Box 3, Folder 15, Document 13

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Richard J. Tatham
(D.C. Department of Public Health)

This is Richard J. Tatham, Chief of the Office of Alcoholism and Drug Addiction
Program Development, for the District of Columbia Department of Health. I've
been asked to relate to you some of our recent experiences in the District of
Columbia which have resulted from a U.S. Court of Appeals decision last March 31,
1966, in the case of DeWitt Easter vs the Court of Columbia. As many of you know,
the result of this court decision was a reversal of court decisions which found
DeWitt Easter to be guilty of the crime of intoxication, in spite of the fact
that he had clearly established that he was a chronic alcoholic. This decision
was appealed to the U.S. Court of Appeals and it was found that alcoholism is an
illness and that it would constitute cruel and unusual punishment for a sick
person to be convicted and punished for exhibiting a symptom of his illness in
public, and it was further established that the essential common law element of
criminal intent is lacking when an alcoholic becomes intoxicated. As a result of
this case, the Court of General Sessions began utilizing the Alcoholic Rehabili-
tation Act of 1947, which authorized that court, in the District of Columbia, to
suspend criminal hearings whenever a defendant was suspected of having an
alcoholism problem and to commit that person to the Department of Public Health
for diagnosis, classification, and treatment. The 47th Statute had been used

on the average of 100 times each year between the years 1950 and 1963, and was,
therefore, nothing new to the court or to the Health Department. However, in more
recent years its use was discontinued as the court began to develop its own pro-
bation program for alcoholic offenders. Last year the U.S. Court of Appeals
strongly urged the District of Columbia to use its 47th Statute once again and as
& result of this admonition some 3500 individuals have been adjudicated under the
47th Statute to be chronic alcoholics and the majority of these have been
committed to the Health Department for treatment. At the time of the Easter
Decision, the D.C. Health Department operated three alcoholism treatment facili-
ties; namely, an outpatient clinic, known as the Alcoholic Rehabilitation Clinic;
a hospital unit for intensive medical care at the D.C, General Hospital; and, a
brand new comprehensive in-patient, out-patient unit at our Area C Mental Health
Center, However, the latter facility was only in its beginning phases with a
skeleton staff and was not really able to participate appreciably to handle a
court alcoholic problem. Likewise, the in-patient facility at D.C. General Hospitai
concentrated on the short-term intensive treatment for delirium tremens,
hallucinosis, and other serious complications of alcoholism, and so very few of
the court-committed alcoholics were eligible for this service. The only remaining
treatment facility is our out-patient clinic. Now in the month immediately
following the Easter Decision, only six patients were committed to the Health
Department. In the month of May, the number jumped up to 100 and by June, 300
new patients were committed to us. By this time, patients were being transported
from the court to the out-patient clinic by the busload with as many as 50 or
more arriving at a time. The out-patient clinic had no choice but to accept these
in spite of the fact that the clinic was not designed to accammodate the needs of
the patients we were receiving. Utter chaos followed. All attempts to utilize
existing Health Department resources resulted only in the addition of a few part-
time people on an over-time basis in order that the clinic could operate evenings
and Saturdays. Now, nine months after the Easter Decision, the same situation
prevails with one exception - we now have an additional facility ~ a 425-bed,
extended-care rehabilitation center located just outside the District of Columbia
in Occoquan, Virginia, This facility opened November 14, 1966, and was filled to


capacity in less than six weeks, so once again the Health Department is unable
to accommodate all the patients who require in-patient treatment and these
patients are once again going to our out-patient clinic.

A recent article in the Washington Post indicated that the Director of this out-

patient clinic is threatening to leave the Health Department unless the situation
is alleviated somehow. The patients are still coming to clinic in droves. While
they are there, they have entered into fights with other patients, members of the
clinic staff have been assaulted, patients have urinated and expectorated in the

clinic and this has created a situation which threatens the entire survival of a

treatment program that has been in existence since 1949.

The solution of this problem is not a simple one. One might believe that the
Health Department had not anticipated the reversal in the Easter Case; however,
this is not true. Well in advance of the Easter Decision, the Health Department,
along with representatives from Vocational Rehabilitation, Correction, Adminis-
tration, and Welfare Departments prepared an ad hoc report dealing with the
possible impact of an Easter Decision, This report clearly pointed out some of
the problems which might arise and also outlined certain new services and facilities
which might be needed. However, no action was taken by our Board of Commissioners.
The reason for this included the fact that the Commissioners had no assurance that
the Easter Case would be reversed and even if it would be reversed they had no
assurance that the impact would be great. For example, even though the Easter
Case would be reversed, the judges in our local courts might insist that the
question of alcoholism would have to be introduced by the defendant himself and
many alcoholics appearing in court, of course, would choose not to introduce the
problem of alcoholism, By avoiding the question of alcoholism they could return
to their workhouse where they have been long-time residents - they knew that they
would serve an average of 21 days and then could be released without any parole

or any other obligations. However, if they should bring up the question of
alcoholism, they might very well be committed to the Health Department for 90 days
with a possibility that a second 90-day committment would follow. With this in
mind, there was much speculation that the courts would not use the Easter Decision
as @ base of future action in very many cases, In addition to this, the problem
was complicated by the fact that the corporation counsel, known in other cities

as a prosecuting attorney, felt very strongly that according to the definition of
our 1947 Statute, there could not possibly be more than 20 or 30 chronic alcoholics
in the entire District of Columbia. Activities since then have proven quite the
contrary. The problem has become so great that it was necessary to set up a
court-coordination program and patient control system in order to just keep track
of the x~ultitude of patients being committed to us by the court. The situation
became so bad that the Health Department was instructed that it must cut off all
voluntary patient admissions at its treatment facilities in order to make room for
the court-committed patients.

In evaluating the problems that have occurred since the Easter Decision, the
Department has consistently fallen back on its basic comprehensive community
mental health plan, which points out the needs for various facilities ranging
from the extended care rehabilitation center we now operate to mental health
center alcoholism units providing both in-patient and out-patient treatment to
detoxification centers to residential facilities such as hostels and half-way
houses. The big problem, obviously, is the magnitude of the program which we
have proposed and the fact that one or two components of the program still do not
alleviate the problem of handling court-committed patients. Until a complete


system is available and operating which can provide all of the services needed

by this particular patient population, there will be chaos in treating the chronic
court offender. If we do not have community based residential facilities, then
we will either have to expand our in-patient hospital at Occoquan, Virginia,

or we will have to substitute out-patient treatment with all its inadequacies

for this homeless patient group.

The District of Columbia is presently spending approximately $3,000,000 per year
on the alcoholic patients seen by the Health Department. Of this figure,
approximately $1,000,000 a year is expended on the care of alcoholics having
psychosis who are admitted to St. Elizabeths Hospital and paid for by the Health
Department on a contract basis. The other $2,000,000 accounts for our present
services at the rehabilitation center, at the Area C alcoholism unit and at our
out-patient clinic. Also, the figure includes the cost of providing our court
coordination and patient control system, a small alcoholism TB Program at
Glendale Hospital, and our new demonstration detoxification unit.

As we are busily trying to expand our services to accommodate the needs of the
court-committed patients, we are faced with a new problem which has come to light
within the past few weeks in Washington. Our information indicates that two new
bills are to be introduced to Congress this session. One by the administration,

a second by Congressman Hagan from Georgia. Each bill would introduce a new
concept in law enforcement as each would remove intoxication from the criminal
code entirely. This would mean that if either of these bills was passed, an
individual could not be arrested for being intoxicated only in the District of
Columbia, It would mean that if an intoxicated person is helpless, has no place
to go, he could be escorted by a police or Health Department official to a health
facility for detoxification. He would be kept in such a detoxification faciltiy
until his blood alcohol content returned to the legal limits of sobriety and then
could be continued in treatment for alcoholism as a voluntary patient or released
outright. This would mean that our attention to the problems of getting
sufficient hospital care resources for court-committed alcoholics would shift
almost immediately to the problem of obtaining sufficient in-patient detoxification
resources within the community itself. I think this is an excellent example of
how dynemic the field of alcoholism has become as a public health problem and
indicates the importance of planning coupled with flexibility; and, above all, it
impresses with the importance of the magnitude of the problem. Most communities
have never accepted the full impact of the statement that alcoholism is the nations
third or fourth public health problem. We have mouthed this saying without
realizing the financial impact that it carries. As I said earlier, our community
is expending approximately $3,000,000 a year on alcoholics. Now I'm talking

about the Health Departments budget - I'm not adding to this figure what the

Police Department, what the courts, what the Department of Corrections, and other
departments are allocating to the care of alcoholics - just the Health Department.
This $3,000,000 figure, in our estimation, will probably have to be doubled to a
$6,000,000 annual figure just to take care of the immediate emergency problems
arising from the Easter Decision and the possible new legislation which would
remove intoxication from the criminal code. Now, in creating these new services,
of course we would hope any new program would be considered an additional resource
for voluntary patients also; but, it's interesting to note that our 1947 Statute
and the Easter Decision and the possible new statutes removing intoxication from
the criminal code, all focus on the alcoholic who is a law offender and quite often
the most important patient in this group is the chronic drunkenness offender with
fifty or more previous arrests for drunkenness. This means that today, alcoholism,
even though a public health problem, is reaching the public's attention through
the judicial activities of the community and of the nation; thet a complete


revision of some rather well established principles is being questioned; and
that new approaches are being encouraged; and that these new approaches will
require new funds of considerable magnitude unless the community is satisfied
that the treatment of the chronic alcoholic offender should consist of removing
him from the streets only - and I think this is a very real problem that we

face in firmly maintaining that alcoholism, the skid row alcoholic, the chronic
drunkenness offender, is to become truly a public health problem. That the high
quality treatment, the high standards of services that we provide other alcoholic
patients are made available to the chronic drunkenness offender - now this does
not mean that the chronic offender necessarily can benefit from the same type of
treatment that our other alcoholic patients are involved in; but it does mean
that whatever services are provided for them, they are the highest possible
quality of services to meet the needs of this important patient population.

I have been impressed as I have visited many alcoholism facilities throughout this
nation with the fact that even though the Easter Decision is more than nine months
old and that a similar decision in the case of Joe B. Driver in the Fourth
Circuit Court of Appeals at Richmond, Virginia, have established a new legal
precedent, and that these precedents have been set on both a constitutional and
common-law basis and there is no doubt that the precedent will spread from state
to state and circuit to circuit; yet in spite of all these things, many alcoholism
progrems do not seem to be planning to take care of this situation when it
inevitably happens in their own state and community and I was, therefore, very
Pleased to see that in Atlanta there is planning being initiated and that the
Community Council here in Atlanta is drafting a proposal which will be submitted
as an answer to the problems that can arise here; that there are a number of
people interested in the chronic alcoholic offender; and that services are being
demonstrated now which can be extremely important in meeting the treatment, the
rehabilitation, the residential, and other needs of this impoverished group. We
fecl quite strongly in the District of Columbia that we have been bogged down in
our own problems for over a year and that,it's now perhaps our responsibility to
communicate our experiences and observations to others throughout the country and
Canada in order that some of the problems, the mistakes, and the frustrations ex-
perienced in Washington can be minimized elsewhere and it has been with this
thought in mind that I have shared these comments with the staff of the Georgian
Clinic and others who might come into contact with this tape recording.

Richard J. Tatham, Chief

Office of Alcoholism & Drug Addiction
Program Development

Government of the District of Columbia

Department of Public Health

Washington, D.C.

RJT: 2-24-67

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