In re J.C.N.
| Decision Date | 24 August 2017 |
| Docket Number | No. 1021,1021 |
| Parties | IN RE J.C.N. |
| Court | Court of Special Appeals of Maryland |
UNREPORTED
Opinion by Reed, J.
*This is an unreported opinion, and it may not be cited in any paper, brief, motion, or other document filed in this Court or any other Maryland Court as either precedent within the rule of stare decisis or as persuasive authority. Md. Rule 1-104.
On December 1, 2015, Administrative Law Judge Thomas Welshko ("ALJ") ordered that J.C.N., appellant, be involuntarily admitted to University of Maryland Baltimore Washington Medical Center (the "Hospital"), appellee. Appellant petitioned for judicial review by the Circuit Court for Anne Arundel County, which affirmed the ruling of the ALJ. She filed this timely appeal and presents two questions for our review, which we rephrase and consolidate as one issue:1
1. Whether the ALJ erred in ordering appellant's involuntary admission.
For the reasons that follow, we affirm the judgment below.
In the summer of 2015, appellant suffered a stroke and a "thyroid-storm," "a very rare, but life-threatening condition" that results from an overactive thyroid. As a result, her brain swelled, she suffered partial paralysis, and she began treatment that involved physical and occupational therapy and prescription steroids.
On November 17, 2015, Anne Arundel County police escorted appellant to the emergency department of the Hospital after a social worker filed an emergency petition.2 She was admitted to the emergency department then transferred to the "telemetry unit" - "kind of an observation unit" - "due to medical issues." The attending physician diagnosed appellant with steroid-induced psychosis,3 and requested consultations by an endocrinologist and neurologist to rule out possible psychological complications deriving from her recent stoke and thyroid-storm. On November 19, 2015, Drs. Sandeep Sidana and Anisha Bassi diagnosed appellant with bipolar disorder and signed certifications that appellant met the criteria for involuntary admission.4 The doctors noted that appellant suffered from "Bipolar 1 Disorder episode manic, severe with psychotic symptoms, with adifferential diagnosis of steroid-induced psychosis or substance-induced mood disorder with manic features."
The next day, November 20, 2015, the Hospital's discharge coordinator signed an application for appellant's involuntary admission to the Hospital. Due to limited space and her medical history, however, appellant was not transferred to the psychiatric unit of the Hospital until November 24, 2015. On the day of her transfer, the Hospital provided appellant with notice of her admission and the date of her involuntary admission hearing.
The hearing was held on December 1, 2015. Dr. Sidana, the attending psychiatrist, testified that appellant had "grandiose delusions and psychosis about her accomplishments . . . that she personally knew President Obama . . . and various high esteemed figures . . . attempted to purchase an apartment . . . [and] a car . . . that would have been financially disastrous to her . . ." Dr. Sidana further expressed his concern for appellant's safety stating:
[Appellant] has shown very little insight or, actually, has shown no insight into her diagnosis, does not believe at all that she is manic, and therefore, has refused to take her psychiatric medications . . . [and] thyroid medications . . . my concern for her would be . . . she is already demonstrating to me that she is having impaired judgment managing her thyroid state.
Dr. Sidana confirmed that it was his expert opinion that appellant, should she be released, would quickly damage herself financially, and that she was a danger to herself and possibly others.
Based on the evidence produced at the hearing, the ALJ concluded that appellant met the statutory criteria for involuntary admission under Maryland Code by clear and convincing evidence and ordered appellant to remain hospitalized. Appellant filed aPetition for Judicial Review with the Circuit Court for Anne Arundel County on December 10, 2015, asking for reversal of the ALJ's decision ordering her involuntary admission. The Hospital continued to monitor appellant's psychiatric and physical progress, and discharged her on December 14, 2015, well before the judicial review hearing.
The parties appeared in the Circuit Court for Anne Arundel County on June 20, 2016, and on June 24, 2016, the court issued its opinion affirming the decision of the ALJ. This appeal followed.
Additional facts will be discussed in our analysis.
Appellant argues that her involuntary admission was improper for two reasons: (1) the Hospital's failure to comply with procedural requirements of the Health-General Article of the Maryland Code, and (2) its failure to prove by clear and convincing evidence that appellant was "a danger to the life or safety of [herself] or of others." Md. Code Ann., Health-Gen. §10-617(a)(3).
The Hospital first moves to dismiss this appeal as moot "because there is no current controversy between the parties and no effective remedy for Appellant." It maintains that since appellant was released from the Hospital on December 14, 2015, this appeal shouldbe dismissed as a matter of course.5 Alternatively, the Hospital argues that it established, by clear and convincing evidence, that appellant met the criteria for involuntary admission.
The scope of our review of an administrative agency action is narrow; the Court should refrain from substituting its judgment for the expertise of the individuals who constitute the administrative agency. See T-UP, Inc. v. Consumer Protection Div., 145 Md. App. 27, 801 A.2d 173 (2003). We review the agency's decision directly, not the decisionof the circuit court. Marks v. Crim. Injuries Compl. Bd., 196 Md. App. 37, 55 (2010). The role of this Court is limited to determining whether there is substantial evidence in the record, as a whole, to support the agency's findings and conclusions, and to determine if the administrative decision is premised upon an erroneous conclusion of law. Maryland Dep't of Health & Mental Hygiene v. Brown, 177 Md. App. 440, 461, 935 A.2d 1128, 1140 (2007).
We find merit in the mootness argument presented by the Hospital. There does not appear to be an effective remedy for appellant here. Appellant was released from the Hospital on December 14, 2015. Even if we conclude that the ALJ's order was erroneous, which we do not, appellant's involuntary admission ended long ago. Nonetheless, we address the merits of appellant's contentions.
Appellant argues that her involuntary admission to the Hospital was improper because the Hospital failed to comply with several procedural requirements. Specifically, appellant asserts that the Hospital failed to timely: (1) examine appellant to determine her eligibility for involuntary admission, (2) begin the process for involuntary admission, (3) give appellant notice of her admission and attendant rights, or (4) provide a hearing on involuntary admission, and therefore, we must reverse. We disagree.
Involuntary admissions are governed by Title 10, Subtitle 6, of the Health-General Article of the Maryland Code. Section 10-624(b) provides that a physician shall examinean individual within 6 hours after arrival at the emergency facility to determine whether the individual meets the requirements for involuntary admission. Md. Code Ann., Health-Gen. §10-624(b). If the individual meets those requirements, "the examining physician shall take the steps needed for involuntary admission of the emergency evaluee to an appropriate facility[.]" §10-625(a). "Within 12 hours after [an individual's] initial confinement," a hospital must provide the individual notice of his or her admission and of various rights, including the right to consult with a lawyer. §§10-631(a)-(b). The notice includes the date of the involuntary admission hearing which "shall be conducted within 10 days of the date of the initial confinement of the individual." §10-632(b).
Appellant arrived at the Hospital on November 17, 2015. There is nothing in the record to suggest she was not examined within 6 hours of her arrival. The examining physician determined that due to appellant's medical condition - recent stroke and thyroid-storm - she needed to remain on the medical floor for observation and consultations before addressing any psychiatric issues. The emergency room staff considered it "essential" that appellant receive an MRI to see if brain swelling was the cause of her behavior. [E. Appellant's somatic concerns took priority. While addressing appellant's physical health, "there were frequent consultations by [the Hospital's] psychiatric staff," and once she was stable the Hospital promptly determined that appellant was eligible for involuntary admission.
The Hospital then began "the process for involuntary admission." Appellant was diagnosed and certifications for her involuntary admission were signed on November 19,2015. Appellant's family requested that she be transferred to Johns Hopkins Hospital or Sheppard Pratt Health System. After both facilities denied those requests and a bed opened up, the Hospital admitted appellant to the psychiatric unit on November 24, 2015. Appellant received notice of her admission and attendant rights on the same day. There is no evidence that she received notice more than 12 hours later. Therefore, we hold that the Hospital provided timely notice. Appellant's involuntary admission hearing was held on December 1, 2015, within 10 days of appellant's confinement to the psychiatric unit. Ultimately, we do not find any procedural errors here. Appellant's physical health needs tolled the time to meet these procedural requirements.
At the involuntary admission hearing,...
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