In re: J.C.N.
190 A.3d 329
Md.2018Background
- Petitioner J.C.N. was taken to University of Maryland Baltimore Washington Medical Center’s emergency department on Nov. 17, 2015 after a petition for emergency evaluation alleging psychosis; she was initially treated on a medical floor for somatic/medical instability related to a recent stroke and thyroid disorder.
- On Nov. 19 two physicians certified that she met criteria for involuntary admission (bipolar I, manic with psychotic features or steroid-induced psychosis) and an application for involuntary admission was signed on Nov. 20.
- A psychiatric bed at the hospital became available and she was transferred to the hospital’s inpatient psychiatric unit on Nov. 24, 2015.
- An administrative law judge (ALJ) held an involuntary-admission hearing on Dec. 1, 2015; the ALJ credited psychiatric testimony that J.C.N. lacked insight, refused medications (psychiatric and thyroid), had grandiose delusions, and—because of stroke-related deficits—might be unsafe to drive.
- The ALJ found by clear and convincing evidence that (1) she had a mental disorder, (2) needed inpatient care, (3) presented a danger to life or safety of herself or others, (4) was unwilling to be voluntarily admitted, and (5) no less restrictive intervention was available; the ALJ ordered involuntary admission.
- On review, Maryland’s Court of Appeals affirmed: the ten-day hearing deadline runs from confinement to the inpatient psychiatric facility (Nov. 24), not from arrival at the emergency department; substantial evidence supported the dangerousness finding.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Timeliness of involuntary-admission hearing (start of 10-day period) | The 10-day clock began when she was confined to the hospital (including the ER) on Nov. 17; hearing on Dec. 1 (day 15) was untimely and jurisdictionally defective. | The 10-day clock begins when the individual is confined to the inpatient facility pending an involuntary-admission hearing (transferred Nov. 24); hearing Dec. 1 was within 10 days. | Held for Respondents: “initial confinement” means confinement to an inpatient mental-health facility; hearing was timely. |
| Dangerousness required for involuntary admission | Evidence of poor financial/professional decisions, refusal of meds, and beliefs about driving were speculative and insufficient to show danger to life or safety. | Credited expert testimony showed lack of insight, refusal of psychiatric and thyroid medications, grandiose delusions, and stroke-related physical limitations—creating a realistic risk to safety if released. | Held for Respondents: Substantial evidence supported the ALJ’s clear-and-convincing finding that petitioner presented a danger to herself or others. |
Key Cases Cited
- Covington v. Harris, 419 F.2d 617 (D.C. Cir. 1969) (cautionary admonition on construing commitment statutes narrowly because liberty is at stake)
- People’s Counsel for Baltimore County v. Surina, 400 Md. 662 (explains "look-through" review of administrative decisions)
- Kenwood Gardens Condos., Inc. v. Whalen Props., LLC, 449 Md. 313 (substantial-evidence standard in administrative review)
- Critical Area Comm’n for the Chesapeake & Atl. Coastal Bays v. Moreland, LLC, 418 Md. 111 (presumption of validity / deference to agency findings)
- Bd. of Physician Quality Assurance v. Banks, 354 Md. 59 (agency's role in resolving conflicting evidence)
- Williams v. Peninsula Regional Medical Center, 440 Md. 573 (statutory construction principles; ascertain legislative intent)