Gary ALLMOND v. DEPARTMENT OF HEALTH AND MENTAL HYGIENE.
No. 34, Sept. Term, 2015.
Court of Appeals of Maryland.
July 11, 2016.
141 A.3d 57
Kathleen A. Morse, Asst. Atty. Gen. (Brian E. Frosh, Atty. Gen. of Maryland, Baltimore, MD), on brief, for Appellee.
Jennifer Mathis, Esq., Andrew Christy, Esq., Judge David L. Bazelon Center for Mental Health Law, Washington, DC, Paul B. DeWolfe, Esq., Public Defender, Mary J. Pizzo, Esq., Asst. Public Defender, Baltimore, MD, John Townsend Rich, Esq., Matthew S. Williams, Esq., Goodwin Procter LLP, Washington, DC, David Rocah, Esq., American Civil Liberties Union Foundation of Maryland, Baltimore, MD, for Amici Curiae brief of the American Civil Liberties Union of Maryland, the Judge David L. Bazelon Center for Mental Health Law, Mental Health Association of Maryland (MHAMD), the Freedom Center, On Our Own of Maryland, the Image Center for People with Disabilities, and the Maryland Office of the Public Defender in support of Appellant.
G. Daniel Shealer, Jr., Esq., Vice President and Gen. Counsel, The Johns Hopkins Health System Corporation, Baltimore, MD, A. Paul Pineau, Esq., Interim Vice President and Gen. Counsel, The Johns Hopkins University, Baltimore, MD, Andrew H. Baida, Esq., Rosenberg Martin
Argued before BARBERA, C.J., BATTAGLIA*, GREENE, ADKINS, MCDONALD, WATTS, and GLENN T. HARRELL, Jr. (Retired, Specially Assigned), JJ.
MCDONALD, J.
The State mental health law allows for the involuntary medication of an individual committed to a mental health facility if certain procedures are followed and if a clinical review panel—three health care professionals, none of whom is the treating psychiatrist—finds that certain statutory criteria are satisfied and authorizes the involuntary medication. Such an authorization remains valid for 90 days, after which a panel must review again the relevant criteria to authorize continued medication.
The criteria for authorizing involuntary medication are set forth in
cise of professional judgment; and (3) the individual is at substantial risk of continued hospitalization because the individual will remain seriously mentally ill with no relief, or for a significantly longer time, from the symptoms that resulted in the individual‘s hospitalization.
Applying those criteria, a clinical review panel authorized the forced medication of Petitioner Gary Allmond, a resident of a facility operated by Respondent Department of Health And Mental Hygiene (“DHMH“). That decision was affirmed by an administrative law judge when Mr. Allmond invoked his appeal rights under the statute. Mr. Allmond has pursued judicial review in the courts. Before us, he contends that, on its face,
We hold that the statute is not unconstitutional on its face. However, we agree with Mr. Allmond that merely satisfying the challenged provisions of
In any event, the authorization for involuntary medication in this case expired long ago. As a consequence, a clinical review panel must apply the statutory criteria in a constitutional manner if DHMH seeks again to medicate Mr. Allmond against his will.
I
Background
We describe first the involuntary medication statute that is at the heart of this
A. Standards for Involuntary Medication
In order to administer psychiatric medication to an individual confined in a mental health facility against the individual‘s will, the facility must satisfy the standards and follow the process set out in
First, the facility may administer medication against an individual‘s will in an emergency pursuant to a physician‘s order when the individual presents a danger to the life or safety of others in the facility.
Second, and pertinent to this case, the facility may administer medication against an individual‘s will when the individual is hospitalized involuntarily or committed for treatment pursuant to a court order1 and a clinical review panel approves the use of the medication for the reasons allowed by the statute.
A clinical review panel is comprised of: (1) the clinical director of the psychiatric unit of the facility (if the clinical director is a physician) or a physician (if the clinical director is not), a psychiatrist, and a mental health professional other than a psychiatrist.
er person is to be substituted for that particular review.
Among other things, the clinical review panel is to review the individual‘s clinical record, assist the individual and the treating physician in arriving at a mutually agreeable treatment plan, ascertain the reasons why the individual is refusing medication, and review the potential consequences of medication.
The statute provides directions for convening and conducting a meeting of a clinical review panel.
To approve the administration of medication against the individual‘s will, a clinical review panel must make certain
determinations. The statute outlines those determinations as follows:
(g) The panel may approve the administration of medication or medications and may recommend and approve alternative medications if the panel determines that:
(1) The medication is prescribed by a psychiatrist for the purpose of treating the individual‘s mental disorder;
(2) The administration of medication represents a reasonable exercise of professional judgment; and
(3) Without the medication, the individual is at substantial risk of continued hospitalization because of:
(i) Remaining seriously mentally ill with no significant relief of the mental illness symptoms that:
1. Cause the individual to be a danger to the individual or others while in the hospital;
2. Resulted in the individual being committed to a hospital under this title or Title 3 of the Criminal Procedure Article; or
3. Would cause the individual to be a danger to the individual or others if released from the hospital;
(ii) Remaining seriously mentally ill for a significantly longer period of time with the mental illness symptoms that:
1. Cause the individual to be a danger to the individual or to others while in the hospital;
2. Resulted in the individual being committed to a hospital under this title or Title 3 of the Criminal Procedure Article; or
3. Would cause the individual to be a danger to the individual or others if released from the hospital; or
(iii) Relapsing into a condition in which the individual is unable to provide for the individual‘s essential human needs of health or safety.
sional judgment to treat the individual‘s mental disorder. Those conditions are not at issue in this case.
The third condition for involuntary medication—set forth in
B. Facts and Procedural History
The circumstances of Mr. Allmond‘s commitment and the procedural path of this case are undisputed and can be briefly summarized.
Criminal Charges and Commitment
Mr. Allmond has been diagnosed with schizophrenia since 1985, when he was in his mid-20s. On September 1, 2011, police officers responded to a call concerning an assault in an apartment in Baltimore City. At the apartment, the officers
found the body of a woman and Mr. Allmond, who told them that he was the caller, that he had had a dispute with his girlfriend, and that he had struck and strangled her.
Mr. Allmond was charged with first-degree murder. On January 4, 2012, following an evaluation by DHMH, the Circuit Court for Baltimore City determined that Mr. Allmond was incompetent to stand trial and committed him to DHMH for psychiatric hospitalization and treatment at Clifton T. Perkins Hospital Center in Jessup (“Perkins“).4 Such a determination does not necessarily mean that the individual is incapable of making decisions concerning the individual‘s medical treatment—and no such determination was made in Mr. Allmond‘s case.5
Treatment at Perkins
According to Mr. Allmond‘s treating psychiatrist at Perkins, Mr. Allmond‘s condition has caused him to experience paranoia, delusions, hallucinations, and disorganized thinking. The
medical personnel at Perkins have recommended various psychotropic medications to alleviate those
On September 3, 2014, during a medical treatment team meeting, Mr. Allmond‘s treatment team at Perkins suggested to him that he receive psychotropic medication. In response to that suggestion, according to the treatment team‘s account, Mr. Allmond became agitated and appeared to be about to assault one of the staff members. The treatment team then asked Mr. Allmond if he would like to take some sedative medications, whereupon Mr. Allmond became even more agitated. Security was eventually called to restrain Mr. Allmond. According to his treating psychiatrist, Mr. Allmond then attempted to assault a staff member.
Determinations of Clinical Review Panel
In the wake of the September 2014 incident, Mr. Allmond‘s psychiatrist requested that a clinical review panel be convened pursuant to
In early December 2014, shortly before the 90-day period of authorized involuntary medication was due to expire, Mr.
Allmond‘s psychiatrist requested that the clinical review panel reconvene to renew the authorization. The psychiatrist asked the panel to reconvene because he was concerned that Mr. Allmond would stop taking the medication and that his symptoms would worsen.
On December 4, 2014, the clinical review panel reconvened with Mr. Allmond present. The panel found that all six of the criteria under Subparagraph (i) and Subparagraph (ii) were met and authorized medication of Mr. Allmond against his will for another 90 days. In other words, the panel found that, without medication, there was a substantial risk that Mr. Allmond would require continued hospitalization because he would remain seriously mentally ill (1) with no significant relief of his symptoms and (2) for a significantly longer time with those symptoms. In addition, the panel found, those symptoms had resulted in his original commitment and would cause him to be a danger to himself or others, whether in the hospital or released from it.7
Hearing before ALJ
Mr. Allmond requested an administrative hearing to appeal the panel‘s decision. On December 18, 2014, an ALJ of the Office of Administrative Hearings conducted a hearing. At that hearing, various
Mr. Allmond did not present any testimony or other evidence at the hearing. His counsel argued that DHMH had
failed to carry its burden of proof to establish that the statutory criteria for involuntary medication under
The ALJ found that the first two of the three conditions under
Judicial Review
Shortly after the ALJ‘s decision, Mr. Allmond sought judicial review of that decision in the Circuit Court for Howard County.8 In the petition, Mr. Allmond argued generally that the standards for involuntary medication set forth in
primarily advanced the constitutional argument for overturning the ALJ‘s affirmance of the panel determination.9 The Circuit Court rejected that argument. Applying rational basis review, the Circuit Court concluded that
Mr. Allmond then appealed the Circuit Court‘s decision to the Court of Special Appeals. While his appeal was pending in the intermediate appellate court, he filed a petition for a writ of certiorari, requesting that we review the constitutionality of
Discussion
In his petition for a writ of certiorari, Mr. Allmond raised the question whether
Preliminarily, however, we must decide whether, as DHMH argues, Mr. Allmond must return to the administrative forum to make his constitutional arguments there in order to exhaust his administrative remedies.
A. Exhaustion of Administrative Remedies
Mr. Allmond did not make any constitutional arguments before the ALJ. DHMH argues that his failure to do so should result in this appeal—in which he has raised only constitutional issues before us—being dismissed because he failed to exhaust his administrative remedies.
Ordinarily, a party must exhaust administrative remedies before resorting to the courts, even when the party raises constitutional issues. See Maryland Reclamation Associates, Inc. v. Harford County, 342 Md. 476, 493 (1996); Maryland Reclamation Associates, Inc. v. Harford County, Maryland, 382 Md. 348, 366 (2004). However, in this case, Mr. Allmond did not go straight to court and circumvent the administrative process. Rather, he invoked the administrative appeal process provided by statute. It may be more precise to characterize his failing as a lack of preservation—i.e., he followed the statute by beginning his appeal in the administrative forum, but failed to raise there the issues he now asks us to decide.
It would be within our discretion to decline to decide the constitutional issue, as DHMH urges. “[Q]uestions, including Constitutional issues that could have been but were not presented to the administrative agency may not ordinarily be raised for the first time in an action for judicial review.” Board of Physician Quality Assurance v. Levitsky, 353 Md. 188, 208 (1999) (emphasis added). However, this Court has discretion to address unpreserved issues “if necessary or desirable to guide the trial court or to avoid the expense and delay of another appeal.” Maryland Rule 8-131(a). Ordinarily, we do not exercise this discretion, because it is best to allow a “proper record [to] be made with respect to the challenge” and “the other parties and the trial judge [to be] given an opportunity to consider and respond to the challenge.” Chaney v. State, 397 Md. 460, 468 (2007).
Deciding the facial constitutionality of Subparagraphs (i) and (ii) against a substantive due process challenge, though, is
one rare instance in which we will exercise our discretion to address an unpreserved issue, because none of the considerations recited above weighs against addressing the constitutional issue in this case. Mr. Allmond‘s challenge is to a statute that requires further agency action every 90 days, so it is extremely likely that, if we decline to resolve this issue on procedural grounds, there will be another appeal raising
Also, Mr. Allmond asserts that he is challenging the statute on its face and that no factual record needs to be made for a facial challenge. This is largely correct. An as-applied challenge depends on the challenger‘s circumstances, but a facial challenge can be resolved without delving into the particular circumstances of the challenge. We need only ensure that there are sufficient facts to show that Mr. Allmond has standing to make this challenge. It is certainly undisputed that Mr. Allmond has been the subject of several orders authorizing forced medication under
The same cannot be said of Mr. Allmond‘s challenge to
guarantee. That challenge was raised for the first time in this Court and the parties have devoted scant attention to it in their briefs. Given our disposition of the substantive due process challenge, we think it unlikely that deciding the newly-raised issue will avoid the expense and delay of another appeal. Under Maryland Rule 8-131(a), therefore, we decline to exercise our discretion to consider the free speech challenge and limit our review to Mr. Allmond‘s substantive due process challenge.
B. Standard of Review
In a case concerning the merits of a final administrative agency decision—such as that of the ALJ in this case—we review directly the administrative decision, not the decisions of the courts that previously reviewed the agency decision before it came to us. Comptroller v. Science Applications Int‘l Corp., 405 Md. 185, 192 (2008).
In reviewing an agency‘s fact findings, we apply a substantial evidence test, which is deferential to the agency‘s determinations. Gore Enterprise Holdings, Inc. v. Comptroller, 437 Md. 492, 504 (2014). As noted above, because Mr. Allmond asserts a facial challenge, the merits of the ALJ‘s fact findings are not at issue in this appeal.
With respect to the legal issues, the ALJ did not have the opportunity to consider the constitutional challenge and, although the Circuit Court did, it did not engage in any extended analysis. In any event, we generally review conclusions of law by an agency or lower court, including any concerning constitutional issues, without special deference. Lawson v. Bowie State Univ., 421 Md. 245, 256 (2011).
1. Relationship of federal and state substantive due process guarantees
Mr. Allmond challenges certain provisions of
Declaration of Rights, which provides “[t]hat no man ought to be taken or imprisoned or disseized of his freehold, liberties or privileges, or outlawed, or exiled, or, in any manner, destroyed, or deprived of his life, liberty or property, but by the judgment of his peers, or by the Law of the land.” This is the Maryland counterpart of the Due Process Clauses found in the Fifth and Fourteenth Amendments to the United States Constitution. Unless there is good reason to do otherwise, “state constitutional provisions [such as Article 24] are in pari materia with their federal counterparts or are the equivalent of federal constitutional provisions or generally should be interpreted in the same manner as federal provisions.” Dua v. Comcast Cable of Maryland, Inc., 370 Md. 604, 621 (2002). While this does not mean that a state constitutional provision will always be interpreted in the same way as its federal counterpart, cases concerning a federal constitutional provision are persuasive authority as to a Maryland counterpart. Id.
Neither party in the case has presented any reason that our interpretation of the Article 24 of the Maryland Declaration of Rights should differ from interpretations of the analogous provisions of the federal constitution, and we perceive none, so we interpret Article 24 to provide the same protections in this case as do the Due Process Clauses of the United States Constitution. See Pitsenberger v. Pitsenberger, 287 Md. 20 (1980).
2. Supreme Court precedent
Mr. Allmond argues that forcibly medicating him deprives him of his substantive due process rights. “Substantive due process“—a somewhat opaque phrase that has been compared to “green pastel redness” for its seemingly oxymoronic quality12—refers to the principle that there are certain liberties protected by the due process clauses from legislative restrictions, regardless of the procedures provided, unless
those restrictions are narrowly tailored to satisfy an important government interest. See Reno v. Flores, 507 U.S. 292, 302 (1993). One such liberty is “avoiding the unwanted administration of antipsychotic drugs.”13 Washington v. Harper, 494 U.S. 210, 221 (1990); Williams v. Wilzack, 319 Md. 485, 508 (1990). Although this Court has never considered the contours of that liberty interest, the Supreme Court has done so in three decisions rendered during the past quarter century.
Washington v. Harper: Involuntary medication of convicted prisoner who is dangerous to self or others is permissible when medically appropriate and reasonably related to legitimate penological interests.
In Washington v. Harper, the Supreme Court held that the State of Washington could forcibly medicate a prisoner who suffered from a mental disorder such that he posed a likelihood of serious harm to himself, others, or property, provided such medication was medically appropriate. 494 U.S. at 225. The Supreme Court stated that “the proper standard for determining the validity of a prison regulation claimed to infringe on an inmate‘s constitutional rights is to ask whether the regulation is reasonably related to legitimate penological interests.” Id. at 223 (internal
quotation marks omitted). This reasonableness review applies to prison regulations “even when the constitutional right claimed to have been infringed is fundamental, and the State under other circumstances would have been required to satisfy a more rigorous standard of review,” because convicted prisoners have reduced liberty interests. Id. The Court explicitly rejected the contention that, as a precondition to involuntary treatment, the State was required to find that the prisoner was incompetent to make treatment decisions and to obtain court approval of treatment under a “substituted judgment” standard. Id. at 226.
The Supreme Court went on to assess whether the administrative procedures provided by the Washington statute comported with procedural due process and concluded that they did. 494 U.S. at 228-36.
Riggins v. Nevada: Involuntary medication of pretrial detainee is permissible when medically appropriate and either (1) essential for safety or (2) necessary to obtain adjudication of criminal charges.
In Riggins v. Nevada, the Supreme Court held that a lower court applied the wrong standard when a pretrial detainee made a substantive due process challenge to involuntary medication. First, reiterating the holding of Harper, which it articulated as “forcing antipsychotic drugs on a convicted prisoner is impermissible absent a finding of overriding justification and a determination of medical appropriateness,” the Supreme Court added that “[t]he Fourteenth Amendment affords at least as much protection to persons the State detains for trial.” 504 U.S. at 135. The Court then observed that, in this case, “the [lower] court simply weighed the risk that the defense would be prejudiced by changes in [the defendant‘s] outward appearance against the chance that [the defendant] would become incompetent if taken off [medication], and struck the balance in favor of involuntary medication.” Id. at 136. Instead, the trial court should have determined whether “administration of antipsychotic medication was necessary to accomplish
an essential state policy.” Id. at 138. The Court specifically disclaimed a standard of strict scrutiny. Id. at 136. The Court observed that the State “certainly would have satisfied due process if the prosecution had demonstrated, and the District Court had found, that treatment with antipsychotic medication was medically appropriate and, considering less intrusive alternatives, essential for the sake of [the defendant‘s] own safety or the safety of others.” Id. at 135.
Sell v. United States: Involuntary medication of pretrial detainee permissible to render detainee competent for trial only if treatment is medically appropriate and is necessary to further important trial related interests.
Finally, in Sell v. United States, the Supreme Court held that “the Constitution permits the Government involuntarily to administer antipsychotic drugs to a mentally ill defendant facing serious criminal charges in order to render that defendant competent to stand trial, but only if the treatment is medically appropriate, is substantially unlikely to have side effects that may undermine the fairness of the trial, and, taking account of less intrusive alternatives, is necessary significantly to further important governmental trial-related interests.” 539 U.S. at 179. The Court emphasized that this standard contains four requirements. “First, a court must find that important governmental interests are at stake.” Id. at 180. “Second, the court must conclude that involuntary medication will significantly further those concomitant state interests.” Id. at 181. “Third, the court must conclude that involuntary medication is necessary to further those interests.” Id. “Fourth, . . . the court must conclude that administration of the drugs is medically appropriate, i.e., in the patient‘s best medical interest in light of his medical condition.” Id.
Summary
For our purposes, this trio of cases amounts to the following: There is a substantive due process right to refuse psychotropic drugs. Harper, 494 U.S. at 223. For convicted prisoners, a reasonableness test applies. Id. For pretrial detainees, the medication must be “necessary to accomplish an essential state policy.” Riggins, 504 U.S. at 138. In any event, there must be “a finding of overriding justification and a determination of medical appropriateness.” Id. at 135. Overriding justifications include preventing danger to the detainee‘s self or others in the facility and making a detainee competent to stand trial for a serious crime. Harper, 494 U.S. at 225; Riggins, 504 U.S. at 135; Sell, 539 U.S. at 180.
3. Evolution of the Maryland statute
A constitutional challenge to the involuntary medication statute came before this Court in Williams v. Wilzack, 319 Md. 485 (1990). Applying the Supreme Court‘s guidance in Washington v. Harper, supra, this Court held that the original version of
in Harper, the original version of
After the Williams decision, the General Assembly re-enacted
(3) Without the medication, the individual is at substantial risk of continued hospitalization because of:
(i) Remaining seriously mentally ill with no significant relief of the mental illness symptoms that cause the individual to be a danger to the individual or to others; [or]
Remaining seriously mentally ill for a significantly longer period of time with mental illness symptoms that cause the individual to be a danger to the individual or to others;
A question arose as to whether the reference to dangerousness that appeared in both Subparagraphs (i) and (ii) required a finding of dangerousness within the facility. In Department of Health & Mental Hygiene v. Kelly, 397 Md. 399 (2007),
this Court held that the references to dangerousness in Subparagraphs (i) and (ii) implicitly referred only to dangerousness in the facility, much as Subparagraphs (i)(1) and (ii)(1) expressly do today.15
The statute was amended effective October 1, 2014, to its current version which, in adding Subparagraphs (i)(2), (i)(3), (ii)(2), and (ii)(3), permits the authorization of involuntary medication in some circumstances without a showing of dangerousness to the individual or others within the facility. See Chapters 314, 315, Laws of Maryland 2014.
4. Mr. Allmond‘s facial challenge of the statute
Mr. Allmond argues that, absent a finding that, in an unmedicated state, he is a danger to himself or others within the facility—i.e., a finding that either Subparagraph (i)(1) or Subparagraph (ii)(1) is satisfied—DHMH may not medicate him against his will. Mr. Allmond characterizes his challenge as a “facial” challenge to
Under Maryland law, we resolve such challenges under the “no set of circumstances” test: the law is invalid if, and only if, the challenger can demonstrate that “no set of circumstances exist under which the Act would be valid.”
Koshko v. Haining, 398 Md. 404, 426 (2007) quoting United States v. Salerno, 481 U.S. 739, 745 (1987); see also King v. State, 425 Md. 550, 600 (2012), rev‘d on other grounds, --- U.S. ---, 133 S.Ct. 1958 (2013). Crucially, though, the “no set of circumstances” test “consider[s] only applications of the statute in which it actually authorizes or prohibits conduct.” City of Los Angeles, Calif. v. Patel, --- U.S. ---, 135 S.Ct. 2443, 2451 (2015). Thus, a facial challenge to the relevant provisions of
We can imagine such a set of circumstances. Suppose the State desired to make a pretrial detainee competent to stand trial for a serious crime and was able to meet all the requirements of Sell for involuntarily medicating that individual. Then medication of the individual would be constitutional. However, the State could not simply go ahead and medicate the detainee; the State would need statutory authorization in order for involuntary medication to be lawful. The statutory authorization may be found in
detainee was not dangerous within the facility without the medication, the detainee nonetheless was at substantial risk of continued hospitalization because of remaining seriously mentally ill with no significant relief of the mental illness symptoms that resulted in the individual being committed to a hospital. Then the State invoked Subparagraph (i)(2) to forcibly medicate the prisoner. In this scenario, involuntary medication would be constitutional,
As a result, Mr. Allmond‘s facial challenge must fail, albeit barely. Subparagraphs (i)(2), (i)(3), (ii)(2), and (ii)(3) can be applied constitutionally—but only if they are applied under the standards set forth in Harper, Riggins, and Sell.
5. The State‘s proposed justifications
DHMH suggests that it can satisfy the constitutional minimum by meeting the standards in the statute and no more. DHMH observes that the Supreme Court‘s list of overriding justifications is not explicitly exclusive, so it suggests a few more that it believes would serve to override a pretrial detainee‘s liberty interest. In our view, none are sufficient.
First, DHMH suggests that it has an interest in providing medical care to those committed to its custody, because it is required to provide such care. See
Court meant in Riggins when it referred to the two requirements of “a finding of overriding justification and a determination of medical appropriateness.” See 504 U.S. at 135. This interest alone is not sufficient.
Second, as an alternative justification, DHMH suggests that it has a significant interest in shortening the length of an individual‘s in-patient care for two reasons. One reason is that the State has an obligation under the Americans with Disabilities Act (“ADA“) to provide care in the least restrictive setting possible. See
A second reason that DHMH suggests that it has a significant interest in shortening the length of an individual‘s in-patient care is that the State would like to make optimal use of its resources. An individual who needs medication but does not receive it is unlikely to experience reduced symptoms and may even experience worsening symptoms instead. See, e.д., Penttila, Jaaskelainen, et al., Duration of Untreated Psychosis as Predictor of Long-Term Outcome in Schizophrenia: Systematic Review and Meta-Analysis, 205 British
individuals who need treatment may not receive all that they otherwise could, because resources are limited.
There is no question that resource allocation is a valid concern, but this, too, would collapse medical appropriateness and overriding justification into one inquiry. Nearly any treatment that is medically appropriate would have a fair chance of shortening the length of the individual‘s in-patient care; one of the primary goals of medicine is to make the patient well enough to return to ordinary life, so nearly every treatment is at least intended to serve this purpose. The Supreme Court precedent does not say that the State‘s burden is merely to show that the treatment is medically effective; the State also must show that there is some separate reason that treatment is necessary.
In short, none of these additional justifications constitute an “overriding justification” for the purpose of medicating an individual against the individual‘s will when the individual is not being held as a result of a criminal conviction. The State must meet the standards of Harper, Riggins, and Sell in order to subject a pretrial detainee to involuntary medication. For a pretrial detainee like Mr. Allmond, Riggins and Sell approve the State interests in preventing harm to the individual or others and in making the individual competent to stand trial. The State has presented no other sufficient interests in this appeal. Thus, although the statute can be applied constitutionally, if the State offers nothing more than the bare minimum to satisfy the statute—that the individual has the same symptoms as resulted in the individual‘s hospitalization or that the individual would be dangerous if released—then application of this statute would not be constitutional.19
III
Conclusion
For the reasons set forth above, the judgment of the Circuit Court is affirmed. In the interest of clarity, we note that this does not mean that Mr. Allmond can immediately be medicated against his will.
JUDGMENT OF THE CIRCUIT COURT FOR HOWARD COUNTY AFFIRMED. COSTS TO BE PAID BY PETITIONER.
Notes
1—a defendant in a pending criminal case who is committed under a court order after being found incompetent to stand trial and dangerous, pursuant to
2—a criminal defendant who is committed pursuant to a court order under
3—an individual who is civilly committed pursuant to a court order under
For each of these categories, an individual may be released from confinement upon a finding that the individual is no longer a danger to self or others. See