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In re J.C.N.

Court of Appeals of Maryland

July 31, 2018

In Re: J.C.N.

          Argued: April 10, 2018

          Circuit Court for Anne Arundel County Case No. C-02-CV-15-003887

          Barbera, C.J., Greene, Adkins, McDonald, Watts, Hotten, Getty, JJ.


          Barbera, C.J.

         We are presented here with a second opportunity in a span of several weeks to address the operation of the involuntary admission provisions of the Maryland Mental Health Law, found within Subtitle 6 of Title 10 of the Health-General Article, §§ 10-601- 633. We begin by repeating the opening lines of the first of our opinions:

Civil commitment of an individual to a mental institution against the individual's will may be sought when it appears necessary for treatment of the individual's mental disorder and for the safety of that individual or others. However, a decision on involuntary admission must take account not only of health and safety concerns, but also of the individual's right to liberty under the State and federal constitutions.

Bell v. Chance, No. 36, 2018 WL 3409919, at *1 (Md. July 12, 2018). The competing concerns addressed above-the individual's liberty interest and society's concern for the health and safety of the individual and others-lay at the center of the case before us.

         Petitioner in the present case is J.C.N., who challenges her involuntary admission to the psychiatric unit of the University of Maryland Baltimore Washington Medical Center in December 2015. Respondents are the Baltimore Washington Medical Center and the Maryland Department of Health. J.C.N.'s involuntary admission was pursuant to the decision of an administrative law judge who, following a hearing, determined that she met the requirements for involuntary admission, including that she was at that time a danger to the life or safety of herself or others.

         J.C.N., represented by counsel then and throughout judicial review of the administrative law judge's decision, argues that there were errors of procedure and substantive law on the part of Respondents and the administrative law judge. On judicial review in the Circuit Court for Anne Arundel County and on appeal to the Court of Special Appeals, both courts determined that there was no error. For reasons that follow, we likewise find no error.


         The Statutory and Regulatory Scheme

         Resolution of the parties' dispute turns largely on the proper interpretation and application of the Health-General Article ("HG") of the Maryland Code, Title 10, Subtitle 6, in particular the provisions found in Parts III ("Involuntary Admissions") and IV ("Emergency Evaluations"). We outline the pertinent statutory and regulatory provisions here.

         The Petition for Involuntary Admission

         An involuntary admission may be initiated by application. HG §§ 10-614 (permitting an application for involuntary admission to be made "by any person who has a legitimate interest in the welfare of the individual"), 10-615 (listing the requirements of an application). The process also may be initiated by a petition for emergency evaluation.

         J.C.N. was admitted under the procedures governing petitions for emergency evaluations. Those procedures are found in Part IV of Subtitle 6, HG §§ 10-620-630, and associated regulations adopted by the Secretary of Health.[1] Peace officers and other enumerated professionals may make a "petition for emergency evaluation" of an individual. HG § 10-622(b). The petition may be made if the petitioner[2] believes that the individual has a mental disorder and "presents a danger to the life or safety of the individual or of others." HG § 10-622(a). Once lawfully executed, the petition is presented to a peace officer, [3] who is authorized to transport the individual against his or her will "to the nearest emergency facility." HG § 10-624(a). "If the petition is executed properly, the emergency facility shall accept the emergency evaluee." HG § 10-624(b)(1). An "emergency facility" is one that the Department of Health ("Department") "designates, in writing, as an emergency facility," and "includes a licensed general hospital that has an emergency room." HG § 10-620(d).

         Within six hours of the individual's arrival at the emergency facility, "a physician shall examine the emergency evaluee, to determine whether the emergency evaluee meets the requirements for involuntary admission." HG § 10-624(b)(2). If the evaluee does not meet the requirements for involuntary admission, the emergency facility "shall" release the individual unless the individual requests voluntary admission. HG § 10-624(b)(3). "An emergency evaluee may not be kept at an emergency facility for more than 30 hours." HG § 10-624(b)(4).

         The Start of the Involuntary Admission Process

         If it is determined that the emergency evaluee meets the requirements for involuntary admission, the examining physician at the emergency facility "shall take the steps needed for involuntary admission of the emergency evaluee to an appropriate facility, which may be a general hospital with a licensed inpatient psychiatric unit." HG § 10-625(a); see HG § 10-101(g)(1) (defining "facility," "[e]xcept as otherwise provided in this title," to mean "any public or private clinic, hospital, or other institution that provides or purports to provide treatment or other services for individuals who have mental disorders"). An "inpatient facility" is defined in the regulations, much as it is in the statute, as "an inpatient institution that provides evaluation, care, or treatment for individuals who have mental disorders." COMAR An application to initiate the process for involuntary admission must be in writing and accompanied by the certificates of two physicians (or other statutorily enumerated health care providers) who have examined the individual and believe that the individual has a mental disorder; the individual requires inpatient care; and "admission to a facility . . . is needed for the protection of the individual or another." HG §§ 10-615-616.

         Once confined initially in an appropriate inpatient facility, the individual remains in "observation status" pending a hearing to determine whether the individual should be admitted involuntarily. COMAR

         Notice and the Involuntary Admission Hearing

         Within twelve hours after the individual's "initial confinement," the facility must present to the individual a standard form providing notice of admission and advising of various rights, including the right to consult with a lawyer. HG § 10-631(a), (b). The notice includes the date of the individual's scheduled involuntary admission hearing, COMAR, "to determine whether the individual is to be admitted to a facility . . . as an involuntary patient or released without being admitted," HG § 10-632(a).

         The procedures attendant to the involuntary admission hearing are spelled out in HG § 10-632 and COMAR The hearing "shall be conducted" by an administrative law judge ("ALJ")[4] "within 10 days of the date of the initial confinement of the individual." HG § 10-632(b). This requirement is repeated in the regulations: "When an individual is confined on observation status in an inpatient facility on the basis of application and certificates for [involuntary admission], inpatient facility staff shall: (a) Schedule a hearing to take place within 10 days of the individual's initial confinement in the inpatient facility[.]" COMAR Unless the ALJ for good cause orders otherwise, "the hearing shall take place in the inpatient facility where the individual is confined." COMAR

         At the hearing, the ALJ shall:

(1) Consider all the evidence and testimony of record; and
(2) Order the release of the individual from the facility unless the record demonstrates by clear and convincing evidence that at the time of the hearing each of the following elements exist as to the individual whose involuntary admission is sought:
(i) The individual has a mental disorder;
(ii) The individual needs in-patient care or treatment;
(iii) The individual presents a danger to the life or safety of the individual or of others;
(iv) The individual is unable or unwilling to be voluntarily admitted to the facility; [and]
(v) There is no available less restrictive form of intervention that is consistent with the welfare and safety of the individual[.]

HG § 10-632(e).[5] The regulations add that the ALJ shall "[o]rder the release of the individual from the inpatient facility" if there was an "error in the process"; the error "is substantial"; and "[n]o other available remedy is consistent with due process and the protection of the individual's rights." COMAR


         The Present Case

         Factual Background

         In the summer of 2015, J.C.N. suffered a stroke and "thyroid storm"-a rare medical condition stemming from an overactive thyroid. Her brain swelled, she suffered partial paralysis on the right side of her body, [6] and she experienced partial loss of ...

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