Johnson v. Dept. of Health, 236 A.3d 574

Gregory Johnson was charged with attempted murder; a Baltimore City court found him incompetent to stand trial (IST) and committed him to Clifton T. Perkins Hospital Center.
Diagnosed with an unspecified schizophrenia-spectrum/psychotic disorder, Johnson repeatedly refused prescribed antipsychotics; Perkins convened a clinical review panel under HG § 10-708 which approved involuntary medication for up to 90 days to restore competency.
Johnson requested a de novo administrative hearing; an ALJ (Office of Administrative Hearings) heard testimony (Department’s psychiatrist as expert), applied the Sell framework, and ordered involuntary medication based on clear-and-convincing evidence.
The circuit court (Howard County) affirmed the ALJ; Johnson appealed to the Court of Appeals, raising statutory-interpretation, separation-of-powers, and procedural-due-process challenges to HG § 10-708 and the administrative process.
The ALJ found Johnson not presently dangerous within the hospital but concluded without medication he risked continued hospitalization and danger if released; the ALJ found restoration of competency an "overriding justification."
The Court of Appeals affirmed: HG § 10-708 authorizes involuntary medication to restore competency, assigning that authority to the Department/ALJ does not violate separation of powers, and the administrative procedures satisfied procedural due process (Mathews balancing; clear-and-convincing standard for Sell analysis).

Issue	Plaintiff's Argument (Johnson)	Defendant's Argument (Department)	Held
Statutory authority to medicate for competency restoration	§10-708 does not authorize meds to restore competency; its language refers only to symptoms causing present dangerousness	§10-708 covers treatment of the mental disorder/symptoms that resulted in commitment, including those preventing competency	HG §10-708 authorizes involuntary medication to restore competency
Separation of powers: who may decide competency-restoring meds	Only the criminal trial judge may make competency-related decisions; ALJ usurps judicial function	ALJ/Department decide medical treatment appropriateness, not the legal question of competency; trial court retains competency determinations and can be alerted to changed condition	Permissible: ALJ may order meds (quasi-judicial function) so long as judicial review is available
Procedural due process for involuntary medication	Admin process risks erroneous deprivation: barred from asserting competency defense at OAH; lacked criminal counsel involvement; timeline too compressed	§10-708 provides multiple safeguards (notice, lay advisor, counsel, de novo ALJ hearing, judicial review); ALJ applied Sell factors by clear-and-convincing evidence	No procedural due process violation; Mathews balance favors current administrative scheme; clear-and-convincing standard required/applied for Sell factors

Allmond v. Department of Health & Mental Hygiene, 448 Md. 592 (2017) (upheld HG § 10-708 as facially valid and endorsed Sell analysis plus "overriding justification" for competency-restoring meds)
Sell v. United States, 539 U.S. 166 (2003) (four-part test governing involuntary medication to restore competency)
Riggins v. Nevada, 504 U.S. 127 (1992) (forced antipsychotic medication implicates substantial liberty interests; requires overriding justification)
Mathews v. Eldridge, 424 U.S. 319 (1976) (procedural due process balancing test: private interest, risk of erroneous deprivation, and governmental interest)
Washington v. Harper, 494 U.S. 210 (1990) (recognized liberty interest in avoiding unwanted antipsychotics and the role of medical judgment/procedural safeguards)
Youngberg v. Romeo, 457 U.S. 307 (1982) (treatment decisions for committed persons involve professional medical judgment)