A.S. v. LincolnHealth

• Citation: 246 A.3d 157
• Decision Date: 28 January 2021
• Docket Number: Docket: Lin-20-117
• Parties: A.S. v. LINCOLNHEALTH
• Court: Maine Supreme Court

246 A.3d 157

A.S.

v.LINCOLNHEALTH

Docket: Lin-20-117

Supreme Judicial Court of Maine.

Argued: November 18, 2020

Decided: January 28, 2021

Meegan J. Burbank, Esq. (orally), Berry & Burbank, Boothbay Harbor, for appellant A.S.

James P. Bailinson, Esq. (orally), and Michelle Bush, Esq., MaineHealth, Portland, for appellee LincolnHealth

Steven L. Johnson, Esq. (orally), and Taylor D. Fawns, Esq., Kozak & Gayer, P.A., Augusta, for amicus curiae Maine Hospital Association

Emma E. Bond, Esq. (orally), and Zachary L. Heiden, Esq., American Civil Liberties Union of Maine Foundation, Portland, for amicus curiae American Civil Liberties Union of Maine Foundation

Aaron M. Frey, Attorney General, and Molly Moynihan, Asst. Atty. Gen. (orally), Office of the Attorney General, Augusta, for amicus curiae Department of Health and Human Services

Panel: MEAD, GORMAN, HUMPHREY, HORTON, and CONNORS, JJ.

GORMAN, J.

[¶ 1] On February 24, 2020, law enforcement officers brought A.S. to the LincolnHealth Miles Hospital Campus in Damariscotta, and he was held in the emergency department of that hospital for the next thirty days. At no time during that period did LincolnHealth seek or obtain judicial endorsement of its detention of A.S., as required by 34-B M.R.S. § 3863 (2020). On the eighteenth day of his detention, A.S. petitioned the Superior Court to issue a writ of habeas corpus for his release but, after a hearing, held on the twenty-fifth day of A.S.'s detention, the court (Lincoln County, Billings, J. ) denied A.S.’s petition. A.S. appeals from the judgment denying his habeas petition, contending that the court erred by concluding that LincolnHealth did not violate the statutory procedure for emergency involuntary hospitalization provided in 34-B M.R.S. § 3863. A.S. also asserts that the court violated his due process rights by applying a standard of preponderance of the evidence to determine whether he posed a likelihood of serious harm. We agree and vacate the judgment.

I. BACKGROUND

[¶ 2] On March 13, 2020, A.S. filed a petition for a writ of habeas corpus in the Superior Court (Lincoln County), seeking to be released from the LincolnHealth emergency department. See 34-B M.R.S. § 3804 (2020). A hearing on that petition was scheduled to be heard by videoconference on March 20, 2020. See 14 M.R.S. §§ 5521, 5523 (2020). At the start of the hearing, the parties submitted the following set of stipulated facts, which the court adopted as its findings. See Fuller v. State , 282 A.2d 848, 849 (Me. 1971). Starting on February 24, 2020, LincolnHealth, which is not a psychiatric hospital within the meaning of 34-B M.R.S. § 3801(7-B) (2020), detained A.S. in its emergency department. Although hospital staff had completed sixteen applications for emergency involuntary hospitalization since February 24, 2020, see 34-B M.R.S. § 3863(1)-(2), (3)(B), LincolnHealth did not file any of the involuntary hospitalization application forms with any court, see 34-B M.R.S. § 3863(3)(B)(2). Throughout this period, despite exercising due diligence, LincolnHealth could not find an appropriate placement in a psychiatric hospital for A.S.

[¶ 3] Before any evidence was presented, A.S. requested judgment on the stipulated record, arguing that LincolnHealth's restraint of him was unlawful and that the appropriate remedy was his release. The court (Billings, J. ) denied A.S.’s request, explaining,

[E]ven if I was in complete agreement with [A.S.’s] legal argument, I think the proper thing for the Court to do is to consider evidence from [LincolnHealth] in regards to whether or not is it appropriate, even if [A.S.] is correct legally—if it is appropriate when considering the equities for the Court to issue the extraordinary writ.

[¶ 4] A.S. objected to the hearing process, noting that the court was "about to have [an] involuntary commitment hearing without the protections that the statute provide[s]." The court overruled the objection and allowed LincolnHealth to present a series of witnesses. Among LincolnHealth's witnesses were its medical director, who explained the process that the hospital had used to find a psychiatric bed for A.S. and the actions that it took while it held A.S. in its emergency department; the vice president of medical affairs for Maine Behavioral Healthcare, who explained Maine Behavioral Healthcare's role in trying to find placements for psychiatric patients; and the Maine Behavioral Healthcare program manager who had been working to find a placement for A.S. since his arrival at the hospital.

[¶ 5] At the close of LincolnHealth's presentation, A.S. moved for judgment as a matter of law based on the uncontradicted evidence that, at no time during the days it held A.S. had LincolnHealth complied with 34-B M.R.S. § 3863(3) by obtaining judicial authorization for its actions. In its response to that motion, LincolnHealth argued that it was not required to seek or obtain judicial authorization for its actions. It explained,

The hope here and the ... full intentions of the hospital are to get [A.S.] a placement and to have that occur as soon as possible, at which point due process protections of the involuntary hospitalization statute will kick into full effect , where the hospital that accepts him would have to determine, I think within 72 hours, if he requires continued treatment, at which point a White paper application would be made and ... he would have a protective custody hearing within, I think, a two-week period.

But ... unfortunately ... for [A.S.’s] protection and the protection of the community, he needs to be held in ... custody until an appropriate hospital placement can be ... identified.

(Emphasis added.) LincolnHealth acknowledged there was no "court authority" supporting its interpretation of section 3863 but told the court that this "practice ... has been occurring for ... for several years ... without any licensing violations being issued by [the] Department of Health and Human Services or any other entity objecting to this practice."

[¶ 6] Although noting that it was "quite striking that in this case, [A.S.] has been hospitalized ... until this hearing ... [with] no court proceeding," the court nonetheless denied A.S.’s motion for judgment as a matter of law.

[¶ 7] At the conclusion of the hearing, after hearing testimony from A.S., the court denied A.S.’s habeas petition. Without directly addressing section 3863 ’s requirement that a hospital obtain judicial authorization for any emergency involuntary hospitalization, the court concluded that the section 3863 process "can be reset every 48 hours, based upon a new Blue Paper being completed based upon a new evaluation by a physician." In addition, the court concluded that "the proper standard" for adjudicating a habeas petition pursuant to section 3804 "is whether as of now, an application for emergency involuntary admission to a psychiatric hospital could be granted, and basically whether the Blue Paper criteria could be met." The court then found that "the Blue Paper standard could be met and has been met by the evidence." The court did not explicitly state what evidentiary standard it applied in making that finding, but the record makes clear that the court rejected A.S.’s argument that a heightened standard should apply. Instead, the court applied a standard different from the standard of clear and convincing evidence that would apply in an involuntary commitment hearing. See 34-B M.R.S. § 3864(6)(A)(1) (2020). The court also stated that it might have reached a different finding pursuant to the standard of clear and convincing evidence, stating that "the improvement that [the doctors] have noted in [A.S.] while he has been hospitalized might make that kind of finding difficult." A.S. timely appealed. See 14 M.R.S. § 1851 (2020) ; M.R. App. P. 2B(c)(1).

II. DISCUSSION

A. Mootness

[¶ 8] The record in this case demonstrates that A.S. was discharged from LincolnHealth on March 25, 2020—after he spent a total of thirty days in LincolnHealth's emergency department—and is currently residing with a relative out of state.¹ Because A.S. was discharged from LincolnHealth while this appeal was pending, there is no real or effective relief we can provide to him. This absence of controversial vitality renders his appeal moot. See In re Christopher H. , 2011 ME 13, ¶ 11, 12 A.3d 64. Generally, we decline to hear an appeal when the issues are moot, but, "we will address the merits where: (1) [s]ufficient collateral consequences will result from the determination of the questions presented so as to justify relief; (2) there exist ‘questions of great public concern’ that we address in order to provide future guidance; or (3) the issues are capable of repetition but evade review because of their fleeting or determinate nature." Id. (quotation marks omitted).

[¶ 9] The public interest exception and the repeat presentation exception to the mootness doctrine both apply here. When confronted with cases regarding involuntary emergency hospitalization or commitment, we have consistently determined the issues to be of great public concern and applied the public interest exception to the mootness doctrine.² See, e.g., In re Marcia E., 2012 ME 139, ¶ 4 n.1, 58 A.3d 1115 ; In re Christopher H. , 2011 ME 13, ¶ 12, 12 A.3d 64 ; In re Walter R. , 2004 ME 77, ¶ 9, 850 A.2d 346. We find that the same interests support review in this case. In addition, because the process used by LincolnHealth is apparently used frequently by Maine's nonpsychiatric hospitals when those hospitals are forced to "board" psychiatric patients, we specifically determine that the hospitals and the courts dealing with those hospitals are in need of guidance in this area.³

[¶ 10] The exception to mootness for issues that present repeatedly has also been routinely applied to involuntary commitment proceedings "[b]ecause of the brief length of ... commitment, and because it is likely that the specific issue[s] ... will be repeatedly...