[House Report 108-729]
[From the U.S. Government Publishing Office]



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

                     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 community-based 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.''

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 one-year probationary 
period. Subsequent appointments may be made for four-year 
terms. This section would amend Sec. 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 Sec. 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 Sec. 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 Sec. 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 Sec. 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 Sec. 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 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.

                     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.

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-   2005-
                                                                     2005   2006   2007   2008   2009   2010   2011   2012   2013   2014   2009    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 less-restrictive 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 considered 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 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 one-half of the 
individuals released each year would access outpatient programs 
from St. Elizabeth's and that 70 percent of those 
individualswould 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 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.
     * * * * * * *
    [21-502. 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

           *       *       *       *       *       *       *


[Sec. 21-502. Commission on Mental Health; composition; appointment and 
                    terms of members; organization; chairman; salaries.

  [(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 Commission. 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.
  [(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.
  [(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.
  [(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.
  [(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.]

Sec. 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 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.

Sec. 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. [The 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 psychologist-patient privilege is 
not applicable.

           *       *       *       *       *       *       *


Subchapter III. Emergency Hospitalization

           *       *       *       *       *       *       *


Sec. 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 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

           *       *       *       *       *       *       *


Sec. 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. [A 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.

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Sec. 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 towhom 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.
  [(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.

Sec. 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 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 Columbia, 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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