Case Name: Charles C. BOUSE, Appellant, v. Dale C. CAMERON, Superintendent, Saint Elizabeths Hospital, Appellee
Court: United States Court of Appeals for the District of Columbia Circuit
Jurisdiction: United States
Decision Date: 1966-10-10
Citations: 373 F.2d 451
Docket Number: No. 19863
Parties: Charles C. BOUSE, Appellant, v. Dale C. CAMERON, Superintendent, Saint Elizabeths Hospital, Appellee.
Judges: Before Bazelon, Chief Judge, and Fahy and Danaher, Circuit Judges.
Reporter: Federal Reporter 2d Series
Volume: 373
Pages: 451–468

Head Matter:
Charles C. BOUSE, Appellant, v. Dale C. CAMERON, Superintendent, Saint Elizabeths Hospital, Appellee.
No. 19863.
United States Court of Appeals District of Columbia Circuit.
Argued March 23, 1966.
Decided Oct. 10, 1966.
As Amended April 4, 1967.
Mr. Edward E. O’Neill, Washington, D. C., for appellant.
Mr. John A. Terry, Asst. U. S. Atty., with whom Messrs. David G. Bress, U. S. Atty., and Frank Q. Nebeker and Earl J. Silbert, Asst. U. S. Attys., were on the brief, for appellee. Mr. Oscar Altshuler, Asst. U. S. Atty., also entered an appearance for appellee.
Before Bazelon, Chief Judge, and Fahy and Danaher, Circuit Judges.

Opinion:
BAZELON, Chief Judge.
In this habeas corpus case appellant attacks his confinement in Saint Elizabeths Hospital. He was involuntarily committed in November 1962 by the Municipal Court,' now the Court of General Sessions, upon finding him not guilty by reason of insanity of carrying a dangerous weapon, a misdemeanor for which the maximum imprisonment is one year. The District Court has held a hearing and denied relief in habeas corpus. It refused to consider appellant's contention that he has received no psychiatric treatment. The judge said:
My jurisdiction is limited to determining whether he has recovered his sanity. I don't think I have a right to consider whether he is getting enough' treatment. .
I
The principal issues raised by this ap-. peal are whether a person involuntarily committed to a mental hospital on being acquitted of an offense by reason of insanity has a right to treatment that is cognizable in habeas corpus, and if so, how violation of this right may be established.
The purpose of involuntary hospitalization is treatment, not punishment. The provision for commitment rests upon the supposed "necessity for treatment of the mental condition which led to the acquittal by reason of insanity." Absent treatment, the hospital is "transform [ed ] into a penitentiary where one could be held indefinitely for no convicted offense, and this even though the offense of which he was previously acquitted because of doubt, as to his sanity might not have been one of the more serious felonies" or might have been, as it was here, a misdemeanor.
Absence of treatment "might draw into question 'the constitutionality of [this] mandatory commitment section' as applied." (1) Lack of improvement raises a question of procedural due process where the commitment is under D.C. Code § 24-301 rather than under the civil commitment statute, for under § 24-301 commitment is summary, in contrast with civil commitment safeguards. It does not rest on any finding of present insanity and dangerousness but, on the contrary, orf a jury's reasonable doubt that the defendant was sane when he committed the act charged. Commitment on this basis is permissible because of its humane therapeutic goals. (2) Had appellant been found criminally responsible, he could have been confined a year, at most, however dangerous he might have been. He has been confined four years and the end is not in sight. Since this difference rests only on need for treatment, a failure to supply treatment may raise a question of due process of law. It has also been suggested that a failure to supply treatment may violate the equal protection clause. (3) Indefinite confinement without'treatment of one who has been found not criminally responsible may be so inhumane as to be "cruel and unusual punishment."
Impressed by the considerable constitutional problems that arise because "institutionalized patients often receive only custodial 'care," Congress established a statutory "right to treatment" in the 1964 Hospitalization of the Mentally 111 Act. The Act provides:
A person hospitalized in a public hospital for a mental illness shall, during his hospitalization, he entitled to med-' ' ical and psychiatric care and treatment. The administrator of each pub Jic hospital shall keep records detailing all medical and psychiatric care and treatment received by a person hospitalized for a mental illness and the records shall be made available, upon that person's written authorization, to his attorney or personal physician.
It appears that this provision, like the one limiting the use of mechanical restraints, was intended to cover persons hospitalized under any statutory authorization. Other sections of the Act apply only to patients "hospitalized pursuant to [the 1964 Act]," or to "mentally ill persons," which term'is defined by the Act to exclude persons committed by court order in a criminal proceeding. Since there are no such limitations in the "right, to treatment" provision set forth above, that right necessarily extends to involuntary commitment under D.C.Code § 24-301.
Moreover, the considerations underlying the right to treatment provision in the 1964 Act apply with equal force to commitment under D.C.Code § 24-301. These considerations are reflected in the statement of Senator Ervin, sponsor of the bill in the Senate. He called mere custodial care of hospitalized persons "shocking" and stated that of all the areas in which reform is badly needed, the "right to treatment" was "perhaps the most critical." He further said:
Several experts advanced the opinion that to deprive a person of liberty on the basis that he is in need of treatment, without supplying the needed treatment, is tantamount to a denial of due process. [The Senate bill] embodies provisions which will ameliorate this problem whereas existing law makes no provisions for safeguarding this right.
Regardless of the statutory authority, involuntary confinement without treatment is "shocking." Indeed, there may be greater need for the protection of the right to treatment for persons committed without the safeguards of civil commitment procedures. Because we hold that the right to treatment provision applies to appellant, we need not resolve the serious constitutional questions that Congress avoided by prescribing this right.
The Group for the Advancement of Psychiatry has urged that "provisions that safeguard the patient's right to good treatment as opposed to simple custody" are an essential element of commitment laws. A right to' treatment in some form is recognized by law in many states. The requirement' in the 1964 Act that the hospital keep records detailing psychiatric care and treatment and make them available to the patient's attorney reinforces our view that Congress intended to implement the right to treatment by affording a judicial remedy for its violation.
The patient's right to treatment is clear. We now consider how violation of the right may be established.
II
According to leading experts "psychiatric care and treatment" includes not only the contacts with psychiatrists but also activities and contacts with the hospital staff designed to cure or improve the patient. The hospital need not show that the treatment will cure or improve him but only that there is a bona fide effort to do so. This requires the hospital to show that initial and periodic inquiries are made into the needs and conditions of the patient with a view to providing suitable treatment for him, and that the program provided is suited to his particular needs. Treatment that has therapeutic value for some may 'not have such value for others. For example, it may not be assumed that confinement in a hospital is beneficial "environmental therapy" for all.
The effort should be to provide treatment which is adequate in light of present knowledge. Some measures which have therapeutic value for the particular patient may be too insubstantial in comparison with what is available. On the other hand, the possibility of better treatment does not necessarily prove that the one provided is unsuitable or inadequate.
It has been said that "the only certain thing that can be said about the present state of knowledge and therapy regarding mental disease is that science has not reached finality of judgment." But lack of finality cannot relieve the court of its duty to -render an informed decision. Counsel for the patient and the government can be helpful in presenting pertinent data concerning standards for mental care, and, particularly when the patient is indigent and cannot present experts of his own, the court may appoint independent experts. Assistance might be obtained from such sources as the American Psychiatric Association, which has published standards and is continually enghged in studying the.problems of mental care. The court could also consider inviting the psychiatric and legal communities to establish procedures by which expert assistance can be best provided.
Continuing failure to provide suitable and adequate treatment cannot be justified by lack of staff or facilities. Congress considered a Draft Act Governing Hospitalization of the Mentally III prepared by the National Institute of Mental Health and the General Counsel of the Federal Security Agency, which contained the following provision:
Every patient shall be entitled to humane care and treatment and, to the extent that facilities, equipment, and personnel are available, to medical care and treatment in accordance with the highest standards accepted in medical practice. [Emphasis supplied.]
The italicized language was omitted in the present Act. This omission plainly evidences the intent tp,establish a broad er right to treatment. As the Fourth Circuit Court of Appeals said of the right to treatment under Maryland's "defective delinquent" statute, "[djeficiencies in staff, facilities, and finances would undermine the justification for the law, and ultimately the constitutionality of its application." Sas v. State of Maryland, 334 F.2d 506, 517 (4th Cir. 1964).
We are aware that shortage of psychiatric personnel is a most serious problem today in the care of the mentally ill. In the opinion of the American Psychiatric Association no tax-supported hospital in the United States can be considered adequately staffed. We also recognize that shortage cannot be remedied immediately. But indefinite delay cannot be approved. "The rights here asserted are present rights and, unless there is an overwhelmingly compelling reason, they are to be promptly fulfilled." Watson v. City of Memphis, 373 U.S. 526, 533, 83 S.Ct. 1314, 1318, 10 L.Ed.2d 529 (1963).
One who is "in custody in violation of the Constitution and laws" of the United States is entitled to relief in habeas corpus, and the court is required to "dispose of the matter as law and justice require." If the court finds that a mandatorily committed patient, such as appellant, is in custody in violation of the Constitution and laws, it may allow the hospital a reasonable opportunity to initiate treatment. In determining the extent to which the hospital will be given an opportunity to develop an adequate program, important considerations may be the length of time the patient has lacked adequate treatment, the length of time he has been in custody, the nature of the mental condition that caused his acquittal, and the degree of danger, resulting from the condition, that the patient would present if released. Unconditional or conditional release may be in order if it appears that the opportunity for treatment has been exhausted or treatment is otherwise inappropriate. It is unnecessary to detail the possible range of circumstances in which release would be the appropriate remedy.
The government says the record shows that appellant is receiving adequate treatment. Since the District judge found no right to treatment, he did not inquire into the question of adequacy. There was evidence that appellant voluntarily left group therapy several months before the hearing below. But there was no inquiry into such questions as the suitability of group therapy for his particular illness, whether his rejection of this therapy was a manifestation and symptom of his mental illness, and whether reasonable efforts were made either to deal with such rejection or to provide some other suitable treatment. Also, the government psychiatrist said that appellant was receiving "environmental therapy." But the suitability and adequacy of the "milieu" as therapy-for this petitioner was not explored.
We think "law and justice require" that we remand for a hearing and findings on whether appellant is receiving adequate treatment, and, if not, the details and circumstances underlying the reason why he is not. The latter information is essential to determine whether there is "an overwhelmingly compelling reason" for the failure to provide adequate treatment.
III
The appellant challenges also the District Court's finding that he has not recovered his mental health. A person involuntarily committed and confined under D.C.Code § 24-301 is entitled to release if he has "recovered his sanity and will not in the reasonable future be dangerous to himself or others." That the "person so confined hás some dangerous propensities does not, standing alone, warrant his continued confinement in a government mental institution under § 24-301 D.C.Code. The dangerous propensities must be related to or arise out of an abnormal mental condition." The District Court's findings concerning mental illness and dangerous propensities are not to be disturbed unless they lack support in the record or rest on an erroneous legal principle.
Three psychiatrists gave conflicting testimony.' Dr. Eeonomon of Saint Elizabeths testified that appellant was suffering from "ahti-social reaction" and described its symptoms. Dr. Marland, in private practice, and Dr. Bunge, of the Commission on Mental Health, testified that appellant was not suffering from mental illness. But we do not reach the _ question whether the record would have supported a finding of present men-: tal illness and dangerous propensities. For the record shows that in assessing ^ danger the District judge may have relied primarily on the nature of the offense with which the appellant had been charged in 1962 rather than his present condition. For example, the judge said to government counsel, after questioning him and Dr. Marland about the offense:
I venture to suggest, Mr. Silbert, that in these cases that arise out of a criminal proceeding it would be useful to know the facts of the crime in every case, even if you have to dig them up from the files of the Municipal Court, because I have to protect the public. That is the principal thing that I have to consider. I would consider myself derelict in my duty if I released him and then a few weeks later he shot somebody with a .45 Colt automatic. That is why I want to know how he came to be arrested for carrying a gun. He must have done something to call the attention of the police to the fact that he had a gun. The police don't just stop anybody on the street and say, have you got a gun.
You could talk to the arresting Officer if he is still on the Force. He would probably remember how he came to arrest this man. I think those facts are important.
• There is a big difference between releasing a man, say, who overdrew his bank account and one who had a gun. If you release a man who overdrew his bank account, the worst that can happen, he might do it again; but when you release a man who has been carrying a .45 automatic, that is a pretty serious matter.
The . judge concluded: "In view of the fact that the original arrest involved a' dangerous weapon, an extremely dangerous weapon, with a great deal of ammunition, the Court is not going to undertake to release him unconditionally and would have great hesitancy in releasing him even conditionally." The judge then continued the hearing pending a report from the Commission on Mental Health.
The Commission reported that appellant had "recovered" and that "further confinement would stifle his future development." The hearing resumed with the following colloquy:
Court: The court has before it the report of the Commission on Mental Health. Is this the case in which the petitioner was arrested in possession of á .45 caliber revolver?
Mr. Silbert: With 600 rounds of ammunition, too. This was at 1:45 in the morning at 14th & Harvard Sts. N.W.
The judge then pursued at length with Dr. Bunge, as he had with Dr. Marland, appellant's purpose in possessing a gun and ammunition. At the conclusion of the doctor's testimony the judge said:
I do want to ask you one question, Doctor. I am going to ask you that question in view of the fact that [petititioner] was caught in the possession of a .45 pistol and 600 rounds of ammunition. My principal interest must be to protect the public. Would he be dangerous to himself or others, in your opinion, if he is released ?
Dr. Bunge replied: "I don't believe he would be at this time."
The judge made plain not only his reliance on the offense charged, but also his doubt whether the appellant was mentally ill. He said to Dr. Economon, the only psychiatrist who thought him so:
Do you mean to say, Doctor, that to carry — of course I strongly disapprove of anybody carrying a .45 unless he is in uniform and on and ' of anybody carrying 500 rounds of ammunition, but, certainly, that is not a symptom of insanity, Doctor, because many sane people do those things.
Jr X1 Js* S'
You know, we just couldn't accept any psychiatric testimony or theory to the effect that the commission of a crime is a sign of mental disease because if we accepted that our whole system of criminal law would have to break down. - -
*
You practically ask us to take your opinion for the sum total of the tendencies and all the data, instead of enumerating the data so that we could test the conclusion that you reach.
Appellant may not be held in custody for an offense of which he was found not guilty Since, as we have pointed out above, he may not be held unless his dangerous propensities "are related to or arise out of an abnormal mental condition" and since the case is being remanded for a hearing and findings concerning treatment, the District Court may reconsider and clarify its findings concerning illness and dangerous propensities.
Reversed and remanded for further proceedings in accordance with this opinion.
FAHY, Circuit Judge.
My purpose is merely to point out why I believe our dissenting colleague is mistaken in saying that we are deciding a case which is not before us.
1. In the District Court the transcript of record has the following statement of appellant's counsel at the beginning of thé hearing:
If the Court please, at this time we would like to put on testimony to show that this case falls within Darnell v. Cameron, No. 19043, decided May 28, 1965 by the Court of Appeals, here, which indicates that if no treatment is given and St.-Elizabeths is used only as a place of confinement, it could be a violation of the petitioner's rights under the Constitution.
•K- -if *
[T]his boy was acquitted on the ground of insanity some, approximately, three years ago. He has been confined to St. Elizabeths as a result of that acquittal on the ground of insanity and I am informed that he has received very little, if any, treatment, and we have witnesses to show that he is not of unsound mind and he ought not to be kept in St. Elizabeths Hospital, at least John Howard Pavilion, under this short [sic] of maximum security confinement. And, of course, if the Government wants to proceed against him civilly, nobody can stop them from doing -that. But as far as treatment is concerned, he is receiving none. He has received very little, if any, and he has served three years, and the offense for which he was acquitted, I think the maximum penalty was one year.
On the next page of the transcript appears the following ruling of the court:
The Court: My jurisdiction is limited to determining whether he has recovered his sanity. I don't think I have a right to consider whether he is getting enough treatment or not enough treatment 'because', after all, treatment of a mental disease ordiiiarily is only talking to a person. That is what treatment consists of, you know.
Mr. Ehrlich [counsel for petitioner] : Well, if the Court please—
The Court: Also, I cannot determine whether he should be in one pavilion rather than in another.
Mr. Ehrlich: I am not'going to ask the Court to determine that. I am saying that failure to accord this accused any treatment at all is a violation of his constitutional rights in keeping him there.
The Court: I have to determine whether he has recovered his sanity.
Thus counsel raised in the District Court, and the court rejected, the treatment issue discussed in our opinion.
2. . The following appears as the "Statement of Points" in appellant's brief in this court:
Where the record shows that appellant has been confined to a mental institution under D.C.Code § 24-301 since November 9,1962, upon a finding of not guilty by reason of insanity on a misdemeanor charge and has received no treatment for over the past eighteen (18) months and in fact is not now insane, the trial court erred:
(a) in discharging the Writ of Habeas Corpus and remanding appellant to further confinement with no treatment.
Thus the question was again presented in this court.
. D.C.Code § 24-301 (d) (1961).
. D.C.Code § 22-3215 (1961).
. S.Rep.No. 1170, 84th Cong., 1st Sess. (1955); H.R.Rep. No. 892, 84th Cong., 1st Sess. (1955). See Overholser v. Lynch, 109 U.S.App.D.C. 404, 410, 288 F.2d 388, 394 (1961) (en banc), rev'd on other grounds, 369 U.S. 705, 82 S.Ct. 1063, 8 L.Ed.2d 211 (1962) :
[0]nee it is determined that a defendant is to be'hospitalized for treatment of a mental disease or defect, further consideration of the criminal penalty provided by statute becomes irrelevant, for any and all purposes. The length of his hospitalization must depend solely on his need (or lack of it) for further treatment. It is true that he may be hospitalized for a longer time than tlie maximum jail sentence provided by statute. It is equally true that he may be released in a shorter time than the minimum sentence. Hospitalization, in this respect, bears no relation to a jail sentence. A jail sentence is punitive and is to be imposed by tlie judge within the limits set by tlie legislature. Hospitalization is remedial and its limits are determined by the condition to be treated.
See also Ragsdale v. Overholser, 108 U.S. App.D.C. 308, 281 F.2d 943 (1960); Hough v. United States, 106 U.S.App. D.C. 192, 196, 271 F.2d 458, 462 (1959); Williams v. United States, 102 U.S.App. D.C. 51, 57-58, 250 F.2d 19, 25-26 (1957).
. Ragsdale v. Overholser, 108 U.S.App. D.C. 308, 315, 281 F.2d 943, 950 (1960) (Fahy, J., concurring).
. Ibid.
. Darnell v. Cameron, 121 U.S.App.D.C. 58, 62, 348 F.2d 64, 68 (1965). See Birnbanm, The Right to Treatment, 46 A.B.A.J. 499 (1960).
. Ragsdale v. Overholser, supra note 4, 108 U.S.App.D.C. at 316, 281 F.2d at 951 (Fahy, J., concurring).
. Lynch v. Overholser, 369 U.S. 705, S2 S.Ct. 1063, 8 L.Ed.2d 211 (1962); Ragsdale v. Overholser, supra note 4, 108 U.S. App.D.C. at 316, 281 F.2d at 951 (Fahy, J., concurring).
. Ragsdale v. Overholser, supra note 4. Such summary commitment, of course, also serves to protect society from danger. Ragsdale v. Overholser, supra at 312, 281 F.2d at 947. But if this were the only purpose, then a full range of procedural safeguards might be constitutionally required. Cf. Benton v. Reid, 98 U.S.App.D.C. 27, 231 F.2d 780 (1956); Kautter v. Reid, 183 F.Supp. 352, 353-354 (D.D.C.1960) (Youngdahl, J.).
. See note 3 supra.
. See Sas v. State of Maryland, 334 F.2d — 506, 509 (4th Cir.1964).
. Cf. Robinson v. State of California, 370 U.S. 660, 82 S.Ct. 1417, 8 L.Ed.2d 758 (1962); Easter v. District of Columbia, 124 U.S.App.D.C. 33. 361 F.2d 50 (1966).
. Hearings before the Subcommittee on Constitutional Rights of the Senate Committee on the Judiciary on a Bill to Protect the Constitutional Rights of the Mentally Ill, 88th Cong., 1st Sess. 12 (1963) [hereinafter 1963 Hearings].
. D.C.Code § 21-562 (Supp. V, 1966). .
. D.C.Code § 21-563 (Supp. V, 1966).
. See, e. g., D.C.Code § 21-561, 21-564 (Supp. V, 1966).
. See D.C.Code § 21-543 (Supp. V, 1966).
. D.C.Code § 21-501 (Supp. V, 1966).
. The plain language of the statute that "[a] person hospitalized in a public hospital for a mental illness shall be entitled to medical and psychiatric care and treatment" should be followed even if the legislative history may be construed to the contrary. Moreover, the legislative history in this case is ambigous.
The House Committee Report did make the broad statement that the bill applied' .'only. to.'those committed .in- civil proceed-. ings. H.R.Rep. No. 1833, SSth Cong., 2d Sess. 3 (1964). The Report-did not recommend enactment of this broad statement. It did recommend an amendment which defined a "mentally ill person" to exclude persons "committed in a criminal proceeding." H.R.Rep. No. 1S33, at p. 1. Since this definition was used in only a few sections of the Act, the Committee could not have based the broad statement in the Report on the amended definition. If the Committee had believed that its broad statement was true even without the amendment, the Committee would not have suggested the amendment.
The Committee Report made one other similarly broad statement about most of the Act when it suggested that the words "in a noncriminal proceeding" be added to the section, now D.C.Code § 21-5S9(a) (Supp. V, 1966), which made several sections (including the right to treatment provision) retroactive. H.R.Rep. No. 1S33, at 19. The statement is not supported by the retroactivity section which, by its terms, applies only to people committed before September 15, 1904. And again, if the Committee believed the entire Act applied only to those committed in civil jironeedings, even without the amendment to the retroactivity section, then the Committee could not have thought the amendment necessary.
Likewise, Senator Ervin's statement on the floor, that the House version of the bill applied only to "civil hospitalization procedures," 110 Cong.Rec. 21345 (1964), is not supported by either amendment. Once again, if be thought that the entire Act was so limited even without the House amendments, then both amendments would have been unnecessary. Further, • the . right to treatment of a patient already in a mental institution is not related to "hospitalization procedures," either civil or criminal.
We must assume that the language of the .treatment provision,- and not the state-. ments, represents the will of .Congress, peeially since the provision — unlike' the-statements — does not raise the serious equal protection question of discrimination between those committed in "criminal proceedings" and those civilly committed. Baxstrom v. Herold, 383 U.S. 107, 86 S. Ct. 760, 15 L.Ed.2d 620 (1966) (prior criminal conduct not a proper basis for denial without a hearing of confinement rights that may only be taken from others after a hearing).
The ambiguity of the legislative history and of much of the statute is further illustrated by D.C.Code § 21-5S0(a) which provides that certain sections of the Act, including the right to treatment provision, "apply to a person, who. on or after January 1, 1966, is a patient in a hospital in the District of Columbia by reason of having been declared insane or of unsound mind pursuant to a court order entered in a noncriminal proceeding prior ' to September 15, 1964."
If this section describes the only people who will enjoy its rights then those rights would not apply to anyone who was committed after the enactment of the statute. This interpretation would be unthinkable. Nor can this section describe the only people committed before September 15, 1964. who will enjoy those rights. This reading would create two arbitrary distinctions, at least with regard to the right to treatment. First, the right to treatment would be available to those criminally committed after September 15, 1964, but not to those criminally committed before that date. Second, and more important,the right to treatment would apply to those civilly committed before September 15, 1964, but not to those criminally committed at the same time. As a general matter this distinction is unwarranted (see text following note ISa infra) and may raise constitutional doubts (Baxstrom v. Herold, supra.) But it is especially irl rational in the context of a statute which we have construed to provide a right to treatment without distinction between those civilly and those criminally committed after September 15, 1964.
We think D.C.Code § 21-589(a) must be read as permissive, describing one group of people who will enjoy certain rights without necessarily excluding anyone else. Again, this interpretation avoids imputing to Congress an intent to discriminate irrationally among patients in mental institutions. Baxstrom v. Herold, supra.
Our construction is not affected by any other matter of legislative history. See, e. g., H.R.Rep. No. 1833, at p. 7; S.Rep. No. 925, 88th Cong., 2d Sess. 30, 40 (1964) ; 110 Cong.Rec. 14552, 20791, 20792, 21346 (1964).
. 1963 Hearings at 12. See, e. g., Statement of Richard Arens, Attorney, 1963 Hearings at 49; Statement of Dr. Dale Cameron, Superintendent, Saint Elizaberhs Hospital, 1963 Hearings at Statement of Dr. Morton Birnbaum, Hearings Before the Subcommittee on Constitutional Rights of the Senate Committee on the Judiciary On Constitutional Rights of the Mentally Ill, 87th Cong., 1st Sess. 278-305 (1961) [hereinafter 1961 Hearings]; Statement of Dr. Winfred Overholser, 1961 Hearings at 25; Statement of Dr. Addison Duval, 1961 Hearings at 14; Statement of Abe Krash, Attorney, 1961 Hearings at 620.
. Group for the Advancement of Psychiatry, Laws Governing Hospitalization of the Mentally Ill 157 (Report No. 61,1966).
. See New York Mental Hygiene Law, McKinney's Consol. Laws, c. 27, § 86; Idaho Code Ann. § 66-344; Iowa Code § 225.15; Mo.Stat.Ann. § 202.840; New Mexico Stat. § 34-2-13; Okla.Stat. tit. 43A, § 2, 91; Vernon's Ann.Tex. Civ.Stat.Ann. Art. 5547-70; Cal.Welf. and Inst.Code Ann. § 6621; Utah Code Ann. § 64-7-46; Ill.Rev.Stat. ch. 91½ § 12-2, 12-16, 100-7 (1965 Supp.). See generally Ross. Commitment of the Mentally Ill: Problems of Law and Policy, 57 Mich.L.Rev. 945, 1002, n. 156 (1959).
. This requirement also suggests the appropriateness of administrative procedures for considering complaints alleging lack of treatment. These procedures would not only provide the Hospital an opportunity to afford a remedy, but would also provide a record which might assist in the disposition of any resulting litigation. And given "adequate and available" administrative procedures, it might be argued, although we do not decide, that the doctrines of primary jurisdiction and exhaustion of remedies would apply. . See, e.g., Myers v. Bethlehem Shipbuilding Corp., 303 U.S, 41, 50-52, 58 S.Ct. 459, 82 L.Ed. 638 (1938); Sohm v. Fowler, 124 U.S.App.D.C. 382, 365 F.2d 915, decided June 16, 1966.
. Senator Robert Kennedy has recently introduced a bill in Congress to establish procedures and standards for commitment of defendants found not guilty by reason of insanity in all federal jurisdictions except the District of Columbia, which is already covered by the mandatory commitment statute, D.C.Code § 24-301 (1961), and the 1964 Hospitalization of the Mentally Ill Act, D.C.Code § 21-501 to 21-591 (Supp. V, 1966). This bill explicitly states dial any iierson confined under its provisions "shall receive medical and psychiatric care and treatment." S. 3689, 89th Cong., 2d Sess. § 4249(b) (1966). In introducing this bill on the floor of the Senate, Senator Kennedy noted that this statutory right to treatment
is based upon the language in section 21-562 of the District of Columbia Code, which is the part of the District of Columbia Hospitalization of the Mentally 111 Act that expressly creates a right to care and treatment. This bill therefore contemplates that the adequacy of the treatment which a confined person is receiving will be relevant in later inquiries as to whether his commitment for treatment should be continued.
112 Cong.Rec. 17522 (daily ed. Aug. 4, 1966).
. See Overholser & Richmond, Handbook of Psychiatry 35 (1947).
. The need for periodic examination of the patient is explicitly recognized in the 1964 Hospitalization of the Mentally III Act, .which provides that "the chief of service of a; public or private hospital .shall, as often as practicable, but not less often-than every six-months, examine or cause to be examined each patient admitted to a hospital pursuant to this subchapter " D.C.Code § 21-548 (Supp. V, 1966). Of. Handbook; of Public Assistance Administration, Medical Assistance Programs, Supp. D, D-5230 item D (May 13,1966):
Responsibilities for Recipient Patient in Mental Hospitals.
He >1: Hí * H*
3. Periodic joint planning and assessment by designated agency and institutional staff regarding the care, treatment, and progress of each recipient-patient. at intervals not to exceed three months, to assure that all appropriate measures are taken for his improvement and that continued treatment in the institution is necessary.
. See Jones, The Therapeutic Community (1953): Stanton & Schwartz, The Mental Hospital (1954).
. "[T]ho milieu of the hospital, if properly structured, is a constructive force for getting well; if improperly constructed it is a force for remaining sick." Statement of Dr. Dale Cameron, Superintendent, Saint Elizabeths Hospital, 1968 Hearings, at 146.
. We need not now resolve the implications of the "right to treatment" for a patient who is demonstrated by the hospital to be "untreatable" in the present state of psychiatric knowledge, if such a patient exists. See Statement of Dr. Winfred Overholser, then Superintendent of Saint Elizabeths Hospital, 1961 Hearings at 594:
I do not believe we should write off any patient as incurable. In other words, we are going to try our hand at treating every patient that is sent to us.
. Greenwood v. United States, 350 U.S. 366, 375, 76 S.Ct. 410, 415, 100 L.Ed. 412 (1956) (Frankfurter, J.).
. Cf. Rollerson v. United States, 119 U.S. App.D.C. 400, 343 F.2d 269 (1965). Courts are familiar with problems of determining medical standards in medical malpractice suits. See, e.g., Price v. Neyland, 115 U.S.App.D.C. 355, 358, 320 F.2d 674, 677, 99 A.L.R.2d 1391 (1963). While the issue of adequacy of treatment is not the same as the issue of negligence, the evidentiary problems are similar.
. See Lake v. Cameron, 124 U.S.App.D.C. 264, 364 F.2d 657, decided May 19, 1966. Cf. DeMarcos v. Overholser, 78 U.S.App. D.C. 131, 132, 137 F.2d 698, 699, cert. denied, 320 U.S. 785, 64 S.Ct. 157, 88 L. Ed. 472 (1943); Curry v. Overholser, 109 U.S.App.D.C. 283, 286, 287 F.2d 137, 140 (1960) (right of indigent to independent examination).
. "Appellate courts no longer question, the inherent power of a trial court to appoint an expert under proper circumstances to aid it in the just disposition of a case." Scott v. Spanjer, 298 F.2d 928, 930, 95 A.L.R.2d 383 (2d Cir. 1962). See Wigmore, Evidence § 2484 at 270 (3rd ed. 1940); Lake v. Cameron, supra note 31. Cf. Rule 28, Fed.R.Crim.P.
. American Psychiatric Association, Standards for Hospitals and Clinics (Rev. 1958); American Psychiatric Association, Emerging Patterns of Administration in Psychiatric Facilities (1964).
. Other such sources might include the National Institute of Mental Health, the National Association of^State Mental Health Program Directors, the Group for the Advancement o^Psychiatry, and experts from various universities.
. Such procedures might include provision of permanent or rotating panels of experts.
. At the 1963 Hearings before the Subcommittee on Constitutional Sights, the following colloquy occurred between"'William A. Creech, Chief Counsel and Staff Director to the Committee, and Dr. Dale Cameron, Superintendent of Saint Elizabeths Hospital:
"Mr. Creech: In your memorandum you say that your hospital has a severely limited staff. I wonder, sir, if you feel, inasmuch as you mentioned providing a staff for the Mental Health Commission, that you also must have an adequate staff to provide treatment for the mentally ill individuals who are hospitalized?
"Dr. Cameron: Well, we certainly, I certainly, believe that our staff is not what it should be, and we do need additional help in this regard.
"I am not at all sure that a commitment law or an admission procedure is necessarily the place to try to provide the additional staff needed for the hospital, but I think it is a quite appropriate place to state what the goal of treatment in these hospitals should be, and recognize that it takes staff as well as reporting systems to assure adequacy of treatment."
. IT.S. Surgeon General's Ad Hoc Committee on Planning for Mental Health Facilities, Planning of Facilities for Mental Health Services 38 (1961). See Albee, Mental Health Manpower Trends (1959).
. U.S. Surgeon General's Ad Hoc Committee, supra note 37, at 39. In 1958, Dr. Harry C. Solomon, then President of the American Psychiatric Association, stated, "After 114 years of effort, in this year 1958, rarely has a state hospital an adequate staff measured by the minimum standards set by our Association, and these standards represent a compromise between what was thought to be adequate and what it was thought had some possibility of being realized." Solomon, The American Psychiatric Association in Relation to American Psychiatry, 115 AM.J. Psychiatry 1, 7 (1958).
. Those authorities who recognize the problem also advance means for its amelioration. See U. S. Surgeon General's Ad Hoc Committee, supra note 37, at 39; Albee, supra note 37, at 241-59.
. See also Bradley v. School Board, 382 U.S. 103, 105, 86- S.Ct. 224, 15 L.Ed.2d 187 (1965); Goss v. Board of Education, 373 U.S. 683, 689, 83 S.Ct. 1405, 10 L.Ed. 2d 632 (1963); Florida ex rel. Hawkins v. Board of Control, 350 U.S. 413, 76 S. Ct. 464,100 L.Ed. 486 (1956).
. 28 U.S.C. § 2241(c) (3), 2243 (1964).
. Overholser v. O'Beirne, 112 U.S.App. D.C. 267, 269-270, 302 F.2d 852, 854-855 (1961) . See Overholser v. Lynch, 109 U.S.App.D.C. 404, 288 F.2d 388 (1961) (en banc), rev'd on other grounds, 369 U.S. 705, 82 S.Ct. 1063, 8 L.Ed.2d 211 (1962) : Ragsdale v. Overholser, 108 U.S. App.D.C. 308, 281 F.2d 943. (1960); Hough v. United States, 106 U.S.App.D.C. 192, 271 F.2d 458 (1959); Starr v. United States, 105 U.S.App.D.C. 91, 96-97, 264 E.2d 377, 382-383 (1958) (en banc), cert. denied, 359 U.S. 936, 79 S.Ct. 652, 3 L.Ed.2d 639 (1959). See generally Gold-stein & Katz, Danyerousness and Mental Illness: Some Observations on the Decision to Release Perso)is Acquitted by Reason of Insanity, 70 Yale L.J. 225 (1960).
. It is true, of course, that a jury finding: of not guilty by reason of insanity presupposes its conclusion that, aside from the question of sanity, the defendant committed the acts charged. See Rucker v. United States, 108 U.S.App.D.C. 75, 77, 280 F.2d 623, 625 (1960). However, his continued confinement depends not upon the fact that he committed the acts, but upon his present mental condition.
. Overholser v. O'Beirne, supra note 42, at 269-270, 302 F.2d at 854-855 (1961).
. The finding that appellant has not recovered his mental health does not allay our doubts since it mereli' recites a conclusion essentially in the statutory language. Upon conclusion of the hearing below, the government advised the hearing judge that it would submit the "customary findings." They were thereafter submitted and signed by another judge who had nothing to do with the case. When this error was discovered almost two weeks later, the hearing judge signed the findings submitted without change.
. Claiming he was sane, appellant sought his complete freedom. This being denied on the ground he had not satisfied the court that he had met the conditions for release specified in Section 24-301 of the Code, there remained for consideration whether the continued deprivation of liberty at St. Elizabeths was valid without treatment, a question adequately raised by his counsel in both courts.