Beeman v. Department of Health & Mental Hygiene

• Decision Date: 01 September 1994
• Docket Number: No. 1353,1353
• Citation: Beeman v. Department of Health & Mental Hygiene, 658 A.2d 1172, 105 Md.App. 147 (Md. App. 1994)
• Parties: , 6 NDLR P 416 Arlena BEEMAN v. DEPARTMENT OF HEALTH & MENTAL HYGIENE. ,
• Court: Court of Special Appeals of Maryland

Page 147

105 Md.App. 147

658 A.2d 1172, 6 NDLR P 416

Arlena BEEMAN v. DEPARTMENT OF HEALTH & MENTAL HYGIENE.

No. 1353, Sept. Term, 1994.

Court of Special Appeals of Maryland.

June 2, 1995.

Ada E. Cherry-Mahoi, Baltimore (Andrew S. Penn, Landover, on the brief), for appellant.

David R. Morgan, Asst. Atty. Gen. (J. Joseph Curran, Jr., Atty. Gen., on the brief), Baltimore, for appellee.

Argued before BISHOP, DAVIS and HOLLANDER, JJ.

HOLLANDER, Judge.

In this appeal, we consider the extent to which a patient, involuntarily committed to a State psychiatric facility, can be forced to take neuroleptic ¹ and side-effect medications pursuant to Md.Code Ann., Health-Gen. Art. ("HG") § 10-708 (1993). Appellant Arlene Beeman, who was involuntarily committed to the Thomas B. Finan Center (the "Finan Center") for treatment of schizo-affective disorder, refused to take certain drugs prescribed by Dr. E. Michael Ehlers, her psychiatrist. The Finan Center's Clinical Review Panel ("CRP"), convened pursuant to HG § 10-708, authorized Dr. Ehlers to administer a series of drugs, alone or in combination, at a wide range of doses. After holding a de novo hearing, an Administrative Law Judge ("ALJ") at the Office of Administrative Hearings ("OAH") agreed with the CRP's decision. Thereafter, the Circuit Court for Allegany County affirmed the ALJ's decision.

On appeal to this Court, Beeman has raised four issues:

1. Whether the Administrative Law Judge and the circuit court erred in approving forced administration of Cogentin and other side effect medications to involuntary patients even though they are not medications prescribed for treatment of a mental disorder as defined by Section 10-708?

2. Whether the Panel's authorization of the involuntary administration of psychiatric medication up to the maximum allowable therapeutic dosage and in various combinations in nonspecific doses violates the statutory requirement that "the decision shall specify: (1) the medication or medications approved and the dosage and frequency range"?

3. Whether the circuit court improperly ruled that the administrative hearing record contained substantial evidence to support the findings in light of the court's admission that the ALJ hearing audiotape was inaudible and that the court had to rely instead on counsel's representations of what had occurred?

4. Whether the failure of the circuit court to hear the case within the statutorily mandated timeframe constitutes reversible error?

Appellee, the Department of Health and Mental Hygiene ("DHMH"), contends that all of these issues are moot. We agree with DHMH that, based on the posture of this case, all issues are moot. Nonetheless, issues 1 and 2 are worthy of consideration despite their mootness; we conclude that the authorization of forced medication, including medication prescribed for "side-effects," did not violate the requirements of HG § 10-708. On the other hand, the CRP lacked authority to approve any medications or dosage ranges that were not requested by the treating psychiatrist. On the ground of mootness, we decline to consider the procedural questions raised in issues 3 and 4.

Factual Background

The evidence in the thin record in this case essentially consists of a transcript of the audiotapes of the hearing before the ALJ. Unfortunately, the tapes were of such poor quality that the testimony is largely unintelligible. Nevertheless, for the purposes of this appeal, the facts are largely undisputed. Accordingly, we have gleaned the summary that follows from the decisions of the ALJ and the circuit court, along with the few usable portions of the transcript, and as amplified by the uncontested portions of the parties' briefs.

Appellant, who is sixty-two years old, has long been diagnosed as having schizo-affective disorder. More than once, she has been committed involuntarily to the Finan Center for this illness. Although she does respond to medication, the symptoms of her condition have been difficult to manage.

The dispute that gives rise to this appeal began after Beeman was committed on July 14, 1993. In early January 1994, Dr. Ehlers prescribed three oral medications: Haldol at 10 milligrams twice per day, Anafranil at 50 milligrams per day, and Depakote at 500 milligrams twice per day. When Beeman refused to take any of these medications, Dr. Ehlers requested authorization to administer the drugs forcibly. Following a hearing on January 6, 1994, at which Beeman and a lay adviser were present, the Finan Center's CRP authorized the following treatment for 90 days:

Haloperidol (Haldol) PO at a total daily dose not to exceed 100 mg. If the PO dose is refused, Haloperidol Lactate at a total daily dose not to exceed 1/2 of the current PO dose may be given. In the event that the patient refused the PO doses and requires IM injections for two times in a given week, the Panel approves Haloperidol Decanoate at a dosage equivalent not to exceed 250 mg IM q 4 weeks. The dosage is to be titrated by the Attending Physician based on the clinical symptoms. The Panel also approves the use of Depakote at a total daily dose not to exceed 3000 mg. The dosage will be titrated by the Attending Physician based on the clinical symptoms. In the event that the patient experiences any extrapyramidal symptoms, the Panel approves Anti-dyskinetic medications with the Attending Physician titrating them based on the clinical symptoms. Benztropine (Cogentin) not to exceed 6 mg/day PO or IM, Trihexyphenidyl (Artane) not to exceed 8 mg/day PO or IM, Amantadine (Symmetrel) PO not to exceed 200 mg/day, or Diphenhydramine (Benadryl) not to exceed 150 mg/day PO or IM. If [the] patient develops akathisia, Propranolol at a total daily dosage not to exceed 240 mg, may be given if needed. If the patient does not respond to Haldol, the Attending Physician may use other neuroleptics not to exceed the following daily doses: Chlorpromazine (Thorazine) 200 mg; Mesoridazine (Serentil) 500 mg; Thiothixene (Navane) 80 mg; Perphenazine (Trilafon) 64 mg; Trifluoperazine (Stelazine) 80 mg; Fluphenazine (Prolixin) 80 mg; Loxapine (Loxitane) 250 mg; Molindone (Moban) 250 mg; or Fluphenazine Decanoate (Prolixin) 750 mg q 2 weeks.

(Emphasis added).

Beeman received a copy of the decision on January 11, 1994. Some forty minutes later, she filed a petition for administrative review through her counsel. ² On January 24, 1994, following a de novo hearing, the ALJ affirmed the CRP's authorization of treatment, appending and annexing the CRP's instructions to his own decision, without modification. No one asked the ALJ to stay its order. Accordingly, two days later, forced treatment began.

On January 27, 1994, Beeman filed a petition for review by the circuit court, but incorrectly captioned her petition. Thereafter, on February 2, 1994, Beeman filed an amended petition for review, this time with the correct caption. In her petitions for review, appellant requested a stay of the ALJ's decision; her request, however, apparently was never addressed by the circuit court. On February 17, 1994, DHMH filed a Motion for Reversal, based on procedural grounds. Evidently, no request was made to transcribe the audiotapes from the OAH hearing, and no one attempted to listen to the five and a half hours of audiotapes prior to the hearing before the circuit court. The circuit court ultimately heard the case on March 18, 1994. According to the docket entries in the record, the OAH audiotapes were transmitted to the circuit court on that day.

After listening to the audiotapes, the court described them as "generally poor quality and in substantial part inaudible due to static and background noise," and "of essentially minimal help." The court therefore decided to place "supplemental reliance ... upon the notes and recall of counsel, as provided at oral argument." On the merits of Beeman's appeal, the court found "substantial evidence" to support the ALJ's decision, but did not identify that evidence specifically.

The ALJ's order authorizing forced treatment expired after ninety days. According to DHMH, Beeman responded well to the treatment; she was released from the Finan Center on August 18, 1994, and has been receiving treatment on an out-patient basis.

Discussion

I. Scope of Review

The scope of review on appeal to this Court is essentially the same as the circuit court's scope of review. We must review the administrative decision itself. Pub. Svce. Comm'n v. Baltimore Gas & Elec. Co., 273 Md. 357, 362, 329 A.2d 691 (1974); State Election Bd. v. Billhimer, 72 Md.App. 578, 586, 531 A.2d 1298 (1987), rev'd on other grounds, 314 Md. 46, 548 A.2d 819 (1988); see also Dep't Econ. & Emp't Dev't v. Hager, 96 Md.App. 362, 625 A.2d 342 (1993). Decisions of the OAH are subject to review under the Administrative Procedure Act ("APA"), Md.Code Ann., State Gov. Art. ("SG") § 10-222 (Supp.1994). Subsection (h) provides that the reviewing court may--

(1) remand the case for further proceedings;

(2) affirm the final decision; or

(3) reverse or modify the decision if any substantial right of the petitioner may have been prejudiced because a finding, conclusion, or decision:

i. is unconstitutional;

ii. exceeds the statutory authority or jurisdiction of the final decision maker;

iii. results from an unlawful procedure;

iv. is affected by any other error of law v. is unsupported by competent, material, and substantial evidence in light of the entire record as submitted; or

vi. is arbitrary or capricious.

See also, Md. State Police v. Lindsey, 318 Md. 325, 332-34, 568 A.2d 29 (1990); State Election Bd. v. Billhimer, 314 Md. 46, 548 A.2d 819 (1988); Warner v. Town of Ocean City, 81 Md.App. 176, 567 A.2d 160 (1989); Harford Mem'l Hosp. v. Health Svces. Cost Rev. Comm'n, 44 Md.App. 489, 410 A.2d 22 (1980).

Where the question on appeal is the sufficiency of the evidence to support a decision, we must determine "whether a reasoning mind could have...