Circuit Court for Howard County Case No. C-13-FM-18-50
Friedman, Beachley, Wells, JJ.
Circuit Court for Howard County granted Appellee, the Clifton
T. Perkins Hospital Center's ("Perkins")
petition for a guardianship of the person for Appellant,
Ronald Meddings, a criminal defendant diagnosed with
schizophrenia and atrial fibrillation. Meddings has
resided at Perkins since 2017 after he was found incompetent
to stand trial for assault. After a bench trial on
Perkins' petition, the court found that Meddings was
disabled and appointed Meddings' brother, Fred Osborne,
as his guardian.
filed a timely appeal and asks the following question:
"Did the Trial Court err in finding that no less
restrictive form of intervention is available?"
reasons discussed below, we affirm.
AND PROCEDURAL HISTORY
Meddings, age 68, has had a long history of mental and
physical health problems. At some point during his life,
Meddings was diagnosed with schizophrenia. According to the
testimony of his brother, Fred Osborne, Meddings has received
at-home, self-living, outpatient, and in-patient medical care
since the 1970's. In 2008, the circuit court appointed a
guardian to make decisions regarding Meddings' finances
and property. In the Matter of Ronald L. Meddings,
Circuit Court for Cecil County, Maryland, 07-D-08-523.
2017, while Meddings was being treated at a Veterans
Administration Hospital in Baltimore, he allegedly approached
a nurse, grabbed her by the neck, and attempted to choke her.
As the nurse tried to defend herself, she and Meddings fell
to the floor. Security personnel had to forcibly remove
Meddings from the nurse, but he continued to try to kick her.
As a result of this incident, the State charged Meddings with
first and second-degree assault. During that prosecution, the
Department of Health and Mental Hygiene confirmed that
Meddings suffered from schizophrenia. The circuit court found
Meddings incompetent to stand trial and committed him to
Perkins on August 7, 2017.
Issues that Led Perkins to File for Guardianship
number of issues arose after Meddings was committed.
First, Meddings refused to take psychotropic
medication or drugs prescribed to treat his atrial
fibrillation. As a result, Perkins resorted to the use of a
Clinical Review Panel ("CRP"). A CRP is a group of
Perkins doctors and other medical professionals who convene
at 90-day intervals to review and approve Meddings'
anti-psychotic medicine. Once the panel approves the
medication, and if Meddings refuses to take it, Perkins staff
may forcibly administer it to him. From the time Meddings
arrived at Perkins in August 2017 until April 2018, when
Perkins filed for guardianship, a CRP had to be convened
three times. On each occasion, the CRP determined that
Meddings' psychotropic medications, Squetiapine,
Oxcarbazepine, and Benztropine, were appropriate. Meddings
was involuntarily medicated based on the panel's
approval. Even after taking these drugs, Meddings remained
according to the testimony of Meddings' doctors,
treatment of Meddings' atrial fibrillation is not subject
to the CRP. Meddings was prescribed the drug Metoprolol to
treat his heart problem, but he refused to take it. With his
atrial fibrillation untreated, according to his doctors,
Meddings risks having a heart attack or stroke. Meddings'
doctors fear if he had either a stroke or heart attack, he
will need additional medical treatment, in which case the CRP
would be ineffective as the CRP may be used only to treat
Meddings' mental health issues.
Meddings did not have an advance medical directive. This fact
complicated the range of options available to Perkins should
Meddings need somatic medical treatment, since Meddings never
made known his intentions for extraordinary medical
intervention should he be physically incapacitated and in
need of such care. As there was no way to force Meddings to
treat his coronary problems via the CRP, the risk that he
would need some sort of somatic intervention increased.
address these on-going concerns, on April 20, 2018, Perkins
filed a petition in the Circuit Court for Howard County
seeking the appointment of a guardian for Meddings'
person. As Meddings did not have the funds to hire his own
attorney, the court appointed counsel for him. On May 31,
2018, the court named the Howard County Office of Aging as
Meddings' temporary guardian, specifically to approve
administration of somatic medication. After contacting Fred
Osborne, Meddings' brother, Perkins amended the
guardianship petition and added Osborne an interested party
to the proceedings.
Summary of Trial Testimony
August 5, 2018, the court, sitting without a jury, heard
testimony on Perkins' petition for guardianship. At
trial, Meddings' psychiatrist at Perkins, Dr. Htwe,
testified that Meddings' prior diagnoses of schizophrenia
and atrial fibrillation were accurate. According to Dr. Htwe,
Meddings suffers from "psychosis, paranoia, hearing
voices," and delusions. As a result, Meddings is often
irritable and can frequently be heard yelling and screaming.
to Dr. Htwe, Meddings has had several violent outbursts that
placed him or others at risk of physical harm while at
Perkins. For example, Dr. Htwe recounted that on one occasion
Meddings attempted to jump over the nurse's station and
tried to attack a nurse. On a different occasion, Meddings
threw his glasses over the nurse's station. At times,
Meddings has thrown shoes at Dr. Htwe. On another occasion,
Meddings assaulted a Perkins security guard. During yet
another episode, Meddings was so violent that he required
five restraints to contain him.
Meddings' heart problems, Dr. Htwe testified that because
of his atrial fibrillation, a clot could form on
Meddings' heart. If this were to happen, Dr. Htwe feared
that Meddings might suffer "a stroke, heart attack, and
lead to. . . losing the limbs for instance causing
gangrene." Additionally, the doctors are unsure whether
Meddings may also suffer from a "seizure disorder,
chronic COPD, [and/or] chronic obstructive lung
disease." According to Dr. Htwe, Meddings needs to see a
heart specialist to treat his atrial fibrillation and any
other cardiovascular issues. Meddings was prescribed the drug
Metoprolol for atrial fibrillation. Dr. Htwe noted that,
"95 percent of the time, he's not taking it. Lately
he is not taking it." Specifically, Dr. Htwe noted that
Meddings did not take the Metoprolol in July or August of
Htwe testified that Meddings does not understand the
diagnosis for schizophrenia nor for atrial fibrillation. In
Dr. Htwe's view, Meddings has no ability to
"understand, make, and communicate decisions with
respect to his health care." Meddings refuses to
voluntarily take medication, which Dr. Htwe believes to be a
result of the schizophrenia. Further, Dr. Htwe noted that
Meddings has no healthcare advance directive on file because
"he is unable to do it and understand the concept of it.
So [Perkins] couldn't do it" and Meddings does not
have the ability to complete one at present. In fact, Perkins
never attempted to ask Meddings to sign one because
"it's very, very difficult to engage him. Let alone
the advance directive involves quite a bit of
Htwe opined that the CRP is not an effective long-term
treatment plan for Meddings. In addition to the CRP not being
able to approve somatic medications, Dr. Htwe noted that the
CRP is by necessity an adversarial process where he, as
Meddings' doctor, is pitted against him. According to Dr.
Htwe, the CRP "has already affected the . . .
relationship between me and him." Further, according to
Dr. Htwe, the CRP is time-limited in that the period for
which involuntary medication is approved is only ninety (90)
days. In Dr. Htwe's opinion, the CRP is an unstable
procedure because a medication approval could lapse without
vigilant monitoring, leaving Meddings without a necessary
drug. Dr. Htwe alluded to an instance in January 2018 when
Meddings' psychotropic medicines ran out, the CRP could
not be convened quickly, and Meddings "was really out of
control." "So we learned the hard way this
January." Overall, Dr. Htwe felt that the CRP was
unreliable and bad for the doctor-patient relationship.
second psychiatrist at Perkins, Dr. Samer Patel, who sees
Meddings several times per year, testified that he has tried
to communicate with Meddings about the schizophrenia
diagnosis. According to Dr. Patel, Meddings' disorganized
thinking leads Meddings to believe that he is not
schizophrenic. In fact, Dr. Patel said Meddings,
"believes he is being held [at Perkins] against his will
and that we are poisoning him with medications." When
asked if Meddings was ever part of a conversation about
taking medications after discharge from Perkins, Dr. Patel
responded: "When I spoke with [Meddings in mid-June
2018, ] he said he did not feel he needed to take
medications, that it was poison, and that we were holding him
hostage and feeding him poison." Dr. Patel also tried to
discuss Meddings' somatic problems with him, which was
Dr. Htwe, Dr. Patel's testimony described episodes of
Meddings' aggressive behavior, including an incident that
occurred in May 2018, when Meddings "ran to the bathroom
and tried to unscrew a pipe from the sink. When staff
inquired what he was going to do he said he was going to
unscrew it to assault staff with it." Staff brought in
security personnel who restrained him.
Patel opined that Meddings lacks the capacity to make his own
health care decisions and testified that he thought a
guardianship would be the best alternative. "I think he
would need guardianship to be able to maintain his safety at
this time." Dr. Patel specifically stated that the CRP
has undermined Meddings' relationship with Dr. Htwe, his
primary psychiatrist, because Dr. Htwe has had to testify
against Meddings at the CRP hearings, "upsetting"
Meddings. Dr. Patel also noted that the CRP cannot address
Meddings' somatic needs.
Osborne, Meddings' brother who put himself forward to be
Meddings' guardian, also testified. Osborne stated that
his brother "needs medical attention whether he wants it
or not. He needs to be medicated, he needs to be under
care." After recounting Meddings' physical and
mental decline over more than a dozen years, Osborne told the
I am here for purposes of meds more than anything else. I
know that right now he's not capable of performing or
doing and living on his own, or even in a controlled
out-patient kind of scenario. It's not there. I just want
the Court to understand that I am here for him. That's
end of the testimony and counsels' arguments the court
recessed. The judge later returned and said the following:
Thank you very much. Well, I accept the expert testimony that
the defendant has schizophrenia, thought disorder, psychosis,
paranoia, not fully oriented in time, month, year.
Doesn't understand his diagnosis, won't take his
He is aggressive, throwing things, assaulting officers,
yelling and screaming, trying to choke a nurse at the
nurse's station, fighting with his peers. And he also has
the somatic issue of atrial fibrillation which could be a
very serious impediment to his health in terms of blood clots
and strokes and heart attacks.
I do find by clear and convincing evidence that the
respondent lacks sufficient understanding or capacity to make
or communicate responsible decisions concerning his health
care. And that because of his mental disability,
schizophrenia, no less-restrictive form of intervention is
available that is consistent with his welfare and safety.
And I would appoint, hearing no objection, I would appoint
Mr. Fred Osbourne to serve as the guardian of his person.
And, Counsel, would you submit an order consistent with
that? Meddings, through counsel, subsequently
filed this appeal.
parties do not agree on the appropriate standard of appellate
review. Meddings urges us to employ the least deferential
standard, namely, de novo review. He argues that the circuit
court committed legal error in interpreting Maryland Code
Annotated (1974, 2017 Repl. Vol.), Estates and Trusts Article
("E&T") §13-705(b)(2),  when it
determined that there "was no less restrictive form of
intervention available in Meddings' case." Meddings
specifically states in a footnote that clear error should not
be the standard. "[T]he Trial Court made a legal
conclusion based on findings of fact; thus, the clearly
erroneous standard does not apply."
support of his position, Meddings relies on our holding in
Simbaina v. Bunay, 221 Md.App. 440 (2015), a custody
case concerning a "special immigrant juvenile"
(SIJ). The Circuit Court for Baltimore City denied
mother's request to amend a judgment of absolute divorce
to include factual findings that the child at the center of
the parties' custody dispute was an SIJ. Id. at
447. In taking up the appeal, we acknowledged that,
generally, we review the circuit court's denial of a
motion to alter or amend judgment using the abuse of
discretion standard. Id. at 448. But we concluded
that when the circuit court, sitting as a court of equity,
has issued an order that involves an interpretation and
application of Maryland constitutional, statutory, or case
law, our Court must determine whether the trial court's
conclusions are 'legally correct' under a de novo
standard of review." Simbaina, 221 Md.App. at
448 (quoting Schisler v. State, 394 Md. 519, 535
also favorably cites Himelstein v. Arrow Cab, 113
Md.App. 530 (1997), aff'd., Arrow Cab v.
Himelstein, 348 Md. 558 (1998), in which this Court was
asked to consider whether a security interest held by the
Maryland Motor Vehicle Administration was an asset that could
be used to satisfy a claim against Arrow Cab for injuries a
passenger, Himelstein, sustained in an accident involving a
cab. Id. at 533. The issue was whether Arrow Cab, as
a separate entity, could use the security interest to satisfy
the judgment, or whether the security interest was an asset
of individual cab owners who were members of the
unincorporated association trading as "Arrow Cab."
Id. at 531-32. The Circuit Court for Baltimore City
found that the interest was held by the individual cab owners
and could not be used to satisfy Himelstein's judgment.
Id. at 534-35.
considering the merits of Himelstein's appeal, we first
had to determine the appropriate standard of review. As the
matter was tried without a jury, we determined that Rule
8-131(c) mandated that we apply clear error to the circuit
court's factual determinations. Himelstein, 113
Md.App. at 536. But, because the central issue was the
circuit court's interpretation of the Maryland
Self-Insurance regulation (COMAR 20.90.02.19 (as in effect in
1997)), we concluded that the de novo standard was
appropriate. Id. "Because the trial judge's
interpretation of the statute is a question of law, our
standard of appellate review is whether the lower court was
'legally correct.'" Id. (citation
on the other hand, urges us to employ the "clearly
erroneous" standard. In Perkins' estimation, the
circuit court did not engage in interpretation of E&T
§ 13-705(b), but, rather, only applied the facts
presented at trial to the statute. Perkins finds support for
its position in L.W. Wolfe Enters., Inc. v. Maryland
Nat'l Golf, L.P., 165 Md.App. 339 (2005) and
Webb v. Nowak, 433 Md. 666 (2013).
Wolfe was a contractor who performed work for Maryland
National Golf but was not paid. 165 Md. App at 342. After a
show cause hearing, Wolfe was granted an order establishing
an interlocutory lien against Maryland National Golf.
Id. Later, after trial, Wolfe was denied a
mechanic's lien against Maryland National Golf, and the
court terminated the interlocutory order. Id. Wolfe
determined the "clearly erroneous" standard was
appropriate because the trial court exclusively made factual
determinations and applied the law, rather than interpreting
[A]t the hearing, Judge Adams referred exclusively to the
contents of exhibits and testimony when discussing her
finding that the work was repair, in contrast to her
discussion of whether paving work was lienable, in which she
did discuss precedent. The lower court therefore applied the
law in this matter-it did not interpret it. As such, the
"clearly erroneous" standard is indeed the correct
one and we will use it here.
Id. at 345. It should be noted that a second issue,
review of the circuit court's determination of the value
of repairs, required a legal determination. Consequently, we
engaged in an independent appraisal of whether the circuit
court's decision was legally correct. Id.
Webb, the Webbs sued their neighbors, the Nowaks,
alleging that the Nowaks removed timber from Webbs'
property. 433 Md. at 669. The Webbs sought compensatory and
punitive damages, as well as damages under a common law
theory of trespass. Id. The Nowaks filed a
counterclaim seeking a declaratory judgment that they, in
fact, owned the disputed property. Id. After a bench
trial, the Circuit Court for Washington County entered a
judgment in favor of Nowaks. Id. The Webbs appealed.
addressing the merits, the Court of Appeals considered
whether we were correct in applying the clear error standard
of review. Id. at 675. Before the Court of Appeals,
the Webbs argued that because the appeal concerned the
interpretation of a deed, a reviewing court should apply a de
novo standard. Id. at 676. The Nowaks argued that a
boundary dispute, not the interpretation of a deed, was the
issue on appeal. Therefore, in the Nowaks' view, we
applied the proper standard, clear error. Id. The
Court of Appeals agreed with the Nowaks, holding:
We agree with Respondents' [the Nowaks'] contention
that the "clearly erroneous" standard is the
correct standard of appellate review for this case. In
Union United Methodist Church, Inc. v. Burton, 404
Md. 542, 556 (2008), we held that "the ultimate
determination by the circuit court of the proper location of
[a] disputed boundary is a question of fact, which we shall
review for clear error." Further, according to
Millar v. Bowie, 115 Md.App. 682, 688 (1997)
"[i]t is clear that a decision of a trial judge, sitting
without a jury, that resolves a boundary line dispute, is not
to be disturbed unless clearly erroneous."
Webb, 433 Md. at 676.
Meddings' case, the circuit court conducted a bench trial
to determine whether a guardianship was appropriate.
Accordingly, we look to Rule 8-131(c), which states in its
(c) Action Tried Without a Jury.-When an action has been
tried without a jury, the appellate court will review the
case on both the law and the evidence. It will not set aside
the judgment of the trial court on the evidence unless
clearly erroneous, and will give due regard to the
opportunity of the trial court to judge the credibility of
Md. Rule 8-131(c). Writing for this Court in Starke v.
Starke, 134 Md.App. 663, 669 (2000), Judge Moylan made
clear that "Rule 8-131(c) applies only to verdicts,
conferring on an appellate court the authority to review a
verdict on the evidence." Indeed, "no such review
of the sufficiency of the evidence was traditionally
available in a court trial, however, because a judge, in his
capacity as a legal referee, was not required to make a legal
ruling before submitting the case to himself, in his capacity
as a fact finder." Id. As has been noted, the
Rule informs us that the circuit court's factual
determinations that form the court's verdict are subject
to clear error review. Himelstein, 113 Md.App. at
536. "This Court 'will not set aside the judgment of
the trial court on the evidence unless clearly erroneous, and
will give due regard to the opportunity of the trial court to
judge the credibility of the witnesses.'" L. W.
Wolfe, 165 Md.App. at 343 (citations omitted). "If
there is any competent and material evidence to support the
factual findings of the trial court, those findings cannot be
held to be clearly erroneous." Id.
research has found scant discussion of the appropriate
standard of review in adult guardianship cases. However, in
one case, Mack v. Mack, 329 Md. 188, 191 (1993), the
Court of Appeals affirmed in part and reversed in part a
circuit court's decision regarding the guardianship of
Ronald Mack, an adult who was hospitalized in "a
persistent vegetative state." Specifically, the Court of
Appeals reviewed the circuit court's decision to appoint
a temporary guardian before the court sorted out dueling
petitions for guardianship between Mack's father and
Mack's wife. Id. 194-95. The circuit court also
ordered that life support could not be withdrawn, as