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11/06/92 LYDIA ARTIS

November 6, 1992


Appeal from the Superior Court of the District of Columbia; (Hon. Samuel B. Block, Trial Judge)

Before Steadman and King, Associate Judges, and Pryor, Senior Judge.

The opinion of the court was delivered by: Pryor

PRYOR, Senior Judge:

Lydia Artis appeals her civil commitment to D.C. Village Nursing Home after a unanimous jury found her to be mentally ill and likely to injure herself if allowed to remain at liberty. D.C. Code § 21-545 (b) (1981) ("Ervin Act"). Appellant maintains on appeal that (1) the evidence adduced at trial was insufficient to support the jury's determination; (2) the government counsel's single mention during voir dire that the jury was "to determine whether Lydia Artis required further treatment" constituted reversible error; and (3) by choosing a nursing home for appellant, the trial court failed (a) to choose the "least restrictive alternative" available, and (b) to issue explicit findings supporting his decision. We find no error and affirm.


On January 8, 1987, appellant was admitted to Saint Elizabeths Hospital pursuant to application by Dr. Robert Keisling, the director of the District of Columbia's emergency mental health services program at the time. D.C. Code § 21-521 (1981). The following day, appellee successfully petitioned the court seeking to extend appellant's emergency hospitalization. Four days later, the Superintendent of the Hospital's timely petition seeking appellant's continued hospitalization for seven more days was granted after an ex parte hearing. D.C. Code § 21-523 (1981). Subsequently, in accordance with D.C. Code § 21-541 (1981), the Superintendent filed a petition for appellant's judicial hospitalization. A hearing was convened before the Superior Court's Commission on Mental Health. The Commission found appellant suffering from Bipolar Affective Disorder -- Manic, delusions, and impaired memory, judgment and insight. They concluded that she was likely to injure herself if allowed to remain at liberty and recommended placement in a nursing home, where she could receive necessary daily supervision. When these recommendations were filed with the trial court, appellant requested and was granted a jury trial. D.C. Code § 21-545 (1981).

The Evidence at Trial

The hospital presented three witnesses: Constance Laurent-Roy, Vice President for Clinical Affairs and Director of Residential Programs, JMC Associates; Mary Cromartie, R.N., Saint Elizabeths Hospital; and Dr. Toledo, appellant's treating psychiatrist at Saint Elizabeths.

Ms. Laurent-Roy testified that in October 1986, upon referral from the Crisis Resolution Branch at D.C. General Hospital, appellant had been accepted into the residential crisis bed program of JMC Associates. Placement in the JMC Euclid Residence was triggered by appellant's eviction from her home following foreclosure proceedings. Based upon daily contact with appellant, Ms. Laurent-Roy related that the JMC program could not accommodate appellant for more than a few weeks due to her physical and mental circumstance. In particular, appellant exhibited chronic incontinence; refused to maintain a diet necessary to control her elevated blood pressure and diabetes; and was either incapable or unwilling to self-administer her medication. As a result, on December 18, 1986, Ms. Laurent-Roy personally returned appellant to the Crisis Resolution Branch at D.C. General, from where she was subsequently transferred to Saint Elizabeths.

Mary Cromartie, a nurse for thirty years, has been employed at Saint Elizabeths since 1976. Based on numerous encounters with appellant, she maintained that appellant was unable to care for herself, citing severe personal hygiene problems centering around appellant's incontinence. Ms. Cromartie opined that appellant's refusal to bathe aggravated her diabetic condition, increasing her susceptibility to infection. As a result, the hospital staff was often forced to bathe her. Consistent with previous testimony, Ms. Cromartie affirmed that appellant refused to self-administer her prescribed insulin despite several attempts at instruction by hospital staff.

Finally, Dr. Amanda Toledo, upon being qualified without objection as an expert in the treatment and diagnosis of mental illness, testified that appellant suffered from Bipolar Disorder, Manic, and exhibited symptoms such as increased psychomotor activity, pressure of speech, flight of ideas, paranoid thoughts, and delusions. Based on her review of the record, Dr. Toledo described appellant's living conditions prior to her present commitment as being without heat or electricity and with evidence of Ms. Artis' incontinence everywhere. Of particular note, Dr. Toledo testified to appellant's failure to appreciate the potentially fatal consequences of her diabetic condition if untreated. Dr. Toledo concluded that appellant was a danger to herself as a result of her mental illness, resulting from her inability to regularly take her required medicine and care for her personal hygiene -- conditions further exacerbated by appellant being homeless and without family upon whom to rely.

Ms. Artis was the sole witness in her own behalf. During her testimony, she maintained, inter alia, that she was a doctor of medicine as well as the past Superintendent of Saint Elizabeths during the late 1930s, all of which is refuted by public records. Upon cross-examination, she revealed that for some time her home had neither heat nor electricity and despite the foreclosure proceedings precipitating her eviction, she intended to return there upon her release.

After appropriate instructions, the jury found there was clear and convincing evidence that Ms. Artis was mentally ...

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