D.L.
v.
SHEPPARD PRATT HEALTH SYSTEM, INC., et al.
Page 522
Circuit Court for Howard County, Case No. 13-C-15-103393,
Timothy J. McCrone, Judge.
Argued
by Michael T. Torres, Asst. Public Defender (Paul B. DeWolfe,
Public Defender of Maryland, Baltimore, MD), on brief, for
Petitioner.
Argued
by Susan Sugar Nathan (Susan Sugar Nathan, P.A., Riderwood,
MD; Morgan E. Clipp, Asst. Atty. Gen. and Brian E. Frosh,
Atty. Gen. of Maryland, Baltimore, MD), on brief, for
Respondents.
Argued
before: Barbera, C.J. [*] Greene, McDonald, Watts, Hotten,
Getty, Lawrence F. Rodowsky (Senior Judge, Specially
Assigned), JJ.
OPINION
Getty,
J.
[465
Md. 341] 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]
[465
Md. 342] 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
Page 523
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 [465 Md.
343] 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 [465
Md. 344] 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
Page 524
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:
[465 Md. 345] 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.pdf
(https://perma.cc/ST98-VEUJ) (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;
Page 525
(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 [465 Md. 346] 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 [465 Md. 347] 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:
Page 526
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 [465 Md. 348] 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) [465
Md. 349] 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
Page 527
exception was not implicated. 206 Md. 36, 42-43, 111 A.2d 379
(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 [465 Md. 350] 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, 194 A.3d 935 (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, 191 A.3d 1188 (2018) (quoting Davis v. Frostburg
Facility Operations, LLC, 457 Md. 275, 284, 177 A.3d 709
(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, 126 A.3d 765 (2015)
(citations omitted), cert. denied, Sutton v.
FedFirst Fin., 446 Md. 293, 132 A.3d 195 (2016).
Page 528
DISCUSSION
We
begin our analysis with a brief discussion of the procedural
framework surrounding involuntary admissions. [465 Md. 351]
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 ...