Circuit Court for Howard County Case No. 13-C-17-112909
Wright, Nazarian, Wilner, Alan M. (Senior Judge, Specially
February 2016 in the Circuit Court for Charles County,
Romechia Simms, appellant, was found not criminally
responsible ("NCR") for the death of her
three-year-old son. She was conditionally released from
commitment to the Maryland Department of Health ("the
Department"), appellees, subject to conditions. Alleging
that Ms. Simms violated her Order of Conditional Release, the
State petitioned the circuit court to issue a hospital
warrant pursuant to Md. Code (2001, 2008 Repl. Vol.), §
3-121(c) of the Criminal Procedure Article ("CP").
The circuit court granted the relief requested and issued a
hospital warrant directing that Simms be transported to the
hospital for an administrative review hearing.
September 2017, an Administrative Law Judge ("ALJ")
recommended that Ms. Simms be released from confinement
subject to several conditions, including a voluntary stay at
the Clifton T. Perkins Hospital Center ("Perkins
Hospital") until she could be placed at an appropriate
residential treatment center. In October 2017, the circuit
court accepted the ALJ's recommendations.
being conditionally released, Ms. Simms filed a Petition for
Writ of Habeas Corpus with the Circuit Court for Howard
County, the county where the hospital was located, alleging
that she was being unconstitutionally confined. The circuit
court found that Ms. Simms was not entitled to relief because
the hospital warrant issued by the Circuit Court for Charles
County was lawful. Ms. Simms timely appealed and presents the
following questions for our review, which we have expanded
for ease of discussion:
1. Is this appeal permitted by law?
2. Is this appeal moot?
3. Whether a finding of dangerousness must be made to support
a circuit court's finding that a hospital warrant should
be issued for a person on conditional release, and whether a
lack of such a finding be violative of due process?
the first question presented, we answer in the affirmative,
and answer the second third questions in the negative. As to
the third question, Ms. Simms makes two arguments but they
are really two faces of the same coin. Her first argument is
that dangerousness must be established anew during the
hospital warrant phase, and second that it is a failure of
due process not to do so. We must necessarily address the
first argument before we address the second, as the negative
answer to the first, necessarily requires an answer of no
merit to the second.
AND PROCEDURAL BACKGROUND
Simms has battled serious mental health issues since late
2014, when she first began experiencing visions and beliefs
that people were knocking on her door with guns. In February
2015, her symptoms worsened, and she began to believe that
people were trying to kill her. Around this time, Ms. Simms
was evaluated at Southern Maryland Hospital Center
("SMHC"), where she would later be readmitted.
SMHC, Ms. Simms espoused beliefs that she and her family
members had been raped under hypnosis, and that both she and
her son had been shot. Around that same time, she jumped out
of a moving taxi with her son and threatened the taxi driver.
She was diagnosed with a psychotic disorder and was
discharged in March 2015.
April 2015, Ms. Simms participated in an intake assessment at
Regenerations Counseling Services where she complained of
"stress" but was unable to identify the cause
behind her stress. She was described as "guarded,
paranoid, depressed, and irritable." Later that month,
Ms. Simms met with a psychiatrist and stated a belief that
people, including her boyfriend, were trying to kill her.
Simms' degrading mental health condition ended in
tragedy. In May 2015, police found Ms. Simms pushing a swing
holding the body of her deceased three-year-old son. Ms.
Simms had reportedly pushed the child on the swing for forty
straight hours. She was charged with Child Abuse Resulting in
Death, Involuntary Manslaughter and Child Neglect on
September 11, 2015.
December 2015, Ms. Simms participated in a pretrial
evaluation where she was considered competent to stand trial.
Ultimately, she was found NCR based on evidence of
experiencing auditory hallucinations, visual hallucinations,
and paranoid delusions that made her feel unsafe. She also
claimed that her sleep was impaired and voices told her to
take her son to the park. Once there, the voices told her
that there was a battle in the park between heaven and hell,
and that her son would remain safe in the swing.
Simms was readmitted at SMHC after her son's death. The
reason for admission was listed as "psychosis." Ms.
Simms was described as tearful and confused. She was
diagnosed with schizophrenia, prescribed Haloperidol,
Benztropine, and Mirtazapine, and was discharged at the end
of the month. In August 2015, Ms. Simms met with a
psychiatrist and endorsed "passive death wishes,
stating, 'Sometimes I wish I was dead.'"
February 2016, Ms. Simms entered an Alford
to the charge of involuntary manslaughter. After reviewing
reports from experts for both the State and the defense, the
Circuit Court for Charles County found that, at the time of
the criminal act, Ms. Simms had a mental disorder that caused
her to lack the capacity to appreciate the criminality of her
act and to conform her actions in accordance with the law.
Subsequently, the circuit court found Ms. Simms NCR for the
involuntary manslaughter of her son and determined that she
would not be a danger to herself or the person or property of
others, if released with conditions.
March 2016, the circuit court issued an Order of Conditional
Release for Ms. Simms, pursuant to CP §§ 3-111 and
CP 3-112. Ms. Simms was conditionally released from
commitment to the Department subject to the following
1. The Community Forensic Aftercare Program
("CFAP") of the [Department] shall be responsible
for coordinating and monitoring the conditions of the
defendant's release, including notification to all of the
necessary parties that will be expected to provide services
to [Ms. Simms]. [Ms. Simms] shall comply with all lawful
instructions, directions and recommendations given to her by
2. [Ms. Simms] shall reside at [her address]. Any change in
residence must be reported by [Ms. Simms] to and approved by
CFAP prior to relocation.
3. [Ms. Simms] shall be seen for psychiatric follow-up with
QCI Behavioral Health . . . . She will participate in
individual therapy twice per week with a therapist identified
by the agency. The patient will initially be seen monthly by
the psychiatrist and twice per week by a therapist.
Thereafter, any change in therapist, psychiatrist, clinic or
frequency of appointments must be approved in writing by CFAP
prior to any changes going into effect.
4. [Ms. Simms] shall attend and participate in any other
program or activity as recommended and arranged by the
therapist, psychiatrist or [the Department]. Ms. Simms shall
follow all of their rules and requirements. This may include
a day treatment or partial hospitalization program.
5. [Ms.] Simms will take medication as prescribed, and shall
submit to periodic blood tests to confirm the presence or
levels of medication if requested. Ms. Simms shall pay for
6. [Ms.] Simms shall not take illicit drugs including
marijuana, or use alcohol. She will also not take the
substance commonly referred to as "K2" or
"Synthetic Marijuana." She shall submit to
toxicology testing, urine, blood and breathalyzer testing
upon request of her treatment team or CFAP monitor. She shall
participate and complete an outpatient substance abuse
program and provide documentation of completion of the
program. In addition, Ms. Simms may be required to attend
NA/AA if requested by her treatment team or CFAP monitor.
7. [Ms.] Simms shall not own, possess or use, or attempt to
own, possess or use a firearm or weapon.
8. [Ms.] Simms shall not be in the company of any minor
unless there is another adult present. [Ms.] Simms will not
undertake to be the care giver of any minor.
9. [Ms.] Simms shall immediately discuss with her therapist
or case manager and abide by any resulting reasonable
recommendations made regarding the following:
a. Change in residence, employment, or activities
b. Change in marital status or family composition
c. Change in physical or mental health
d. Legal involvements
e. Trips outside the state of Maryland
f. Failure to meet clinic or program requirements.
10. [Ms.] Simms shall obey all laws and in the event she is
charged, arrested or convicted of any crime she will notify
the CFAP immediately.
11. [Ms.] Simms will appear in Court when instructed to do
so. For the first year of [Ms.] Simms' Conditional
Release, the Court will hold a hearing every 90 days to
determine the Defendant's progress and compliance with
her treatment and release. The Defendant will appear at each
hearing. After the first year of Conditional Release, the
Court shall have the discretion to hold a hearing at any time
to determine the Defendant's progress and compliance with
her treatment and release. Additionally, the State and/or
Defendant may request a hearing at any time to determine the
Defendant's progress and compliance with her treatment
12. [Ms.] Simms agrees that [the Department] will have the
right to order an independent psychiatric evaluation at any
time, and she further agrees she will participate in and
fully cooperate with such an evaluation.
13. If [Ms.] Simms' mental illness becomes active, she
may seek voluntary admission to a mental hospital for the
purpose of treatment. Any such hospitalization shall not be
construed to be a violation of conditional release.
14. If [Ms.] Simms' mental illness becomes active such
that her treating mental health personnel recommend inpatient
treatment and she is unwilling to be voluntarily admitted to
a mental hospital, this shall be deemed a violation of
15. The CFAP shall be permitted to frequently communicate
with any person, including the therapist, having knowledge of
[Ms.] Simms' clinical condition, and shall be furnished
with all documentation concerning her status that may be
necessary to monitor her ongoing clinical condition.
16. During the period of conditional release, [Ms.] Simms
shall remain subject to the jurisdiction of this court, to
the general supervision of [the Department], and to the
reasonable requirements of [the Department] pertaining to her
conditions of the release.
17. If at any time within the five years of this Conditional
Release Order, [Ms.] Simms does not comply with the
conditions of her release, the CFAP shall immediately notify
the Court and the State's Attorney. Pursuant to [CP
§ 3-121], a hospital warrant may be issued and [Ms.]
Simms may be committed to a facility designated by [the
Department] pending a revocation hearing. If, after a
revocation hearing, Ms. Simms is found to have violated any
condition of her release, the Court may revoke her
Conditional Release and she could be committed to [the
Department] for placement in an inpatient facility designated
by [the Department].
circuit court further ordered that CFAP would promptly notify
the State's Attorney for Charles County and the court if
Ms. Simms failed to comply with the conditions.
March 2017, the circuit court issued an Amended Order of
Conditional Release. The amended order stated that the
Department recommended that Ms. Simms be discharged from the
Assertive Community Treatment Team to regular outpatient
clinical services with QCI Behavioral Health. This modified
September 12, 2017, Kierrah Flipping, Ms. Simms'
therapist and the clinical director of QCI Behavioral Health,
wrote to Lori Mannino, LCSW-C, expressing concerns about Ms.
Simms because she was exhibiting a "decrease in
psychological functioning." She noted that Ms. Simms
missed appointments on August 7, August 21, September 7, and
September 11, 2017. Ms. Flipping observed that Ms. Simms had
shown symptoms of "depression, anxiety, irritable mood,
easily distracted, unable to concentrate/focus, short term
memory loss, and grieving the death of her son," which
she believed might have been attributable to the anniversary
of Ms. Simms' son's death. Ms. Flipping recommended
that Ms. Simms "obtain a psychological evaluation and be
reconsidered for a higher level of treatment than what is
currently being given."
Conditional Release Reporting Form dated September 12, 2017,
noted that for the reporting period of August 2017, Ms. Simms
had five appointments scheduled and had missed two of them
because she forgot the appointments, although her treatment
team had put several interventions in place, including
telephone reminders. An Emergency Reporting Form also
indicated that Ms. Flipping believed that Ms. Simms'
mental status was in decline.
Simms' 90-day status hearing was held on September 13,
2017, and the State's Attorney filed a Petition for
Revocation of Conditional Release with the circuit court
alleging that Ms. Simms violated condition #4 of her
Conditional Release Order.
to the State, a therapist at QCI Behavioral Health informed
the State that Ms. Simms was not complying with all of her
clinical appointments, and that she missed appointments on
June 20, August 7, August 21, September 7, and September 11,
2017. Thus, the State petitioned the circuit court to (1)
issue a hospital warrant for Ms. Simms, (2) direct that upon
execution of the warrant Ms. Simms be transferred to Perkins
Hospital for examination and evaluation, (3) set an
administrative hearing within ten days after the attachment
of Ms. Simms, and (4) revoke Ms. Simms' conditional
release. On September 13, 2017, the circuit court heard the
State's Petition for Revocation of Conditional Release.
Counsel for Ms. Simms argued that Ms. Simms had attended some
of her therapy appointments. The State informed the court
that it had "added the condition of [Ms. Simms] not
appearing [for this court date], to the violations of
conditional release," which it later
waived. The court recessed to give Ms. Simms time
circuit court reconvened from its recess and heard testimony
from Lori Mannino, Ms. Simms' monitor. Ms. Mannino
testified that she had reached out to Ms. Simms' mental
health providers on September 8, 2017, to inform them that a
court date was scheduled for September 13, 2017, and that she
had not received documentation from them. Ms. Flipping
notified Ms. Mannino of concerns she had regarding Ms.
Simms' behavior. Ms. Mannino reviewed the appointment log
and learned that, excluding some missed appointments that
were excused by the court, Ms. Simms was a no-call and
no-show on August 7, August 21, September 7, and September
11, just two days before her September 13, 2017 status
hearing. Ms. Mannino testified that Ms. Simms was
given appointment cards and reminders by phone.
Mannino inquired with the therapist about Ms. Simms'
mental health status. She testified that the documentation
indicated that Ms. Simms needed a higher level of
care. Ms. Mannino further testified that Ms.
Simms would need to be evaluated to determine whether she
needed a higher level of care.
circuit court resumed hearings on September 14, 2017. Ms.
Simms' counsel argued that there was no probable cause of
Ms. Simms' dangerousness because Ms. Simms had gone to
the hospital that morning and was deemed "not
appropriate for hospitalization." Therefore, Ms.
Simms' counsel argued that the State's position
raised due process concerns. Further, Ms. Simms' counsel
argued that the court only had a "recommendation for
more intensive care," which was not enough under the
probable cause standard.
State argued that Ms. Simms needed appropriate mental care,
which was bolstered by her inconsistent attendance at therapy
appointments. The State noted that it did not seek a
Revocation of Conditional Release when Ms. Simms missed
appointments due to her car accident. Of note, the State
[W]hen there is a pattern of missing appointments, no call,
no show, no explanation for it, and there is in combination
with that concern about some observations they're making
of her mental health, absolutely I think that it's [the
State's] job to bring that then to the Court's
attention. That's probable cause right there.
circuit court noted that it was just looking at whether there
was "probable cause that a conditional release has been
violated," and that an ALJ would determine
dangerousness. Ms. Simms informed the court that she did not
believe "the missed appointments [are] valid based on
the flow of things at QCI at the time." The court
granted the State's request and issued a hospital
warrant, pursuant to CP § 3-121, on September 14, 2017,
noting that "probable cause exists that [Ms. Simms]
violated a conditional release[, ] and ordering that Ms.
Simms be transferred to the [Perkins Hospital] for evaluation
and examination." The order set the matter for an
administrative hearing at Perkins Hospital within ten days
after the execution of the warrant.
admission at Perkins Hospital, Ms. Simms was evaluated by Dr.
Monica Chawla who reported that Ms. Simms was "guarded,
minimized the significance of her symptoms, and lacked
insight into her mental illness." However, Dr. Chawla
determined that Ms. Simms would not pose a danger to self or