Footnote 8 of the majority opinion of the Court of Appeals indicates that economic dependency or indigency, as is present here, should be no reason for sending patients to mental hospitals. The note points out that inquiries such as this "will not only reveal the facilities available but will uncover the need for those that are not available." While this inquiry has shown the need, it has not shown the availability. The pathos of economic deprivation cannot detour well reasoned obligations of the Court.
Title 21, Section 545(b) D.C.Code, (Supp. V 1966) and The Court of Appeals majority opinion leave unanswered the two most difficult questions before this trial Court. As this Court remarked in its preliminary statement to this investigation,
it has always, prior to the enactment of the new statute, considered alternative facilities for mental health patients. That inquiry was and is made with the aid of the Mental Health Commission and the social service agency at St. Elizabeth's. While the opinion of the majority speaks mainly in terms of facilities, the statute speaks in terms of treatment. To be sure, the facility may be an element of treatment, but the facility as an entity itself, does not appear approachable under the statute.
A second problem is the Court's actual commitment power. The statute says the Court may "order any other alternative course of treatment". This raises the question of whether or not the Court may legally commit a patient to a facility or institution, other than St. Elizabeth's. If the statute does clothe the District Court with authority to order the patient into a private nursing home or to a foster home, the question arises as to whom may the Court look as a responsible party.
At present, when a patient is committed to St. Elizabeth's, and transferred by the Hospital to a foster home, the hospital is the responsible party. Their officials check on both the conditions in the foster home and the patient's adaptability to that environment. If the patient is unable to get along satisfactorily, he is returned to the Hospital.
If the Court were to order a patient directly to a foster home or a private nursing home, who would replace St. Elizabeth's as the responsible party? It may be that the Court has the authority to order the patient into another facility and still place the responsibility on St. Elizabeth's, but this point is not clear.
These unanswered questions need resolutions before effective commitments for "alternate course of treatment" can become practical.
The Court would like to make it clear that the problems of 1) distinguishing between facility and treatment, 2) the scope of the Court's "order" authority under the new Act, and 3) the burden of responsibility to the patient and to the Court, had no bearing on this particular case. There is no question that Mrs. Lake requires 24-hour supervision for her own safety, and that the only facility within the District of Columbia available to her which affords that type of treatment is St. Elizabeth's Hospital.
Counsel for respondent to prepare an appropriate order.