended] to insure that only those who need treatment and may be dangerous are confined.”

A discharge as “improved” purports, on its face, to rest upon an expert medical judgment that the patient’s condition has sufficiently improved so as not to require further hospitalization for the safety of the patient or the community. In the present case, however, the testimony was ambiguous as to whether, in fact, appellant’s discharge was based upon such judgment or was merely a bookkeeping entry recorded for administrative convenience. The Acting Superintendent of the Hospital testified that at the time appellant left the Hospital without permission to return to New York, and at the time she was discharged a few weeks later, the Hospital staff was of the opinion that she was still in need of hospital care. There was also testimony .to support the District Court’s finding that “because petitioner was a non-resident of the District of Columbia, because she could not be compelled to return to this jurisdiction, and as a matter of administrative policy in the keeping of its records, the hospital on December 8, 1958 noted petitioner discharged as improved.” ³ But other testimony of the Acting Superintendent was to the effect that if the staff had thought her dangerous, the New York police would have been notified and further hospitalization proceedings would have been instituted. This was not considered necessary.⁴ At the very least, the testimony fails to show that appellant’s discharge is not what it purports to be, namely, an unconditional discharge. Therefore she may not be recommitted under the 1958 commitment order, and her detention is legal only if the 1958 adjudication of unsoundness of mind affords an adequate basis.

We turn, therefore, to the District Court’s ruling that, since appellant had then been declared to be “of unsound mind” and since she has not been legally restored, “this patient needs no further adjudication as being of unsound mind and is properly in Saint Elizabeths Hospital under the 1958 adjudication. * * ” We agree that the adjudication of unsoundness of mind is still in effect.⁵ But in our opinion it does not follow that her present detention is authorized. To hold otherwise would overlook the proper distinction between the standards which-should be applicable to determining unsoundness of mind, on the one hand, and the need for commitment to a hospital on the other.⁶

Although our law provides that only persons of unsound mind may be committed, it does not require the commitment of all persons of unsound mind. See D.C.Code §21-316(0) (2). Nor does it provide that one who has been committed must be detained until he is legally declared of sound mind. To hold that it does, “would be to ignore the rule that although a person may be of unsound mind to the extent that he cannot contract, nevertheless he cannot lawfully be restrained unless his mental condition is such as to render it necessary that he be placed under restraint. [It] * * * would be to hold that when a mentally ill patient has once been confined in a state hospital for treatment he cannot be discharged until he has been completely restored to reason.” Hatton v. State Board of Control, 146 Tex. at 163-164, 204 S.W.2d at 391. Since the law recognizes that not all persons adjudged of unsound mind need be hospitalized, it follows that once a patient has been discharged from the hospital, even though he remain under an adjudication of unsoundness of mind, he cannot on that account be recommitted without a de novo proceeding. Therefore the District Court erred in holding that appellant’s failure to obtain restoration to legal competency rendered her subject to recommitment under the 1958 order.

We reverse the District Court and hold that appellant’s present detention under the 1958 commitment order is illegal. If it now appears that appellant requires further hospitalization, additional commitment proceedings must be instituted.

This case suggests a problem which deserves comment. The legislative trend throughout the country is away from making commitment depend on an adjudication of incompetency.⁷ Those concerned to protect the rights of the mentally disordered are looking with increasing disfavor on judicial decrees which take away a collection of individual rights, without specific findings as to the need to do so in each individual instance.⁸ The law in the District of Columbia would seem to be particularly vulnerable to criticism on these grounds. Dr. Harris testified that “commitment to a hospital here automatically renders a patient legally incompetent. We feel that there are many patients in the hospital who are legally competent * * Yet in order for these patients to get the hospitalization they require, they are, under our statutory procedure adjudged “of unsound mind.” The disadvantages of commitment being dependent on such an adjudication of general incompetency are compounded by the failure of the statute to specify the implications of the adjudication. The result is a rebuttable presumption of incompetency to engage in any activity for which the law requires one to be “of sound mind.” ⁹ Thus, without any inquiry or finding as to actual competence in the given area, a patient in St. Elizabeths Hospital, or a former patient who has not been legally restored to soundness of mind, may apparently be deprived of the right to vote,¹⁰ to drive an automobile,¹¹ *to enter into binding legal arrangements¹² and to exercise other civil rights.¹³

Reversed.

1 . The Acting Superintendent of the Hospital testified that, unlike other released patients, paroled patients are not dropped from the rolls and discharged. They continue their treatment as out-patients and make periodic visits to the Hospital. The record is silent as to whether paroled patients are returned to the Hospital without further proceedings. But the general rule is that no' further proceedings are necessary since the patient is released only conditionally — the condition presumably being that he demonstrate ability to function adequately outside the hospital. See Lindman & Me- . Intyre, eds., The Mentally Disabled and the Law 227 (1961).

2 . In Byers, as in the present case, the former patient had been “discharged as improved.” 16 Wyo. at 245, 93 P. at 63.

3 . The District Court also pointed out that the Hospital authorities advised the Secret Service that she had left the Hospital. But the notification to the Secret Service was part of an administrative policy requiring that notice be given whenever the Hospital discharges a patient who had attempted to see the President, as appellant had done prior to the 1958 commitment. Such notification is not based on the staff’s opinion as to the patient’s condition.

4 . The Acting Superintendent also testified:

“We felt she had been ill for a period of at least 10 years before this. She had gotten along out of the hospital with her illness. We felt that she had improved to some degree, but was still ill, was still showing some impairment of judgment. We felt she would still benefit from hospitalization * * *. But we decided it was to her best interests if she had the responsibility of trying to continue her life as at least free of the possibility of being picked up and being returned to the hospital.”

5 . Although appellant was eligible to do so, she did not petition for restoration under D.C.Code § 21-320 which provides that one who has been committed to St. Elizabeths and has been released for six months or longer either as improved or on parole, may petition the District Court for “restoration to the status of a person of sound mind.”

Dr. Harris testified that St. Elizabeths Hospital institutes proceedings for patients whom it discharges as recovered. Statutory authority for this procedure is contained in ch. 738, § 2, 33 Stat. 740 (1905), 24 U.S.C. § 210 (1934) (apparently through oversight, this section does not appear in later editions of the United States Code or in the current District of Columbia Code).

6 . The confusion is compounded in this jurisdiction because only those who are adjudicated of unsound mind may be committed. See D.C.Code §§ 21-315, 21-316(C) (1) (1961).

The Mental Health Commission’s recommendation for commitment must be predicated on a finding that the person is “of unsound mind.” § 21-316(C) (1). The court may then order commitment if it, or a jury, finds the person to be “insane.” § 21-315. The latter term is thus apparently used synonymously with the phrase “of unsound mind.” Indeed, the standard form of order entered by the court in such cases, as in the instant case, adjudicates the person “of unsound mind.” See In the Matter of Gillis, Mental Health No. 1473-58 (1958).

7 . See Lindman. & McIntyre, supra at 221 and sources cited. See also S. 935, 88th Cong., 1st Sess. (1963) (“A bill to protect the constitutional rights of certain individuals who are mentally ill, to provide for their care, treatment, and hospitalization, and for other purposes.” This bill would change the law in the District of Columbia.)

8 . See Report of the Task Force on Law, President’s Panel on Mental Retardation pp. 20-21 (1963) :

“The retardate must have unhampered access to all lawful activities, except those for which he is disqualified by lawful restrictions.

“Such restrictions may be of several kinds. The first includes activities for which some general ‘capacity,’ ‘competency,’ ‘soundness of mind,’ or similar standard is the legal touchstone, such as the right to enter into enforceable contracts or to make a valid will. A second category relates to special restrictions which have no direct reference to ‘general competence’ and which most adults, but only some who are retarded, can satisfy. Some retarded people can drive a car safely, for example, others of equal ‘general competence’ cannot. A third category concerns activities for which the law requires a named competence beyond the customary knowledge and achievements of the general population, e. g., licensing requirements for a wide variety of businesses and professions, particularly where the licensing requires formal examination, or the demonstration of special experience or skill.

“The retardate may thus be excluded from a number of activities, or precluded from the exercise of what would be his rights if he were not retarded. This can happen without any formal challenge, or identification of retardation. But it does not render the procedure contrary to his interest, or to the public interest, provided the statutory or administrative requirements are reasonably related to the performance of the regulated activity. It is, however, important to avoid indiscriminate disqualification from a particular activity because of a finding of ‘incompetence’ under a statute regulating other activities of a different type.”

9 . Cf. In re Williams, 157 F.Supp. 871, 875, aff’d, Overholser v. Williams, 102 U.S.App.D.C. 248, 252 F.2d 629 (1958).

We do not mean to imply that our statutes limiting the rights of the mentally disordered use uniform terminology. Indeed, one of the difficulties in ascertaining precisely what rights are affected by a general adjudication is the variety of ill-defined legal phrases. E. g., the commitment statutes use the terms “of unsound mind” and “insane,” see note 6 supra; the phrase “insane person” is defined to include “every idiot, non compos, lunatic, and insane person,” D.C.Code § 49-207 (1961); the statute governing appointment of a committee refers to persons “non compos mentis,” D.C.Code § 21-301 (1961); the electoral law, to the “mentally incompetent,” D.C.Code § 1-1102 (2) (1961); the statute governing the issuance of drivers’ licenses, to the “mentally qualified,” D.C.Code § 40-301 (1961). The Mentally Disabled and the Law rightly points out in this contest that “one of the major sources of confusion in the law has been the use of vague and nebulous descriptive terms.” Id. at 4.

10 . D.C.Code § 1-1102(2) (1961).

11 . D.C.Code § 40-301 (1961).

12 . See Life Ins. Co. of Va. v. Herrmann, 35 A.2d 828 (Mun.Ct.App.D.C.1944) (adjudication of unsoundness of mind created rebuttable presumption of incapacity to change beneficiary of life insurance policy). And see the testimony of Dr. Harris: “We also had the problem of patients who were discharged from the hospital as improved, legally unrestored, who wished to return to the hospital on a voluntary basis, and could not get in because they were not legally competent to sign the contract with the District of Columbia.”

13 . See Mental Competency Study, The George Washington University, Objective Data for the District of Columbia pp. 15-17 (preliminary mimeographed draft, July 17, 1963). See generally, Lindman & McIntyre, supra at 220.