Washington Post
September 26, 1998

D.C. Balks at Paying Bills of Some at St. E's

By Toni Locy
Washington Post Staff Writer
Monday, October 5, 1998; Page B01

John W. Hinckley Jr. was a resident of Colorado when he came to Washington in 1981 to shoot a president and impress an actress.

Eight years later, Chun Callen traveled from Olympia, Wash., intent on talking to the president about her divorce.

Both were confined to the District-owned St. Elizabeths Hospital by federal authorities who said they posed a threat. But it is D.C. taxpayers who have covered the psychiatric bills for Hinckley, Callen and about 200 other patients at the Southeast Washington hospital because the federal agencies that delivered them to the door refuse to pay for their care.

Hinckley's bill is more than $600,000. Callen's is more than $1.2 million. And costs rise by $425 a day for each of those 200 patients.

According to the District's tally, the U.S. Marshals Service owes the city more than $13 million, and the Secret Service owes more than $6.5 million for patients their officers have taken to St. Elizabeths after they acted irrationally at the White House, at embassies or at other federally protected sites.

The city is questioning why it should shoulder those costs, given that so many of the patients came to the District solely because it is home to the federal government and, in particular, home to the president.

The bills are part of a more extensive lawsuit that the city filed in 1993 in U.S. Claims Court contending that the federal government has not kept its pledge to help bring St. Elizabeths up to federal and city code when it transferred the hospital to city control in 1987.

Legally and morally, the dispute over patients' bills is complicated.

Under law, the city cannot force hospitals in patients' home states to take them, nor can the District force patients to return home. Hospital staff members can try to persuade patients to go back to their families or home towns, but those discussions rarely change the mind of a patient who has come to Washington intent on a personal mission. Because the patients are seriously ill and most are poor, the city also feels an obligation not to abandon them, District lawyers said in the lawsuit.

For all of those reasons, it is nearly impossible to remove them once they cross the threshold at St. Elizabeths.

City officials point to Russell E. Weston Jr. as a reminder why such individuals have to be viewed seriously and why St. Elizabeths would never hold back treatment. Weston is charged with killing two Capitol Police officers during a shooting rampage in July. He wasn't referred to St. Elizabeths, but he is a former mental patient.

Scott H. Nelson, the city's mental health receiver, said federal authorities "ought to pay us," instead of forcing the city to tap its budget to cover the costs. St. Elizabeths could use the money it spends on the federal patients, he said, to comply with more than 20 years of court orders directing it to develop community-based programs for the mentally ill.

The federal argument for not paying, Nelson said, "doesn't seem to be a very good one."

He and other city officials insist that the District is not suggesting it would refuse to take in tourists who are mentally ill and suffer breakdowns while in the District. Under a 34-year-old city law passed when St. Elizabeths was federally owned and operated, the hospital must accept them.

But lawyers in the city's corporation counsel's office say District taxpayers shouldn't have to pay for the care of people drawn to Washington, particularly to the White House, from across the country. If the city weren't also the nation's capital, those people would not come here and therefore would not further burden an already overtaxed mental health system, the city argues.

Among the bills entangled in the court case are those for several people who turned up at the White House gates and declared that they were the president. Other patients believed they were God's emissaries with messages for the nation's leaders. And one visitor, who was taken to the hospital, had wanted to talk to the then-first family's dog.

The 200 patients cited in the lawsuit are those taken to St. Elizabeths through the U.S. Marshals Service or Secret Service -- the federal agencies that most often deliver patients to the hospital.

The Marshals Service once covered the bills of 56 patients, including Hinckley, who were confined to St. Elizabeths after federal juries or judges found them not guilty of a crime by reason of insanity. But four years ago, the Marshals Service stopped paying. It objected to St. Elizabeths' raising its rate and questioned whether the federal government was being billed for days when patients were off the hospital grounds.

In the cases of Callen and 146 others, the Secret Service took them to the hospital for a civil commitment using a little-known police power, but it has never paid for their care. Under the Ervin Act of 1964, Secret Service officers, like all police officers in the District, can seek civil commitments to the public hospital if they believe someone is mentally ill and dangerous.

The result is that troublesome visitors are removed from the White House and detained for at least 48 hours if a hospital psychiatrist agrees that they are mentally ill and pose a danger to themselves or to others.

Federal lawyers say Secret Service officers are being "neighborly" and "public-spirited" by taking deeply disturbed tourists to St. Elizabeths. The cases have absolutely no federal connection, "other than that the District benefited by obtaining free local policing assistance from the Secret Service," federal lawyers wrote.

Spokesmen Bill Dempsey of the Marshals Service and Jim Mackin of the Secret Service each declined to discuss the case because it is ongoing litigation. Likewise, Channing Phillips, spokesman for the U.S. attorney's office, which represents the federal government, also declined to comment.

The District says Congress was clear at the time of the transfer when it said that "the appropriate federal agency" should pay the full costs of "diagnostic and treatment services" for individuals brought for emergency detention if they threaten a federal official or try to carry out threats on the grounds of the White House or the Capitol. The Secret Service disputes that the appropriate agency description means it.

In court papers, the Secret Service said it might be willing to pay for the first 48 hours of care for people in two circumstances: those who tried to jump the White House fence or directly threatened the president. Most of the people whom the Secret Service took to St. Elizabeths were so ill, however, that they often stayed longer than 48 hours, according to the city.

Quentin V. Mendoza stayed 16 years.

He was taken to St. Elizabeths in September 1979, when he was 23, after he threatened President Jimmy Carter in a letter. To agents, Mendoza appeared to be dangerous to himself because of deep, self-inflicted scratches on his face.

Mendoza stayed until November 1995, when he was released to a community group home. The city says the Secret Service owes it $820,046 for his bill.

The disputed patient bills vary by individual because St. Elizabeths rates changed over time and patients have had varying lengths of stay.

The Secret Service says in court papers that it might be responsible for Mendoza's first 48 hours of treatment because of the threat, but it says it shouldn't have to pay for patients such as Callen who were detained because they seemed unstable. In court papers, federal lawyers argued that officers aren't doctors and didn't know how ill Callen was -- and so, how long she would be hospitalized -- when they took her in after she talked to officers outside the White House in 1989, insisting on telling President George Bush about her divorce.

Yet in nearly 30 of the disputed cases, files kept in the mental health office of D.C. Superior Court's Family Division show the Secret Service often relies on psychiatric terms when seeking emergency commitments.

About Callen, Officer Linwood L. Tynes wrote: "Subject appears to have manic mood swings and a feeling of isolation from family and friends. She appears to express feelings of paranoia."

In several cases, Secret Service officers sought civil commitments because they feared the tourists posed a danger to themselves more than to others but still wanted to get them to a psychiatric hospital.

In June 1993, Cynthia Ware was a regular at the White House who insisted she was "Mrs. Clinton" and demanded to be allowed inside. When refused entry, she stood for hours on the sidewalk. Seeking her hospitalization, Officer Dale M. Cockayne wrote that he was concerned about her standing in the "hot sun."

Secret Service Agent Richard J. Podkowski, in seeking the commitment of a Shreveport, La., woman, said he was worried that she was hungry. Joann Thomas told him that her television set had told her to "cohabitate" with the president in April 1991. When she couldn't get inside, she sat in front of the White House for two days and did not eat.

The Secret Service also refuses to pay for Mark C. Beall, then 23, of Bowie, who appeared at the Northwest gate of the White House in July 1988 and said "voices" told him that he was President Ronald Reagan.

Because the Secret Service has wide-ranging police powers in the city and responsibility for more than the president, District attorneys contend it should pay treatment costs for people its officers picked up throughout town.

In particular, the agency should pay for the likes of Stephen Clyde Baker, who was taken into custody at an embassy, an area that receives Secret Service protection, the city's attorneys said.

Baker, a middle-aged Hyattsville man, told a Secret Service officer at the Embassy of Russia that Russians had killed and eaten his son. He spent three days at St. Elizabeths in September 1993.

By demanding payment for such cases, the District is wrongly trying to expand the White House's boundaries to all areas "within eyeshot" of 1600 Pennsylvania Ave. NW, the Secret Service's attorneys said.

Lawrence Moore was within earshot.

Moore, whose age and address were unknown, was honking the horn and gnawing on the steering wheel of a red Camaro that wasn't his on April 5, 1989, when Secret Service officers sought his emergency hospitalization. The car was parked in the 700 block of Jackson Place NW, across the street from the White House.

Charles Connelly was cruising in his van, bearing a sign that read "Give me room or we both go boom," when he caught the attention of Secret Service officers at the White House and several embassies in April 1988.

Guns and ammunition were found in the van. Connelly, then 70, of Yorktown Heights, N.Y., was hospitalized for nearly a month.

John M. Ferren, the city's corporation counsel, said the District would like to send nonresidents to hospitals in their home states because it would save the city money and allow patients to be closer to their families.

But because of a federal court decision several years ago, he said, it cannot force a state to receive a patient or force one to go.

There is, Ferren said, "a constitutional right to travel."

And traveling, according to the city's lawsuit, is how this all started.