A D.C. judge has assigned a medical guardian to the city’s most frequent 911 user after officials argued that she had burdened the emergency medical system for more than three decades, accounting for thousands of emergency calls and ambulance rides.

Superior Court Judge Erik P. Christian approved the guardianship petition Monday for Martha Rigsby, marking the first known case in which D.C. officials sought a guardian to limit a 911 caller.

The ruling is expected to set a precedent for how the District handles “frequent fliers,” who have been flagged in cities across the nation for their impact on limited emergency-response resources. Although guardianship proceedings are often the first course of action in these cases, some jurisdictions, such as Los Angeles, have recently chosen to pursue criminal charges against habitual 911 callers.

While announcing his decision, Christian described Rigsby’s calls as “a serial, excessive and unwarranted” burden on the District’s emergency medical system, including the D.C. Fire and Emergency Medical Services Department, the Metropolitan Police Department, the Department of Behavioral Health and mobile crisis teams.

The quandary of how to help Rigsby developed in the 1980s, when the woman began to repeatedly fall to the ground, usually in public places, with seizures or fainting spells. Back then, firefighters knew her as “Metro Martha” because her spells almost always occurred at Metro stations. A news story in 1987 referred to her as the “biggest customer” of the D.C. fire department.

Martha Rigsby gets into a car with her attorney as she leaves the courthouse on Nov. 6, 2013, in Washington. (Mark Gail/The Washington Post)

By conservative estimates, Rigsby, 59, has generated thousands of 911 calls and ambulance trips to hospitals, with many calls accumulated in the years before cellphones. In November, a fire department official said Rigsby was connected to at least 226 calls to 911 and 117 ambulance trips in the previous 12 months. Since November, Rigsby has been transported in an ambulance about 30 times, a fire department spokesman said Monday.

Both sides made their closing arguments in November, and in December, Rigsby underwent more thorough neuropsychological testing.

In early January, Rigsby fell in a courthouse hallway less than a minute before her case was scheduled to begin. She said that she had tripped on her cane, and she lay facedown while witnesses called 911. Firefighters from Engine 3 responded to the call, greeting Rigsby by her first name as they put her on a stretcher and into an ambulance.

Much of the District’s case hinged on proving that Rigsby did not have the mental capacity to make medical decisions or to ensure her safety.

A key witness for the government was Abayomi Jaji, a psychiatrist with the Department of Behavioral Health, who strongly asserted that Rigsby lacked the mental capacity to care for herself because of bipolar and borderline personality disorders, along with conversion disorder, a condition in which psychological stress causes neurological symptoms.

On Monday, Christian delivered a nuanced ruling, explaining that Rigsby’s case was complicated because, in many ways, the woman is “quite capable” of taking care of herself. She lives at an apartment complex for seniors in the Trinidad neighborhood of Northeast Washington. She pays her bills, bathes and dresses herself, schedules the van ride for her medical appointments and uses a microwave oven to cook meals.

The limited guardianship allows for oversight of Rigsby’s medical decisions but not her legal or financial affairs. The guardian could recommend a home health aide and coordinate doctor visits. Rigsby’s private insurance would probably cover the costs, officials said. In November, The Washington Post reported that Rigsby has an outstanding balance of $61,366.33 owed to D.C. Fire and EMS for ambulance transports.

After the hearing, District officials were unable to say whether a limited medical guardian could recommend more aggressive intervention, such as mandating that Rigsby move into an assisted-living facility.

Elspeth Ritchie, the lead psychiatrist who filed the guardianship petition on behalf of the D.C. Department of Behavioral Health, said Monday that she was “very pleased” with the judge’s decision.

“I hope that this is a solution,” Ritchie said after the hearing. “But given the past history, there well may be more steps needed.”

Rigsby’s court-appointed attorney, Vickey Wright-Smith, said in her closing arguments that she was concerned a nursing home was the end goal for Rigsby.

“That’s not what these cases are about,” Wright-Smith said. “We want to have the least restrictive measures put in place to help members in the community.”

The decision to seek a guardianship rather than pursue criminal charges, Ritchie said, was a “humane” one.

In the District, guardianships are normally long-term arrangements with minimal court-mandated follow-up. But Christian said he would consider modifying or even terminating Rigsby’s guardianship if the 911 calls are reduced. He scheduled a follow-up hearing in October.

Rigsby declined to comment after the ruling.

In her previous testimony, she said that she had been diagnosed with narcolepsy and fainting spells but that she did not need a guardian.

“Well, if I’m doing everything for myself, well, why would I need a guardian, you know?” she said. “I see no reason for it.”

Rafael Sa’adah, a battalion chief for the fire department, testified that Rigsby’s call patterns fluctuate but that she personally dials 911 about 40 percent of the time. Rigsby disputed those figures, testifying that she placed 10 percent of the 911 calls and that bystanders made the rest.

“I either fall backwards or go forward,” she said. “I also try to tell people if I’m not out too long, try to tell them not to call because I’m all right. But they don’t listen to me.”

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