Former colleagues described Theodora Charles as an intelligent and conscientious attorney. But by the late 1990s, the Washington solo practitioner was struggling.

A client complained that Charles had mishandled her case, according to a District of Columbia Bar report. Records from the Board on Professional Responsibility show she failed to file documents on time and had acted erratically, quoting Bible passages at court hearings despite warnings from a judge. Her law license was suspended for 30 days in 2004, and she never moved for reinstatement.

From there, things got worse. In 2009, Charles, showing signs of mental illness, was involuntarily admitted to a hospital. She agreed to remain voluntarily but doctors soon demanded she stay, believing that she posed a danger to herself or to others.

Charles’ case, now before the District of Columbia Court of Appeals, is raising fundamental questions about when doctors in Washington can forcibly commit someone who already has voluntarily agreed to seek help. In other words, under what conditions can doctors in D.C. “convert” voluntary mental patients into involuntary ones?

Washington’s Ervin Act, passed in 1964, was one of the first laws nationwide spelling out the standards for the civil commitment of the mentally ill. Before then, patients had few protections available against indefinite involuntary commitment, according to Aileen Kroll, legislative and policy counsel at the Arlington, Va.-based nonprofit Treatment Advocacy Center.

The Ervin Act and a similar law passed early on in California were “revolutionary for their time,” Kroll said. “These two laws were saying … there has to be due process, there has to be a way to get people out and it has to be predictable.”

Washington sets one of the highest bars to involuntary commitment nationwide. According to Kroll—whose organization advocates in favor of removing legal barriers to treatment—only Washington and a handful of states set the standard at “dangerousness.” Others cast a wider net to include persons deemed unable to provide for basic human needs, for instance. In the region, Maryland aligns with Washington, while Virginia applies the broader criteria, Kroll said.

Washington solo practitioner Patrick Hand, who argued unsuccessfully on behalf of an involuntarily committed patient in a conversion challenge before the appeals court in 2006, said that, although the Ervin Act’s criteria is high, he sees the court leaning toward a broader interpretation of “dangerousness” in these types of cases. He said the problem is that a close reading of the “dangerousness” standard makes it difficult to involuntarily hospitalize someone who isn’t already receiving treatment.

“It seems that the higher up you go in the judicial hierarchy, the broader definition the courts will give to ‘likely to injure oneself or others,’” said Hand, who believes a legislative fix is needed. “I agree that the spirit of the law was to make it very difficult to commit people but that’s proved unworkable. … There are too many people falling through the cracks.”

Threatening remarks

In early April 2009, Charles was admitted to Providence Hospital as an involuntary emergency patient with the D.C. Department of Mental Health, after police responded to neighbors’ complaints that she was banging on a door with a hammer and allegedly making threats. But several days later, a doctor determined Charles no longer posed any danger, and Charles signed a form agreeing to stay as a voluntary patient.

Charles soon began asking to leave. The Ervin Act requires a discharge plan to be in place within 48 hours of a written request by a voluntary patient, but because her request wasn’t in writing, doctors weren’t bound to act. Charles had been refusing medication and on April 15, 2009, she was transferred to St. Elizabeths Hospital in Southeast Washington, the city’s public psychiatric facility, as an involuntary patient. The doctor described Charles in the application as “psychotic [with] paranoid delusions, hyperreligious, irritable, physically & verbally aggressive,” according to briefs.

Charles, represented by her current attorney, Laurie Davis of the D.C. Public Defender Service, challenged her commitment. District of Columbia Superior Court Judge Laura Cordero denied Charles’ motion to dismiss, finding that her case presented one of the “rare circumstances” under the Ervin Act that permits the voluntary-to-involuntary conversion.

Charles appealed Cordero’s ruling. She was released soon after from St. Elizabeths.

Though Charles is currently walking free, Davis is arguing that her case isn’t moot, because the scenario could happen again in the future, to Charles or to others.

Attorneys for the city argue that the law as written offers flexibility to doctors to make sure patients whose condition puts them and the public at risk receive care.

But Davis counters that the law supports the “primacy” of voluntary treatment—and she warns that a broader interpretation would create a “chilling effect” on a person’s willingness to voluntarily seek help later.

Under the Ervin Act and previous case law, Davis is arguing doctors had no legal right to change Charles’ status because there was no urgency—Charles hadn’t triggered the 48-hour discharge window under the Ervin Act by making a written request for release—and she hadn’t displayed “imminent dangerousness” when compared to other cases where a patient was violent and threatening.

Holly Johnson of the D.C. Office of the Attorney General argued in court that Charles’ attorney would place the bar too high. Charles was making verbal threats to her doctors and refusing to take medication, according to the city’s brief, clear signs that Charles would have posed a danger to herself or others. Urgency existed because Charles had been making oral requests to leave, Johnson said.

“The status of voluntary, while a legal one, only applies when a patient is amenable to treatment,” Johnson told the court.

Charles, now 52, declined to comment through her attorney. Davis and Johnson also declined to comment on the case.

A three-judge panel of the Court of Appeals, D.C.’s high court, heard arguments on Sept. 8. Chief Judge Eric Wash­ington and judges John Fisher and Inez Smith Reid will decide the case.