In re Meddings

• Decision Date: 23 December 2019
• Docket Number: No. 2096, Sept. Term, 2018,2096, Sept. Term, 2018
• Citation: 244 Md.App. 204,222 A.3d 302
• Parties: In the MATTER OF Ronald MEDDINGS
• Court: Court of Special Appeals of Maryland

244 Md.App. 204

222 A.3d 302

In the MATTER OF Ronald MEDDINGS

No. 2096, Sept. Term, 2018

Court of Special Appeals of Maryland.

December 23, 2019

Argued by: Barrett R. King(David A. Hall, Kelly Raynaud, King Hall, LLC, on the brief), Ellicott City, MD, for Appellant.

Argued by: Adam J. Storch(Brian E. Frosh, Atty. Gen., on the brief), Baltimore, MD, for Appellee.

Panel: Friedman, Beachley, Wells, JJ.

Wells, J.The Circuit Court for Howard County granted Appellee, the Clifton T. Perkins Hospital Center's ("Perkins") petition for a guardianship of the person for Appellant, Ronald Meddings, a criminal defendant diagnosed with schizophrenia and atrial fibrillation.¹Meddings has resided at Perkins since 2017 after he was found incompetent to stand trial for assault.After a bench trial on Perkins' petition, the court found that Meddings was disabled and appointed Meddings' brother, Fred Osborne, as his guardian.

Meddings filed a timely appeal and asks the following question: "Did the Trial Court err in finding that no less restrictive form of intervention is available?"

For the reasons discussed below, we affirm.

FACTUAL AND PROCEDURAL HISTORY

Ronald Meddings, age 68, has had a long history of mental and physical health problems.At some point during his life, Meddings was diagnosed with schizophrenia.According to the testimony of his brother, Fred Osborne, Meddings has received at-home, self-living, outpatient, and in-patient medical care since the 1970's.In 2008, the circuit court appointed a guardian to make decisions regarding Meddings' finances and property.In the Matter of Ronald L. Meddings, Circuit Court for Cecil County, Maryland, 07-D-08-523.

In 2017, while Meddings was being treated at a Veterans Administration Hospital in Baltimore, he allegedly approached a nurse, grabbed her by the neck, and attempted to choke her.As the nurse tried to defend herself, she and Meddings fell to the floor.Security personnel had to forcibly remove Meddings from the nurse, but he continued to try to kick her.As a result of this incident, the State charged Meddings with first and second-degree assault.During that prosecution, the Department of Health and Mental Hygiene confirmed that Meddings suffered from schizophrenia.The circuit court found Meddings incompetent to stand trial and committed him to Perkins on August 7, 2017.

A.Issues that Led Perkins to File for Guardianship

A number of issues arose after Meddings was committed.First , Meddings refused to take psychotropic medication or drugs prescribed to treat his atrial fibrillation.As a result, Perkins resorted to the use of a Clinical Review Panel("CRP").A CRP is a group of Perkins doctors and other medical professionals who convene at 90-day intervals to review and approve Meddings' anti-psychotic medicine.Once the panel approves the medication, and if Meddings refuses to take it, Perkins staff may forcibly administer it to him.From the time Meddings arrived at Perkins in August 2017 until April 2018, when Perkins filed for guardianship, a CRP had to be convened three times.On each occasion, the CRP determined that Meddings' psychotropic medications, Quetiapine, Oxcarbazepine, and Benztropine, were appropriate.

Meddings was involuntarily medicated based on the panel's approval.Even after taking these drugs, Meddings remained actively psychotic.

Second , according to the testimony of Meddings' doctors, treatment of Meddings' atrial fibrillation is not subject to the CRP.Meddings was prescribed the drug Metoprolol to treat his heart problem, but he refused to take it.With his atrial fibrillation untreated, according to his doctors, Meddings risks having a heart attack or stroke.Meddings' doctors fear if he had either a stroke or heart attack, he will need additional medical treatment, in which case the CRP would be ineffective as the CRP may be used only to treat Meddings' mental health issues.

Third , Meddings did not have an advance medical directive.This fact complicated the range of options available to Perkins should Meddings need somatic medical treatment, since Meddings never made known his intentions for extraordinary medical intervention should he be physically incapacitated and in need of such care.As there was no way to force Meddings to treat his coronary problems via the CRP, the risk that he would need some sort of somatic intervention increased.

To address these on-going concerns, on April 20, 2018, Perkins filed a petition in the Circuit Court for Howard County seeking the appointment of a guardian for Meddings' person.As Meddings did not have the funds to hire his own attorney, the court appointed counsel for him.On May 31, 2018, the court named the Howard County Office of Aging as Meddings' temporary guardian, specifically to approve administration of somatic medication.After contacting Fred Osborne, Meddings' brother, Perkins amended the guardianship petition and added Osborne an interested party to the proceedings.

B.Summary of Trial Testimony

On August 5, 2018, the court, sitting without a jury, heard testimony on Perkins' petition for guardianship.At trial, Meddings' psychiatrist at Perkins, Dr. Htwe, testified that Meddings' prior diagnoses of schizophrenia and atrial fibrillation were accurate.According to Dr. Htwe, Meddings suffers from "psychosis, paranoia, hearing voices," and delusions.As a result, Meddings is often irritable and can frequently be heard yelling and screaming.

According to Dr. Htwe, Meddings has had several violent outbursts that placed him or others at risk of physical harm while at Perkins.For example, Dr. Htwe recounted that on one occasion Meddings attempted to jump over the nurse's station and tried to attack a nurse.On a different occasion, Meddings threw his glasses over the nurse's station.At times, Meddings has thrown shoes at Dr. Htwe.On another occasion, Meddings assaulted a Perkins security guard.During yet another episode, Meddings was so violent that he required five restraints to contain him.

Regarding Meddings' heart problems, Dr. Htwe testified that because of his atrial fibrillation, a clot could form on Meddings' heart.If this were to happen, Dr. Htwe feared that Meddings might suffer "a stroke, heart attack, and lead[ ] to... losing[ ] the limbs for instance causing gangrene."Additionally, the doctors are unsure whether Meddings may also suffer from a "seizure disorder, chronic COPD, [and/or] chronic obstructive lung disease."According to Dr. Htwe, Meddings needs to see a heart specialist to treat his atrial fibrillation and any other cardiovascular issues.Meddings was prescribed the drug Metoprolol for atrial fibrillation.Dr. Htwe noted that, "95 percent of the time, he's not taking it.Lately he is not taking it."Specifically, Dr. Htwe noted that Meddings did not take the Metoprolol in July or August of 2018.

Dr. Htwe testified that Meddings does not understand the diagnosis for schizophrenia nor for atrial fibrillation.In Dr. Htwe's view, Meddings has no ability to "understand, make, and communicate decisions with respect to his health care."Meddings refuses to voluntarily take medication, which Dr. Htwe believes to be a result of the schizophrenia.Further, Dr. Htwe noted that Meddings has no healthcare advance directive on file because "he is unable to do it and understand the concept of it.So [Perkins] couldn't do it" and Meddings does not have the ability to complete one at present.In fact, Perkins never attempted to ask Meddings to sign one because "it's very, very difficult to engage him.Let alone the advance directive involves quite a bit of understanding."

Dr. Htwe opined that the CRP is not an effective long-term treatment plan for Meddings.In addition to the CRP not being able to approve somatic medications, Dr. Htwe noted that the CRP is by necessity an adversarial process where he, as Meddings' doctor, is pitted against him.According to Dr. Htwe, the CRP "has already affected the ... relationship between me and him."Further, according to Dr. Htwe, the CRP is time-limited in that the period for which involuntary medication is approved is only ninety (90) days.In Dr. Htwe's opinion, the CRP is an unstable procedure because a medication approval could lapse without vigilant monitoring, leaving Meddings without a necessary drug.Dr. Htwe alluded to an instance in January 2018 when Meddings' psychotropic medicines ran out, the CRP could not be convened quickly, and Meddings "was really out of control.""So we learned the hard way this January."Overall, Dr. Htwe felt that the CRP was unreliable and bad for the doctor-patient relationship.

A second psychiatrist at Perkins, Dr. Samer Patel, who sees Meddings several times per year, testified that he has tried to communicate with Meddings about the schizophrenia diagnosis.According to Dr. Patel, Meddings' disorganized thinking leads Meddings to believe that he is not schizophrenic.In fact, Dr. Patel said Meddings, "believes he is being held [at Perkins] against his will and that we are poisoning him with medications."When asked if Meddings was ever part of a conversation about taking medications after discharge from Perkins, Dr. Patel responded: "When I spoke with [Meddings in mid-June 2018,]he said he did not feel he needed to take medications, that it was poison, and that we were holding him hostage and feeding him poison."Dr. Patel also tried to discuss Meddings' somatic problems with him, which was similarly unsuccessful.

Like Dr. Htwe, Dr. Patel's testimony described episodes of Meddings' aggressive behavior, including an incident that occurred in May 2018, when Meddings "ran to the bathroom and tried to unscrew a pipe from the sink.When staff inquired what he was going to do he said he was going to unscrew it to assault staff with it."Staff brought in security personnel who restrained him.

Dr. Patel opined that Meddings lacks the capacity to make his own health care decisions and testified that he...