J.H. v. Prince George's Hospital Center
165 A.3d 664
Md. Ct. Spec. App.2017Background
- Four mentally ill individuals (J.H., C.B., M.G., B.N.) were brought to Prince George’s Hospital Center on emergency evaluation petitions and faced involuntary admission hearings before OAH administrative law judges (ALJs).
- At each hearing counsel asserted the Hospital failed to follow statutory preadmission procedures (e.g., 6‑hour evaluation, 12‑hour written notice, 30‑hour ER limit, 10‑day hearing) and sought release.
- The Hospital presented evidence on the five statutory involuntary‑admission elements in Health‑Gen. § 10‑632(e)(2); ALJs found each appellant met those elements and ordered involuntary admission.
- Circuit court consolidated the appeals and affirmed the ALJs. Appellants appealed to the Court of Special Appeals raising whether hospitals must first prove compliance with preadmission procedures at involuntary admission hearings.
- The Court held: patients must raise alleged preadmission procedural violations with particularity; once raised the burden shifts to the hospital to prove compliance by a preponderance of the evidence; the hospital retains the statutory clear‑and‑convincing burden to prove the §10‑632(e) elements; release is required only if the process error is established, is substantial, and no other remedy suffices.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether hospital must affirmatively prove compliance with preadmission procedures before an ALJ may order involuntary admission | Appellants: noncompliance with preadmission procedures is jurisdictional and deprives ALJ of authority; hospital must prove compliance before merits | Hospital: statute requires proof only of the §10‑632(e) substantive elements at hearing; preadmission compliance not a prerequisite | Court: Not jurisdictional. Hospital need only prove §10‑632(e) elements unless patient timely raises procedural violations with particularity |
| Who bears burden to raise and prove preadmission procedure violations at hearing | Appellants: Hospital should bear burden to prove compliance | Hospital: burden to prove §10‑632(e) elements; COMAR silent on who proves preadmission steps | Court: Patient bears initial burden to raise alleged procedural defects with particularity; once raised, burden shifts to hospital to prove compliance by preponderance |
| Evidentiary standard for proving involuntary‑admission elements and for proving procedural compliance | Appellants: unclear but argued strict proof required for procedures | Hospital: §10‑632(e) requires clear and convincing proof of substantive elements; COMAR places same burden on hospital | Court: Hospital must prove the §10‑632(e) elements by clear and convincing evidence; compliance with preadmission procedures (once raised) is proved by preponderance per State Government evidentiary standard |
| Remedy for procedural violations (automatic release?) | Appellants: procedural violations should result in release | Hospital: not every procedural error requires release; ALJ may consider prejudice and alternative remedies | Court: COMAR controls — release only if error occurred, error is substantial, and no other remedy is consistent with due process and protection of individual’s rights |
Key Cases Cited
- Specht v. Patterson, 386 U.S. 605 (Sup. Ct.) (precommitment proceedings subject to due process)
- O’Connor v. Donaldson, 422 U.S. 563 (Sup. Ct.) (state may not confine a nondangerous individual who can survive safely in freedom)
- Anderson v. Solomon, 315 F. Supp. 1192 (D. Md.) (constitutional deficiencies in ex parte commitment procedures prompted regulatory reform)
- Johnson v. Solomon, 484 F. Supp. 278 (D. Md.) (mandatory periodic review required for constitutionally adequate commitment process)
- Motor Vehicle Admin. v. Jones, 380 Md. 164 (Md.) (statutory text limits issues an ALJ may consider where legislature enumerates factors)
- Liberty Nursing Ctr., Inc. v. Dep’t of Health & Mental Hygiene, 330 Md. 433 (Md.) (appellate review limited to whether substantial evidence supports administrative findings)
- Moss v. Director, Patuxent Inst., 279 Md. 561 (Md.) (certain mandatory procedural requirements, when not complied with, can require release)