39–006 

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 

2 

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 communitybased 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.’’

3 

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 oneyear probationary period. Subsequent appointments may be made 

for four-year terms. This section would amend § 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 § 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 § 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 § 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 § 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 § 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 

4 

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. 

5 

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. 

6 

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 2006 2007 2008 2009 2010 2011 2012 2013 2014 2005– 

2009 

2005– 

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 lessrestrictive 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 considVerDate Aug 04 2004 11:41 Oct 10, 2004 Jkt 039060 PO 00000 Frm 00006 Fmt 6659 Sfmt 6602 E:\HR\OC\HR729.XXX HR729
7 

ered 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 

8 

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 onehalf of the individuals released each year would access outpatient 

programs from St. Elizabeth’s and that 70 percent of those individuals would 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 

9 

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. 

* * * * * * * 

ø21–502. 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

* * * * * * * 

ø§ 21–502. Commission on Mental Health; composition; appointment and terms of members; organization; 

chairman; salaries. 

ø(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 CommisVerDate Aug 04 2004 11:41 Oct 10, 2004 Jkt 039060 PO 00000 Frm 00009 Fmt 6659 Sfmt 6601 E:\HR\OC\HR729.XXX HR729
10 

sion. 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. 

ø(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. 

ø(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. 

ø(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. 

ø(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.¿ 

§ 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 

11 

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. 

§ 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. øThe 

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 psychologistpatient privilege is not applicable. 

* * * * * * * 

SUBCHAPTER III. EMERGENCY HOSPITALIZATION

* * * * * * * 

§ 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 

12 

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

* * * * * * * 

§ 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. øA 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. 

* * * * * * * 

13 

§ 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 to whom 

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. 

ø(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. 

§ 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 

14 

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 CoVerDate Aug 04 2004 11:41 Oct 10, 2004 Jkt 039060 PO 00000 Frm 00014 Fmt 6659 Sfmt 6603 E:\HR\OC\HR729.XXX HR729
15 

lumbia, 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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