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In re Smith

August 11, 2005


Appeal from the Superior Court of the District of Columbia (MH-239-89) (Hon. Lee F. Satterfield, Trial Judge).

The opinion of the court was delivered by: Terry, Associate Judge

Argued October 14, 2004

Before TERRY and RUIZ, Associate Judges, and KING, Senior Judge.

This is an appeal from an order of the Superior Court, entered in May 2003, revoking appellant's outpatient status and committing her indefinitely for inpatient treatment to the District of Columbia Commission on Mental Health Services ("MHS"). While appellant is now committed pursuant to a subsequent order, she contends that the trial court's revocation of her outpatient status in the original order was wrongful and should be vacated. Consequently, she is not requesting release but instead seeks a ruling that her commitment based on the May 2003 order was unlawful. We conclude that intervening events since the entry of the May 2003 order have made this appeal moot.


On January 10, 1989, the trial court committed appellant Greta Smith to the care of MHS after finding her to be mentally incompetent and "unlikely to regain competency in the reasonably foreseeable future" to stand trial on a pending criminal charge of distributing cocaine. On April 26, 1989, the court held a final hearing on MHS's petition that Ms. Smith continue to be hospitalized for treatment. MHS maintained that, if released, she would not continue her psychiatric treatment, and thus would become a "danger to herself and . . . would place herself in dangerous situations." The court found that Ms. Smith was "mentally ill and . . . likely to injure herself or others if allowed to remain at liberty" and ordered her indefinitely committed to the custody of MHS for inpatient treatment.

Between 1989 and 1999, Ms. Smith escaped twice from Saint Elizabeths Hospital. Then, on April 22, 1999, Saint Elizabeths terminated Ms. Smith's inpatient treatment and released her to Community Connections, an outpatient clinic specializing in intensive case management. A letter from Community Connections, dated March 8, 2000, outlined Ms. Smith's subsequent failure to comply with her treatment plan, including several instances of drug abuse, refusing treatment, sexual solicitation, and violating curfew. In addition, Ms. Smith had ceased to report to Community Connections for scheduled outpatient treatment sessions. On March 10, after a psychiatric examination, the trial court found probable cause to believe that Ms. Smith had failed to abide by her treatment regimen and that her mental condition had deteriorated. The court issued an order authorizing Ms. Smith's involuntary return to the Comprehensive Psychiatric Emergency Program at MHS. She was returned to Saint Elizabeths by the United States Marshals Service on March 17 and was transferred to Community Connections for outpatient care on March 30, 2000.

Between April 2000 and October 2002, Ms. Smith moved in and out of Saint Elizabeths, but when she was away from the hospital, she failed to comply with her treatment plan.*fn1 She was again involuntarily rehospitalized on October 11, 2002, after threatening some people in a laundromat with a bottle. Further psychiatric examinations revealed that Ms. Smith had failed to adhere to her treatment plan, failed to take prescribed medication, used illegal substances, and suffered from hallucinations. Eventually the government filed a petition to revoke Ms. Smith's outpatient status and reinstate her inpatient commitment. A hearing on that petition was held on March 6, 2003.*fn2

A. The March 6 Hearing

The hearing on March 6 consisted solely of testimony from Dr. Bota,*fn3 an attending psychiatrist at Saint Elizabeths Hospital. The doctor explained the circumstances surrounding Ms. Smith's rehospitalization on October 11, 2002, describing Ms. Smith's condition on admission as "quite angry," "agitated," and "depressed," with slurred speech and a "disorganized thought process" that indicated "impaired" insight and judgment. Consistently with earlier diagnoses, Dr. Bota identified Ms. Smith's condition as "schizoaffective disorder, bipolar type, and cocaine abuse." Dr. Bota also acknowledged that, pending suitable arrangements, Ms. Smith had been ready for release since November 2002, but he warned that, if released without proper supervision, financial support, and housing, Ms. Smith would pose a danger to herself and others. Absent a stable environment, Ms. Smith would be likely to discontinue taking her medication and thus would deteriorate mentally and relapse into drug abuse and prostitution, as she had done on prior occasions. Given these possibilities, and with the knowledge that Ms. Smith was HIV-positive, the doctor concluded that Ms. Smith posed a high risk to herself and others if released.

Dr. Bota therefore recommended continued hospitalization as the least restrictive treatment alternative available to Ms. Smith until a suitable placement could be arranged. When the court pressed Dr. Bota to articulate why inpatient hospitalization was the least restrictive alternative, the doctor emphasized the risk that Ms. Smith would relapse into destructive behavior because of her mental illness and substance abuse. He stressed that Ms. Smith had previously been charged with soliciting for prostitution, had spent time in jail, and was still on probation.

At the conclusion of Dr. Bota's testimony, the government argued that the principal obstacles to placing Ms. Smith in an outpatient program involved securing approval for her social security application and replacing her case manager. The court reserved ruling on the petition until April 10, 2003, to give the hospital an additional thirty days to find a suitable outpatient placement. On April 10, however, the judge was unavailable, and the hearing was continued to May 1.

B. The May 1 Hearing

At the next hearing, the court considered whether, without a secure placement in the community, inpatient hospitalization was the least restrictive treatment alternative for Ms. Smith. The hospital still had not secured a placement for her, and the government asserted that the main reason for the delay was that Ms. Smith did not have an established social security benefit. Counsel for the government requested another two-week continuance because "everything's almost put in place." He said that, once ...

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