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Beall v. Ujoatuonu

United States District Court, D. Maryland, Southern Division

February 21, 2019




         Plaintiff Richard Howard Beall, Jr. is involuntarily committed for treatment to the Department of Health and Mental Hygiene (the “Department”). Beall is a patient at Clifton T. Perkins Hospital Center (“Perkins”), a state psychiatric hospital. He claims that Defendant Macauley Ujoatuonu, R.N., a nurse employed at Perkins, forcibly administered medication to him. ECF Nos. 4-5. Defendant has filed an Amended Motion to Dismiss or, in the Alternative for Summary Judgment.[1] ECF No. 14. No. hearing is necessary. See Loc. R. 105.6. For the following reasons, Defendant's Motion for Summary Judgment, ECF No. 14, is granted.

         I. BACKGROUND

         Beall's mental health diagnoses include schizoaffective disorder (bipolar type) and antisocial personality disorder. ECF No. 14-4 ¶ 6 (Affidavit of Sameer Patel, M.D.). Beall's symptoms of mental illness include grandiosity, hyper-spirituality, delusions about having superpower, and paranoia. Id. ¶ 7.[2] Beall exhibits poor insight into his mental illness. Id.

         Beall also exhibits aggressive and assaultive behavior. ECF No. 14-4 ¶ 10; see also ECF No. 10-3 at 4-5. Beall has been involuntarily medicated periodically pursuant to determinations made by a clinical review panel (“CRP”). ECF Nos. 14-4 ¶ 8, 14-5 at 2.[3] Due to Beall's inconsistent compliance with medication prescribed for him and increased aggression, the treatment team pursued a medication order through a CRP pursuant to Md. Code Ann. Health-Gen., § 10-708. ECF Nos. 10-5 at 2, 14-4 ¶ 11, 14-5 at 3.

         On May 13, 2016, Beall was provided a notice of the clinical review panel meeting. ECF No. 14-8. On May 17, 2016, when the CRP met to discuss Beall's medication and whether to recommend administration of medication for Beall, it considered medical compliance and incidents of aggression. See ECF No. 14-4 ¶¶ 9, 10; ECF No. 14-5 at 2-6. Beall, Sonny Miranda, M.D., and Eseigboria Ogunbor, Rights Advisor, were present at the meeting. ECF No. 14-5 at 1. The CRP was composed of Inna Taller, M.D., David Chandran, M.D., and Valorie Grimes, LCSW-C. Id. During this CRP, the following incidents were documented. In November 2015, Beall threatened to harm staff. Id. at 3. In December 2015, Beall was verbally aggressive towards a registered nurse and required the use of restraints to control his aggression. Id. On March 19, 2016, Beall had an altercation with a peer about the television. Id. On March 21, 2016, he threatened to kill staff by “spraying them with AK47 bullets.” Id. He also threatened to harm his psychiatrist. Id.

         At the CRP meeting, Dr. Miranda explained that Beall's aggression is psychotically driven and dissipates when he adheres to his medication regimen. Id. Dr. Miranda indicated that Beall's adherence to his medication regimen had been “short-lived.” Id. When Beall misses his medication, he clinically decompensates and becomes violent. Id. Miranda told the CRP that Beall has poor insight into his illness and need for treatment, and would not take his medications without CRP oversight. Id. The CRP record shows that during the meeting Beall was irritable, agitated, and made paranoid and delusional comments. ECF No. 14-4 ¶ 11; ECF No. 14-5 at 3. Beall told CPR members that Satan was talking in his ear and commanding that angels were to be sprayed with bullets from AK47 weapons. ECF No. 14-5 at 3.

         The CRP determined Beall posed a danger to himself or others without his medication. Id. at 4. The CRP recommended a combination of the following medications for Beall: Quetiapine by mouth, Fluphenazine by mouth, Fluphenazine decanoate by intramuscular injection, Olanzapine or Olanzapine Zydis by mouth, Divalproex Sodium or Valproic Acid by mouth, Fluphenazine by intramuscular injection, Olanzapine by intramuscular injection, Lorazepam by intramuscular injection, and Diphenhydramine by intramuscular injection. Id. at 5. The use of an intramuscular injection of Olanzapine and Fluphenazine was authorized if Beall refused medications by mouth. ECF No. 14-4 ¶ 12. ECF No. 14-5 at 5. Dr. Sameer Patel, Beall's treating psychiatrist, stated that these medications are standard practice for treating schizoaffective disorder, and in his professional opinion, is a reasonable exercise of professional judgment. ECF No. 14-4 ¶¶ 5, 18.

         Beall appealed the CRP decision. On May 26, 2016, an Administrative Law Judge held a hearing on the appeal, found that Beall met the criteria for involuntary medication under the Maryland Health-General Code § 10-708, and authorized the use of medications approved by the CRP on May 17, 2016 for a ninety-day period. ECF No. 14-6; ECF No. 14-4 ¶ 14.

         From May 26, 2016 through June 1, 2016, Beall received his medication by injection after he refused to take his medication orally. Id. ¶ 16; ECF No. 10-9. Dr. Patel opines that it was a reasonable exercise of professional judgment to administer the intramuscular injections (Olanzapine and Fluphenazine) authorized by the CRP to treat Beall's mental illness. ECF No. 14-4 ¶ 19.

         On May 31, 2016, Beall approached the nurse's station, where Ujoatuonu offered him the medications authorized by the CRP. ECF No. 10-6. Beall was told that he would receive an intramuscular injection if he did not take the prescribed dose of Olanzapine by mouth. ECF No. 10-6, ECF No. 14-4 ¶ 15. Beall indicated he would not accept the intramuscular medication backup that the clinical review panel had approved. Beall refused redirection when asked to leave the nurse's station so that other patients could receive their medication. Id. Beall then reached into the nurse's station and punched Ujoatuonu in the face. Id. Beall remained combative. While staff placed him into a restraint chair, Beall used his head to hit Ujoatuonu in the lower abdomen. Id. Beall was then administered CRP authorized injections of Olanzapine and Fluphenazine. ECF 10-7; ECF No. 14-7.

         On October 13, 2016, Beall initiated this case against multiple defendants alleging that he was subjected to excessive force when he was placed in restraints. ECF No. 1. On October 24, 2016, Beall filed an Amended Complaint, which he supplemented on November 2, 2016. ECF Nos. 4, 5. As supplemented, the Complaint alleged that in May of 2016, Beall was placed in cervical restraints, his head was pushed back, and he was injected with medication. ECF No. 4 at 3; ECF No. 5 at 3.[4] As relief, Beall sought damages, investigation, expungement of his criminal history, and his release. Id.

         On February 2, 2017, the Court dismissed Beall's claims against all Defendants except Macauley Ujoatuonu, the only defendant alleged to be personally involved in the actions underlying the Complaint. ECF No. 7. The Court also ordered counsel for the Department to submit a report on Beall's mental health status to assist in determining whether appointment of a guardian ad litem was necessary. ECF No. 7. On March 1, 2017, counsel filed the court ordered mental health status report. ECF No. 9. Based on this information, the Court determined appointment of a guardian ad litem was not warranted. ECF No. 12 at 5-9.

         On March 28, 2017, Defendant Ujoatuonu filed a Motion to Dismiss or, in the Alternative, for Summary Judgment. ECF No. 10. On March 26, 2018, the Court granted Ujoatuonu's Motion for Summary Judgment in part. ECF No. 13, ECF No. 12 at 11 (discussing use of restraint and use of force claim). On that date, the Court provided Ujoatuonu twenty-eight days to submit evidence addressing whether the decision to administer medication forcibly to Beall complied with due process. ECF No. 13. He filed no response, and on April 16, 2018, the Court mailed a Rule 12/56 letter to Beall warning him of the ...

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