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D.L. v. Sheppard Pratt Health System, Inc.

Court of Appeals of Maryland

August 13, 2019

D.L.
v.
SHEPPARD PRATT HEALTH SYSTEM, INC., et al.,

          Argued: January 4, 2019

          Circuit Court for Howard County Case No. 13-C-15-103393

          Barbera, C.J., Greene, [*] McDonald, Watts, Hotten, Getty, Rodowsky, Lawrence F. (Senior Judge, Specially Assigned), JJ.

          OPINION

          GETTY, J.

         In 2015, an Administrative Law Judge ("ALJ") involuntarily admitted Petitioner, D.L., to a facility operated by Respondent, Sheppard Pratt Health Systems, Inc. ("Sheppard Pratt") in Ellicott City, Maryland. After D.L. was released from Sheppard Pratt, she filed a petition for judicial review in the Circuit Court for Howard County challenging her involuntary admission. Without holding a hearing, the circuit court granted Sheppard Pratt's motion to dismiss on grounds of mootness because D.L. had already been released from the facility. Accordingly, the primary issue within this case is whether judicial review of an ALJ's involuntary admission decision is mooted by the juvenile's release.[1]

         Ultimately, we hold that D.L. is subject to collateral consequences stemming from her involuntary admission and, therefore, the circuit court erred in dismissing the case as moot. In accordance with this determination, we remand the case to the circuit court for further proceedings on D.L.'s petition for judicial review. Although D.L. also presents us with an issue of whether the Court of Special Appeals erred in determining she failed to preserve the capable of repetition yet evading review exception to the mootness doctrine, we need not resolve this inquiry based on our conclusion regarding collateral consequences.

         BACKGROUND

         A fourteen-year-old girl, D.L., presented at the emergency department of MedStar Southern Maryland Hospital ("MedStar Southern") with fresh cut wounds along her left arm stretching from her elbow to her wrist. In addition to the new cuts, the arm of D.L. displayed scars from prior cuts. D.L. confessed to staff that the superficial wounds and scars were self-inflicted using a razor blade.

         According to the testimony of Katie Krauch, a hospital representative for Sheppard Pratt at Ellicott City, before an ALJ, D.L. was brought to MedStar Southern by a police officer from Prince George's County. After being examined by two physicians, she was certified with a "diagnosis of other specified depressive disorder with the following symptoms, impulsive disturbance in eating and sleeping, poor insight and judgment, engaging in self-mutilation."

         Ms. Krauch testified that Dr. Banks, one of the physicians at MedStar Southern who evaluated D.L., wrote that the patient was in need of institutional inpatient care and treatment because the she was impulsive, had severely impaired insight and judgment, and felt helpless and hopeless. In addition, Ms. Krauch summarized the assessment made by Dr. Banks that

[D.L.] presents a danger to her own life or [the] life or safety of others because the patient is severely depressed and recently engaged in self-mutilation which places her at great risk of self-harm. The patient is unable to be voluntarily admitted as evidenced by the patient is a minor and in the care and custody of [the local Department of Social Services ("DSS")] and [Child Protective Services ("CPS")]. There is no less restrictive [form of intervention] than in-patient psychiatric care available for the patient which is consistent with [her] welfare and safety and that the severity of the patient's symptoms places her in need of 24 hour care and supervision[.][2]

         Based upon this assessment, D.L. was initially confined to Sheppard Pratt-Ellicott City on March 26, 2015. The ALJ conducted the hearing at Sheppard Pratt-Ellicott City on April 7. In addition to the testimony of Ms. Krauch cited above, the attending psychiatrist, Dr. Laura Seidel, testified. Regarding the need for D.L. to be involuntarily committed, Dr. Seidel stated that,

[s]he exhibits symptoms of severe depression where she's had decreased energy, hypersomnia where she's been in bed pretty much for the past 24 hours, not participating in the activities and the groups on the unit. Some decrease in appetite and she has expressed some hopelessness about, you know, the discharge plans that her DSS worker is, is kind of forming with myself and the team.

         When the ALJ asked Dr. Seidel whether D.L. represents a danger to herself or others, Dr. Seidel responded,

I do, partly because she [ ] has been in [ ] three foster homes and the last one that she went in when she finally became hopeless, towards the end she ended up going to a store and bought a razor blade and cut herself actually in the store, you know, multiple marks on her arms. And I feel like she could be at risk of doing that again if she had access to a sharp object and given her level of depression and her hopelessness.

         Dr. Seidel added her opinion that she did not believe D.L. was a danger to others but only to herself. Her conclusion was primarily based on D.L.'s earlier self-injurious behavior.

         Before the ALJ, the primary point of contention was whether a less restrictive form of intervention was available at the time. When asked, Dr. Seidel testified that she did not believe such an alternative was available due to a lack of available placement beds. Based upon her earlier discussions with an individual from the DSS, Dr. Seidel noted that they were attempting to place D.L. at two alternative facilities, the Berkeley & Eleanor Mann School and Residential Treatment Center at the Sheppard Pratt Towson Campus ("Mann RTC") and Stone Bridge psychiatric respite facility ("Stone Bridge").[3] However, she indicated that at the time, both facilities lacked an available bed for admission.

         Regarding the availability of space at Mann RTC, Dr. Seidel testified that, "[a]t this point[, ] they're still working on the insurance authorization but she has been accepted and we're hoping that there will be a bed, there is a bed available that the insurance will come through, you know, by Friday of this week." Concerning placement at Stone Bridge, she testified that:

The other option [ ] presented is [Stone Bridge] . . . which there may be an opening today but there may not. [A DSS employee], you know, [ ] would look into that if [D.L.] was released but she did not say that there was a definite spot at [Stone Bridge] where she could be placed today.

         However, Dr. Seidel also testified that D.L. did not wish to return to Mann RTC. Instead, she preferred placement in a therapeutic foster home.

         Based on this testimony, Sheppard Pratt argued that there was no less restrictive form of intervention available at the time, and, therefore involuntary admission was appropriate under § 10-617(a)(5) of the Health-General Article ("HG"). Whether an institution offers a form of intervention rightfully considered a less restrictive alternative form of intervention generally depends upon the level of supervision and security within an institution and the extent to which a patient retains individual autonomy. In-patient facilities such as foster care, therapeutic foster care, group homes, independent/alternative living programs, residential treatment centers, behavioral programs, and, in some situations, out-patient care are considered less restrictive forms of intervention compared to psychiatric hospitals. See generally 2018 Data Resource Guide, Section IV: Committed Programs, Maryland Department of Juvenile Services at 139-140, 160, available at: https://djs.maryland.gov/Documents/DRG/Data_Resource_Guide_FY2018_full_book.pd f (last visited Aug. 12, 2019) (outlining and explaining the types of psychological treatment programs available to adolescents within the State). Accordingly, in the instant appeal, Mann RTC and Stone Bridge both constitute less restrictive forms of intervention when compared to involuntary admission at Sheppard Pratt.

         The ALJ concluded that there was clear and convincing evidence that D.L.: (i) was diagnosed with major depressive disorder; (ii) presented a danger to her own life and safety; (iii) was in need of institutional care or treatment; (iv) was insufficiently assisted under her current placement in therapeutic foster care; and (v) if released, there was a substantial likelihood that she would resort to self-injurious behavior again in the future. In addition, the ALJ concluded that there was clear and convincing evidence that no less restrictive form of intervention, consistent with D.L.'s welfare, was available at the time. On this issue, the ALJ commented, "I have the possibility that something might or might not be available today. That is not clear and convincing that [a less restrictive form of] intervention is available."

         Subsequently, D.L. filed a petition for judicial review of the ALJ's decision, pursuant to HG § 10-633, in the Circuit Court for Howard County on May 1, 2015. In her petition for judicial review, the sole issue presented was whether there was sufficient evidence that no less restrictive form of intervention was available. In response, on June 18, 2015, Sheppard Pratt filed a motion to dismiss alleging that the controversy was moot because D.L. had been released from Sheppard Pratt on April 10, 2015. Thereafter, the parties exchanged numerous responsive motions.[4] Subsequently, the circuit court granted Sheppard Pratt's motion to dismiss, without holding a hearing, in an order dated July 28, 2015 on the basis that the case was moot due to D.L.'s release.

         D.L. then filed a motion to alter or amend the circuit court's order in which she argued that the circuit court erred by dismissing her petition for judicial review on August 12, 2015 without holding a merits hearing. Specifically, she argued that she was entitled to a hearing on the merits under Maryland Rule 7-208(b) that provides that after the record associated with an administrative law judge's decision is filed in the circuit court, the court shall set a date for a "hearing on the merits." The circuit court disagreed and again without holding a hearing issued an order dated September 15, 2015, that denied D.L.'s motion to alter or amend. Following D.L.'s first motion to alter or amend, but preceding the circuit court's disposition on the motion, D.L. filed a second motion to alter or amend on August 24, 2015 arguing that the circuit court erred in denying her motion to strike Sheppard Pratt's "Reply Memorandum in Support of Motion to Dismiss[.]" The circuit court denied her second motion to alter or amend on October 5, 2015. On October 16, 2015, D.L. filed a notice of appeal in the circuit court to appeal its decision to the Court of Special Appeals.

         Before the intermediate appellate court, the parties filed a joint motion to remand the case to the circuit court. The motion was primarily based on the circuit court's failure to hold a hearing in the case. Paragraph 12 of the motion provided the basis on which the parties agreed remand was warranted:

The parties are in accord that justice will be served by remanding the matter [to] the Circuit Court for a hearing. In particular, the parties request a remand for the Circuit Court to first consider after argument Appellee Sheppard Pratt Health[] System's Motion to Dismiss. Thereafter, depending on the disposition of that motion, the Circuit Court may also consider after argument [D.L.]'s Petition for Judicial Review.

         The parties also stipulated in the motion that no further briefing was required and that the court should remand solely for the purposes of conducting a hearing. On May 9, 2016, the Court of Special Appeals granted the motion, stayed the appeal, and remanded "for the limited purpose of conducting a hearing on the motion filed by [Sheppard Pratt.]"

         On October 13, 2016, in accordance with the intermediate appellate court's remand, the circuit court held a hearing on Sheppard Pratt's motion to dismiss. Therein, the circuit court judge commented that it was unclear what was before him due to the unusual procedural posture of the case. The judge explained that motions to dismiss originating from administrative appeals are rather uncommon and expressed confusion over what materials are encompassed in the record and should rightfully be considered.

         The hearing transcript reveals that there was also an issue as to the scope of the circuit court's review on remand. Counsel for D.L. argued that she was entitled to a hearing on the merits and that dismissal based on mootness is inappropriate within the context of judicial review of involuntary admission decisions. In addition, counsel for D.L. made an additional argument indicating that the potential of collateral consequences stemming from involuntary admissions may overcome mootness. In contrast, Sheppard Pratt argued that the hearing was limited to mootness, D.L. had been released from commitment, the case lacked a justiciable controversy, and therefore the circuit court's earlier dismissal as moot was warranted. In reference to the scope of the hearing, the judge commented several times that the remand was limited in nature:

Because I think the only thing I'm authorized to do today is to conduct a hearing on the issue of mootness
Quite frankly, when I review the transcript [of the ALJ hearing], it does seem to me that [Sheppard Pratt presented sufficient evidence that no less restrictive form of intervention was available]. But I'm just here to make a determination as to whether or not the case has become moot because she was discharged three days later.
But would you agree with me that, that the remand in this particular case was very specific and narrow in that I was directed to conduct a hearing essentially on the issue of the Motion to Dismiss.

         On November 4, 2016, the circuit court issued its memorandum and order. Therein, the court analyzed two questions: (i) whether D.L.'s petition for judicial review was moot; and (ii) if the petition was moot, should Sheppard Pratt's motion to dismiss be granted? The circuit court first found that D.L.'s petition was moot because she had already been released. The circuit court commented, "[t]he only status of which [D.L.] complains no longer exists. Under these facts and circumstances, [D.L.]'s Petition is moot."

         Second, the court analyzed whether the public interest exception to the mootness doctrine applied. Relying primarily on Lloyd v. Supervisors of Elections, the circuit court determined that the public interest exception was not implicated. 206 Md. 36, 42-43 (1954). In particular, the circuit court determined that D.L. presented insufficient evidence that the matter would frequently recur. Accordingly, the circuit court's order granted Sheppard Pratt's motion to dismiss and dismissed the case. On November 28, 2016, D.L. filed a notice of appeal in the circuit court and appealed its second dismissal of her petition for judicial review to the Court of Special Appeals.

         In an unreported opinion dated February 12, 2018, the intermediate appellate court affirmed the judgment of the circuit court and held that the case was moot. In re D.L., No. 2463 Sept. Term, 2015, 2016 WL 7159506 (Md. Ct. Spec. App. Dec. 8, 2016). Rather than dismissing the appeal by order, the Court of Special Appeals considered mootness on its merits including arguments concerning collateral consequences and exceptions to the mootness doctrine.[5] The primary thrust of the Court of Special Appeals' analysis was whether possible collateral consequences existed because of D.L.'s involuntary admission. The court considered several areas in which D.L. alleged the existence of collateral consequences including restrictions on future employment, firearm ownership, driving license privileges, immigration, and the social stigmatization of mental illness. Ultimately, however, the court held that any possible collateral consequences originating from D.L.'s involuntary admission already existed because of her prior stay at Mann RTC. Second, the court held that the public concern exception to the mootness doctrine was inapplicable and arguments concerning the capable of repetition, yet evading review exception were not made in the courts below and therefore, not properly preserved.

         Subsequently, D.L. petitioned this court for writ of certiorari, which we granted. D.L. v. Sheppard Pratt Health System, 461 Md. 480 (2018). In her petition for writ of certiorari, D.L. presents us with two questions for review:

1. Did the Court of Special Appeals err in concluding that D.L.'s challenge to her involuntary admission was moot and, alternatively, that no exception to the mootness doctrine applied?
2. Did the Court of Special Appeals err in concluding that the applicability of the capable-of-repetition-yet-evading-review exception to the mootness doctrine was not preserved for appellate review?

         STANDARD OF REVIEW

         When reviewing the grant of a motion to dismiss, the appropriate standard of review "is whether the trial court was legally correct." Blackstone v. Sharma, 461 Md. 87, 110 (2018) (quoting Davis v. Frostburg Facility Operations, LLC, 457 Md. 275, 284 (2018)). Therefore, "[w]e review the grant of a motion to dismiss de novo. We will affirm the circuit court's judgment 'on any ground adequately shown by the record, even one upon which the circuit court has not relied or one that the parties have not raised.'" Sutton v. FedFirst Fin. Corp., 226 Md.App. 46, 74 (2015) (citations omitted), cert. denied, Sutton v. FedFirst Fin., 446 Md. 293 (2016).

         DISCUSSION

         We begin our analysis with a brief discussion of the procedural framework surrounding involuntary admissions. Title 10 Subtitle 6 of the Health-General Article ("HG") regulates the admissions of individuals, either voluntary or involuntary, to certain facilities. Pursuant to HG § 10-613, an involuntary admission "includes every admission of a minor to a State facility unless the admission is [ ] voluntary[.]" HG § 10-613. A "facility" is statutorily defined as "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." HG § 10-101(g)(1).[6] Before an individual can be involuntarily admitted, several statutorily enumerated factors must be met. HG § 10-617(a), in pertinent part, provides these factors and limits the applicability of involuntary admission to situations where,

(1) The individual has a mental disorder;
(2) The individual needs inpatient care or treatment;
(3) The individual presents a danger to the life or safety of the individual or of others;
(4) The individual is unable or unwilling to be admitted voluntarily; and
(5) There is no available less restrictive form of intervention that is consistent with the welfare and safety of the individual.

         In the present appeal, D.L. sought judicial review of the ALJ's admission decision with respect to only one of these factors-the fifth. In other words, D.L. presented only one issue in her petition for judicial review: whether there was sufficient evidence presented to the ALJ that no less restrictive form of intervention was available. We now turn our analysis to a consideration ...


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