Martha Rigsby gets into a car with her attorney, Vickey Wright-Smith, as she leaves the courthouse on Wednesday in Washington. Rigsby is the most frequent 911 caller in the city’s history. (Mark Gail/The Washington Post)

Martha Rigsby collapsed to the ground for the first time in 1977. The spells continued, and she began calling 911 for help.

She hasn’t stopped.

In the past year alone, she’s accounted for 226 calls to 911 and been whisked by an ambulance to a hospital 117 times.

Among firefighters in the District, she’s a dreaded legend. They can recite her date of birth and Social Security number from memory.

Over 30 years, Rigsby has become the most frequent 911 user in D.C. history, totaling thousands of emergency calls and trips to the hospital after falling down, court papers say.

Dubbed “super users” or “frequent fliers,” repeat 911 callers have long been identified as burdens on the health system and a drain on public-safety resources. That’s why a group of city officials met earlier this year to figure out how to solve their problem with Rigsby.

The situation has led to the first known attempt in the city to seek guardianship for a serial 911 caller. The Department of Behavioral Health filed a court petition in April, alleging that Rigsby, 58, has bipolar and borderline personality disorders and does not have the mental capacity to handle her medical affairs.

These are “uncharted waters,” said David Miramontes, medical director of the D.C. Fire and Emergency Medical Services Department.

Public documents and legal proceedings detail Rigsby’s 911 habits and assessments of her mental state and medical problems. They also reveal continued concerns from D.C. officials about the impact of one woman’s troubles on public-health and safety resources.

Although Rigsby has had various medical insurance plans throughout the years, she has an outstanding balance of $61,366.33 owed to the D.C. Fire and EMS for ambulance transports, according to Andrew Beaton, the department’s management program analyst.

In the past five years, each ambulance trip has averaged $478.

Rigsby opposes the city’s attempt at guardianship. Over two weeks, she has quietly watched the proceedings in Judge Erik P. Christian’s courtroom in the D.C. Superior Court’s probate division. She has whispered instructions to her court-appointed attorney, Vickey Wright-Smith, at times.

Wright-Smith has argued that Rigsby is able to care for herself and has no malicious intent for calling 911.

If the District’s petition is successful, the medical guardian could take responsibilities for such things as hiring a home health aide, filling prescriptions and proposing a different living environment. But it would still be possible for Rigsby to dial 911 because the guardian would not be a live-in caregiver.

After a court session this week, Rigsby seemed taken aback by a question about her calls to 911. “Well, I don’t do it on purpose,” she responded.

According to testimony during the court hearings, Rigsby’s calls follow the same general pattern. She feels faint and collapses. About 40 percent of the time, she dials 911 on her own. Other times, she’s out in the District when passersby see her fall and call for help, the testimony indicated.

About 55 percent of the time, she refuses to be transported in an ambulance and signs a waiver allowing emergency responders to leave.

Court proceedings won’t resume until January, when Rigsby will have had a neuropsychological assessment, attorneys in the case said.

Several mental-health experts have already been called to testify.

According to court records, Abayomi Jaji, a psychiatrist with the city’s Department of Behavioral Health, said that Rigsby continues “to place herself in real danger of bodily injuries from falls under the claim of ‘seizures’ or ‘Narcolepsy,’ which have never been correlated with medical findings.”

Jaji also said that Rigsby lacks the mental capacity to take care of herself as evidenced by “almost every other day calls to 911.”

On Oct. 31, he testified in court that Rigsby’s repeated calls may be driven by a feeling of “impending doom.”

“She seems to be aware at some level that she shouldn’t be calling,” he said.

Rigsby first remembers passing out in 1977. She thinks the spells “could be stress,” according to the examiner’s report.

Born in the District in 1955, Rigsby was adopted when she was 6 months old. She attended Anne Beers Elementary School in Southeast Washington but then transferred to a private school,according to court filings.

After college, she did volunteer work for about five years and then kept a steady job in the mailroom at the Energy Department from 1995 to 2009, according to the examiner’s report.

By most standards, Rigsby is not the typical serial 911 caller. Many documented 911 super users are homeless and struggling with substance abuse.

Rigsby has reliable housing and a steady income, and court documents have not suggested any alcohol or drug abuse. She receives about $1,300 a month in Social Security disability payments, court documents show.

Her home in the Trinidad area is problematic, officials have testified, because the neighborhood already has some of the highest call volumes in the city.

The closest firehouse to Rigsby is Engine Company 10, which is nicknamed the “House of Pain” because of the constant grind.

For years, there has been concern that if crews are tending to Rigsby, the next 911 caller with an emergency might get a paramedic from a farther distance, said Miramontes, the medical director.

“There will come a time when one of these [frequent 911 callers] will call and they will cost someone else their life,” said Jim Dunford, the emergency medical director for San Diego and a known expert on frequent 911 callers.

Some cities, including San Diego, track mileage and ambulance hour time for each frequent caller to calculate the long-term costs and effects of serial 911 callers, Dunford said.

“All cities are going through a similar experience of how do we deal with this small subset of people,” he said.

Officials with the District’s fire and EMS department have not done any studies of whether Rigsby’s calls have led to problems for other callers, nor have they examined her financial impact on the system.

In the District, first responders cannot refuse a patient. The patient’s bill of rights, which has been posted in every ambulance since 2011, explicitly states this policy.

When Rigsby calls 911, the reported symptoms “generally prompt the highest level of response,” including the first available paramedic and a separate ambulance for transport, testified Rafael Sa’adah, the fire department’s battalion fire chief for emergency medical services.

“Our default assumption must be that she is suffering from a life-threatening medical condition,” Sa’adah said.

Although Rigsby has been known to paramedics for decades, city officials increased their focus on her in December after she called 911 and threatened to harm herself, according to court testimony.

The Department of Behavioral Health’s mobile crisis team was sent, and Rigsby was involuntarily admitted to the hospital for a mental-health evaluation, according to testimony by Jonathan Ward, the team’s director.

After that, a group including representatives from several city agencies met to discuss a plan for Rigsby. Rigsby declined some suggestions, such as having a home health aide and using a wheelchair, Ward testified.

She has a lingering fear that the volume of calls might lead to criminal charges and said she has been handcuffed before. “I’ve been through a lot,” she said. “I’m surprised they haven’t put me in jail by now.”

But as discussions continued, the idea of the guardianship emerged.

“It’s a high bar to prove someone is not competent to make decisions,” Miramontes said. “We didn’t think we had enough data. The goal of the committee was to pool our data together.”

It might be a unique attempt in the District, but other cities have reported success with similar proceedings.

Niels Tangherlini, a paramedic captain for the San Francisco Fire Department, led a successful pilot program from 2004 through 2009 to stop 911 serial callers.

During the height of the program, Tangherlini said, officials successfully filed conservator petitions, which are legally similar to guardianships, for about 12 serial 911 users a year.