Stouffer v. Reid, No. 54, September Term, 2009 (Md. App. 4/19/2010)

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J. MICHAEL STOUFFER, COMMISSIONER OF CORRECTION v. TROY REID.

No. 54, September Term, 2009.

Court of Appeals of Maryland.

Filed: April 19, 2010.

Bell, C.J., Harrell, Battaglia, Greene, Adkins, Barbera, Eldridge, John C. (Retired, specially assigned), JJ.

Opinion by GREENE, J.

The respondent, Troy Reid ("Reid"), an adult male, was committed to the custody of the Commissioner of Correction in 1995 to serve a forty year sentence. Reid's medical history while in the institution revealed a diagnosis of high blood pressure, human immunodeficiency virus and end-stage renal disease.¹ In July 2007, prison medical personnel diagnosed Reid with end-stage renal disease and prescribed the application of kidney dialysis three times per week.² Initially, Reid consented to the dialysis treatment; however, even though he understood the medical consequences of ceasing dialysis (serious bodily injury and even death), he eventually requested that all treatment be terminated. As a result of his refusal to submit to kidney dialysis in April 2008, the petitioner, J. Michael Stouffer, Commissioner of Correction ("Commissioner"), filed a complaint in the Circuit Court for Baltimore City seeking declaratory and injunctive relief to compel Reid to submit to kidney dialysis and medical treatment that medical professionals had determined was necessary.

This case presents the question of whether the Commissioner presented sufficient evidence to override a competent adult inmate's right to object to life-sustaining medical treatment.³ We shall hold that, under the circumstances of the present case, the Commissioner's non-specific claim of preservation of life, safety, and security was insufficient to demonstrate that Reid's refusal of medical treatment would cause a disruption or impact safety in the institution, or endanger the ethics of the medical profession.

Following a hearing in the Circuit Court for Baltimore City, the court denied the Commissioner's request for an injunction. The Commissioner noted a timely appeal to the Court of Special Appeals. Pending the appeal, the Commissioner obtained a temporary injunction permitting Reid's physicians to continue providing Reid with dialysis and other necessary medical treatment. Prior to expiration of the temporary injunction, the Commissioner filed a petition for a writ of certiorari and a motion for injunction pending appeal, which this Court denied. Subsequently, the Court of Special Appeals affirmed the judgment of the Circuit Court denying the Commissioner's request for an order requiring that Reid submit to kidney dialysis. Stouffer v. Reid, 184 Md. App. 268, 965 A.2d 96 (2009). The Commissioner filed an additional petition for a writ of certiorari, which we granted. Stouffer v. Reid, 409 Md. 44, 972 A.2d 859 (2009).

FACTS

The underlying facts are not in dispute. We shall adopt the facts as found by the Circuit Court judge at the hearing held on May 1, 2008, and as subsequently adopted by the Court of Special Appeals in its opinion in Stouffer, 184 Md. App. at 273-76, 965 A.2d at 99-100:

[T]he trial judge, in an oral ruling from the bench, denied [the Commissioner's] request for an permanent injunction and declared that [Reid] had the right to refuse kidney dialysis and other medical treatment:

[The Commissioner] is the head of the Department of Correction. He . . . [has] the responsibility of maintaining the operation of the correctional institutions in the State of Maryland. . . . [Reid] is an inmate within the Department of Correction . . . [and is] a charge of [the Commissioner]. [The Commissioner] has the responsibility of insuring [safety] . . . and provid[ing] proper medical treatment and care for. . . inmates.

* * * *

The testimony submitted by [the Commissioner] . . . is that failure to abide by that medical treatment . . . would negatively impact this inmate. It would impact his heart, his heartbeat, the regularity of his heartbeat, that may cause a heart attack; is that it would cause fluid to build up in the body that is not being taken out of the body under normal means and that fluid may build up in his leg, in his face, in his lungs, and in his lungs could cause respiratory failure and that respiratory failure could lead to heart attack or death.

* * * *

[T]he inmate also has high blood pressure and that failure to receive the treatment in question may impact negatively to his high blood pressure. The impact could lead to the heightening of his blood pressure, that also could lead to stroke.¹

* * * *

Maryland is clear that a mentally competent adult may refuse medical care, even though the refusal may result in his or her death, and that unless there are compelling State interests which override the person's interest in their body's integrity, as the Mack² case says, is that the Court should recognize it.

In this case . . . [what the Commissioner] is saying, [Reid], is that he recognizes that you are a competent individual and he recognizes that you have not been a troubling impact overall while in this facility. That is clearly what is being said here is that you have not disrupted the system; is that it is, in fact, raising the question of concern (a) for your health and trying to make sure that you receive the medical treatment that he and the medical providers say are necessary . . . . [I]t's been determined by the doctors that you need this treatment.

* * * * Additional facts will be presented as necessary for purposes of our discussion.

DISCUSSION

The Commissioner contends that he is entitled to compel Reid to submit to kidney dialysis and medical treatment because the State's legitimate interest in the orderly and safe operation of the state prison system outweighs Reid's right to refuse medical treatment. According to the Commissioner, both the Court of Special Appeals and the Circuit Court "failed to give appropriate deference to the Commissioner and Assistant Commissioner regarding the impact of Reid's refusal to receive life-sustaining medical treatment." The intermediate appellate court's conclusion that the State has not shown a legitimate penological interest in forcing Reid to submit to dialysis, the Commissioner contends, "overlooks the effect of the inmate's refusal to receive life-sustaining treatment on prison security." Finally, the Commissioner maintains that "the State's interest in preserving Reid's life" and the need to "maintain . . . the ethical integrity of the medical profession outweigh[] Reid's limited right to refuse medical treatment" and "his limited interest in refusing medical treatment."

To the contrary, Reid contends that "[the Commissioner] failed to establish a sufficient factual basis constituting a countervailing State interest under Mack v. Mack, 329 Md. 188, (1993)." In addition to failing to establish "any of the four factors enumerated in Mack v. Mack, supra," Reid maintains that we should reject the Commissioner's invitation to expand our decision in Mack, thereby creating an exception that would override Reid's qualified common law right to refuse medical treatment. According to Reid, the evidence does not support the conclusion that his refusal to accept medical treatment constituted a threat to maintenance of prison security and order.

Moreover, Reid points out that the State's authority over prisons and the need to maintain security does not automatically afford the Commissioner the discretion to compel an inmate to submit to medical treatment. Reid maintains that the evidence in this case does not support the proposition that he had any specific intent to "manipulate corrections officials or prison policies." Thus, according to Reid, "[a] significant component in assessing penological interest, is whether there is the presence of a direct threat, a protest or manipulation of prison officials." Reid asserts that here, as the Court of Special Appeals concluded, no such argument was advanced by the Commissioner nor does the record reflect that Reid "is a direct threat to the safety and well being of others" or "that [Reid] is protesting any prison policies or attempting to manipulate an official." Finally, Reid contends that his decision to refuse medical treatment did not threaten the integrity of the medical profession because it was an informed decision made with full knowledge of the risks involved in refusing medical treatment.

As the Court of Special Appeals observed, the Commissioner attempts to distinguish this case from Mack, 329 Md. 188, 618 A.2d 744, on the basis that in Mack we did not address the unique circumstances involved when the right to refuse medical treatment is asserted by a prison inmate. We note at the outset that the Mack case did not involve a prison inmate's refusal to accept medical treatment. In Mack, in the context of whether Maryland law authorized the withholding of life support to a previously competent, adult ward of the court, we had occasion to review the right of a patient, generally, under Maryland law to refuse medical treatment. Mack, 329 Md. at 210-11, 618 A.2d at 755-56. We explained that the "fountainhead of the doctrine [of informed consent] is the patient's right to exercise control over his own body, . . . by deciding for himself [or herself] whether or not to submit to the particular therapy." Mack, 329 Md. at 210, 618 A.2d at 755 (quoting Sard v. Hardy, 281 Md. 432, 439, 379 A.2d 1014, 1019 (1977)). Further, we pointed out that "[a] corollary to the doctrine is the patient's right, in general, to refuse treatment and to withdraw consent to treatment once begun." Id.

In acknowledging this common law right of a mentally competent patient to refuse medical treatment under non-emergency circumstances, we emphasized that it is not an absolute right. It is a right subject to "at least four countervailing State interests: (1) the preservation of life; (2) the protection of interests of innocent third parties; (3) the prevention of suicide; and (4) the...