Appeals from the Superior Court of the District of Columbia. (MH-373-91) (Hon. Zinora M. Mitchell-Rankin, First Trial Judge). (Hon. Susan R. Winfield, Second Trial Judge).
Before Terry, Schwelb, and Glickman, Associate Judges.
These consolidated appeals both involve Eleanor Walker, who was committed to Saint Elizabeths Hospital as an outpatient under the Ervin Act, D.C. Code §§ 21-501 et seq. (2001),*fn1 after her treating psychiatrist sought her involuntary hospitalization. Following a mental health examination, the Commission on Mental Health Services ("CMHS") filed a petition to revoke her outpatient commitment so that she could be recommitted as an inpatient. While that petition was pending, a physician at Saint Elizabeths ordered that Ms. Walker receive involuntary injections of Haldol Decanoate. Thereafter the trial court denied CMHS's petition, and Ms. Walker was released. In the first appeal, Ms. Walker challenges the trial court's denial of her post-release "Motion for Appropriate Relief," asserting that the hospital violated her due process rights by forcibly injecting her without following the appropriate procedures for involuntary medication as set forth in a document known as CMHS Policy 50000.430.2B.
In the second appeal, CMHS challenges the trial court's denial of its application, pursuant to D.C. Code § 21-592, for an order directing the United States Marshals Service to detain Ms. Walker and return her to Saint Elizabeths Hospital. In ruling as it did, the court held that section 21-592 applied only to patients who have escaped from the hospital or to those who have failed to return as directed, and that neither category included Ms. Walker. On appeal, CMHS argues that the statute is ambiguous and urges this court to apply section 21-592 to all patients.
We reverse in Ms. Walker's appeal and affirm in CMHS's appeal.
Ms. Walker has a long history of mental illness. In April 1991, Officer David Wilhight of the Metropolitan Police responded to a call from the Mount Carmel Shelter for Women. When the officer arrived at the shelter, he found Eleanor Walker "tearing up papers, yelling obscenities about killing herself and [others] . . . ." The officer brought her to Saint Elizabeths Hospital, where she was examined by a psychiatrist on duty. The psychiatrist concluded that Ms. Walker was mentally ill, suffering from "schizophrenia, paranoid, chronic with acute exacerbation," and that she was likely to injure herself or others if allowed to remain at liberty. Accordingly, pursuant to D.C. Code § 21-523, the court entered an order authorizing Ms. Walker's emergency hospitalization for a period not to exceed seven days.
At the time of her admission to the hospital, Ms. Walker's symptoms included suspiciousness, anxiety, threats to kill herself, auditory hallucinations, and the belief that she was being poisoned by the government. At a hearing requested by Ms. Walker, the court found that CMHS had established probable cause to believe that she was mentally ill and, because of that illness, was likely to injure herself or others unless immediately hospitalized. Before the seven-day emergency commitment expired, CMHS filed a petition for judicial hospitalization seeking inpatient commitment. After a trial on the petition, see D.C. Code § 21-545, a jury found by clear and convincing evidence that Ms. Walker was mentally ill, but the court committed her to the hospital only for outpatient treatment. The commitment order provided that Ms. Walker would be released from Saint Elizabeths but directed her to participate in a treatment program at a community mental health center and to take prescribed medication.
Ms. Walker received treatment over the next five years with no apparent complications. On December 18, 1996, however, Ms. Walker was involuntarily admitted to Saint Elizabeths pursuant to Super. Ct. Mental Health Rule 16 in a proceeding initiated by Dr. Shakuntala Dhir, her treating psychiatrist at North Community Mental Health Center. Believing that her sister was trying to poison her, Ms. Walker had filled apple juice and soda bottles with bleach and placed them in the refrigerator in an attempt to poison her sister. A psychiatric examination performed the next day indicated that Ms. Walker was "irritable, suspicious, having an angry mood, defensive and derealization [sic]." It was also discovered that Ms. Walker had not been taking her medication. Acting on these observations, CMHS filed a petition to revoke her outpatient commitment and to commit her instead as an inpatient. Counsel was appointed for Ms. Walker, and a hearing on the petition was scheduled.
While the petition was pending, Ms. Walker remained at Saint Elizabeths Hospital. On December 27, 1996, Altephenos Boone, a patient advocate at Saint Elizabeths, spoke to Ms. Walker about a request from someone at the hospital (unidentified in the record) "to initiate involuntary medication procedures." Haldol had been prescribed for treatment of her symptoms "associated with schizophrenia," but according to her treatment team, Ms. Walker had refused since her arrival on December 18 to take any neuroleptic medication other than Prozac. It was Mr. Boone's job to explain the contemplated procedure to her and to try to resolve any conflict over the medication. Ms. Walker told him that she was refusing to take it because "she was not mentally ill and [therefore] she should not be here." She also remarked that Dr. Dhir "was harassing her."
Mr. Boone informed Dr. Robert Keisling, Acting Medical Director of the Acute Psychiatric Unit at Saint Elizabeths, of Ms. Walker's refusal to take her prescribed medication. Thereafter, on January 7, 1997, after examining Ms. Walker and reviewing her medical records, Dr. Keisling ordered that she receive involuntary injections of Haldol Decanoate for a sixty-day period.*fn2 Over the next several days Ms. Walker was twice forcibly medicated by the hospital staff. Then, on January 16, after a two-day hearing, the court dismissed CMHS's petition to revoke her outpatient commitment. Ms. Walker was thereupon released from the hospital.
A few weeks after her release, Ms. Walker filed with the court a "Motion for Appropriate Relief." In that motion, Ms. Walker claimed that the hospital had forcibly injected her without following the appropriate procedures for involuntary medication outlined in CMHS Policy 50000.430.2B and thus had violated her "constitutional right to privacy as well as her right to procedural due process." Specifically, Ms. Walker alleged that the hospital had failed to obtain a proper request for involuntary medication from her treating physician, nor had it informed her of her right to have the decision reviewed by the CMHS Medical Director. To remedy these asserted violations of her rights, Ms. Walker asked the court to rescind Dr. Keisling's order for involuntarily medication, to direct the hospital to correct the medical records to reflect such rescission, and to require the hospital to provide her with a written explanation of her right to refuse medication. CMHS filed an opposition, arguing that the issues raised by Ms. Walker were moot and that, in any event, she had been medicated in accordance with applicable CMHS policies while in the hospital.
The trial court denied Ms. Walker's motion, concluding that the hospital had followed the appropriate procedures. ...