Rouse v. Cameron

Decision Date10 October 1966
Docket NumberNo. 19863.,19863.
Citation373 F.2d 451
PartiesCharles C. ROUSE, Appellant, v. Dale C. CAMERON, Superintendent, Saint Elizabeths Hospital, Appellee.
CourtU.S. Court of Appeals — District of Columbia Circuit

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.

BAZELON, Chief Judge.

In this habeas corpus case appellant attacks his confinement in Saint Elizabeths Hospital. He was involuntarily committed1 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.2 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. * * *


The principal issues raised by this appeal 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.3 The provision for commitment rests upon the supposed "necessity for treatment of the mental condition which led to the acquittal by reason of insanity."4 Absent treatment, the hospital is "transformed * * * 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"5 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."6 (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,7 for under § 24-301 commitment is summary, in contrast with civil commitment safeguards.8 It does not rest on any finding of present insanity and dangerousness but, on the contrary, on 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.9 (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,10 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.11 (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."12

Impressed by the considerable constitutional problems that arise because "institutionalized patients often receive only custodial care,"13 Congress established a statutory "right to treatment" in the 1964 Hospitalization of the Mentally Ill Act. The Act provides:

A person hospitalized in a public hospital for a mental illness shall, during his hospitalization, be entitled to medical and psychiatric care and treatment. The administrator of each public 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.14

It appears that this provision, like the one limiting the use of mechanical restraints,15 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,"16 or to "mentally ill persons,"17 which term is defined by the Act to exclude persons committed by court order in a criminal proceeding.18 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 § 24-301.18a

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.19

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.20 A right to treatment in some form is recognized by law in many states.21 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.22

The patient's right to treatment is clear.23 We now consider how violation of the right may be established.


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.24 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,25 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"26 for all.27

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.28

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."29 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,30 and, particularly when the patient is indigent and cannot present experts of his own,31 the court may appoint independent experts.32 Assistance might be obtained from such sources as the American Psychiatric Association, which has published standards33 and is continually engaged in studying the problems of mental care.34 The court could also consider inviting the psychiatric and legal communities to establish procedures by which expert assistance can be best provided.35

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 Ill 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 to establish a broader right to treatment.36 As the Fourth Circuit Court of Appeals said of the right to treatment under Maryland's "defective delinquent" statute, "deficiencies 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.37 In the opinion of the American Psychiatric Association no...

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