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

465 Md. 339

214 A.3d 521

D.L.

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

No. 38, Sept. Term, 2018

Court of Appeals of Maryland.

August 13, 2019

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.

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.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 ; (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...