Opinion ID: 2009306
Heading Depth: 1
Heading Rank: 1

Heading: Cade and Richardson

Text: Leonard Cade was admitted to the Hospital as an emergency patient in March 1982, upon the application of Dr. Yavit, an accredited officer of the District of Columbia Department of Health. Id. §§ 21-521, -522. In his application, Dr. Yavit observed that Cade had discharged himself from the Hospital against medical advice in February of that year, and subsequently refused to admit himself voluntarily. The application revealed that Cade had difficulty controlling his behavior, noting that on the previous day he broke the front door of his mother's home, threatened a relative with a knife, then suffered a broken arm and cut his mother when she tried to wrest the knife from him. Dr. Yavit further noted that Cade's condition improved when he used his medicine as prescribed, but that he had failed to comply with his treatment program and had been without medication for several weeks. Jerome Richardson was admitted to the Hospital in April 1982, as an emergency patient pursuant to the application of a United States Park Police officer. In his application, the officer stated that Richardson had been observed nude, masturbating and attempting to gain entry to a locked building. Immediately following the admission of Cade and Richardson, the Hospital petitioned the court for orders extending the emergency hospitalization of each, and soon thereafter, instituted civil commitment proceedings against both men pursuant to id. § 21-541(a). Subsequently, the Commission on Mental Health (Commission) conducted hearings, finding Cade and Richardson to be mentally ill and, as a result of their illnesses, likely to injure themselves or others. The Commission noted that Cade had been admitted to the Hospital on six occasions and was presently experiencing hallucinations and paranoid delusions that others wanted to harm him. In Richardson's case, the Commission observed that he had recently signed out of the Hospital against medical advice, and eloped from the institution numerous times in the past. The Commission added that without medication and appropriate treatment, Richardson's condition would deteriorate, yet noted that he has been hostile about taking his medication which has required [that he] be placed in seclusion. The Commission concluded that the conditions of both men had been sufficiently stabilized to permit their return to the community, provided that each take his medication and abide by his treatment regimen. Subsequently, Cade and Richardson appeared before the court, waived trial [1] and accepted the Commission's recommendation of commitment to outpatient treatment [2] under the Hospital's supervision. The court accepted the recommendation and entered final orders committing both men to outpatient treatment programs. Pursuant to the Hospital's request, the court incorporated into both commitment orders a provision authorizing the Hospital to return the patient summarily to the institution for no more than five days in the event his condition deteriorates or he fails to comply with the outpatient therapy program. The orders further provided that should the Hospital seek to detain the patient beyond the five-day period, it must petition the court to commit him for an indeterminate period of institutionalization; otherwise, he must be returned to the outpatient program. Cade and Richardson appeal from the final orders of commitment, arguing that the temporary return provision fails to comport with either due process or the Act. Ellerbee On October 1, 1981, Carlton Ellerbee was admitted to the Hospital as an emergency patient after being subdued by police officers in his home where he had threatened to kill several members of his family. After a period of emergency observation and diagnosis, the Hospital filed a petition for Ellerbee's involuntary hospitalization. The Commission issued its report, noting that Ellerbee had been admitted to the Hospital on five previous occasions and had failed in the past to take his medication or comply with the outpatient therapy program. The Commission recommended that Ellerbee remain an inpatient at the Hospital until placement in a supervised residential facility could be arranged. Ellerbee appeared before the court, waived trial and accepted the Commission's recommendation. The court determined that the least restrictive course of treatment for Ellerbee was indeterminate commitment to the Hospital, provided that he be released into the community as an outpatient once a suitable residential facility could be located. The court then issued a final order of commitment in accordance with its determination. The Hospital had requested the court to include in the final commitment order a provision similar to those incorporated into the Cade and Richardson orders authorizing Ellerbee's temporary return to the Hospital in the event of deterioration or noncompliance with the treatment plan. The court denied the request, concluding that it was without discretion to include the temporary return provision. The court ruled that should the Hospital seek Ellerbee's temporary return to inpatient care it must adhere to certain procedures which the court concluded were mandated by due process and the least restrictive alternative doctrine embodied in the Act. These procedures require that where the Hospital determines the patient is likely to injure himself or others as a result of his mental illness unless immediately rehospitalized, it must file with the court an affidavit setting forth sufficient information to permit the court to find probable cause justifying the proposed temporary detention. The court is then to determine within twenty-four hours whether the patient should be returned to the Hospital for a period not to exceed five days. As in the Cade and Richardson orders, the court provided that if Ellerbee is returned, the Hospital must either release him after the fifth day or commence proceedings before the court seeking his indefinite return to inpatient care. Where the Hospital is unable to demonstrate that Ellerbee is in need of emergency rehospitalization, he may not be returned to inpatient care, even for a temporary period, until a judicial hearing is held and the court determines that the temporary detention is justified. The Hospital, through counsel, the United States Attorney for the District of Columbia, appeals from the final order committing Ellerbee to outpatient treatment, asserting that the trial court erred in concluding that judicial review must precede Ellerbee's temporary return to inpatient care. [3]