Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

In re Meddings

Court of Special Appeals of Maryland

December 23, 2019

IN THE MATTER OF RONALD MEDDINGS

          Circuit Court for Howard County Case No. C-13-FM-18-50

          Friedman, Beachley, Wells, JJ.

          OPINION

          Wells, J.

         The 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.[1] 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.

         Meddings 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?"

         For the reasons discussed below, we affirm.

         FACTUAL AND PROCEDURAL HISTORY

         Ronald 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.

         In 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.

         A. Issues that Led Perkins to File for Guardianship

         A 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 actively psychotic.

         Second, 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.

         Third, 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.

         To 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.

         B. Summary of Trial Testimony

         On 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.

         According 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.

         Regarding 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 2018.

         Dr. 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 understanding."

         Dr. 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.

         A 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 similarly unsuccessful.

         Like 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.

         Dr. 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.

         Fred 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 court:

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 it.

         At the 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 meds.
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?[2] Meddings, through counsel, subsequently filed this appeal.

         STANDARD OF REVIEW

         The 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), [3] 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."

         In 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 (2006)).

         Meddings 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.

         Before 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 omitted).

         Perkins, 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).

         L.W. 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 then appealed.

         We determined the "clearly erroneous" standard was appropriate because the trial court exclusively made factual determinations and applied the law, rather than interpreting it.

[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.

         In 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.

         Before 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.

         In 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 entirety:

(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 the witnesses.

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.

         Our 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 Mack's ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.