House Report 108-729 - DISTRICT OF COLUMBIA CIVIL COMMITMENT MODERNIZATION ACT OF 2004

[House Report 108-729]
[From the U.S. Government Publishing Office]

108th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 108-729
======================================================================

DISTRICT OF COLUMBIA CIVIL COMMITMENT MODERNIZATION ACT OF 2004

_______

October 5, 2004.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed

_______

Mr. Tom Davis of Virginia, from the Committee on Government Reform,
submitted the following

R E P O R T

[To accompany H.R. 4302]

[Including cost estimate of the Congressional Budget Office]

The Committee on Government Reform, to whom was referred
the bill (H.R. 4302) to amend title 21, District of Columbia
Official Code, to enact the provisions of the Mental Health
Civil Commitment Act of 2002 which affect the Commission on
Mental Health and require action by Congress in order to take
effect, having considered the same, report favorably thereon
without amendment and recommend that the bill do pass.

CONTENTS

Page
Committee Statement and Views.................................... 2
Section-by-Section............................................... 2
Explanation of Amendments........................................ 4
Committee Consideration.......................................... 4
Rollcall Votes................................................... 4
Application of Law to the Legislative Branch..................... 4
Statement of Oversight Findings and Recommendations of the
Committee...................................................... 4
Statement of General Performance Goals and Objectives............ 4
Constitutional Authority Statement............................... 4
Federal Advisory Committee Act................................... 5
Unfunded Mandate Statement....................................... 5
Committee Estimate............................................... 5
Budget Authority and Congressional Budget Office Cost Estimate... 5
Changes in Existing Law Made by the Bill, as Reported............ 9

Committee Statement and Views

PURPOSE AND SUMMARY

H.R. 4302 would amend the authorities of the District of
Columbia Commission on Mental Health, a branch of the District
of Columbia Superior Court that presides over the civil
commitment process. The bill will modernize the District's
civil commitment process to incorporate national best practices
such as community-based mental health services and shortened
commitment terms with options to recommit. This bill would (1)
change the duration of civil commitment to one year and create
a streamlined procedure for re-commitment; (2) permit the
Commission to determine the least restrictive setting for a
patient's care; (3) set new limits on the postponement of the
Commission's hearing; and (4) permit qualified psychologists to
join the panel of doctors who preside over hearings on a
rotating basis.

BACKGROUND AND NEED FOR LEGISLATION

The District of Columbia's current mental health care
practices are outdated. Most care provided at a central
location, St. Elizabeth's Hospital, and there is no limitation
on the length of a patient's civil commitment. The Final Order
in the 30-year-old Dixon lawsuit requires comprehensive changes
in D.C.'s mental health care to reflect national best
practices, such as the provision of community-based services
and increasing the involvement of consumers in their treatment
and recovery process.
In order to implement these changes and comply with the
Dixon Plan, a revision of the mental health civil commitment
process is imperative. These changes will make it feasible for
private hospitals to provide emergency inpatient psychiatric
treatment, relieving a significant financial burden from the
District. Those resources can then be reallocated to implement
other requirements of the Dixon Plan.
The bill is comprised of provisions from the District of
Columbia Council's D.C. Mental Health Civil Commitment Act of
2002 (D.C. Law 14-283), which became law on April 4, 2003,
following the 30-day Congressional review period. Since, the
Home Rule Act restricts the D.C. Council from acting on
measures that affect the Commission, affirmative Congressional
approval is necessary before the provisions can take effect.

LEGISLATIVE HISTORY

H.R. 4302 was introduced by Representative Tom Davis and
Delegate Eleanor Holmes Norton on May 6, 2004, and referred to
the Committee on Government Reform.

Section-by-Section

Section 1. Short title

The short title is ``District of Columbia Civil Commitment
Modernization Act of 2004.''

Section 2. Composition, appointment, and organization of commission on
mental health

The Commission on Mental Health (``the Commission'') would
be continued and be comprised of nine members. This section
would clarify that the Chairperson and the alternate
Chairperson of the Commission are Magistrate Judges appointed
to D.C. Superior Court pursuant to Title 11 of the D.C.
Official Code. This section would establish the rules for the
appointment of Commission members. Commission members would
serve four-year terms. Newly appointed psychiatrists or
qualified psychologists would serve a one-year probationary
period. Subsequent appointments may be made for four-year
terms. This section would amend Sec. 21-502 of the District of
Columbia Code to expand membership in the Commission to include
psychologists as well as psychiatrists.

Section 3. Commission members deemed competent and compellable
witnesses at mental health proceedings

This section would revise Sec. 21-503(b) of the District of
Columbia Code to clarify that only the psychiatrist and
psychologist members of the Commission are compellable
witnesses at a subsequent trial or hearing.

Section 4. Detention for emergency observation and diagnosis

This section would add new subsections to Sec. 21-526 of
the District of Columbia Code, providing that an emergency
involuntary patient's detention may be extended beyond the
court's initial seven-day order for a period of 21 days if a
petition for commitment is filed before the seven-day order
expires (previously, the filing of such a petition extended the
detention indefinitely under Sec. 21-528, which Section 2(n) of
the District of Columbia Mental Health Civil Commitment Act of
2002 would repeal). The court may extend the period of
emergency detention beyond the 21 days for good cause shown.
Also, detention may be extended consistent with the
Commission's findings following a hearing on the commitment
petition. In addition, where the Commission determines that a
person should be committed as an outpatient, the petitioner/
hospital is required to transfer the person to outpatient
status within 14 days.

Section 5. Representation by counsel of persons alleged to be mentally
ill

Section 5 would amend the redesignated Sec. 21-543(a) in
the District of Columbia Code and would add a new section 21-
543(b) to prescribe the Commission's authority to postpone or
grant continuances of its hearings, and provide for the
person's involuntary detention to continue for the duration of
a postponement.

Section 6. Hearing and determination on question of mental illness

Section 6 would amend Sec. 21-545 of the District of
Columbia Code to alter the duration of commitment from an
indeterminate period to a one-year period and update the
language.

Section 7. Renewal of commitment status commission

This section would add a new section 21-545.01 to the
District of Columbia Code setting forth a procedure for
renewing an order of commitment or an order of renewed
commitment for periods of up to one year at a time. The
procedure would be initiated by the filing of a petition with
the Commission, which must be filed at least 60 days before
expiration of the existing commitment order, except for good
cause shown. A hearing on the petition would be held before the
Commission, which has the authority to issue an order renewing
the commitment. The person who is the subject of the commitment
may seek review of the Commission's order pursuant to court
rule.

Explanation of Amendments

No amendments were adopted.

Committee Consideration

On May 12, 2004, the Committee met in open session and
ordered reported the bill, H.R. 4302, by voice vote, a quorum
being present.

Rollcall Votes

No rollcall votes were held.

Application of Law to the Legislative Branch

Section 102(b)(3) of Public Law 104-1 requires a
description of the application of this bill to the legislative
branch where the bill relates to the terms and conditions of
employment or access to public services and accommodations.
This bill will modernize the District's civil commitment
process to incorporate national best practices such as
community-based mental health services and shortened commitment
terms with options to recommit. The benefits of this bill will
be available to all residents of the District of Columbia
regardless of whether on not they are employed by the Federal
government.

Statement of Oversight Findings and Recommendations of the Committee

In compliance with clause 3(c)(1) of rule XIII and clause
2(b)(1) of rule X of the Rules of the House of Representatives,
the Committee's oversight findings and recommendations are
reflected in the descriptive portions of this report.

Statement of General Performance Goals and Objectives

In accordance with clause 3(c)(4) of rule XIII of the Rules
of the House of Representatives, the Committee's performance
goals and objectives are reflected in the descriptive portions
of the report.

Constitutional Authority Statement

Under clause 3(d)(1) of rule XIII of the Rules of the House
of Representatives, the Committee must include a statement
citing the specific powers granted to Congress to enact the law
proposed by H.R. 4302. Article I, Section 8, Clauses 17 and 18
of the Constitution of the United States provide Congress the
power to enact this law.

Federal Advisory Committee Act

The Committee finds that the legislation does not establish
or authorize the establishment of an advisory committee within
the definition of 5 U.S.C. App., Section 5(b).

Unfunded Mandate Statement

Section 423 of the Congressional Budget and Impoundment
Control Act (as amended by Section 101(a)(2) of the Unfunded
Mandate Reform Act, P.L. 104-4) requires a statement whether
the provisions of the reported include unfunded mandates. In
compliance with this requirement the Committee has received a
letter from the Congressional Budget Office included herein.

Committee Estimate

Clause 3(d)(2) of rule XIII of the Rules of the House of
Representatives requires an estimate and a comparison by the
Committee of the costs that would be incurred in carrying out
H.R. 4302. However, clause 3(d)(3)(B) of that rule provides
that this requirement does not apply when the Committee has
included in its report a timely submitted cost estimate of the
bill prepared by the Director of the Congressional Budget
Office under section 402 of the Congressional Budget Act.

Budget Authority and Congressional Budget Office Cost Estimate

With respect to the requirements of clause 3(c)(2) of rule
XIII of the Rules of the House of Representatives and section
308(a) of the Congressional Budget Act of 1974 and with respect
to requirements of clause 3(c)(3) of rule XIII of the Rules of
the House of Representatives and section 402 of the
Congressional Budget Act of 1974, the Committee has received
the following cost estimate for H.R. 4302 from the Director of
Congressional Budget Office:

U.S. Congress,
Congressional Budget Office,
Washington, DC, August 12, 2004.
Hon. Tom Davis,
Chairman, Committee on Government Reform,
House of Representatives, Washington, DC.
Dear Mr. Chairman: CBO has prepared the enclosed estimate
for H.R. 4302, the District of Columbia Civil Commitment
Modernization Act of 2004.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contacts are Jeanne De
Sa and Eric Rollins.
Sincerely,
Elizabeth Robinson
(For Douglas Holtz-Eakin, Director).
Enclosure.

H.R. 4302--District of Columbia Civil Commitment Modernization Act of
2004

Summary: H.R. 4302 would revise District of Columbia (D.C.)
law concerning involuntary commitment of the mentally ill. Most
of the bill's provisions have been passed by the D.C. Council
and signed by the Mayor. Under the Home Rule Act, any
legislation enacted by the city must be approved by the
Congress.
CBO anticipates that the bill would shift the provision of
care for some mentally ill individuals from St. Elizabeth's
Hospital, D.C.'s inpatient psychiatric facility, to local
general hospitals and outpatient mental health programs.
Because the Medicaid program restricts federal reimbursement
for certain services provided at state psychiatric facilities,
this shift would enable more of those individuals to receive
Medicaid-funded services. CBO estimates that enacting H.R. 4302
would increase federal Medicaid spending by $2 million over the
2005-2009 period and by $5 million over the 2005-2014 period.
H.R. 4302 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
While the bill would increase D.C.'s share of Medicaid spending
by $1 million over the 2005-2009 period, it would reduce D.C.'s
spending for medical costs at Saint Elizabeth's Hospital (both
Medicaid and non-Medicaid) by $15 million over the same period.
Estimated cost to the Federal Government: The estimated
budgetary impact of H.R. 4302 is shown in the following table.
CBO assumes enactment by the end of 2004. The bill's effect
would fall within budget function 550 (health).

--------------------------------------------------------------------------------------------------------------------------------------------------------
By fiscal year, in millions of dollars--
-------------------------------------------------------------------------------------
2005- 2005-
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2009 2014
--------------------------------------------------------------------------------------------------------------------------------------------------------
CHANGES IN DIRECT SPENDING
Medicaid:
Estimated Budget Authority.................................... * * * * * 1 1 1 1 1 2 5
Estimated Outlays............................................. * * * * * 1 1 1 1 1 2 5
--------------------------------------------------------------------------------------------------------------------------------------------------------
Notes: Components may not sum to totals because of rounding.
* = Costs of less than $500,000.

Basis of estimate: H.R. 4302 would provide Congressional
approval for legislation already enacted by D.C. to amend its
civil commitment laws. The bill would simplify the rules
governing emergency involuntary hospitalization for mentally
ill individuals and would require judicial review of the
commitment status for hospitalized individuals on an annual
basis. Both changes would provide more opportunities for
individuals to be discharged to less-restrictive settings, such
as community outpatient programs. Based on information from
D.C. officials, CBO expects that the bill would reduce the
length of stay for emergency visits, promote early release of
long-term patients, and shift some involuntary emergency
admissions from St. Elizabeth's to general hospitals.
By shifting individuals out of St. Elizabeth's to community
programs and to emergency rooms and psychiatric wards of local
general hospitals, H.R. 4302 would increase the amount of care
paid for by Medicaid. Although many committed individuals in
D.C. meet Medicaid eligibility criteria, reimbursement for
inpatient treatment at St. Elizabeth's is limited because the
facility is considered an Institution for Mental Disease (IMD)
for the purposes of Medicaid reimbursement. Under Medicaid law,
federal matching funds are not permitted for treatment in an
IMD for individuals between the ages of 21 and 65. Federal
Medicaid funding is available for certain outpatient mental
health services and inpatient services provided in psychiatric
wards of general hospitals. The federal match rate for D.C. is
70 percent. On balance, we estimate that the costs to the
federal government would sum to about $5 million over the 2005-
2014 period.

Costs of Inpatient and Outpatient Care

The costs of providing inpatient care to mentally ill
individuals can be very high. According to D.C. officials, the
daily rate at St. Elizabeth's Hospital in state fiscal year
2003 was about $425 (or about $155,000 per year), a figure that
is consistent with rates at other similar facilities
nationwide. Based on government and academic studies, CBO
estimates that rates for inpatient care in state psychiatric
facilities tend to be lower than those at private psychiatric
hospitals and psychiatric wards of general hospitals (which
were about $600 per day in fiscal year 2003). Outpatient
programs can cost far less. According to D.C. officials, the
total cost of its outpatient treatment program for Medicaid
enrollees (including counseling, medication, and diagnostic
assessment) was about $6,000 per person in state fiscal year
2003.

Reduction in Emergency Room Stays

St. Elizabeth's admits about 600 mentally ill individuals
on an involuntary emergency basis each year, according to D.C.
officials. Local general hospitals admit several hundred others
annually. This type of admission generally occurs for people
with severe mental illness who are considered a harm to
themselves or others. Individuals are held for observation
pending a determination whether they require further inpatient
care, mandatory enrollment in an outpatient program, or release
into the community. Although D.C.'s existing civil commitment
law provides for a court hearing after 30 days, most
individuals remain in St. Elizabeth's for an average of 14 days
before a placement determination is made. Length of stay at
general hospitals tends to be shorter than that at St.
Elizabeth's.
Under the bill, CBO expects that the length of stay for
mentally ill individuals admitted to St. Elizabeth's for
emergency stays would decrease by about 50 percent over the
next 10 years. As a result, some individuals would enter
community programs earlier than they otherwise would have.
Based on discussions with D.C. officials and information
provided by the Government Accountability Office, CBO assumes
that about 70 percent of additional community-based care would
be for Medicaid-eligible individuals. CBO estimates that
federal Medicaid costs for those services would increase by
about $1 million over the 2005-2014 period.

New Admissions to Local General Hospitals

Under current law, local general hospitals handle several
hundred emergency admissions for mentally ill individuals that
had previously gone to St. Elizabeth's. CBO anticipates that
the bill would increase the number of emergency involuntary
admissions to general hospitals by an additional 20 percent
over the next 10 years. Assuming that 70 percent of those
admissions are for Medicaid-eligible individuals and that
Medicaid reimbursement for an emergency stay at a local general
hospital is about $3,700 in fiscal year 2005 (7 days for $525
per day), CBO estimates that federal Medicaid costs would
increase by about $2 million over the 2005-2014 period. A few
mentally ill individuals admitted to general hospital emergency
rooms would subsequently be admitted on an involuntary basis to
those hospitals' psychiatric wards. Assuming a cost of about
$50,000 per stay in fiscal year 2005 (100 days at $500 per
day), CBO estimates that Medicaid spending would increase by $1
million over the 2005-2014 period.

Early Release of Long-Term Patients

Individuals with severe mental illness who are admitted to
St. Elizabeth's on an emergency basis and do not comply with
treatment regimens in outpatient programs can be subsequently
committed on an involuntary basis to St. Elizabeth's. In most
circumstances, individuals remain in that facility on an
indeterminate basis without automatic and periodic judicial
review of their cases. St. Elizabeth's houses about 500
individuals at any given time, about 200 of whom are connected
with criminal cases (such as John Hinckley Jr.). Of the
remaining cases, most are voluntary commitments, but about 100
individuals remain at St. Elizabeth's on an involuntary basis.
Although average length-of-stay for individuals in state
psychiatric hospitals can exceed 400 days, it is also common
for mentally ill individuals to cycle in and out of community
mental health placement and inpatient treatment at St.
Elizabeth's.
Because the bill would require annual judicial review of
the commitment status of institutionalized individuals, there
would be more opportunities for individuals to be discharged to
less restrictive settings, such as community outpatient
programs. D.C. officials note that instituting such a review
process likely would shift some individuals from an inpatient
setting to an outpatient system or the community earlier. By
2014, when the provisions of D.C.'s civil commitment bill would
be fully implemented, CBO estimates that the number of
involuntary commitments at St. Elizabeth's would be reduced to
about 40 people. CBO assumes that about one-half of the
individuals released each year would access outpatient programs
from St. Elizabeth's and that 70 percent of those
individualswould be eligible for Medicaid coverage of community mental
health services. CBO estimates that Medicaid spending for outpatient
mental health services would increase by about $1 million over the
2005-2014 period.
Intergovernmental and private-sector impact: H.R. 4302
would provide Congressional approval for legislation that has
already been enacted by the D.C. government. The bill contains
no intergovernmental or private-sector mandates as defined in
UMRA, and it would provide net savings to the District over the
2005-2009 period.
By reducing the amount of time that patients remain in
Saint Elizabeth's Hospital for either emergency room or
tertiary care, the bill would reduce expenditures by the city
District. As patients move from Saint Elizabeth's to other
hospitals or treatment facilities, CBO estimates that D.C.
would save about $15 million over the 2005-2009 period.
Patients who would have received care at Saint Elizabeth's
would likely receive care at other hospitals or treatment
facilities; the costs of some of that care would be
reimbursable by Medicaid. Consequently, CBO estimates that
District spending for Medicaid would increase by about $1
million over the 2005-2009 period.
Estimate prepared by: Federal costs: Jeanne De Sa and Eric
Rollins; Impact on State, Local, and Tribal Governments: Leo
Lex; and Impact on the Private Sector: Paige Piper/Bach.
Estimate approved by: Peter H. Fontaine, Deputy Assistant
Director for Budget Analysis.

Changes in Existing Law Made by the Bill, as Reported

In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italic, existing law in which no change is
proposed is shown in roman):

CHAPTER 5 OF TITLE 21 OF THE DISTRICT OF COLUMBIA OFFICIAL CODE

Chapter 5--Hospitalization of the Mentally Ill

Subchapter I. Definitions; Commission on Mental Health

Section
21-501. Definitions.
* * * * * * *
[21-502. Commission on Mental Health; composition; appointment and
terms of members; organization; chairman; salaries.]
21-502. Commission on Mental Health; composition; appointment and
terms of members; organization; chairperson; salaries.
* * * * * * *

Subchapter IV. Commitment Under Court Order

21-541. Petition to Commission; copy to person affected.
* * * * * * *
21-545.01. Renewal of commitment status by Commission; review by
Court.
* * * * * * *

Subchapter I. Definitions; Commission on Mental Health

* * * * * * *

[Sec. 21-502. Commission on Mental Health; composition; appointment and
terms of members; organization; chairman; salaries.

[(a) The Commission on Mental Health is continued. The
Superior Court of the District of Columbia shall appoint the
members of the Commission, and the Commission shall be composed
of nine members. One member shall be a member of the bar of the
court, who has engaged in active practice of law in the
District of Columbia for a period of at least five years prior
to his appointment. He shall be the Chairman of the Commission
and act as the administrative head of the Commission and its
staff. He shall preside at all hearings and direct all of the
proceedings before the Commission. He shall devote his entire
time to the work of the Commission. Eight members of the
Commission shall be health care professionals who are
psychiatrists, or doctoral level psychologists, practicing in
the District of Columbia who have had not less than five years'
experience in the treatment of mental illnesses.
[(b) Appointment of members of the Commission shall be for
terms of four years each, which shall be staggered as provided
by section 2 of the Act approved June 8, 1938 (chapter 326, 52
Stat. 625), under which, except for the original four-year term
of the lawyer-member, staggered terms of one year for two
members, two years for two members, three years for two
members, and four years for two members, were made.
[(c) Members of the Commission who are health care
professionals shall serve on a part-time basis and shall be
rotated by assignment of the Chief Judge of the court, so that
any one time the Commission shall consist of the chairman and
two members who are health care professionals. Members of the
Commission who are health care professionals may practice their
profession during their tenure of office, but may not
participate in the disposition of a case in which they have
rendered professional service or advice.
[(d) The court shall also appoint an alternate lawyer-member
of the Commission who shall have the same qualifications as the
lawyer-member of the Commission and who shall serve on a part-
time basis and act as Chairman in the absence of the permanent
Chairman.
[(e) The salaries of the members of the Commission and its
employees shall be fixed in accordance with the provisions of
the Classification Act of 1949, as amended. The alternate
Chairman shall be paid on a per diem basis at the same rate of
compensation as fixed for the permanent Chairman.]

Sec. 21-502. Commission on Mental Health; composition; appointment and
terms of members; organization; chairperson;
salaries.

(a) The Commission on Mental Health is continued. The Chief
Judge of the Superior Court of the District of Columbia shall
appoint the members of the Commission, and the Commission shall
be composed of 9 members and an alternate chairperson. One
member shall be a magistrate judge of the Court appointed
pursuant to title 11, District of Columbia Official Code, who
shall be a member of the bar of the Court and has engaged in
active practice of law in the District of Columbia for a period
of at least 5 years prior to his or her appointment. The
magistrate judge shall be the Chairperson of the Commission and
act as the administrative head of the Commission. The
Chairperson shall preside at all hearings and direct all of the
proceedings before the Commission. Eight members of the
Commission shall be psychiatrists or qualified psychologists,
as those terms are defined in section 21-501, who have not had
less than 5 years of experience in the diagnosis and treatment
of mental illness.
(b)(1) Appointment of members of the Commission shall be for
terms of 4 years.
(2) The initial appointment of a psychiatrist or a qualified
psychologist shall be for a probationary period of one year.
After the initial one-year probationary appointment, subsequent
appointments of the psychiatrist or qualified psychologist
shall be for terms of 4 years.
(c) The psychiatrist or qualified psychologist members of the
Commission shall serve on a part-time basis and shall be
rotated by assignment of the Chief Judge of the Court, so that
at any one time the Commission shall consist of the Chairperson
and 2 members, each of whom is either a psychiatrist or a
qualified psychologist. Members of the Commission who are
psychiatrists or qualified
psychologists may practice their professions during their
tenures of office, but may not participate in the disposition
of a case of a person in which they have rendered professional
service or advice.
(d) The Chief Judge of the Court shall appoint a magistrate
judge of the Court to serve as an alternate Chairperson of the
Commission. The alternate Chairperson shall serve on a part
time basis and act as Chairperson in the absence of the
permanent Chairperson.
(e) The rate of compensation for the members of the
Commission who are psychiatrists or qualified psychologists
shall be fixed by the Executive Officer of the Court.

Sec. 21-503. Examinations and hearings; subpoenas; witnesses; place.

(a) * * *
(b) Except as otherwise provided by this chapter, the
Commission may conduct its examinations and hearings either at
the courthouse or elsewhere at its discretion. The court may
issue subpoenas at the request of the Commission returnable
before the Commission, for the appearance of the alleged
mentally ill person, witnesses, and persons who may be liable
for his support. [The Commission, or any of the members
thereof,] Commission members who are psychiatrists or qualified
psychologists are competent and compellable witnesses at any
trial, hearing or other proceeding conducted pursuant to this
chapter and the physician- or psychologist-patient privilege is
not applicable.

* * * * * * *

Subchapter III. Emergency Hospitalization

* * * * * * *

Sec. 21-526. Extension of maximum periods of time.

(a) * * *

* * * * * * *

(c) The maximum period of time for detention for emergency
observation and diagnosis may be extended for up to 21 days, if
judicial proceedings under subchapter IV of this chapter have
been commenced before the expiration of the order entered under
section 21-524 and a psychiatrist or qualified psychologist has
examined the person who is the subject of the judicial
proceedings and is of the opinion that the person being
detained remains mentally ill and is likely to injure himself
or others as a result of the illness unless the emergency
detention is continued. For good cause shown, the Court may
extend the period of detention for emergency observation and
diagnosis. The period of detention for emergency observation
and diagnosis may be extended pursuant to section 21-543(b) or
following a hearing before the Commission pursuant to
subsections (d) and (e) of this section.
(d) If the Commission, at the conclusion of its hearing
pursuant to section 21-542, has found that the person with
respect to whom the hearing was held is mentally ill and,
because of the mental illness, is likely to injure himself or
others if not committed, and has concluded that a
recommendation of inpatient commitment is the least restrictive
alternative available to prevent the person from injuring
himself or others, the detention for emergency observation and
diagnosis may be continued by the Department or hospital--
(1) pending the conclusion of judicial proceedings
under subchapter IV of this chapter;
(2) until the Court enters an order discharging the
person; or
(3) until the Department or hospital determines that
continued hospitalization is no longer the least
restrictive form of treatment appropriate for the
person being detained.
(e) If the Commission, at the conclusion of its hearing,
finds that the person is mentally ill, is likely to injure
himself or other persons as a result of mental illness if not
committed, and that outpatient treatment is the least
restrictive form of commitment appropriate, then, within 14
days of the date of the hearing, the person shall be discharged
from inpatient status and shall receive outpatient mental
health services or mental health supports as an emergency
nonvoluntary patient consistent with this subchapter, pending
the conclusion of judicial proceedings under subchapter IV of
this chapter.

Subchapter IV. Commitment Under Court Order

* * * * * * *

Sec. 21-543. Representation by counsel; compensation; recess.

(a) The person alleged to be mentally ill and, because of the
mental illness, likely to injure himself or others shall be
represented by counsel in any proceeding before the Commission
or the court, and if he fails or refuses to obtain counsel, the
court shall appoint counsel to represent him. The counsel so
appointed shall be awarded compensation by the court for his
services in an amount determined by it to be fair and
reasonable. The compensation shall be charged against the
estate of the individual for whom the counsel was appointed, or
against any unobligated funds of the Commission, as the court
in its discretion directs. The Commission or the court, as the
case may be, shall, at the request of the counsel so appointed,
grant a recess in the proceeding to give the counsel an
opportunity to prepare his case. [A recess may not be granted
for more than five days.]
(b) The Commission may not grant a continuance for counsel to
prepare his case for more than 5 days. The Commission may grant
continuances for good cause shown for periods of up to 14 days.
If the Commission grants a continuance, the emergency
observation and detention of the person about whom the hearing
is being held shall be extended for the duration of the
continuance.

* * * * * * *

Sec. 21-545. Hearing and determination by court or jury; order;
witnesses; jurors.

(a) Upon the receipt by the court of a report referred to in
section 21-544, the court shall promptly set the matter for
hearing and shall cause a written notice of the time and place
of the final hearing to be served personally upon the person
with respect towhom the report was made and his attorney,
together with notice that he has five days following the date on which
he is so served within which to demand a jury trial or a trial by the
Court. The demand may be made by the person or by anyone in his behalf.
If a jury trial or a trial by the Court is demanded within the five-day
period, it shall be accorded by the court with all reasonable speed. If
a timely demand for jury trial or a trial by the Court is not made, the
court shall determine the person's mental condition on the basis of the
report of the Commission, or on such further evidence in addition to
the report as the court requires.
[(b) If the court or jury, as the case may be, finds that the
person is not mentally ill, the court shall dismiss the
petition and order his release. If the court or jury finds that
the person is mentally ill and, because of that illness, is
likely to injure himself or other persons if allowed to remain
at liberty, the court may order his hospitalization for an
indeterminate period, or order any other alternative course of
treatment which the court believes will be in the best
interests of the person or of the public. The Commission, or a
member thereof, shall be competent and compellable witnesses at
a hearing or jury trial held pursuant to this chapter. The jury
to be used in any case where a jury trial is demanded under
this chapter shall be impaneled, upon order of the curt, from
the jurors in attendance upon other branches of the court, who
shall perform the services in addition to and as part of their
duties in the court.]
(b)(1) If the Court or jury finds that the person is not
mentally ill or is not likely to injure himself or others as a
result of mental illness, the Court shall dismiss the petition
and order the person's release.
(2) If the Court or jury finds that the person is mentally
ill and, because of that mental illness, is likely to injure
himself or others if not committed, the Court may order the
person's commitment to the Department or to any other facility,
hospital, or mental health provider that the Court believes is
the least restrictive alternative consistent with the best
interests of the person and the public. An order of commitment
issued pursuant to this paragraph shall be for a period of one
year.
(c) The psychiatrists and qualified psychologists who are
members of the Commission shall be competent and compellable
witnesses at a hearing or trial held pursuant to this chapter.
(d) The jury to be used in any case where a jury trial is
demanded under this chapter shall be impaneled, upon order of
the Court, from the jurors in attendance upon other branches of
the Court, who shall perform the services in addition to and as
part of their duties in the Court.

Sec. 21-545.01. Renewal of commitment status by Commission; review by
Court.

(a) At least 60 days prior to the expiration of an order of
commitment issued pursuant to section 21-545 or this section,
the chief clinical officer of the Department, or the chief of
service of the facility, hospital, or mental health provider to
which the person is committed may petition the Commission for a
renewal of the order of commitment for that person. For good
cause shown, a petition of commitment may be filed within the
last 60 days of the one-year period of commitment. The petition
for renewal of commitment shall be supported by a certificate
of a psychiatrist or qualified psychologist stating that he has
examined the person and is of the opinion that the person is
mentally ill, and, because of the illness, is likely to injure
himself or other persons if not committed. The term of the
renewed commitment order shall not exceed one year.
(b) Within 3 days of the filing of a petition under
subsection (a) of this section, the Commission shall send a
copy of the petition and supporting certificate by registered
mail to the person with respect to whom the petition was filed
and by regular mail to the person's attorney.
(c) The Commission shall promptly examine a person for whom a
petition is filed under subsection (a) of this section, and, in
accordance with the procedures described in sections 21-542 and
21-543, shall thereafter promptly hold a hearing on the issue
of the person's mental illness and whether, as a result of a
mental illness, the person is likely to injure himself or other
persons if not committed.
(d) If the Commission finds, after a hearing under subsection
(c) of this section, that the person with respect to whom the
hearing was held is no longer mentally ill, or is not mentally
ill to the extent that the person is likely to injure himself
or other persons if not committed, the Commission shall
immediately order the termination of the commitment and notify
the Court of that fact in writing.
(e) If the Commission finds, after a hearing under subsection
(c) of this section, that the person with respect to whom the
hearing was held remains mentally ill to the extent that the
person is likely to injure himself or others if not committed,
the Commission shall order the renewal of the commitment of the
person for an additional term not to exceed one year and shall
promptly report that fact, in writing, to the Court. The report
shall contain the Commission's findings of fact and conclusions
of law. A copy of the report shall be served by registered mail
on the person with respect to whom the hearing was held and by
mail on the person's attorney.
(f) If a petition for a renewal of an order of commitment is
pending at the expiration of the commitment period ordered
under section 21-545 or this section, the Court may, for good
cause shown, extend the period of commitment pending resolution
of the renewal petition.
(g) Within the last 30 days of the period of commitment, the
chief clinical officer of the Department, or the chief of
service of the facility, hospital, or mental health provider to
which a person is committed, shall notify the Court which
ordered the person's commitment pursuant to section 21-545 or
this section of the decision not to seek renewal of commitment.
Notice to the Court shall be in writing and a copy of the
notice shall be mailed to the person who was committed and the
person's attorney.
(h)(1) A person for whom the Commission orders renewed
commitment pursuant to subsection (e) of this section may seek
a review of the Commission's order by the Superior Court of the
District of Columbia, and the Commission, orally and in
writing, shall advise the person of this right.
(2) A review of the Commission's order of renewed commitment,
in whole or in part, may be made by a judge of the appropriate
division sua sponte and shall be made upon a motion of one of
the parties made pursuant to procedures established by rules of
the Court. The reviewing judge shall conduct such proceedings
as required by the rules of the Court.
(3) An appeal to the District of Columbia Court of Appeals
may be made only after a judge of the Court has reviewed the
Commission's order of renewed commitment.

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