Leroy C. Bell, Jr. and Bon Secours Hospital Baltimore, Inc. v. Patricia Chance, Individually and as Personal Representative of the Estate of Brandon Mackey
No. 36
IN THE COURT OF APPEALS OF MARYLAND
July 12, 2018
September Term, 2017; Circuit Court for Baltimore City Case No. 24-C-13-001083; Argument: January 5, 2018
Barbera, C.J., Greene, Adkins, McDonald, Watts, Hotten, Getty, JJ. Opinion by McDonald, J.
Medical Malpractice – Mental Health Law – Involuntary Admission – Statutory Immunity. The Maryland Mental Health Law provides criteria for the involuntary admission of an individual to a mental health facility and a process for assessing whether the individual meets those criteria. The facility, as well as its agents and employees, have immunity from civil or criminal liability when they follow that process in good faith. The process begins with an application for involuntary admission made by an interested person, accompanied by certifications of two health care providers that the individual meets the statutory criteria, and ends with a hearing before an impartial hearing officer to determine whether the criteria are in fact satisfied. The statutory immunity applies to a decision by a psychiatrist at the facility in the interim – i.e., between initial confinement pursuant to an application and the hearing – that the individual must be released because he or she no longer meets the statutory criteria for involuntary admission.
Opinion by McDonald, J.
Filed: July 12, 2018
An assessment of these criteria is made by a mental health facility when it
Brandon Mackey, the 23-year-old son of Respondent Patricia Chance, attempted to commit suicide in April 2011. He was eventually taken to Petitioner Bon Secours Hospital (“Bon Secours“) pursuant to an application for involuntary admission certified by two doctors at another hospital, and came under the care of Petitioner Dr. Leroy Bell, a psychiatrist then employed by Bon Secours. In accordance with the Mental Health Law, a hearing to determine whether Mr. Mackey should be admitted involuntarily or released was scheduled for 10 days later. In the interim, Mr. Mackey was confined at Bon Secours where Dr. Bell assessed and treated him. Two days before the scheduled hearing, Dr. Bell decided that Mr. Mackey did not meet the statutory criteria required for involuntary admission and authorized his release. Tragically, the day after Mr. Mackey was released, he committed suicide.
Litigation ensued in the Circuit Court for Baltimore City. Ms. Chance contended that Dr. Bell – and Bon Secours vicariously as his employer – were negligent in releasing her son. After a jury returned a verdict in Ms. Chance‘s favor, the Circuit Court vacated that judgment based in part on its understanding of the immunity statute. A divided Court of Special Appeals reversed the Circuit Court decision.
We hold that the process of involuntary admission begins with the initial application for involuntary admission of an individual and ends upon the hearing officer‘s decision whether to admit or release that individual. During that process, if a physician applies the statutory criteria for involuntary admission and concludes in good faith that the individual no longer meets those criteria, the facility must release the individual. That decision is immune from civil liability and cannot be the basis of a jury verdict for medical malpractice.
I
Background
A. Involuntary Admission to a Mental Health Facility
To place the issues in this case in context, we first outline the relevant statutory provisions governing involuntary admissions to mental health facilities and summarize a key decision of this Court construing the immunity from liability provided for those involved in that process.
Admission to a Mental Health Facility under the Mental Health Law
The Maryland Mental Health Law comprises Title 10 of the Health-General Article (“HG“) of the Maryland Code.
Particularly pertinent to this case are Part III of Subtitle 6 (
Involuntary Admission – the Application and Certifications
Any person with “a legitimate interest in the welfare of [another] individual” may apply for the involuntary admission of that individual to a facility.
A facility presented with such an application may not admit the individual involuntarily unless five criteria are met:
- the individual has a mental disorder;
- the individual needs inpatient care or treatment;
- the individual presents a danger to the life and safety of the individual or of others;
- the individual is unable or unwilling to be admitted voluntarily; and
- there is no available, less restrictive form of intervention that is consistent with the welfare and safety of the individual.
The statute entitles “any individual proposed for involuntary admission” to “a hearing to determine whether the individual is to be admitted to a facility ... as an involuntary patient or released without being admitted.”
After considering all the evidence and testimony of record, the hearing officer is to order the release of the individual from the facility unless there is clear and convincing evidence of each of the five criteria required for involuntary admission.
Involuntary Admissions – Regulations Governing the Process
The regulations adopted by the Department of Health for involuntary admission provide additional detail concerning the process of admission. COMAR 10.21.01. Those regulations refer to the individual as being in “observation status” during the time the individual is confined in a facility involuntarily on the basis of an application before “the individual is either admitted, voluntarily or involuntarily, to the inpatient facility or is released by a physician or by an ALJ from the inpatient facility without being admitted.” COMAR 10.21.01.02B(18).5 The regulations provide that an individual confined in a facility on observation status remains in that status unless (1) admitted voluntarily to the facility; (2) released upon a finding by a physician that the individual no longer meets the criteria for involuntary admission; or (3) either admitted to or released from the facility as a result of the hearing before the ALJ. COMAR 10.21.01.07F. The regulations thus contemplate that an individual confined in a facility as a result of an application for involuntary admission is considered admitted to the facility only if the individual consents (i.e., the admission becomes voluntary) or if involuntary admission is authorized by an
Involuntary Admission – Statutory Immunity
The Mental Health Law provides immunity from liability for those involved in the decision whether to admit an individual to a mental health facility against his or her will.
The Williams Case: Statutory Immunity Applies to Decision Not to Admit
This Court construed the scope of the immunity granted in
That same night, the son spent several hours wandering the streets, broke into a residence, and stood in the front yard wielding a knife. Id. When the police arrived, the son rushed the officers, who then shot and killed him. Id.
The family sued the mental health care providers, asserting they were liable for their “failure to admit” the son which, the family alleged, proximately caused his death. The circuit court dismissed the complaint on the basis of statutory immunity – a decision affirmed by the Court of Special Appeals. 213 Md. App. 644 (2013).
In this Court, the family argued that the statutory immunity provided by Mental Health Law applies only when a facility decides to admit an individual and not when it decides against admitting the individual. The Court reviewed the structure of Part III of Subtitle 6 and its legislative history. The Court noted that its purpose was to discourage excessive institutionalization and to protect the due process rights of individuals who are proposed for involuntary admission. Id. at 586. “That the General Assembly mandated a multi-step process before an individual‘s involuntary admission ... suggests a legislative concern that individuals may be wrongfully admitted.” Id. at 584. If a health care provider has immunity only when the provider admits an individual, the immunity provision would undermine the purpose of the statute, creating “an incentive to err on the side of involuntary admittance in order to receive statutory immunity and avoid liability.” Id. at 587. The Court reasoned that applying the immunity provisions to the provider‘s decision on admission – regardless of whether
Id. at 587. Accordingly, the Court held that the statutory immunity extended to the good faith decision to release the son.
B. Facts
While the parties differ on whether Dr. Bell was negligent or has immunity, the basic chronology of events appears to be undisputed.
The Attempted Suicide of Brandon Mackey
On March 13, 2011, after struggling for years with chronic mental illness, 23-year-old Brandon Mackey cut his wrists with a knife in an apparent attempt to commit suicide. At the time, Mr. Mackey lived at home with his mother and her husband, who witnessed the incident and called the police. An ambulance arrived and transported Mr. Mackey to Harbor Hospital.
Mr. Mackey‘s First Stay at Bon Secours – Voluntary Admission
Harbor Hospital referred Mr. Mackey to Bon Secours, where he was voluntarily admitted for psychiatric treatment the next day, March 14, 2011. Once at Bon Secours, Mr. Mackey came under the care of Dr. Bell, an attending psychiatrist at the hospital.
Dr. Bell evaluated Mr. Mackey and gathered that Mr. Mackey was depressed. He prescribed an antidepressant, an antipsychotic (as the need might arise), and other medications for Mr. Mackey. Mr. Mackey remained at Bon Secours from March 14 until March 21, 2011, under Dr. Bell‘s care. At the time of Mr. Mackey‘s discharge, Dr. Bell diagnosed him as having “major depressive disorder.” According to Dr. Bell, at that time he did not see symptoms of schizophrenia in Mr. Mackey, and the “psychotic behavior”
that was apparent at the beginning of Mr. Mackey‘s time at Bon Secours “appeared to withdraw” by the time of his discharge. Dr. Bell also felt that the level of Mr. Mackey‘s depression had decreased over the course of his treatment at Bon Secours. In Dr. Bell‘s view, Mr. Mackey became more active, interacted more with others, and no longer communicated any suicidal thoughts. Dr. Bell decided to discharge Mr. Mackey on March 21, 2011, and move him to an aftercare program – a lower level of care that included partial hospitalization.7
Mr. Mackey‘s Second Stay at Bon Secours – Involuntary Admission
Less than two weeks later, on April 1, 2011, Mr. Mackey was again taken to an emergency room. This time, Ms. Chance brought Mr. Mackey to St. Agnes Hospital after Mr. Mackey sustained a wound to his neck. Mr. Mackey claimed that the cut had happened by accident when he fell on the stairs while holding a pair of scissors. However, the emergency room doctor believed that Mr. Mackey had intentionally cut his neck in a suicide attempt. A psychiatric evaluation of Mr. Mackey was performed, and a social worker completed an application for Mr. Mackey‘s involuntary admission to Bon Secours. Two clinicians at St. Agnes Hospital provided the required certificates that accompanied the application for involuntary admission of Mr. Mackey to Bon Secours. A hearing was scheduled for April 11, 2011 – 10 days after Mr. Mackey‘s initial confinement, and he was transferred to Bon Secours.
Dr. Bell once again began to treat Mr. Mackey. Dr. Bell examined Mr. Mackey, and agreed with the emergency room doctor at St. Agnes that Mr. Mackey had attempted to commit suicide. On this occasion, Dr. Bell diagnosed Mr. Mackey with
According to Dr. Bell, he saw improvement in Mr. Mackey‘s symptoms over time. While Mr. Mackey had started his stay at Bon Secours denying that he had attempted to commit suicide, by April 6, 2011, he had admitted to Dr. Bell that the wound on his neck was the result of a suicide attempt.8 Additionally, Mr. Mackey was denying suicidal
thoughts, paranoia, and suspiciousness. According to Dr. Bell, Mr. Mackey was compliant with his medication, was future oriented, and made no efforts to harm himself.
Throughout his stay Mr. Mackey maintained that he wanted to leave Bon Secours and return home. In light of the improvements in Mr. Mackey‘s condition, Dr. Bell felt that he “was stable enough to go to a lower level of care and was not a danger to himself or others” – which meant that two of the criteria required for involuntary admission no longer applied. As a result, Dr. Bell authorized the release of Mr. Mackey on April 9, 2011. On the day of Mr. Mackey‘s discharge, Dr. Bell referred him to an aftercare program, which was to begin on April 12, 2011. Mr. Mackey left Bon Secours with Ms. Chance and returned home.
Mr. Mackey‘s Suicide
The next day, on the morning of April 10, 2011, Mr. Mackey left his home after his mother went to church. He went to a subway station, jumped in front of an oncoming train, and was killed.
C. Legal Proceedings
The Complaint
Almost two years after her son‘s death, on February 25, 2013, Ms. Chance commenced this wrongful death and survivorship action against Dr. Bell and Bon Secours.9
in the Circuit Court for Baltimore City. Acting individually and as personal representative of Mr. Mackey‘s estate, Ms. Chance sued Dr. Bell and Bon Secours for medical malpractice. In her complaint, Ms. Chance claimed, among other things, that Dr. Bell – and through vicarious liability, Bon Secours as his employer10 – breached the accepted standard of care in the treatment of Mr. Mackey by prematurely releasing Mr. Mackey from Bon Secours.11
Motion for Summary Judgment Based on Immunity Statutes
On December 16, 2013, Dr. Bell filed a motion for summary judgment arguing that he was entitled to statutory immunity under
to release Mr. Mackey was essentially a decision “not to admit” Mr. Mackey, and under the recent Court of Special Appeals decision in Williams, a decision not to admit is covered by the immunity granted in
On February 24, 2014, the Circuit Court denied the motions for summary judgment, ruling that “admission” under the Mental Health Law is “limited to the initial decision concerning admission and not to decisions that are made while a patient remains admitted in the facility.” Accordingly, the Circuit Court ruled, Dr. Bell and Bon Secours were not entitled to immunity for Dr. Bell‘s decision to release Mr. Mackey after Bon Secours initially accepted him when he first entered the hospital. The implicit premise of the Circuit Court decision was that the decision on involuntary admission of Mr. Mackey was complete when he was first confined at Bon Secours on April 1, 2011, and his subsequent release was not part of that decision. Both the motions for summary judgment and the Circuit Court decision referred only to the statutory provisions concerning immunity and the initial application. Neither made any reference to
Plaintiff‘s Motion in Limine to Preclude Evidence Concerning Immunity
After the Circuit Court denied the motion for summary judgment, Ms. Chance filed a motion in limine on April 4, 2014, to preclude Dr. Bell and Bon Secours from presenting any evidence or argument to the jury relating to immunity under
decided by the Circuit Court in its ruling on summary judgment. Dr. Bell and Bon Secours did not file oppositions to the motion in limine.
At a motions hearing held shortly before trial, the trial judge – who was not the same judge who had ruled on the summary judgment motion – asked counsel for Dr. Bell and Bon Secours whether they “concede that there is no issue with the statutory immunity for health care providers who admit patients[.]” Defense counsel responded that it was not an issue that would be presented to the jury. The Court then granted the motion in limine, indicating that it agreed with the earlier decision on summary judgment that the immunity under the statute “occurs at the point of admission and possibly continued admission,”
The Trial
The case was tried before a jury during June 23-26, 2014. At the trial, the medical records concerning Mr. Mackey‘s various hospitalizations were introduced in evidence by stipulation. Plaintiff‘s counsel called Ms. Chance and Dr. Bell to the stand to describe the events surrounding Mr. Mackey‘s two stays at Bon Secours, his release on April 9, 2011, and the aftermath. The defense examined Dr. Bell extensively as well, and called a registered nurse from Bon Secours who worked with Dr. Bell and who cared for Mr. Mackey during both of his stays at the hospital. She testified as to the improvement in Mr. Mackey‘s condition during his second stay at Bon Secours.
The heart of the case was a battle of two highly-credentialed expert psychiatrists concerning the merits of the decision to release Mr. Mackey. Dr. Nicola Cascella was
called to testify as an expert witness for the plaintiff on whether Dr. Bell had complied with the standard of care. In his testimony, Dr. Cascella criticized Dr. Bell for not consulting more with Mr. Mackey‘s family and not obtaining additional records of Mr. Mackey‘s prior hospitalizations. He also opined that Dr. Bell had failed to diagnose Mr. Mackey correctly and implement an appropriate course of treatment. Ultimately, Dr. Cascella testified that Dr. Bell‘s decision to discharge Mr. Mackey on April 9, 2011 was a breach of the applicable standard of care. Dr. Cascella testified that, in his opinion, Mr. Mackey continued to meet all five criteria required for involuntary admission at the time of his release from Bon Secours. Dr. Cascella concluded that Dr. Bell‘s decision to release Mr. Mackey “more likely than not” caused Mr. Mackey‘s suicide.
In its case, the defense called Dr. John Lion, who opined that Dr. Bell‘s decision to release Mr. Mackey on April 9, 2011, complied with the applicable standard of care. We need not chronicle the details of Dr. Lion‘s testimony for purposes of this opinion, as we will assume that the jury accepted Dr. Cascella‘s opinion as to one or more of the points in dispute. See Part II.B. of this opinion concerning the standard of review.
At the close of the plaintiff‘s case, Dr. Bell and Bon Secours moved for judgment. They argued, among other things, that no reasonable juror could find, on the basis of Dr. Cascella‘s testimony, that there was a breach of the standard of care or causation of Mr. Mackey‘s suicide. The trial court denied the motion with the observation that it was “very difficult [to determine] whether Dr. Cascella‘s opinion [was] sufficient, both on the standard of care and breach of the standard of care...” At the close of all of the evidence,
Dr. Bell and Bon Secours renewed their motion for judgment. The Circuit Court again characterized the plaintiff‘s “best evidence” on the standard of care and causation – Dr. Cascella‘s testimony – as “very marginal,” but elected to reserve its ruling on the motion, pursuant to Maryland Rule 2-519(c), and send the case to the jury.
On June 26, 2014, the jury returned a verdict in Ms. Chance‘s favor. It awarded $6,112 for funeral expenses and noneconomic damages of $2.3 million.13
Post-Trial Motion for Judgment Notwithstanding the Verdict
Dr. Bell and Bon Secours filed a post-trial motion for judgment notwithstanding the verdict (“judgment NOV“) or alternatively
In a memorandum opinion dated December 11, 2014, the Circuit Court granted the motion for judgment NOV and vacated the judgment in favor of Ms. Chance. The Circuit Court explained that Dr. Cascella‘s testimony failed to establish that Dr. Bell or Bon Secours had breached the applicable standard of care. Although the court recognized that neither Dr. Bell nor Bon Secours had relied on statutory immunity in their motion for judgment NOV,14 the court reasoned that the statutory process for involuntary admission
immunity and the recently-issued Williams decision were relevant to the question before it.15 The Circuit Court held that the Mental Health Law requires a physician, when deciding whether to “continue admission” of a patient, to “consider the patient‘s countervailing liberty interest and to discharge the patient as soon as the [physician] believes, in his or her best judgment, the patient safely can be treated and maintained in a less restrictive setting.” The Circuit Court ruled that Dr. Cascella‘s opinion that Dr. Bell “could have found the statutory criteria to be satisfied and therefore could have held Mr. Mackey until the ALJ hearing on the following Monday, both failed to give weight to Mr. Mackey‘s liberty interest and failed to answer the negligence question.” (emphasis in original). Determining that the “criteria for involuntary admission are necessarily subject to a broad range of judgment,” and “that is why the General Assembly has afforded immunity from civil liability when that discretion is exercised in good faith,” the Circuit Court found that Dr. Cascella failed to answer the question “whether no reasonable physician exercising reasonable care in [those] circumstances would have discharged Mr. Mackey.”
Appeal to Court of Special Appeals
Ms. Chance appealed the Circuit Court‘s decision to the Court of Special Appeals. In an unreported 2-1 decision, the Court of Special Appeals reversed the Circuit Court. Chance v. Bon Secours Hosp., 2017 WL 1716258, at *6 (May 2, 2017). The opinion of the panel majority stated that the dispositive question on appeal was whether there was evidence from which the jury could have concluded that Dr. Bell‘s decision to discharge Mr. Mackey on April 9, 2011, was a breach of the applicable standard of care. It concluded that Dr. Cascella‘s testimony was sufficient to support the jury verdict. Id. at *4. Specifically, the jury could have found from Dr. Cascella‘s testimony that: “(1) the standard of care required Dr. Bell not to discharge [Mr. Mackey] until his symptoms of psychosis were significantly reduced by Risperdal, (2) that, at the time Dr. Bell discharged [Mr. Mackey], the patient continued to present symptoms of responding to internal stimuli, as well as poor insight and poor judgment, indicating that [Mr. Mackey‘s] symptoms had not yet been significantly reduced by Risperdal, and (3) that [Mr. Mackey‘s] premature discharge from Bon Secours was a proximate cause
Judge Friedman dissented from the panel decision. In Judge Friedman‘s view, Dr. Bell‘s decision to release Mr. Mackey “could not, as a matter of law, constitute a violation of the standard of care.” Id. at *6 (emphasis in original). Judge Friedman opined that Dr. Cascella‘s proposed standard of care would mean that “any physician who decided not to commit his patient under these circumstances would be open to civil liability.” Id. at *6. This, Judge Friedman argued, would conflict with
We granted a petition for writ of certiorari filed by Dr. Bell and Bon Secours.
II
Discussion
The petition for a writ of certiorari in this case raised the question whether a psychiatrist‘s decision to release a patient who has been confined pursuant to an application for involuntary admission is covered by the immunity from civil and criminal liability provided in
A. Preservation
Ms. Chance argues that Dr. Bell and Bon Secours failed to preserve any argument concerning immunity in the trial court. “Ordinarily, the appellate court will not decide any issue [other than jurisdiction] unless it plainly appears by the record to have been raised in or decided by the trial court...”
It is true that Dr. Bell and Bon Secours did not rely on statutory immunity in their motion for judgment NOV. But they did raise the question of statutory immunity in their motions for summary judgment. The Circuit Court rejected that argument as a matter of law. A different judge of the Circuit Court, who presided over the trial, confirmed that ruling at the outset of the trial.16 That interlocutory ruling on immunity is open to review on appeal.
B. Standard of Review
We review a trial court‘s grant of a motion for judgment NOV for legal correctness. Sage Title, LLC v. Roman, 455 Md. 188, 201 (2017). In considering a motion for judgment NOV, the evidence and inferences to be drawn from the evidence must be considered in the light most favorable to the party opposing the motion. Lusby v. First National Bank, 263 Md. 492, 499 (1971). However, if there is no rational ground under the law governing the case for upholding the jury‘s verdict, judgment NOV must be granted. Id. at 506. When the primary issue is, as here, one of statutory interpretation and application, we review it without deference to the trial court. Garfink v. Cloisters at Charles, Inc., 392 Md. 374, 383 (2006). Similarly, when a Circuit Court‘s denial of summary judgment turns on its interpretation of a statute — as opposed to a determination that facts are in dispute — that ruling rests on a question of law. We review the resolution of that legal question without deference to the trial court.
C. The Extent of Statutory Immunity for a Physician‘s Decision to Release an Individual Confined in a Mental Health Facility
The question posed in the petition for a writ of certiorari in this case is whether the immunity provided by
This raises two interpretative questions:
- What does it mean to act “in compliance with Part III“?
- What does it mean to act “in good faith and with reasonable grounds“?
The answers to these two questions are matters of statutory construction. When we construe a statute, we search for legislative intent. Hughes v. Moyer, 452 Md. 77, 94 (2017). Consideration of the statutory text in context is our primary guide. We may refer to the statute‘s legislative history to “confirm conclusions or resolve questions” from our examination of the text. Blue v. Prince George‘s County, 434 Md. 681, 689 (2013). Finally, we check our interpretation against the consequences of alternative readings of the text. Id. Throughout this process, we avoid constructions that are illogical or nonsensical, or that render a statute meaningless. Fisher v. Eastern Correctional Inst., 425 Md. 699, 706 (2012); Frost v. State, 336 Md. 125, 137 (1994).
1. Acting in Compliance with Part III
Text in Context
As outlined earlier in this opinion, Part III of Subtitle 6 of the Mental Health Law concerns involuntary admission to a facility like Bon Secours and the decisions to be made by that facility through its agents and employees in the involuntary admission process. What does it mean to be admitted involuntarily to a mental health facility?
It may be said that an individual who enters the facility, is accepted for residence there, and begins to receive care has been “admitted” to the facility. But that is not the end of the involuntary admission process contemplated by Part III. As indicated earlier, it is evident from related provisions of the Mental Health Law that “admission” under statute extends beyond physical entry and initial acceptance into a facility. That law defines “admission” as a “process” that “includes the physical act” of entry into the facility. See
As another related provision makes clear, the involuntary admission process under Part III is not complete until a hearing is conducted to determine whether the criteria for involuntary admission are satisfied. Under
Plainly, the statute does not consider an individual “admitted” as of the time the individual appears before the ALJ for the hearing. Rather, the confined individual is “proposed for involuntary admission“; involuntary admission is “sought” as opposed to already achieved; and the hearing will determine whether that individual is “to be admitted to a facility or released without being admitted.” Moreover, the ALJ is to release the individual unless those five criteria are satisfied at the time of the hearing.
Related Regulations and Legislative History
The regulations adopted by the Department of Health governing involuntary admission are certainly consistent with this interpretation. Those regulations define an involuntary admission as when “an individual has been admitted to an inpatient facility by an ALJ following an [involuntary admission hearing] pursuant to [HG] §10-632.” COMAR 10.21.01.02B(12). They refer to a patient who has been confined but not afforded a hearing as under “observation status,” rather than involuntarily admitted. COMAR 10.21.01.02B(18). Moreover, the regulations require that a physician who examines an individual on observation status “immediately release the individual” if the patient does not meet the criteria required for involuntary admission under
Ordinarily, we would say that the views of the Department, as the agency administering the statute, are entitled to “considerable weight.” Adventist Health Care Inc. v. Maryland Health Care Com‘n, 392 Md. 103, 121 (2006). In this instance, the Department‘s view is even more persuasive, as the legislative history of
During the 1960s and 1970s, a series of court decisions — including several by the Supreme Court20 — emphasized the constitutionally
Consequences
To construe involuntary admission under Part III narrowly to encompass only the initial decision on an application for involuntary admission and not the period during which the individual is considered to be on “observation status” would conflict with the purpose of the immunity provision. As this Court pointed out in Williams, the purpose of the statutory immunity is to eliminate the incentive that a mental health facility or its physicians might otherwise have to err on the side of curtailing an individual‘s liberty in order to protect themselves from liability. A narrow construction of the immunity statute would discourage a facility that made an initial decision that an individual be involuntarily admitted based on the statutory criteria from releasing that individual if, even a day later, it determined that those criteria were no longer met.
It is thus evident that involuntary admission to a mental health facility is a process that includes at least an application accompanied by two certifications, the physical act of the individual entering the facility, and a hearing before an ALJ, after which the individual is either admitted or released without being admitted. Throughout that process, Part III of Subtitle 6 requires that the facility and the psychiatrist treating the patient ensure that the individual is confined against his or her will only if the criteria set forth in
Ms. Chance contends that this view of admission to a mental health facility would extend the scope of immunity and create an “incentive to release a patient
2. In Good Faith and With Reasonable Grounds
The phrase “in good faith” refers to the subjective intent or belief of a person at the time the person acts or makes a decision. The action may be misguided or the belief may be objectively incorrect, but the person acting or making the decision can still be acting “in good faith” if he or she actually holds that belief or makes the decision without actual knowledge of his or her error. See Rite Aid Corp. v. Hagley, 374 Md. 665, 680-83 (2003) (in the context of construing another immunity statute, defining “good faith” as to “act with an honest intention“); see also Black‘s Law Dictionary (9th ed. 2009) at 762 (defining “good faith” as “a state of mind consisting in... honesty in belief or purpose“).
The phrase “with reasonable grounds” may suggest that there is also an objective aspect to the standard — i.e., that the facility or person must have acted “reasonably.” However, as the Court of Special Appeals explained in its decision in the Williams case, that cannot be the meaning of “with reasonable grounds” in
As stated earlier, we do not construe statutes to be illogical or meaningless. As the Court of Special Appeals suggested in Williams, an appropriate way to construe “with reasonable grounds” would be as a requirement that a facility and its agents and employees have followed the process and relied on the grounds set forth in the statutory provisions. 213 Md. App. at 662 n.9; cf. Ziemba v. Riverview Medical Center, 645 A.2d 1276, 1280-81 (N.J. App. 1994) (construing statute conferring immunity with respect to decisions on involuntary commitment when decisionmakers act in good faith and take “reasonable steps“). In other words, there should be a reasoned articulation somewhere in the record that relates the decision to admit or release an individual to the statutory criteria. Thus, immunity does not depend on the merits or reasonableness of a decision to admit — or to release — an individual proposed for involuntary admission, but on whether the process required by the statute was followed
3. Summary
In our view, the plain language of the immunity statutes — read in context, illuminated by their legislative history, and considered together with the agency regulations — extends immunity to every stage of the process by which an individual is involuntarily admitted to a mental health facility and at which the facility and its employees must apply the criteria set out in
This reading is consistent with the statute‘s purpose — protecting individuals from loss of liberty due to an unwarranted involuntary commitment — because it allows for a physician to release an individual without fear of liability when the physician believes that the individual no longer meets the criteria that justify the restriction of that individual‘s liberty. Therefore, a physician acting on behalf of the facility who determines, in good faith and with reasonable grounds, that a patient initially confined under an application for involuntary admission no longer fits the criteria of
D. Application of Immunity Statutes and Disposition of this Appeal
What effect does our holding have on the disposition of this case?
First, it is clear from the analysis above that statutory immunity potentially covers the decision to release Mr. Mackey on April 9, 2011.24 Had Mr. Mackey stayed at Bon Secours long enough to have had a hearing and had the ALJ agreed with Dr. Bell that the criteria for involuntary admission were not met, Mr. Mackey would have been “released without being admitted” pursuant to
The judgment that is before us on this appeal is the Circuit Court‘s decision to grant judgment NOV in favor of Dr. Bell and Bon Secours. As indicated earlier, in reviewing such a decision, we consider the evidence and inferences in the light most favorable to the party who prevailed at trial — in this case, Ms. Chance. There is a factual element to immunity — the person or entity claiming protection from liability must have acted in good faith and with reasonable grounds — i.e., followed the statutory process with an honest intention. Thus, there is at least a possibility that,
In any event, we agree with the Circuit Court that Dr. Cascella‘s opinion on the standard of care was inconsistent with Maryland law to the extent that he opined that Dr. Bell‘s decision to discharge Mr. Mackey, absent bad faith or a lack of reasonable grounds, could be a breach of the standard of care. A decision to discharge a patient, made in good faith and with reasonable grounds, would be immune from liability under
III
Conclusion
For the reasons stated above, we hold that the immunity statutes related to involuntary admission of an individual to a mental health facility apply to the entire process of involuntary admission from the initial application for admission to the mandatory ALJ hearing. If a psychiatrist employed by a facility applies the statutory criteria for involuntary admission in good faith and decides to release an individual prior to the ALJ hearing, the psychiatrist and the facility are immune from civil and criminal liability for that decision pursuant to
JUDGMENT OF THE COURT OF SPECIAL APPEALS REVERSED. COSTS IN THE COURT OF SPECIAL APPEALS AND THIS COURT TO BE PAID BY RESPONDENT.
Notes
A “responsible official” – defined as the director or administrative head of the facility (