Fairfax County has begun providing psychiatric examinations to people facing involuntary commitment to state mental hospitals as part of an effort to ensure adequate medical screening and improve legal representation in the commitment process.
By state law a medical expert must certify that a person is mentally ill and dangerous enough to warrant confinement for up to six months.
From 1951 until his retirement last month at the age of 73, Dr. Claude E. Cooper, a general practitioner and part-time county medical examiner, attended the hearings and served as the medical expert.
Since Cooper's retirement, a psychiatrist has been present at the commitment hearings. So far this year, an average of more than 100 hearings have been held each month.
Critics of Cooper, including civil liberties groups, patients and their families, charged that he conducted a cursory examination of those facing commitment. Some objected to his gruff demeanor and his references to the psychiatric ward as "the squirrel cage."
Others said they believed that examinations should be conducted by a psychiatrist, not a general practitioner.
Sources said court officials had sought a graceful way to replace Cooper since January, when criticism of his role was detailed in a Washington Post series on the Fairfax commitment system.
The series described how many people in Fairfax, one of the nation's richest communities, were committed for up to six months after hearings as brief as three minutes by part-time judges with no mental health training. No record was kept of the hearings, and sometimes Cooper's recommendations were limited to a single word: "hospitalization."
Legal representation was often minimal, according to the series. At times lawyers said nothing during hearings, while others failed to talk to their clients, read hospital charts or cross-examine witnesses.
"I hope this means there will be more quality in the decision-making process," said Leonard Rubenstein, an attorney with the Mental Health Law Project, a Washington-based public interest firm. "Dr. Cooper was only one bad element in a bad system."
Commitment hearings are held six days a week at 7 a.m. in four Northern Virginia hospitals. Cooper received $25 for each hearing he attended, a fee also paid court-appointed lawyers and special justices.
Cooper, who will continue to serve as a part-time county coroner, could not be reached for comment.
Tomorrow he is scheduled to be honored by the Board of Supervisors for his long service.
"You could always count on Claude to be there," said Jim Fourqurean, one of three part-time special justices who preside at commitment hearings. "Cooper's been such an institution, but now is the time to find out if there's a better way to do it."
As part of that process, officials of the Northern Virginia chapter of the Washington Psychiatric Society are trying to determine whether to replace Cooper with a single doctor or to compile a roster of psychiatrists similar to the system in operation for court-appointed attorneys.
Currently lawyers sign up months in advance for a week-long stint during which they handle all commitment cases, as many as 17 in a morning.
Gary Soverow, chairman of the 150-member psychiatric society, said a few members have expressed interest in attending the hearings on a regular basis. Many, however, have balked at the early hours and low pay.
The $25 fee, determined by the General Assembly, has remained unchanged since 1968.
The presence of a psychiatrist at each hearing is one of several recent changes in the commitment process. Last spring the special justices held a 90-minute training seminar for the 53 attorneys who handle commitment cases and reminded them that they are expected to defend their clients.
The message, according to Fourqurean, was, "By God, defend or don't serve."
Recently the Fairfax County Bar Association formed a subcommittee to monitor the commitment process and study a bill, pending in the General Assembly, that would overhaul Virginia's 10-year-old commitment law.
"We felt this was an area that was kind of a void," said Jim Kincheloe, who heads the lawyers' committee. "We felt it needed pretty immediate attention."
The General Assembly, which convenes next month, will consider the commitment bill for the third consecutive year.
The bill would provide greater legal safeguards and upgrade treatment for those sent to mental hospitals against their will.
Last year it was killed by a tie vote in a Senate committee in the final days of the session.