Judge Critical of D.C. Mental Health Care

In late 2003, a federal judge approved 19 performance targets that the agency would have to meet and sustain for four consecutive quarters to end the court supervision. Knisley said the department is in the process of asking the court to give it credit for achieving the first of those targets: Sixty percent of its budget is now dedicated to community-based expenditures.

The court-ordered plan for the city's mental health system that was approved in 2001 calls for razing St. Elizabeths and building a smaller facility that would be used as a forensic and long-term treatment hospital to back up community care programs.

Leonard H. Becker, general counsel to Mayor Anthony A. Williams (D), responded to King's concerns in an April 18 letter to King.

The delays in payments to doctors were caused by difficulties the District government had in making the agency's current budget available for use, as well as technical problems with a relatively new automated payment system, Becker said. The department "has identified the providers not paid and has intensified its efforts to address their problems," he wrote.

Becker said the reduction in admissions to St. Elizabeths resulted from changes the department has made in its process for determining which patients are neediest.

"Such a reduction does not indicate that DMH is failing to fulfill its statutory responsibility to hospitalize those patients deemed to be a danger to themselves or others," his letter said.

Becker noted that the agency has kept the court updated on negotiations with community hospitals to provide services to involuntarily committed patients, although he said those discussions have not progressed as quickly as the District would like.

On the subject of readmissions of patients soon after their discharge, Becker said the current readmission rates "appear to be in line with previous trends."

As for the shuttering of St. Elizabeths' outpatient pharmacy, Knisley said it was closed because only 26 people were using it and others were filling their prescriptions at community pharmacies.

Staff researcher Bobbye Pratt contributed to this report.