In the fall of 1964, Alma Marie Streicher went to a District police station and told police she had killed her husband. She hadn't; the man had died from complications of alcoholism. But she said she felt responsible for his death because she had not prevented him from drinking.
"I wanted to go to court and be punished," Streicher recalled recently. But the police had no intentions of arresting the woman, then living in far Southwest Washington near Bolling Air Force Base. They put her in a paddy wagon and took her to St. Elizabeths Hospital.
After a court hearing that year she was involuntarily committed to the hospital, where she was diagnosed as a paranoid schizophrenic. Streicher has lived at St. Elizabeths off and on for 23 years.
Streicher, who wanted to be released from hospital custody, is the lead plaintiff in a class action lawsuit filed in 1983 that led to a recent court order mandating new commitment hearings for about 345 patients.
Ironically, Streicher will not need a new hearing. She was made aware only last week that in January 1985, a staff psychiatrist who saw her during outpatient clinic visits decided she was doing well and changed her commitment status from involuntary to voluntary.
Hospital officials informed Streicher's attorney, Harry J. Fulton, of the change last week. "Her goal all along was to become voluntary. So it happened and she never knew," Fulton said.
Hospital spokesman Harold Thomas said there is a notation in Streicher's chart about the status change, but it took several days for hospital employes to find the form that Streicher and her doctor signed in 1985 acknowledging the change. Thomas said the misplaced form was a "filing error."
Incomplete and inaccurate patient records are one of the reasons lawyers with the Mental Health Law Project are seeking patient reviews through the class action suit, said project lawyer Arlene Kanter. The Streicher error "is a good example," Kanter said.
In response to Streicher's suit, U.S. District Judge Barrington D. Parker ruled last month that all St. Elizabeths patients who, like Streicher, were involuntarily committed prior to 1973 are entitled to a judicial review hearing to determine if they still need to be hospitalized. Parker said the patients must be reevaluated based on a 1973 Supreme Court decision that increased the amount of evidence necessary to commit people against their will.
Under current hospital practice, staff doctors review patients' progress every six months or so, but that review does not usually include a court decision about whether the commitment should continue, Thomas said.
Twenty years ago it was relatively easy to put seemingly disturbed people in the hospital, say local lawyers familiar with St. Elizabeths. Often, they say, the patients were people no one cared about and society did not know what to do with.
Today about 1,500 patients live at St. Elizabeths. About half were committed against their will, including approximately 350 confined there through the criminal justice system. A few of those committed involuntarily came as early as 1913 and have passed from adolescence to senility at the huge campus off Martin Luther King Jr. Avenue SE.
Streicher is one of the more fortunate patients. Although classified as an inpatient, Streicher, now 66, has lived mostly with family members and at a foster home in Adams-Morgan during the last 23 years. All the while, though, she was in the hospital's official custody, and has been readmitted several times during relapses.
She was brought back again in January because friends at her church were concerned about erratic behavior, including fasting that led to dehydration and malnutrition, relatives and hospital officials said. She now lives on a geriatric ward at St. Elizabeths.
She said she was surprised when her attorney told her of her voluntary status last week, and was angry that the hospital staff had not informed her, although she admits she may have forgotten the conversation.
Streicher is now free to leave the hospital, but said she will stay until her social worker finds a place for her to live. "I would like to live in an apartment where I could fix my own meals," she said. In the meantime, she said, she sits on the porch of her ward reading books about nutrition.
Because she refuses to take medication for her condition, Streicher said, the staff has taken away her privilege to leave the building. She complains that the medicine causes severe trembling.
Her refusal to take medication puts her case at an impasse, according to Streicher's social worker Joylette Porter. While the hospital would like to release her, "there's some thinking that without medication, she is not ready to go back into the community." Managers of community residences are reluctant to take patients who are resistant to treatment, Porter said.
Streicher is a prim but sometimes sharp-tongued woman who carries a plastic bag filled with stationery around the ward. She said she is quite capable of taking care of herself. She said her doctors complain that without medication, she fasts and writes too many letters. Gluttony is a sin, Streicher said, explaining that she fasts to look childlike "so my body will be pleasing to God." Her neatly penned letters to relatives, priests, members of Congress, the pope and Mayor Marion Barry are simply a way to pass time, she says. "What else is there to do?" she asked. "I used to be a secretary."
Her doctor, Amanda Toledo, wants Streicher to stay on medication to calm her delusions and her compulsion to write letters. Without medication, Toledo said, Streicher "gets very suspicious. She thinks people are against her."
One of Striecher's daughters, Catharine Martinoli, believes her mother should remain a ward of St. Elizabeths, and was distressed when she learned last week that Streicher can leave the hospital at will. Over the years, Martinoli said, "The doctors had always said she was not well enough to be released." While her mother has fared well in community residences, she said, "she is totally irrational when she's very bad."
Martinoli said she is pleased with the care Striecher has received at St. Elizabeths and she said the staff has been good about calling her in New Jersey to update her on her mother's condition. Now her concern is that if the woman leaves the hospital and has another crisis, "there would be a huge legal battle to get her back in."
According to spokesman Thomas, if a person in the District is unwilling to receive psychiatric care, a crisis team would be called in to evaluate the person and admit him to St. Elizabeths on an emergency basis. The hospital would then have to request a court hearing to determine if the patient should be committed.
"No one is kidnaped or whisked away here," Thomas said.