Johnson v. Md. Dep't of Health

470 Md. 648

236 A.3d 574

Gregory JOHNSON

v.MARYLAND DEPARTMENT OF HEALTH

No. 71, Sept. Term, 2019

Court of Appeals of Maryland.

August 24, 2020

Argued by Anthony J. May (Andrew D. Levy, Brown Goldstein & Levy, LLP, Baltimore, MD) and Emily Datnoff (Disability Rights Maryland, Baltimore, MD), on brief, for Appellant.

Argued by Nicole Lugo Clark, Asst. Atty. Gen. (Ari S. Elbaum, Asst. Atty. Gen. and Brian E. Frosh, Atty. Gen. of Maryland, Baltimore, MD), on brief, for Appellee.

Barbera, C.J., McDonald, Watts, Hotten, Getty, Booth, Biran, JJ.

Biran, J.

After Gregory Johnson allegedly stabbed his neighbor, he was charged with attempted first-degree murder and related offenses. Prior to this incident, Mr. Johnson had an almost decade-long history of harboring irrational, persecutory beliefs. After receiving a competency evaluation of Mr. Johnson, a circuit court judge in Baltimore City found Mr. Johnson incompetent to stand trial and dangerous, and committed him for treatment to Clifton T. Perkins Hospital Center ("Perkins"), a State-run forensic psychiatric hospital in Howard County.

At Perkins, Mr. Johnson was diagnosed with Unspecified Schizophrenia Spectrum and Other Psychotic Disorder. After Mr. Johnson repeatedly refused to take antipsychotic medication that psychiatrists at Perkins prescribed for him, the Maryland Department of Health (the "Department") began the process under the applicable Maryland statute to administer the medication to Mr. Johnson involuntarily. A clinical review panel at Perkins determined that the prescribed medication was necessary, among other reasons, to restore Mr. Johnson to competency, and informed Mr. Johnson that the Department approved the administration of the medication to him for a period of 90 days. Mr. Johnson then exercised his right under statute to a de novo administrative hearing to review the panel's conclusion. After holding that hearing, an administrative law judge ("ALJ") ordered Mr. Johnson's involuntary medication to restore Mr. Johnson to competency. Mr. Johnson then sought judicial review of the ALJ's decision, and a circuit court judge upheld the ALJ's order.

Mr. Johnson argues that the Maryland statute governing involuntary medication does not authorize the Department to medicate a person for the purpose of competency restoration. Mr. Johnson also argues that, to the extent the statute does authorize involuntary medication to restore competency through an administrative process, it violates Maryland's separation of powers and deprives Mr. Johnson of procedural due process. According to Mr. Johnson, when the Department seeks to forcibly medicate an individual for the purpose of restoring competency to stand trial, the decision to authorize such medication can only be made by the criminal trial judge after holding a hearing during which the defendant has the assistance of criminal defense counsel.

For the reasons discussed below, we hold that Maryland law authorizes involuntary medication to restore an individual's competence to stand trial, and does not violate separation of powers by entrusting an ALJ with the power to order such medication, subject to judicial review. Before the Department may infringe on a person's significant liberty interest in avoiding unwanted psychotropic drugs, the Department and an ALJ must comply with rigorous requirements of due process. Because the Department and the ALJ met these requirements in Mr. Johnson's case, we find no error in the order authorizing Mr. Johnson's involuntary medication.

IBackground

A. Pertinent Statutory Provisions

1. Commitment Following a Finding of Incompetent to Stand Trial

A person accused of committing a crime is presumed competent to stand trial. Wood v. State , 436 Md. 276, 285, 81 A.3d 427 (2013). Title 3 of the Criminal Procedure Article governs the procedures a criminal trial court must use when a defendant's competence is called into question. If, before or during a trial, a defendant "appears to the court to be incompetent to stand trial or the defendant alleges incompetence to stand trial, the court shall determine, on evidence presented on the record, whether the defendant is incompetent to stand trial." Md. Code Ann., Crim. Proc. ("CP") § 3-104(a) (2018 Repl. Vol.). "Incompetent to stand trial" (sometimes abbreviated in this opinion as "IST") means that the defendant is "not able: (1) to understand the nature or object of the proceeding; or (2) to assist in [his or her] defense." Id. § 3-101(f).

Under CP § 3-106(c)(1)(i) :

If, after a hearing, the court finds that the defendant is incompetent to stand trial and, because of mental retardation or a mental disorder, is a danger to self or the person or property of another, the court shall order the defendant committed to the facility that the Health Department designates until the court finds that:

1. the defendant no longer is incompetent to stand trial;

2. the defendant no longer is, because of mental retardation or a mental disorder, a danger to self or the person or property of others; or

3. there is not a substantial likelihood that the defendant will become competent to stand trial in the foreseeable future.

The Department must report to the court whenever the Department believes that the defendant is no longer IST or no longer dangerous because of a mental disorder, or that there is not a substantial likelihood the defendant will become competent to stand trial in the foreseeable future. Id. § 3-108(a)(1)(ii). Whenever the Department makes such a report or otherwise provides the court with "opinions, facts, or circumstances that have not been previously presented to the court and are relevant to the determination" whether the defendant should remain committed, the court must hold a hearing within the next 10 business days to make such a determination. Id. § 3-106(d)(1)(iii). Regardless, the Department must provide the court with a report on the defendant's status every six months. Id. § 3-108(a). A hearing to reassess the defendant's incompetence and dangerousness must be held at least annually, id. § 3-106(d)(1)(i), or upon the filing of a motion by the prosecutor or defense counsel setting forth new facts or circumstances that are relevant to the determination of continued commitment. Id. § 3-106(d)(1)(ii). In addition, the court may hold a conference to review the status of the defendant's commitment at any time on its own initiative. Id. § 3-106(d)(2).

2. Involuntary Medication Under the Health-General Article

The Health-General Article of the Maryland Code provides the process for involuntary administration of psychiatric medication to mentally ill individuals. Md. Code Ann., Health-General ("HG") § 10-708 (2019 Repl. Vol.). Absent an emergency, medication may not be administered to an individual who refuses it unless the individual was admitted to a hospital involuntarily,¹ or was "committed for treatment by order of a court," id. § 10-708(b)(2), including commitment following a finding of IST. In either scenario, a clinical review panel must approve the involuntary medication. Id.

A clinical review panel must consist of: (1) the clinical director of the facility's psychiatric unit (if the clinical director is a physician) or a physician designated by the clinical director; (2) a psychiatrist; and (3) a mental health professional other than a physician. Id. § 10-708(c)(1). A clinical review panel may approve the involuntary administration of medication prescribed by a psychiatrist to treat an individual's mental disorder if the panel determines that the prescribing psychiatrist has exercised reasonable medical judgment and:

Without the medication, the individual is at substantial risk of continued hospitalization because of:

(i) Remaining seriously mentally ill with no significant relief of the mental illness symptoms that:

1. Cause the individual to be a danger to the individual or others while in the hospital; 2. Resulted in the individual being committed to a hospital under this title or Title 3 of the Criminal Procedure Article; or

3. Would cause the individual to be a danger to the individual or others if released from the hospital;

(ii) Remaining seriously mentally ill for a significantly longer period of time with the mental illness symptoms that:

1. Cause the individual to be a danger to the individual or to others while in the hospital;

2. Resulted in the individual being committed to a hospital under this title or Title 3 of the Criminal Procedure Article; or

3. Would cause the individual to be a danger to the individual or others if released from the hospital; or

(iii) Relapsing into a condition in which the individual is unable to provide for the individual's essential human needs of health or safety.

Id. § 10-708(g)(3).

The individual whom the clinical review panel will consider medicating has the right to notice of when and where the panel will convene, id. § 10-708(e)(1)(i), the purpose of the panel, id. § 10-708(e)(1)(ii), and notice of the individual's rights before the panel, which include the right:

(i) To attend the meeting of the panel, excluding the discussion conducted to arrive at a decision;

(ii) To present information, including witnesses;

(iii) To ask questions of any person presenting information to the panel;

(iv) To request assistance from a lay advisor² ; and

(v) To be informed of:

1. The name, address, and telephone number of the lay advisor;

2. The individual's diagnosis; and

3. An explanation of the clinical need for the medication or medications, including potential side effects, and material risks and benefits of taking or refusing the medication.

Id. §§ 10-708(e)(1)(iii) & (e)(2).

A clinical review panel must document its consideration of the issues and the basis for its decision on the administration of medication(s). Id. § 10-708(i)(1). To that end, the panel must provide a written decision to the individual, the individual's lay advisor, and the individual's treatment team. Id. § 10-708(i)(2). If the panel approves the...