Chairman KEFAUVER. The chart shows that you sent 3 to Lexington in September, 3 in October, 6 in November and none in December up to the time this chart was prepared. How many have you sent since then?

Dr. SCHULZ. A total of 12 and 3 waiting or a total of 15 out of the 62 that we have had committed.

Chairman KEFAUVER. Can you project when the staff in the hospital and the prosecuting attorney's office and all the facilities necessary to put the act in actually full operation, the number that you would place in the hospital?

Dr. SCHULZ. We have attempted to do that, sir, and attempted to get various data together for our obvious needs in programing and have been unable to come up with anything very firm other than the fact that this probably represents a relatively small percentage of the total who could be processed.

Chairman KEFAUVER. What do you mean by relatively, 10 percent, 20 percent?

Dr. SCHULZ. I would say perhaps in the order of-there are at least 4 or 5 times this many that could be processed on the basis of what we think is available in the way of drug addicts in the District. Of course this is only for a period of 3 months really, which would mean about 50 patients a year.

The figures we have been using have been in the order of 150 to 200 per year as probably in the District needing treatment and could be rehabilitated and could be processed if they could be found, if they can be processed under the act, if the fact of their addiction can be shown with sufficient definition to warrant their commitmentthere are many factors in other words that make the figure less than the total number of available addicts.

Chairman KEFAUVER. I am very interested in the fact that 31 of the 62 who have come into the hospital have done so voluntarily, is that correct?

Dr. SCHULZ. This is correct.

I might say that is partly influenced by the narcotic squad people who in some instances have suggested this to the individuals or they have suggested it to themselves at the time of an investigation and have said that they wanted treatment and would go into the hospital voluntarily and it is felt, by all concerned, since this is a civil process that the more the voluntary wishes of the individual can be brought to bear the better.

Chairman KEFAUVER. Mr. Mitler, you ask any questions you would like. I think it would be of great interest if you just explained whether this is working satisfactorily and you think it is a good plan.

Dr. SCHULZ. I think it is. Our emphasis is on rehabilitation. For that reason while we realize-I think the addict today, residual addict is a dangerous individual, should be confined. As a physician I am interested in those that can be treated. These represent in our recommendation those that are suitable for rehabilitation and can be helped if the facilities are available.

Mr. MITLER. This is a way of treating and helping the addict without making him a criminal, is that correct?

Dr. SHULZ. Yes, that is correct.

Mr. MITLER. Nonetheless, once they are committed, there is compulsion involved?

Dr. SCHULZ. That is correct.

Chairman KEFAUVER. You mean once they are committed they are required to stay for any given length of time?

Dr. SCHULZ. Yes. The act reads until rehabilitated. It is an indefinite commitment as I recall the exact wording of it.

Mr. MITLER. Certain of these persons go to the facility at Lexington, Ky.?

Dr. SCHULZ. Yes, that is correct; 15 since the act has been in operation.

Mr. MITLER. Do you know what the criterion is when they are dismissed from Lexington?

Dr. SCHULZ. No, I do not.

Mr. MITLER. But they stay at Lexington for a period of time and that is up to the judgment of the hospital authorities at Lexington. Dr. SCHULZ. That is the way I understand it. The act reads. Mr. MITLER. Dr. Chapman, is that correct?

Dr. CHAPMAN. Pardon?

Mr. MITLER. Is that correct that in the civil commitments from the District of Columbia law that the person stays at Lexington until they are certified for release by the hospital?

Dr. CHAPMAN. I believe the law reads up to a year and after that time they have to get special permission of the judge. Also prior to that time at the end of 6 months they may have to show due reason for keeping him for a longer period of time.

Mr. MITLER. The point I had in mind that is most constructive is that after their release from Lexington then do they remain on probation and some supervision when they return here to the district, some form of followthrough?

Dr. SCHULZ. They are required to report to a clinic for periodic evaluation. I might say, we do think the law has some deficiencies and it is in this connection.

Mr. MITLER. Would you want to state what they were?

Dr. SCHULZ. As we see the difficulties, partly that has to do with the fact that they go to Lexington, which is located at a great distance from the environment to which they will return, which precludes any evaluation of the environment while there or attempt to control the setting to which they will return.

When they return they are transferred from the hospital to a clinic that has not known the individual prior to that moment. In other words one physician starts the treatment, another physician completes the treatment.

This is not good medicine, in general. I realize it is good medicine under the circumstances. I am not being critical of the things that are being done. In other words our emphasis is that the followup evaluation is little more than a checkup and cannot be therapy in any real sense of the word, that a more graduated form of release would make more medical sense, which would require, however, that facilities be located nearer the residence of the individual.

Chairman KEFAUVER. Well, the transfer to Lexington and then back here, the fact that there is not the continuity of medical observation is not an insurmountable difficulty.

Dr. SCHULZ. It is not insurmountable; no. It is a factor that would require the greatest and closest liaison between the hospital and the

subsequent followup and treating authorities. I can't speak to that. I don't know what has been developed there.

Mr. MITLER. I think the useful part to learn is the fact that here at least is a seed of a program in which the addict is treated constructively and he is kept on a long-range period of time under some kind of affirmative supervision.

Dr. SCHULZ. It is an excellent and very firm beginning, I think to a good treatment program. I think it is a beginning though. Chairman KEFAUVER. You say it is a beginning and that is quite right. We would certainly like for this to be made a model for States to follow.

Dr. SCHULZ. Yes.

Chairman KEFAUVER. Or to consider. What is the length of supervision that you give a patient after having been discharged from the hospital or discharged from Lexington?

Dr. SCHULZ. I think the act reads 2 years.

Chairman KEFAUVER. Can you make it longer or shorter than that? Dr. SCHULZ. According to the act, I don't believe so. I think again that is one of the criticisms I have of the act that these periods of time as Dr. Chapman has said in Lexington, if they are to remain over a year they must go back in court and justify the reasons for this. That seems to me to place somewhat of a burden on the treating authorities there and the length of time held in the clinic. These people have severe characters of disorders and most psychiatrists would say they are not significantly going to be changed in many instances in 3 years.

At least 3 years is perhaps a good minimum.

Chairman KEFAUVER. Then you would recommend that the 2 years be changed so as to give you authority to keep them under supervision? Dr. SCHULZ. Indefinitely.

Chairman KEFAUVER. Say for years or as long as you think

necessary.

Dr. SCHULZ. In mental cases the commitment is indefinite and the subsequent parole can be made indefinite. I don't know why these same considerations do not apply here. These are mentally sick people.

Mr. MITLER. With respect to the bottom portion of the chart which refers to discharges I assume that means where the people are discharged from the District of Columbia General Hospital.

Dr. SCHULZ. Yes.

Mr. MITLER. The first one is to self, the next one is to Lexington, narcotics squad, et cetera. Can you amplify what this means and what the criterion is?

Dr. SCHULZ. When the process has been completed those discharged to Lexington are discharged because they have been committed to Lexington. They are discharged for transfer to Lexington, that is 12 plus 3 that we noted at the bottom that are awaiting.

A total of 15 have been committed. Those discharged to self are those where it was felt either they are not a drug user sufficiently within the meaning of the act to justify their commitment; in other words, we are guided by the United States attorney's office in this.

He lets us know that he does not think, or our letter of findings is not sufficient to support a civil commitment act and I think he is on somewhat the conservative side in not prosecuting cases where there

may be a great deal of controversy at least in the beginnings of the act. Mr. MITLER. I have no further questions.

Chairman KEFAUVER. This first line, discharges to self. You started this operation of putting the act into effect in September and it seems that in the same month that you just discharged 9 people to themselves and in the second month you discharged 14, that would indicate that they did not get very much treatment.

Dr. SCHULTZ. That's right; they don't.

Chairman KEFAUVER. Do you think they were cured of the addiction in the short time or there is a legal technicality where the district attorney didn't think he could sustain the commitment?

Dr. SCHULZ. I think it is about half of each perhaps, that the first half consists of those that were sufficiently periodic in their use of durgs and used drugs in small amounts and could not be declared a drug user and the other half would be those where the United States attorney did not feel he had sufficient legal material.

Chairman KEFAUVER. These discharged to themselves, do they have to continue to report for any length of time?

Mr. SCHULZ. No. Again the difficulty with the act is in part that the hospital to which they are going to be committed and the only treatment facility is presently at Lexington, Ky.

Chairman KEFAUVER. Well, you have a clinic where they could be required to

Dr. SCHULZ. Not under the act. One of the things I spoke about when this act was being considered is the fact that the treatment must be confinement until cured. I think it reads something to that effect "Confined there for rehabilitation until released." In other words, they must be according to the act treated in confinement. It does not provide for any kind of graduated release or partial confinement as is done with mental cases. My feeling would be that we would be in a stronger position presuming a local facility were available to release them 8 o'clock in the morning to go to work and they returned to the hospital at 8 o'clock in the evening, as is done with other mental

cases.

They are only out of the hospital for a specific purpose and for a specific period of time and having accomplished that purpose they return to the confinement of the hospital.

Under this act it would be impossible even if they were under local care. That is the way I read it.

Chairman KEFAUVER. Even if they didn't return to the hospital, might it not be of value if once a day or certain specified times they could return to be interviewed and talked to by a psychologist or a psychiatrist.

Dr. SCHULZ. Yes, indeed; very definitely.

Chairman KEFAUVER. There is no provision for that.

Dr. SCHULZ. No; there seems to be an abrupt transition, confinement until cure and then released to be watched, that is the emphasis. Chairman KEFAUVER. You spoke about after they came back from Lexington they report to a clinic in the District of Columbia. What clinic is that?

Dr. SCHULZ. That is a clinic operated by the Health Department, it is a legal psychiatric service to the courts and that is it has been assigned this followup responsibility.

Chairman KEFAUVER. Why couldn't that clinic do some followup work with those people released directly here?

Dr. SCHULZ. As I undestand it, the act, that could not be made compulsory.

Chairman KEFAUVER. I know you are the chief psychiatrist.

Dr. SCHULZ. As I understand the act I don't think that could be accomplished under it. Perhaps it could. It would be an interpretation that I don't think most people would make.

Chairman KEFAUVER. That would be of some help even if there were just clinical followup.

Dr. SCHULZ. Very definitely; yes.

Mr. MITLER. Suppose on the probation someone does not turn up, as I understand quite a few don't, when they come back, are there teeth in the law that compel them to come in?

Dr. SCHULZ. Yes; there is. They can be picked up immediately and brought back in for reexamination and determination, whether they are a user or not.

The way the act reads, this implies more of a checkup rather than

treatment.

To answer again your question, Senator, before they could be compulsorily required to go to the clinic they would have to be committed. Those discharged to themselves have not been committed. They are the same again as mental cases where commitment action is not found to be necessary, desirable, or possible, and then we have no authority, we can recommend but we have no authority to require without a commitment process attendance at a clinic. I agree that should be so. It might be desirable to require clinical attendance rather than hospital attendance at all.

This would be a question of medical opinion.

Mr. MITLER. Aren't some discharged because determination is made that treatment would not benefit them? I learned of a case where a girl went to Lexington several times and they discharged her because they gave up in despair?

Dr. SCHULZ. Yes; this is a treatment act and not a punishment act and for that reason the clinic users were we feel at least under the presently available facilities they cannot be held, we have not committed them.

Mr. MITLER. So they go back into the community and the merrygo-round goes on.

Chairman KEFAUVER. The third line under discharges, discharges to narcotic squad, you seem to have none, until November when you had six. Does that refer to the District of Columbia narcotics squad?

Dr. SCHULZ. Those are vagrancy cases who are brought in under title 3 of the act and cannot be committed under the civil portion of the act which excludes any with any criminal charges pending against them. They are discharged back to the squad for prosecution under those criminal aspects and this was what has been done in some of the chronic cases in order to confine them.

Chairman KEFAUVER. So that that means because there are criminal charges pending they cannot be kept in the hospital and they are discharged back to the narcotics squad for prosecution or whatever may be done?

Dr. SCHULZ. That's right.