Opinion ID: 184750
Heading Depth: 2
Heading Rank: 4

Heading: Past Practice and Procedure

Text: 30 Indeed, a demarcation line between a Hospital escort and supervision by some other third party in the community has signaled the point at which the requirements of conditional release come into play since conditional releases first became available for insanity acquittees in 1955. We disagree with our dissenting colleague that 43 years of unchallenged past practice is irrelevant in that respect. The very existence of the 1987 Stipulation--whose sole purpose is to require the Hospital to give notice when Hinckley will be off Hospital grounds--suggests that the government understood then that the Hospital would not otherwise have to give such notice for Hospital-accompanied visits. Moreover, after the Hospital was criticized in 1986 for allowing Hinckley to leave the grounds for a day with a Hospital escort, Congress in 1988 amended the Federal insanity defense law specifically to do what the District of Columbia law does not: to provide prospectively 12 for court supervision of all excursions by Federal insanity acquittees off Hospital grounds. See 18 U.S.C. § 4243(h); see also 133 CONG. REC. 16905 (statement of Rep. Gekas) (Hinckley's supervised outing is when we first discovered that ... decisions for furloughs or off campus excursions ... from the hospital ... [are] subject only to the approval of the hospital mechanism that is in place). 31 Since October 1, 1996, Hospital staff have made 451 trips to D.C. General Hospital with eligible medium and maximum security patients on B-City privileges, as well as 56 other community visits to attend wakes, funerals, or special medical appointments at other facilities. See District of Columbia's (D.C.) Brief at 10-11. In the same period of time, the Hospital's Recreational Therapy Branch has taken minimum and medium security patients on 359 B-City privilege trips to museums, theaters, bowling alleys, arboretums, amusement parks, and shopping. The Hospital also takes groups of patients on trips--with a maximum ratio of one staff member for every five patients--four times per month. See id. & nn.8-9. Yet the government has not previously objected to any of these outings nor to the countless B-City passes issued before 1996. In response to a query at oral argument about whether the government would in the future seek to invoke court jurisdiction over all B-City passes, government counsel answered equivocally that there might be other situations in which the government thought court intervention would be necessary, based on concerns for public safety. But it seems to us that Congress has already struck a balance in the D.C. law between treatment for the criminally insane and the public safety by defining the juncture where court approval is necessary as the point of a patient's reentry into society, not his stepping off Hospital grounds with a Hospital escort. See also DeVeau, 483 A.2d at 311 (judicial review under section 301(e) is to ensure that an acquittee is well enough to reenter the community on a conditional or unconditional basis). In addition, tort law provides strong incentive for the Hospital to make sure it is acting responsibly in issuing B-City privileges. See White v. United States, 780 F.2d 97, 103 (D.C.Cir.1986) ( 'One who takes charge of a third person whom he knows or should know to be likely to cause bodily harm to others if not controlled is under a duty to exercise reasonable care to control the third person to prevent him from doing such harm.' ) (quoting RESTATEMENT (SECOND) OF TORTS § 319 (1965)). A B-City privilege, in allowing the Hospital to monitor how the patient acts outside the Hospital while keeping the public safety firmly in mind by ensuring he is under Hospital control at all times, serves as a crucial precursor to a patient's reentry into larger society. FINAL NIMH REPORT, at 81 (Therapeutic passes are [ ] symbolic of a forensic hospital's legitimate mission to rehabilitate its patients, as well as provide the security necessary to protect the public.); see also District of Columbia Dep't of Human Serv., Policy and Procedure, CMHS Policy 50000.330.1 (superseding St. Elizabeths Hospital Policy no. 3300.1A) (directing the Hospital to classify, for security purposes, patients hospitalized pending or as a result of criminal proceedings). For the first time, in a case involving perhaps the most notorious patient at the Hospital, the government now argues 43 years after section 301(e)'s enactment, that a B-City pass requires court approval. We do not believe it has made its case.