D.L. v. Sheppard Pratt Health Sys.

D.L. v. Sheppard Pratt Health System Inc., et al., No. 38, September Term, 2018. Opinion
by Getty, J.
ACTION—GROUNDS AND CONDITIONS PRECEDENT—MOOT,
HYPOTHETICAL OR ABSTRACT QUESTIONS
The Court of Appeals held that a juvenile’s petition for judicial review of her involuntary
admission was not moot based simply upon her release. The involuntary admission
subjected the juvenile to sufficient possible collateral consequences to justify judicial
review of her involuntary admission, despite her release.
Circuit Court for Howard County
Case No. 13-C-15-103393
Argued: January 4, 2019
IN THE COURT OF APPEALS
OF MARYLAND
No. 38
September Term, 2018
D.L.
v.
SHEPPARD PRATT HEALTH SYSTEM, INC., et
al.,
Barbera, C.J.
*Greene,
McDonald,
Watts,
Hotten,
Getty,
Rodowsky, Lawrence F.
(Senior Judge, Specially Assigned),
JJ.
Opinion by Getty, J.
Filed: August 13, 2019
*Greene, J., now retired, participated in the hearing
and conference of this case while active an member
of this Court; after being recalled pursuant to the
Pursuant to Maryland Uniform Electronic Legal
Materials Act
(§§ 10-1601 et seq. of the State Government Article) this document is authentic.
Maryland Constitution, Article IV, Section 3A, he
2019-08-13 14:23-04:00
also participated in the decision and adoption of this
opinion.
Suzanne C. Johnson, Clerk
In 2015, an Administrative Law Judge (“ALJ”) involuntarily admitted Petitioner,
D.L., to a facility operated by Respondent, Sheppard Pratt Health Systems, Inc. (“Sheppard
Pratt”) in Ellicott City, Maryland. After D.L. was released from Sheppard Pratt, she filed
a petition for judicial review in the Circuit Court for Howard County challenging her
involuntary admission. Without holding a hearing, the circuit court granted Sheppard
Pratt’s motion to dismiss on grounds of mootness because D.L. had already been released
from the facility. Accordingly, the primary issue within this case is whether judicial review
of an ALJ’s involuntary admission decision is mooted by the juvenile’s release.1
Ultimately, we hold that D.L. is subject to collateral consequences stemming from
her involuntary admission and, therefore, the circuit court erred in dismissing the case as
moot. In accordance with this determination, we remand the case to the circuit court for
further proceedings on D.L.’s petition for judicial review. Although D.L. also presents us
with an issue of whether the Court of Special Appeals erred in determining she failed to
preserve the capable of repetition yet evading review exception to the mootness doctrine,
we need not resolve this inquiry based on our conclusion regarding collateral
consequences.
1
We note that D.L. did not present this Court with the meritorious issue of her petition for
judicial review, i.e. whether a less restrictive form of intervention was available.
Therefore, we are merely tasked with determining whether the circuit court erred in
dismissing D.L.’s petition for judicial review as moot. More information on this unique
procedural posture will be provided throughout our analysis.
BACKGROUND
A fourteen-year-old girl, D.L., presented at the emergency department of MedStar
Southern Maryland Hospital (“MedStar Southern”) with fresh cut wounds along her left
arm stretching from her elbow to her wrist. In addition to the new cuts, the arm of D.L.
displayed scars from prior cuts. D.L. confessed to staff that the superficial wounds and
scars were self-inflicted using a razor blade.
According to the testimony of Katie Krauch, a hospital representative for Sheppard
Pratt at Ellicott City, before an ALJ, D.L. was brought to MedStar Southern by a police
officer from Prince George’s County. After being examined by two physicians, she was
certified with a “diagnosis of other specified depressive disorder with the following
symptoms, impulsive disturbance in eating and sleeping, poor insight and judgment,
engaging in self-mutilation.”
Ms. Krauch testified that Dr. Banks, one of the physicians at MedStar Southern who
evaluated D.L., wrote that the patient was in need of institutional inpatient care and
treatment because the she was impulsive, had severely impaired insight and judgment, and
felt helpless and hopeless. In addition, Ms. Krauch summarized the assessment made by
Dr. Banks that
[D.L.] presents a danger to her own life or [the] life or safety of others
because the patient is severely depressed and recently engaged in self-
mutilation which places her at great risk of self-harm. The patient is unable
to be voluntarily admitted as evidenced by the patient is a minor and in the
care and custody of [the local Department of Social Services (“DSS”)] and
[Child Protective Services (“CPS”)]. There is no less restrictive [form of
intervention] than in-patient psychiatric care available for the patient which
2
is consistent with [her] welfare and safety and that the severity of the
patient’s symptoms places her in need of 24 hour care and supervision[.]2
Based upon this assessment, D.L. was initially confined to Sheppard Pratt-Ellicott
City on March 26, 2015. The ALJ conducted the hearing at Sheppard Pratt-Ellicott City
on April 7. In addition to the testimony of Ms. Krauch cited above, the attending
psychiatrist, Dr. Laura Seidel, testified. Regarding the need for D.L. to be involuntarily
committed, Dr. Seidel stated that,
[s]he exhibits symptoms of severe depression where she’s had decreased
energy, hypersomnia where she’s been in bed pretty much for the past 24
hours, not participating in the activities and the groups on the unit. Some
decrease in appetite and she has expressed some hopelessness about, you
know, the discharge plans that her DSS worker is, is kind of forming with
myself and the team.
When the ALJ asked Dr. Seidel whether D.L. represents a danger to herself or
others, Dr. Seidel responded,
I do, partly because she [ ] has been in [ ] three foster homes and the last one
that she went in when she finally became hopeless, towards the end she ended
up going to a store and bought a razor blade and cut herself actually in the
store, you know, multiple marks on her arms. And I feel like she could be at
risk of doing that again if she had access to a sharp object and given her level
of depression and her hopelessness.
Dr. Seidel added her opinion that she did not believe D.L. was a danger to others but only
to herself. Her conclusion was primarily based on D.L.’s earlier self-injurious behavior.
2
Although the transcript reflects that Ms. Krauch testified that D.L. was “in the care and
custody of DSS and CCS[,]” we believe the reference to “CCS” is the result of a
transcription error. Instead, Ms. Krauch was likely referring to CPS.
3
Before the ALJ, the primary point of contention was whether a less restrictive form
of intervention was available at the time. When asked, Dr. Seidel testified that she did not
believe such an alternative was available due to a lack of available placement beds. Based
upon her earlier discussions with an individual from the DSS, Dr. Seidel noted that they
were attempting to place D.L. at two alternative facilities, the Berkeley & Eleanor Mann
School and Residential Treatment Center at the Sheppard Pratt Towson Campus (“Mann
RTC”) and Stone Bridge psychiatric respite facility (“Stone Bridge”).3 However, she
indicated that at the time, both facilities lacked an available bed for admission.
Regarding the availability of space at Mann RTC, Dr. Seidel testified that, “[a]t this
point[,] they’re still working on the insurance authorization but she has been accepted and
we’re hoping that there will be a bed, there is a bed available that the insurance will come
through, you know, by Friday of this week.” Concerning placement at Stone Bridge, she
testified that:
The other option [ ] presented is [Stone Bridge] . . . which there may be an
opening today but there may not. [A DSS employee], you know, [ ] would
look into that if [D.L.] was released but she did not say that there was a
definite spot at [Stone Bridge] where she could be placed today.
3
Stone Bridge is a psychiatric respite facility program offered by Brook Lane Health
Services, Inc. which is headquartered in Hagerstown, MD. Mann RTC is a “63-bed
licensed residential treatment center located on [Sheppard Pratt’s] historic campus in
Towson, Maryland” that focuses on the treatment of adolescents with emotional or
behavioral disabilities by providing “24-hour care in a supportive and nurturing
environment.” The Berkeley & Eleanor Mann School and Residential Treatment Center |
Sheppard Pratt Health Systems available at: https://www.sheppardpratt.org/care-
finder/the-berkeley-amp-eleanor-mann-school-and-residential-treatment-center/ (last
visited Aug. 12, 2019). Before the ALJ, Dr. Seidel testified that D.L. had previously stayed
at Mann RTC.
4
However, Dr. Seidel also testified that D.L. did not wish to return to Mann RTC. Instead,
she preferred placement in a therapeutic foster home.
Based on this testimony, Sheppard Pratt argued that there was no less restrictive
form of intervention available at the time, and, therefore involuntary admission was
appropriate under § 10-617(a)(5) of the Health–General Article (“HG”). Whether an
institution offers a form of intervention rightfully considered a less restrictive alternative
form of intervention generally depends upon the level of supervision and security within
an institution and the extent to which a patient retains individual autonomy. In-patient
facilities such as foster care, therapeutic foster care, group homes, independent/alternative
living programs, residential treatment centers, behavioral programs, and, in some
situations, out-patient care are considered less restrictive forms of intervention compared
to psychiatric hospitals. See generally 2018 Data Resource Guide, Section IV: Committed
Programs, Maryland Department of Juvenile Services at 139-140, 160, available at:
https://djs.maryland.gov/Documents/DRG/Data_Resource_Guide_FY2018_full_book.pd
f (last visited Aug. 12, 2019) (outlining and explaining the types of psychological treatment
programs available to adolescents within the State). Accordingly, in the instant appeal,
Mann RTC and Stone Bridge both constitute less restrictive forms of intervention when
compared to involuntary admission at Sheppard Pratt.
The ALJ concluded that there was clear and convincing evidence that D.L.: (i) was
diagnosed with major depressive disorder; (ii) presented a danger to her own life and
safety; (iii) was in need of institutional care or treatment; (iv) was insufficiently assisted
under her current placement in therapeutic foster care; and (v) if released, there was a
5
substantial likelihood that she would resort to self-injurious behavior again in the future.
In addition, the ALJ concluded that there was clear and convincing evidence that no less
restrictive form of intervention, consistent with D.L.’s welfare, was available at the time.
On this issue, the ALJ commented, “I have the possibility that something might or might
not be available today. That is not clear and convincing that [a less restrictive form of]
intervention is available.”
Subsequently, D.L. filed a petition for judicial review of the ALJ’s decision,
pursuant to HG § 10-633, in the Circuit Court for Howard County on May 1, 2015. In her
petition for judicial review, the sole issue presented was whether there was sufficient
evidence that no less restrictive form of intervention was available. In response, on June
18, 2015, Sheppard Pratt filed a motion to dismiss alleging that the controversy was moot
because D.L. had been released from Sheppard Pratt on April 10, 2015. Thereafter, the
parties exchanged numerous responsive motions.4 Subsequently, the circuit court granted
Sheppard Pratt’s motion to dismiss, without holding a hearing, in an order dated July 28,
2015 on the basis that the case was moot due to D.L.’s release.
4
The responsive motions included: (i) “[Sheppard Pratt’s] Memorandum. . . in Support of
Motion to Dismiss”; (ii) “[D.L.’s] Answer to Motion to Dismiss”; (iii) “[Sheppard Pratt’s]
Reply Memorandum . . . in Support of Motion to Dismiss”; (iv) “[D.L.’s] Motion to Strike
Motion to Dismiss”; (v) “[Sheppard Pratt’s] Memorandum . . . In Opposition to Petitioner’s
Motion to Strike Motion to Dismiss”; (vi) “[D.L.’s] Response to Memorandum of
Sheppard Pratt Health System in Opposition to Petitioner’s Motion to Strike Motion to
Dismiss”; (vii) “[D.L.’s] Motion to Strike [Sheppard Pratt’s] Reply Memorandum in
Support of Motion to Dismiss”; (viii) “[Sheppard Pratt’s] Response to Petitioner’s Motion
to Strike Sheppard Pratt’s Reply Memorandum in Support of Motion to Dismiss”; (ix)
“[Sheppard Pratt’s] Memorandum of Law in Opposition to Petition for Judicial Review”;
and (x) D.L.’s request for postponement.
6
D.L. then filed a motion to alter or amend the circuit court’s order in which she
argued that the circuit court erred by dismissing her petition for judicial review on August
12, 2015 without holding a merits hearing. Specifically, she argued that she was entitled
to a hearing on the merits under Maryland Rule 7-208(b) that provides that after the record
associated with an administrative law judge’s decision is filed in the circuit court, the court
shall set a date for a “hearing on the merits.” The circuit court disagreed and again without
holding a hearing issued an order dated September 15, 2015, that denied D.L.’s motion to
alter or amend. Following D.L.’s first motion to alter or amend, but preceding the circuit
court’s disposition on the motion, D.L. filed a second motion to alter or amend on August
24, 2015 arguing that the circuit court erred in denying her motion to strike Sheppard Pratt’s
“Reply Memorandum in Support of Motion to Dismiss[.]” The circuit court denied her
second motion to alter or amend on October 5, 2015. On October 16, 2015, D.L. filed a
notice of appeal in the circuit court to appeal its decision to the Court of Special Appeals.
Before the intermediate appellate court, the parties filed a joint motion to remand
the case to the circuit court. The motion was primarily based on the circuit court’s failure
to hold a hearing in the case. Paragraph 12 of the motion provided the basis on which the
parties agreed remand was warranted:
The parties are in accord that justice will be served by remanding the matter
[to] the Circuit Court for a hearing. In particular, the parties request a remand
for the Circuit Court to first consider after argument Appellee Sheppard Pratt
Health[] System’s Motion to Dismiss. Thereafter, depending on the
disposition of that motion, the Circuit Court may also consider after
argument [D.L.]’s Petition for Judicial Review.
7
The parties also stipulated in the motion that no further briefing was required and that the
court should remand solely for the purposes of conducting a hearing. On May 9, 2016, the
Court of Special Appeals granted the motion, stayed the appeal, and remanded “for the
limited purpose of conducting a hearing on the motion filed by [Sheppard Pratt.]”
On October 13, 2016, in accordance with the intermediate appellate court’s remand,
the circuit court held a hearing on Sheppard Pratt’s motion to dismiss. Therein, the circuit
court judge commented that it was unclear what was before him due to the unusual
procedural posture of the case. The judge explained that motions to dismiss originating
from administrative appeals are rather uncommon and expressed confusion over what
materials are encompassed in the record and should rightfully be considered.
The hearing transcript reveals that there was also an issue as to the scope of the
circuit court’s review on remand. Counsel for D.L. argued that she was entitled to a hearing
on the merits and that dismissal based on mootness is inappropriate within the context of
judicial review of involuntary admission decisions. In addition, counsel for D.L. made an
additional argument indicating that the potential of collateral consequences stemming from
involuntary admissions may overcome mootness. In contrast, Sheppard Pratt argued that
the hearing was limited to mootness, D.L. had been released from commitment, the case
lacked a justiciable controversy, and therefore the circuit court’s earlier dismissal as moot
was warranted. In reference to the scope of the hearing, the judge commented several times
that the remand was limited in nature:
Because I think the only thing I’m authorized to do today is to conduct a
hearing on the issue of mootness
8
***
Quite frankly, when I review the transcript [of the ALJ hearing], it does seem
to me that [Sheppard Pratt presented sufficient evidence that no less
restrictive form of intervention was available]. But I’m just here to make a
determination as to whether or not the case has become moot because she
was discharged three days later.
***
But would you agree with me that, that the remand in this particular case was
very specific and narrow in that I was directed to conduct a hearing
essentially on the issue of the Motion to Dismiss.
On November 4, 2016, the circuit court issued its memorandum and order. Therein,
the court analyzed two questions: (i) whether D.L.’s petition for judicial review was moot;
and (ii) if the petition was moot, should Sheppard Pratt’s motion to dismiss be granted?
The circuit court first found that D.L.’s petition was moot because she had already been
released. The circuit court commented, “[t]he only status of which [D.L.] complains no
longer exists. Under these facts and circumstances, [D.L.]’s Petition is moot.”
Second, the court analyzed whether the public interest exception to the mootness
doctrine applied. Relying primarily on Lloyd v. Supervisors of Elections, the circuit court
determined that the public interest exception was not implicated. 206 Md. 36, 42—43
(1954). In particular, the circuit court determined that D.L. presented insufficient evidence
that the matter would frequently recur. Accordingly, the circuit court’s order granted
Sheppard Pratt’s motion to dismiss and dismissed the case. On November 28, 2016, D.L.
filed a notice of appeal in the circuit court and appealed its second dismissal of her petition
for judicial review to the Court of Special Appeals.
9
In an unreported opinion dated February 12, 2018, the intermediate appellate court
affirmed the judgment of the circuit court and held that the case was moot. In re D.L., No.
2463 Sept. Term, 2015, 2016 WL 7159506 (Md. Ct. Spec. App. Dec. 8, 2016). Rather than
dismissing the appeal by order, the Court of Special Appeals considered mootness on its
merits including arguments concerning collateral consequences and exceptions to the
mootness doctrine.5 The primary thrust of the Court of Special Appeals’ analysis was
whether possible collateral consequences existed because of D.L.’s involuntary admission.
The court considered several areas in which D.L. alleged the existence of collateral
consequences including restrictions on future employment, firearm ownership, driving
license privileges, immigration, and the social stigmatization of mental illness. Ultimately,
however, the court held that any possible collateral consequences originating from D.L.’s
involuntary admission already existed because of her prior stay at Mann RTC. Second, the
court held that the public concern exception to the mootness doctrine was inapplicable and
arguments concerning the capable of repetition, yet evading review exception were not
made in the courts below and therefore, not properly preserved.
Subsequently, D.L. petitioned this court for writ of certiorari, which we granted.
D.L. v. Sheppard Pratt Health System, 461 Md. 480 (2018). In her petition for writ of
certiorari, D.L. presents us with two questions for review:
5
See In re Kaela C., 394 Md. 432, 452—53 (2006) (indicating that, based on a prohibition
against offering advisory opinions, courts rarely address mootness on its merits and
frequently dismiss such appeals by order).
10
1. Did the Court of Special Appeals err in concluding that D.L.’s challenge
to her involuntary admission was moot and, alternatively, that no
exception to the mootness doctrine applied?
2. Did the Court of Special Appeals err in concluding that the applicability
of the capable-of-repetition-yet-evading-review exception to the
mootness doctrine was not preserved for appellate review?
STANDARD OF REVIEW
When reviewing the grant of a motion to dismiss, the appropriate standard of review
“is whether the trial court was legally correct.” Blackstone v. Sharma, 461 Md. 87, 110
(2018) (quoting Davis v. Frostburg Facility Operations, LLC, 457 Md. 275, 284 (2018)).
Therefore, “[w]e review the grant of a motion to dismiss de novo. We will affirm the
circuit court’s judgment ‘on any ground adequately shown by the record, even one upon
which the circuit court has not relied or one that the parties have not raised.’” Sutton v.
FedFirst Fin. Corp., 226 Md. App. 46, 74 (2015) (citations omitted), cert. denied, Sutton
v. FedFirst Fin., 446 Md. 293 (2016).
DISCUSSION
We begin our analysis with a brief discussion of the procedural framework
surrounding involuntary admissions. Title 10 Subtitle 6 of the Health–General Article
(“HG”) regulates the admissions of individuals, either voluntary or involuntary, to certain
facilities. Pursuant to HG § 10-613, an involuntary admission “includes every admission
of a minor to a State facility unless the admission is [ ] voluntary[.]” HG § 10-613. A
“facility” is statutorily defined as “any public or private clinic, hospital, or other institution
that provides or purports to provide treatment or other services for individuals who have
11
mental disorders.” HG § 10-101(g)(1).6 Before an individual can be involuntarily
admitted, several statutorily enumerated factors must be met. HG § 10-617(a), in pertinent
part, provides these factors and limits the applicability of involuntary admission to
situations where,
(1) The individual has a mental disorder;
(2) The individual needs inpatient care or treatment;
(3) The individual presents a danger to the life or safety of the individual or
of others;
(4) The individual is unable or unwilling to be admitted voluntarily; and
(5) There is no available less restrictive form of intervention that is consistent
with the welfare and safety of the individual.
In the present appeal, D.L. sought judicial review of the ALJ’s admission decision
with respect to only one of these factors—the fifth. In other words, D.L. presented only
one issue in her petition for judicial review: whether there was sufficient evidence
presented to the ALJ that no less restrictive form of intervention was available. We now
turn our analysis to a consideration of the mootness doctrine generally and application and
analysis of the collateral consequences doctrine.
Generally, a case is moot if no controversy exists between the parties or “when the
court can no longer fashion an effective remedy.” In re Kaela C., 394 Md. 432, 452 (2006);
Adkins v. State, 324 Md. 641, 646 (1991). This Court’s reluctance to hear moot cases stems
6
The provision specifically notes that Veterans’ Administration Hospitals do not constitute
“facilities.” HG § 10-101(g)(2).
12
from the prohibition against offering advisory opinions. In re Kaela C., 394 Md. at 452
(citing In re Rosa A. Riddlemoser, 317 Md. 496, 502 (1989)). However, there are several
cases in which an appeal can ostensibly appear moot, yet appellate review is warranted.
First, mootness will not preclude appellate review in situations where a party can
demonstrate that collateral consequences flow from the lower court’s disposition. Adkins,
324 Md. at 645—46. See also Lane v. Williams, 455 U.S. 624, 632 (1982). Second, there
are several exceptions to the mootness doctrine of which two are applicable in the instant
appeal, namely the capable of repetition yet evading review and the public concern
exceptions. However, as we conclude that D.L. faces collateral consequences stemming
from her involuntary admission, we need not analyze these exceptions to the mootness
doctrine.
The collateral consequences doctrine was first adopted by the Supreme Court in
1943. See St. Pierre v. U.S., 319 U.S. 41, 42 (1943). In St. Pierre, a defendant confessed
to embezzlement while testifying before a grand jury but declined to disclose the identity
of the individual from whom he embezzled. Id. As a result, the district court held the
defendant in contempt and sentenced him to five months imprisonment. Id. On appeal,
the United States Court of Appeals for the Second Circuit affirmed the district court’s
judgment. Id. Despite his release from custody, the defendant then filed a petition for writ
of certiorari with the Supreme Court raising issues regarding the constitutional privilege
against self-compelled incrimination. Id. The Court held the defendant’s challenge was
moot commenting:
13
On the argument it was conceded that petitioner had fully served his sentence
before certiorari was granted. We are of opinion that the case is moot
because, after petitioner’s service of his sentence and its expiration, there was
no longer a subject matter on which the judgment of this Court could operate.
A federal court is without power to decide moot questions or to give advisory
opinions which cannot affect the rights of the litigants in the case before it.
The sentence cannot be enlarged by this Court’s judgment, and reversal of
the judgment below cannot operate to undo what has been done or restore to
petitioner the penalty of the term of imprisonment which he has served. Nor
has petitioner shown that under either state or federal law further
penalties or disabilities can be imposed on him as a result of the
judgment which has now been satisfied. In these respects the case differs
from that of an injunction whose command continues to operate in futuro
even though obeyed.
St. Pierre, 319 U.S. at 42–43 (emphasis added) (citations omitted). The emphasized text
represents the emergence of the collateral consequences doctrine. 7
Three years after its decision in St. Pierre, the Supreme Court further developed the
collateral consequences doctrine hinted at in its earlier opinion. See Fiswick v. United
States, 329 U.S. 211, 213 (1946). In Fiswick, several German nationals were convicted of
conspiring to defraud the United States government. Id. Prior to judicial review, one of
the defendants was released from custody. Id. at 229. Ultimately, the Supreme Court held
that the defendant’s challenge to his conspiracy conviction was not moot because of the
potential collateral consequences stemming from it. Id. at 221. Particularly, the Supreme
Court determined that, due to Mr. Fiswick’s status as an “alien[,]” he could be subjected to
deportation for committing a crime involving moral turpitude within five years after his
entry into the United States. Id.
7
At this point in time, the collateral consequences doctrine had yet to develop its current
moniker.
14
The Supreme Court commented that there were several other consequences
stemming from Mr. Fiswick’s conviction including potential deportation, limiting his
ability to become naturalized, his voting rights, his ability to hold public office, and his
ability to participate on a federal jury. Id. at 222. Therefore, based on these consequences
stemming from Mr. Fiswick’s conviction, the Supreme Court commented that “[i]n no
practical sense, [ ] can Fiswick’s case be said to be moot.” Id.
Next, the Supreme Court considered whether a defendant who served his sentence
on a federal conviction, but was then convicted on state charges and subject to a longer
sentence based on his prior federal conviction, was “entitled to an opportunity to attempt
to show that his conviction was invalid” through a writ of coram nobis. See U.S. v. Morgan,
346 U.S. 502, 511—512 (1954). The Court reasoned that the defendant’s sentence was not
moot even though “the term has been served, [because] the results of the conviction may
persist. Subsequent convictions may carry heavier penalties, civil rights may be affected.”
Id. at 512—13.
Subsequently, the collateral consequences doctrine emerged and was formally
named in Pollard v. United States, 352 U.S. 354, 358 (1957). In that case, a defendant
sought review of the validity of a probation order entered when he was not present in the
courtroom. Id. at 356. The defendant was later sentenced to incarceration based upon a
subsequent violation of his probation as initially ordered. Id. at 357. However, he had
been released from detention after the Supreme Court granted his petition for certiorari.
Id. at 358. Therefore, on this issue, the Supreme Court determined that there were
sufficient collateral consequences to overcome the mootness that characterized the case.
15
Id. The Court commented, “that convictions may entail collateral legal disadvantages in
the future” and concluded that “[t]he possibility of consequences collateral to the
imposition of sentence is sufficiently substantial to justify our dealing with the merits.” Id.
(citing Morgan, 346 U.S. at 512—13 and Fiswick, 329 U.S. at 220—23.)
The Supreme Court subsequently refined and expanded the collateral consequences
doctrine. In Carafas v. Lavallee, the Supreme Court held that an appeal was not moot
where a defendant had served his sentence and was released while his petition for habeas
corpus had yet to be adjudicated. 391 U.S. 234, 237—38 (1968). In considering the
potential collateral consequences stemming from the defendant’s conviction, the Supreme
Court cited several:
In consequence of his conviction, he cannot engage in certain businesses; he
cannot serve as an official of a labor union for a specified period of time; he
cannot vote in any election held in New York State; he cannot serve as a
juror. Because of these ‘disabilities or burdens (which) may flow from’
petitioner’s conviction, he has ‘a substantial stake in the judgment of
conviction which survives the satisfaction of the sentence imposed on him.’
On account of these ‘collateral consequences,’ the case is not moot.
Id. at 237—38 (citations and footnotes omitted).
Less than a month later, the Supreme Court recognized in Sibron v. New York “the
obvious fact of life that most criminal convictions do in fact entail adverse collateral legal
consequences.” 392 U.S. 40, 55 (1968). In addition, the Supreme Court defined the
standard with respect to collateral consequences indicating that there need only be a
possibility of collateral consequence to justify overlooking the mootness of a case. Id. In
Sibron, the Supreme Court was tasked with determining whether a pre-trial motion to
suppress evidence seized was moot where the defendant had served the entirety of his
16
sentence. Id. at 45—49. The Supreme Court ultimately held that the case was not moot
because of the potential collateral consequences that may flow from his prior conviction.
Id. at 51, 56. Specifically, the Supreme Court noted that a New York statute would permit
the State to impeach his character with evidence of his prior conviction if, in any
subsequent criminal proceeding, he put his character at issue. Id. at 56. In addition, under
another New York statute, trial judges were permitted to consider a defendant’s prior
convictions when sentencing for subsequent convictions. Id.
Subsequently, the Supreme Court further addressed the limits of collateral
consequences in overcoming mootness. In Lane v. Williams, two defendants were arrested
and pleaded guilty to unrelated Illinois burglary prosecutions. 455 U.S. 624, 624 (1982).
At the time, the offense carried with it a mandatory three-year parole term. Id. However,
neither of the defendants were informed at their respective plea hearings of the mandatory
parole term. Id. Subsequently, both defendants completed their sentences, were released,
and then later reincarcerated based upon parole violations. Id. While serving their
sentences, the defendants filed petitions for federal habeas corpus in which they urged the
court to release them immediately. Id. at 628. The United States District Court for the
Northern District of Illinois granted both defendants’ petitions, released them, and issued
an order that their mandatory parole terms were void. Id. at 627—28. On appeal, the
United States Court of Appeals for the Seventh Circuit determined that the case was not
moot and reversed the decision of the district court, holding that the defendants had not
exhausted all available state remedies. Id. at 629. Primarily, the court determined that the
17
appeal was not moot due to the potential collateral consequences stemming from the
underlying parole violations. Id.
Ultimately, the Supreme Court held that the appeal was moot and the alleged
collateral consequences were insufficient to justify overcoming mootness. Id. at 632—33.
In reaching its conclusion the Court commented:
No civil disabilities such as those present in Carafas result from a finding that an
individual has violated parole. At most, certain non-statutory consequences may
occur; employment prospects, or the sentence imposed in a future criminal
proceeding, could be affected. The discretionary decisions that are made by an
employer or a sentencing judge, however, are not governed by the mere presence or
absence of a recorded violation of parole; these decisions may take into
consideration, and are more directly influenced by, the underlying conduct that
formed the basis for the parole violation. Any disabilities that flow from whatever
respondents did to evoke revocation of parole are not removed-or even affected-by
a District Court order that simply recites that their parole terms are “void.”
Id. (citations and footnotes omitted).
Maryland has also interpreted and applied the collateral consequences doctrine and,
in some cases, the prospect of such consequences have resulted in an appeal not being
considered moot. In Adkins v. State, this Court considered “whether an appeal from an
order revoking a defendant’s probation and reimposing the previously suspended sentence
is rendered moot by that defendant’s completing service of his sentence while the appeal
is pending.” 324 Md. 641, 642 (1991). Therein, we echoed the framework set forth by the
Supreme Court indicating that collateral consequences need not be concrete and actual;
instead, a defendant must demonstrate “only the possibility of collateral legal
consequences” to preclude a finding of mootness. Id. at 654. Further, the Court held that
18
there were possible collateral consequences stemming from the defendant’s violation of
probation, and therefore, the case was not moot. Id. at 654—56.
Thereafter, this Court held that a circuit court order which granted custody of
children to their father over the mother’s objection and which found that the children were
in need of assistance was not moot despite California’s assumption of jurisdiction. In re
Kaela C., 394 Md. at 475—76. In that case, the Court concluded that there were collateral
consequences to justify engaging the issue on its merits. Id. at 464—65. Specifically, we
noted that the California court relied upon the Maryland judgment in its own custody
determinations. Id. at 465. In subsequent cases, we have identified the specific collateral
consequences that flow from felony convictions:
Significant collateral consequences flow from Petitioner’s felony
convictions for first-degree assault. For example, he is disqualified from jury
service; regulated firearm possession; certain employment opportunities; and
military service.
Kranz v. State, 459 Md. 456, 473 (2018) (footnotes omitted). This Court has also held that
collateral consequences may also occur “in the form of substantial civil penalties”
sufficient to overcome mootness. McMannis v. State, 311 Md. 534, 539 (citing Carafas,
391 U.S. at 237—38). In contrast, however, we have indicated that “minor, non-statutory,
collateral consequences alone are insufficient to avoid mootness[.]” McMannis, 311 Md.
At 539 (citing Lane, 455 U.S. at 632—33).
We have also undertaken an inquiry into the potential collateral consequences that
may stem from restrictions on an individual’s driving privileges. Toler v. Motor Vehicle
Admin., 373 Md. 214, 216 (2003). In that case, an ALJ suspended a defendant’s license.
19
Id. at 219. Following the suspension, the defendant sought judicial review of the ALJ’s
decision after the suspension had expired. Id. at 218—19. We concluded that the case was
not moot due to the collateral consequences stemming from the initial suspension. Id.
Specifically, we determined that the defendant’s prior license suspension, although moot,
would influence any future suspensions and the associated penalties:
If [the Defendant’s] license is subsequently suspended, which, in light of his
atrocious driving record, is more than a conjectural possibility, he will face
a minimum period of suspension of fifteen days, rather than two days, and a
maximum period of ninety days, rather than thirty days.
Id.
On prior occasions, Maryland courts have also wrestled with the specific issue
presented in this appeal, i.e. whether a petition for judicial review of an involuntary
admission is moot based on the patient’s discharge from a facility. Last year, this Court
considered what may rightfully be viewed as the predecessor to the instant appeal. In that
case, a patient was diagnosed with bipolar disorder and eventually involuntarily admitted
to a mental health facility. In re J.C.N., 460 Md. 371, 380—384 (2018). There, the
substantive issues on appeal were whether the hospital, i.e. the University of Maryland
Baltimore Washington Medical Center, (i) complied with HG § 10-632(b) which requires
an involuntary admission hearing within ten days of the date the patient is initially confined
and (ii) whether the ALJ’s involuntary admission decision was supported by substantial
evidence. Id. at 385.
However, the importance of In re J.C.N. and its relation to the instant appeal lies
not in the substantive issues engaged therein. Instead, a third question presented in J.C.N.’s
20
petition for certiorari that was not necessary to be decided and thus evaded this Court’s
review illuminates our present analysis. That third question was whether “an individual
[may] challenge an involuntary admission after the individual has been discharged from
the hospital, or does mere discharge render the appeal moot[.]” Id. at 386 n. 8. Ultimately,
we declined to answer this question because the Department of Health and Mental Hygiene
(“the Department”) conceded at oral argument that the case was not moot due to the
potential collateral consequences stemming from J.C.N.’s involuntary admission. Id. In
short, In re J.C.N. identified the doctrine of collateral consequences within the context of
involuntary admissions and brought to light that in many situations where a patient is
released from involuntary admission prior to judicial review of the admission decision,
collateral consequences likely exist and such consequences prohibit dismissal on mootness
grounds.
On January 10, 2019, the Court of Special Appeals published an unreported opinion
in a case which contained strikingly similar facts to the instant appeal. In re A.B., No.
1680, Sept. Term, 2017, 2019 WL 290064 (Md. Ct. Spec App. Jan. 10, 2019). Although
unreported opinions of our intermediate appellate court have no precedential value and do
not constitute persuasive authority, we highlight this case merely to develop the history
and varying perspectives on collateral consequences stemming from involuntary
admissions and to illustrate the frequency in which this issue has entered our jurisprudential
gaze. See Md. Rule 1-104. In that case, like here, an ALJ involuntarily admitted a patient,
A.B., and she filed a petition for judicial review of the ALJ’s decision. Id. at *2. The
substantive issue within her petition for judicial review was whether substantial evidence
21
supported the ALJ’s decision that she constituted a danger to herself. Id. at *6. Prior to
the circuit court entertaining the petition, A.B. was discharged from the facility. Id. at *2.
On this basis, the circuit court dismissed the petition as moot. Id. A.B. was a mother who
sought to regain custody of her child and had previously been hospitalized at a psychiatric
institution in Virginia. Id. at 4.
On appeal, A.B. argued that numerous collateral consequences stemmed from her
involuntary admission. Id. In contrast, the Department argued that any collateral
consequences emanating from involuntary admission of A.B. were previously generated
by her stay at a psychiatric institution in Virginia. Id. at *6. Ultimately, the Court of
Special Appeals rejected the Department’s contentions and concluded that a litany of
potential collateral consequences existed and that the record was insufficient to conclude
that her stay at a psychiatric institution in Virginia was, in fact, an involuntary admission.
Id. at *4—5.
Having reviewed the collateral consequences doctrine and its development since its
inception on both the federal and State levels, we must next turn to the collateral
consequences specifically alleged by D.L. In particular, D.L. contends that the collateral
consequences of an involuntary admission are numerous in Maryland law. Moreover, she
avers that these possible collateral consequences stemming from her involuntary admission
warrant appellate review. The alleged collateral consequences include the following: (i)
potential impact on her driving privileges; (ii) prohibiting D.L. from engaging in certain
occupations; (iii) implications towards child custody disputes; (iv) restrictions on her
immigration status; (v) prohibiting her from serving on a federal jury; (vi) implications
22
towards any future involuntary admissions; (vii) the social stigmatization of mental illness;
(viii) certain statutory reporting requirements; and (ix) restricting her ability to own or
possess certain firearms at the State and federal levels. Due to the sheer number of
collateral consequences alleged, we must analyze each of the preceding consequences
individually to determine their merit.
First, we consider whether possible collateral consequences stemming from D.L.’s
involuntary admission exist that may potentially affect her ability to obtain a driver’s
license. D.L. is correct that an individual’s right to acquire a driver’s license may be limited
by the applicant’s mental health history. Section 16-103.1(3) of the Transportation Article
(“TR”) provides that the Maryland Motor Vehicle Administration may not issue a license
to any individual “[w]ho previously has been adjudged to be suffering from any mental
disability or mental disease and who, at the time of application, has not been adjudged
competent[.]” However, based on the statute’s language, an involuntary admission would
not limit an individual’s right to obtain a driver’s license outright. The provision indicates
that only those adjudged as incompetent without being later adjudged competent will be
excluded from obtaining a license. TR § 103.1(3). At the time of her petition for judicial
review, D.L. was not old enough to obtain a driver’s license. However, she has now
reached the necessary age, and the record contains no indication that she has been
“adjudged as competent[.]” TR § 16-103.1(3). As a result, D.L.’s involuntary admission,
in conjunction with this statutory requirement, will likely generate possible collateral
consequences.
23
Second, D.L. argues that her involuntary admission will have significant collateral
consequences that will limit her employment prospects in the future. Specifically, she
contends that she will be prohibited from engaging in certain occupations. She first alleges
that her involuntary admission could render her ineligible to work as a private security
guard. Generally, for an individual to be employed as a security guard, he or she must
obtain a certification card issued by the State Police. COMAR 29.04.01.02.A.
To obtain such a certification card, one must complete an application form setting
forth certain information about the applicant’s history, provide a photograph of the
applicant, and his or her fingerprints. COMAR 29.04.01.02.B. D.L. draws our attention
to a limiting provision which indicates that an application for a certification card may be
denied if certain conditions are met. COMAR 29.04.01.02.E. One of these conditions
indicates that a certification card may be denied if the applicant “[h]as been confined to a
mental institution for treatment of a mental disorder or disorders[.]” COMAR
29.04.01.02.E(6). However, this regulation does not constitute an outright ban. A
surrounding regulation provides an exception for certain individuals. Id. Specifically, the
provision is inapplicable to those who “attach[ ] to the application a physician’s certificate,
issued within 30 days before the application, certifying that the applicant is of no danger
to himself or others.” Id.
D.L. contends that her employment prospects are further limited by her involuntary
admission, arguing that the admission will preclude her from future employment as an
employee of a private detective agency. Like the above discussion regarding security
guards, the associated regulations provide that an individual who works as an employee for
24
a private detective must apply for, be approved, and receive an identification card.
COMAR 29.04.08.03.A. The application process for a private detective identification card
contains language identical to that found within regulation concerning security guard
certification cards, i.e. COMAR 29.04.01.02.E(6). Just as with an individual’s security
guard certification card, an application for a private detective identification card may be
denied if the applicant “[h]as been confined to a mental institution for treatment of a mental
disorder or disorders[.]” COMAR 29.04.08.03.C(6). Likewise, this regulation provides
the same exception found within the regulation concerning security guard certification
cards. Id. (providing that the exclusion is inapplicable to applicants who attach a
physician’s certificate to the application indicating that the applicant no longer represents
a danger to themselves or others).
Sheppard Pratt argues that these COMAR provisions mitigate any collateral
consequences identified by D.L concerning restrictions on her future employment
opportunities. COMAR 29.04.01.02.E(6); COMAR 29.04.08.03.C(6). As will be seen,
this argument is a recurring theme throughout Sheppard Pratt’s brief. However, our
precedent reveals that we require only the possibility of collateral consequences to justify
overlooking the mootness which characterizes an individual appeal. See Adkins, 324 Md.
at 654. Although D.L. may have any potential restrictions on her employment capacity
removed in the future, these restrictions currently exist and are rightfully characterized by
D.L. as possible collateral consequences. This Court has never held that the possibility of
collateral consequences may be sufficiently mitigated by statute or regulation to the extent
that a case should be considered moot.
25
In addition, D.L. argues that, as a consequence of her involuntary admission, she
will likely be ineligible for certain positions within the federal government that require a
security clearance. She draws our attention to a specific form associated with the security
clearance process, which requires an applicant to disclose whether he or she has ever been
hospitalized for a mental health condition—including whether the admission was voluntary
or involuntary. U.S. Office of Pers. Mgmt., “Questionnaire for National Security
Positions,” at 89, https://www.opm.gov/Forms/pdf_fill/SF86.pdf (last visited Aug. 12,
2019). The form also requires an applicant to disclose whether he or she has: (i) been
diagnosed by a physician or other health professional with certain psychological disorders;
(ii) any mental health conditions that would substantially adversely affect the applicant’s
judgment, reliability, or trustworthiness; (iii) been ordered by a court or administrative
agency to consult with a mental health professional; and (iv) been declared mentally
incompetent by a court or administrative agency. Id. However, the questionnaire provides
that a history of mental illness or treatment alone will not outright preclude obtainment of
a security clearance:
The U.S. government recognizes the critical importance of mental health and
advocates proactive management of mental health conditions to support the
wellness and recovery of Federal employees and others. Every day
individuals with mental health conditions carry out their duties without
presenting a security risk . . . . most individuals with mental health conditions
do not present security risks[.]
Id. Further, the questionnaire indicates that an applicant’s history of mental health care is
not dispositive as to whether the individual would qualify for a position that requires a
security clearance:
26
Mental health treatment and counseling, in and of itself, is not a reason to
revoke or deny eligibility for access to classified information or for holding
a sensitive position, suitability or fitness to obtain or retain Federal or
contract employment, or eligibility for physical or logical access to federally
controlled facilities or information systems. Seeking or receiving mental
health care for personal wellness and recovery may contribute favorably to
decisions about your eligibility.
Id. (alterations in original).
Although the associated forms make clear that an individual’s application for a
security clearance will not be denied solely on the basis of prior mental health treatment,
the provision does not provide sufficient information regarding to what extent instances of
past mental health treatment, including involuntary admissions, would play with respect to
a security clearance determination. However, we are not convinced that a past involuntary
admission will play no role in the security clearance application process. If this was the
case, it would beg the question as to why the federal government would require such
disclosure. More likely than not, a past involuntary admission will have some broad-
reaching effect on an individual’s ability to qualify for a security clearance. Therefore, we
hold that D.L. faces possible collateral consequences regarding future employment based
on her involuntary admission to Sheppard Pratt.
Third, D.L. argues that further collateral consequences stem from her involuntary
admission within the sphere of any child custody disputes or child in need of assistance
(“CINA”) proceedings. In the instant appeal, the circuit court did not consider collateral
consequences and therefore did not develop the record with respect to these relevant factual
underpinnings. Nonetheless, records of a prior involuntary admission will likely become
relevant within certain situations involving the custody or guardianship. For example,
27
Courts and Judicial Proceedings Article (“CJ”) § 3-819.2 sets forth the factors that a court
will consider in making a custody or guardianship determination in a CINA case. In such
situations, a local department or licensed child placement agency must compile a report
detailing “the suitability of the individual to be the guardian of the child.” CJ § 3-
819.2(f)(1)(iii). Such a report includes an inquiry into a parent or proposed guardian’s
mental health history. CJ § 3-819.2(f)(1)(iii). Within this report, any instances of
involuntary or voluntary admissions will likely be brought to light and considered with
respect to determining the fitness of a potential custodial parent or guardian.
In addition, an individual’s history of mental health treatment and evaluation within
the CINA context can have a greater impact than the report alone. CJ § 3-819.2(g) indicates
that a “disability” of the potential custodial parent or guardian is relevant to the extent that
“the disability affects the best interest of the child.” The provision defines “disability”
broadly in the following manner:
(a)(1) In this section, “disability” means:
(i) A physical or mental impairment that substantially limits one or more
of an individual’s major life activities;
(ii) A record of having a physical or mental impairment that substantially
limits one or more of an individual’s major life activities; or
(iii) Being regarded as having a physical or mental impairment that
substantially limits one or more of an individual’s major life activities.
CJ § 3-819.2(a)(1). The statute also provides that a disability of a potential custodian or
guardian are relevant to the limited extent that “the disability affects the best interest of the
child.” CJ § 3-819.2(g). Accordingly, D.L. likely faces possible collateral consequences
28
with respect to future child custody or CINA determinations. In sum, her involuntary
admission would likely be referenced in the local department’s report on her suitability as
a parent. CJ § 3-819.2(f)(1)(iii). The mental illness upon which her involuntary admission
is based and the admission itself may become relevant if characterized as a disability under
CJ § 3-819.2(g). Although the record does not reflect that D.L is a parent at this time, our
jurisprudence requires only the possibility of collateral consequences. Such a possibility
exists here. Moreover, this underscores the importance of the circuit court developing a
full record and hearing testimony on these relevant factors. Such inquiry will only
illuminate the areas in which collateral consequences may or may not exist for a particular
individual.
Fourth, D.L. points out that the Application for Naturalization (“Form N-400”)
provided by the Department of Homeland Security’s U.S. Citizenship and Immigration
services requires disclosure of whether an individual has previously been admitted to a
facility. The N-400 form requires applications to disclose if they have “EVER been
declared legally incompetent or been confined to a mental institution?” Dept. of Homeland
Security, U.S. Citizenship and Immigration Services, Form N-400, “Application for
Naturalization,” at 11, available at https://www.uscis.gov/n-400 (last visited Aug. 12,
2019).
Sheppard Pratt responds by arguing that the record does not reflect that D.L. is not
a U.S. citizen and therefore this alleged collateral consequence is conjectural. Before this
29
Court, D.L. conceded that she is a United States citizen.8 Based on D.L.’s concession, she
will not face any possible collateral consequences concerning her immigration status.
However, we note analysis concerning the existence of collateral consequences within this
context is heavily fact dependent. While the possibility of collateral consequences
concerning immigration status could likely be an issue in future cases, based on the record
before us, we are not convinced that this concern is implicated in the instant appeal.
Fifth, D.L. argues that, as a consequence of her involuntary admission at Sheppard
Pratt, she will be precluded from serving on a federal jury. 28 U.S.C. § 1865(b)(4) provides
that an individual is eligible to serve on federal juries unless he or she “is incapable, by
reason of mental or physical infirmity, to render satisfactory jury service[.]” As a
preliminary issue, we must note that due to D.L.’s age she is currently unable to serve on
a federal jury. However, this provision does not indicate that an individual will be barred
from serving on a federal jury based on a historical involuntary admission. Instead, the
provision indicates that if an individual is affected by mental illness, to the extent that he
or she is unable to perform satisfactorily on a jury, then he or she is excluded from
participating in jury service. Id.
The record before us presents insufficient evidence to conclude that, when D.L.
reaches the age of majority and is therefore eligible to serve on a federal jury, she will be
unable to perform satisfactorily as a juror simply based on an involuntary admission to
8
D.L. made this concession in her brief before this Court. Nonetheless, information
concerning D.L.’s citizenship is not contained within the record, which underscores the
importance of establishing a detailed record in the courts below.
30
Sheppard Pratt. Moreover, the statute is devoid of any indication that any such
determination regarding jury eligibility will be based on admissions to mental health
facilities. Therefore, this alleged collateral consequence is inherently conjectural falling
below the “possibility” threshold elucidated in Adkins. 324 Md. at 654 (citing Morgan,
346 U.S. at 512—13 and Pollard, 352 U.S. at 358).
Sixth, D.L. contends that she will suffer from collateral consequences within the
context of any future proceedings for involuntary admission. To support her position, D.L.
relies on this Court’s decision in Adkins, 324 Md. 641 (1991). In Adkins, we held that an
appeal taken from an order revoking a defendant’s probation that also had the effect of re-
imposing a portion of a previously suspended sentence was not moot because of the
potential collateral consequences stemming from that order. 324 Md. at 656. There, the
defendant completed his sentence before he could appeal the order revoking probation. Id.
at 642—43. The Court concluded that there were collateral consequences which would
prevent the appeal from being moot. Id. at 656. Ultimately, the primary collateral
consequence of the order revoking Mr. Adkins’ probation was that the order may be
relevant to and affect future criminal proceedings. Id. at 654. Specifically, Mr. Adkins
argued that if he were subsequently arrested and convicted of a crime, the order revoking
his probation would become relevant with respect to future sentencing, parole qualification,
and time served credits. Id. at 644—46.
D.L. first attempts to analogize this case to Adkins by contending that if prior
violations of probations may be considered within future criminal prosecution, then prior
involuntary admissions may be considered at future involuntary admission proceedings as
31
well. In support of her position, she urges this Court to examine several holdings of North
Carolina and Washington courts. Particularly, she draws our attention to a decision of the
Supreme Court of North Carolina, see In re Hatley, 231 S.E.2d 633 (N.C. 1977), and the
Court of Appeals of Washington, District Two. See In re M.K., 168 Wash. App. 621, 626
(2012). In contrast, Sheppard Pratt argues that Maryland’s statutory framework regulating
involuntary admissions does not contemplate prior involuntary admissions and any
involuntary admission decision is primarily based on the patient’s mental health at the time
of the hearing.
In In re Hatley, the court held that an appeal stemming from a patient’s involuntary
admission, where the patient was released prior to judicial review, was not moot because
of the associated potential collateral consequences. The Hatley court determined that any
orders requiring involuntary admission would become relevant in future involuntary
admission proceedings. Id. at 635. The court commented, “[m]ost significantly, records
of commitments to a mental institution will certainly be used in any subsequent
proceedings for civil commitment[.]” Id. at 635 (quoting In re Ballay, 482 F.2d 648, 652
(D.C. Cir. 1973)).
In addition to Hatley, D.L. cites to a decision by the Court of Appeals of
Washington, District Two, for the proposition that cases involving involuntary admission
are not rendered moot by an individual’s release because of the collateral consequences
associated with involuntary admission. Therein, the court commented that “[a]n
individual’s release from detention does not render an appeal moot where collateral
consequences flow from the determination authorizing such detention.” In re M.K., 168
32
Wash. App. at 626. The foremost collateral consequence identified by the court was the
potential that a record of the involuntary admission would be used in any subsequent
involuntary admission proceeding:
In the case of civil commitments . . . the trial court is directed to
consider, in part, a history of recent prior civil commitments, thus,
each order of commitment entered up to three years before the current
commitment hearing becomes a part of the evidence against a person
seeking denial of a petition for commitment.
Id. at 626. Therefore, we must review Maryland’s statutory framework regulating
involuntary admissions to determine whether, as Sheppard Pratt contends, that reference to
any prior involuntary admissions are prohibited and may not be considered by an ALJ
within involuntary admission proceedings.
The first step within any involuntary admission is a certificate for admission created
by a medical professional who examined the patient, diagnosed the patient with a
psychological disorder, and opined that the individual requires in-patient psychological
treatment. HG § 10-616(a). Such certificates are limited temporally and may not be used
if the examination referenced in the certificate was performed more than one week prior to
the physician signing the certificate or “[m]ore than 30 days before the facility. . . receives
the application for admission.” HG § 10-616(b). Additionally, Sheppard Pratt contends
that HG § 10-632(e) limits an ALJ’s admission decision to the patient’s mental health at
the time of a potential involuntary admission. The provision, in pertinent part, provides
the following:
[An ALJ shall order] the release of the individual from the facility unless the
record demonstrates by clear and convincing evidence that at the time of the
33
hearing each of the following elements exist as to the individual whose
involuntary admission is sought:
(i) The individual has a mental disorder;
(ii) The individual needs in-patient care or treatment;
(iii) The individual presents a danger to the life or safety of the individual
or of others;
(iv) The individual is unable or unwilling to be voluntarily admitted to the
facility;
(v) There is no available less restrictive form of intervention that is
consistent with the welfare and safety of the individual[.]
HG § 10-632(e)(2).
Based on our review of Maryland’s statutory framework concerning involuntary
admission and the record as a whole, we find Sheppard Pratt’s arguments on this point
unconvincing. Although involuntary admission is based on an admission certificate that is
temporally limited and the hearing judge’s determination is based on an individual’s mental
health and behavior at the time of the hearing, there is no outright prohibition against an
ALJ considering an individual’s past mental health history. Such mental health history
would ultimately encompass any prior involuntary admissions. In fact, Sheppard Pratt’s
substantial reliance on HG § 10-632(e) is unwarranted because the provision does not
forbid a hearing judge from considering prior incidents of mental health or prior instances
of psychiatric treatment.
In addition, out of practical concerns, Sheppard Pratt’s position becomes less
persuasive when one considers how D.L.’s prior stay at Mann RTC made its way into the
record. During the hearing, Dr. Seidel testified that “we are trying to place her back at
34
[Mann RTC] at the Sheppard Pratt Towson campus where she has been before” and
“[s]he’s been at [Mann RTC], she doesn’t want to go back[.]” As evident, there is no
outright prohibition against introducing evidence or commenting that an individual had
previously stayed at an RTC or been admitted to a mental health facility. We find Sheppard
Pratt’s contrary contentions unavailing.
Sixth, D.L. argues that she will face additional collateral consequences stemming
from her involuntary admission based on the social stigmatization of mental illness. This
Court has previously recognized the “stigma that often attaches, however unreasonably, to
a person with a mental disease[.]” State v. Marsh, 337 Md. 528, 536 (1995) (quoting
Treece v. State, 313 Md. 665, 677 (1988)). The Supreme Court has also commented on
the stigma that attaches to involuntary admissions:
[I]t is indisputable that involuntary commitment to a mental hospital after a
finding of probable dangerousness to self or others can engender adverse
social consequences to the individual. Whether we label this phenomena
“stigma” or choose to call it something else is less important than that we
recognize that it can occur and that it can have a very significant impact on
the individual.
Addington v. Texas, 441 U.S. 418, 425—26 (1979). Several of our sister states have also
held that the associated social stigma of an involuntary admission constitutes a collateral
consequence which prevents dismissal on mootness grounds. See In re Joan K., 273 P.3d
594, 597 (2012); Bradshaw v. State, 210 Idaho 429, 432 (1991); In re Splett, 143 Ill. 225,
228-29 (1991); State v. Lodge, 608 S.W.2d 910, 912 (1980).
Sheppard Pratt counters that any records concerning involuntary admission of D.L.
are substantially protected under the Health Insurance Portability and Accountability Act
35
(“HIPAA”). It first argues that any records of a patient’s mental health treatment are
confidential. 42 U.S.C. § 1320d(6); 45 CFR § 164.502(a). The associated HIPAA
provisions also significantly limit external access to protected health information. 45 CFR
§ 164.502(a) (limiting access to such information to individuals, for treatment or payment
of health care operations, with the patient’s consent, and other exceptions not relevant to
the instant appeal). See also 45 CFR § 164.512. HIPAA’s protection of patient information
is enforceable because entities or business associates that violate provisions of HIPAA are
subject to civil monetary penalties. See 45 CFR §§ 164.402, 404. Additionally, any non-
permitted access to information protected under HIPAA carries criminal penalties. 45 CFR
§ 2508.18.
In addition to federal informational protections that would limit the dissemination
of any records or information concerning an individual’s mental health treatment, an
individual’s medical records are also confidential under Maryland law. HG § 4-302(a).
Pursuant to Maryland’s system of protecting medical records, violation of any provision
concerning the confidentiality of medical records is subject to criminal penalties. See HG
§ 4-309(d) (providing criminal penalties for willful violations of confidentiality); HG § 4-
309(e) (providing more substantial criminal penalties to those obtaining medical records
through deception); and HG § 4-309(f) (indicating that violators will be liable for actual
damages).
Despite these informational protections, it does not amount to an outright ban on
dissemination of information concerning an individual’s mental health history. For
instance, some information concerning D.L.’s prior stay at Mann RTC made its way into
36
the record without offending these HIPAA protections. Further, these protections do not
guarantee that records of an individual’s past mental health treatment will be entirely
shielded from access. In fact, in the words of the Department of Health and Human
Services’ guidance materials, HIPAA “support[s] information sharing by providing
assurance to the public that sensitive health data would be maintained securely and shared
only for appropriate purposes or with express authorization of the individual.” HHS.gov,
Understanding Some of HIPAA’s Permitted Uses and Disclosures, available at:
https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/permitted-
uses/indext.html (last visited Aug. 12, 2019). Although the informational protections
afforded such information at both the State and federal levels may mitigate the
dissemination of such information to an extent, they do not constitute an outright ban on
disclosure. Accordingly, D.L. faces possible collateral consequences stemming from her
involuntary admission based on the social stigmatization of mental illness.
Lastly, D.L. argues that she will be subject to collateral consequences that concern
her ability to own, possess, or transfer firearms at both the State or federal levels. First,
pursuant to § 5-133.2(c) of the Public Safety Article (“PS”), facilities are required to submit
to the Federal Bureau of Investigation’s (“FBI”) National Instant Criminal Background
Check System (“NCIS Index”). Particularly, a facility must submit to the NCIS Index the
name and identifying information of the individual admitted, the date of admission, and
the name of the facility. PS § 5-133.2(c)(2). This requirement is not unique in its
application to those who are involuntarily admitted. The reporting requirement also applies
to those who are voluntarily admitted to a facility and stay there for longer than thirty
37
consecutive days. PS § 5-133.2(c)(1)(i). Based on the statute’s language, D.L.’s
information was transmitted to the FBI for addition to the NCIS index based on her
involuntary admission to Sheppard Pratt. Therefore, a possible collateral consequence
exists. Furthermore, this requirement is interrelated with potential restrictions on D.L.’s
ability to own firearms at the federal level. See 2013 Md. Laws ch. 427. Accordingly, we
must analyze the potential collateral consequences D.L. may face through potential
restrictions on her ability to own or possess firearms.
D.L. contends that, as a consequence of her involuntary admission, she will be
precluded from owning or possessing certain firearms under Maryland law. See PS § 5-
118(b)(3)(xi) (excluding those who are involuntarily admitted to a facility from owning
regulated firearms). See also PS § 5-205(b)(10) (prohibiting those who are involuntarily
admitted from possessing rifles and shotguns). We must first note that, due to D.L.’s age,
she is currently unable and will be unable to legally own a firearm for several years.
Additionally, although the restrictions of PS § 5-205(b)(10) would ordinarily apply, the
form commitment order provides the following paragraph:
FURTHERMORE, I FIND THAT THE INDIVIDUAL CANNOT
SAFELY POSSESS A FIREARM BASED UPON CREDIBLE EVIDENCE
OF DANGEROUS TO OTHERS, THEREFORE THE INDIVIDUAL
MUST:
1. Surrender to law enforcement authorities any firearms in the individual’s
possession; and
2. Refrain from possessing a firearm unless the individual is granted relief
from firearms disqualification in accordance with [PS] § 5-133.3
38
(emphasis in original). However, the ALJ in this case failed to check the corresponding
box and sign this paragraph. Therefore, based on the commitment order, D.L. is not subject
to restrictions on possessing firearms found in PS § 5-205(b)(10).
Nonetheless the restrictions apply to her ability to own a regulated firearm and her
ability to obtain a firearm application is limited. PS § 5-118(b)(3)(xi). See also PS § 5-
118(b)(3)(vii) (indicating that an individual may not file a firearm application if he or she
“suffer[s] from a mental disorder as defined in [HG] § 10-101(i)(2) and ha[s] a history of
violent behavior against the firearm applicant or another.”).9 Sheppard Pratt argues that
any restrictions on D.L.’s ability to own firearms are sufficiently mitigated by statutory
provisions which can potentially allow her to regain this right in the future. In particular,
PS § 5-133.3 enables individuals that are prohibited from owning or possessing certain
firearms to have this right reinstated. An aggrieved individual may file an application
signed by a physician licensed and certified in psychiatry or psychology providing
information about the individual’s former mental health treatment, the length of the
treatment, and whether the applicant would pose a safety risk to themselves or others if
allowed to possess a firearm. PS § 5-133.3(d).
The ability for this class of individuals to purchase, possess, or transfer firearms is
also limited by federal law. For example, 18 U.S.C. § 922(d)(4) prohibits the sale or
transfer of firearms to one who has been adjudicated as mentally defective or one who “has
9
A similar provision exists within PS § 5-205(b)(6), which prohibits an individual from
possessing or owning a rifle or shotgun if the individual has a history of violent behavior
towards themselves or others.
39
been committed to any mental institution[.]”10 However, much like its State counterpart,
this federal provision is not unlimited in its scope. Individuals affected by the provision
may file an application with the Attorney General to remove these restrictions. 18 U.S.C.
§ 925(c). The Attorney General will grant such applications if, based on the circumstances
surrounding the applicant’s disability, subsequent record, and reputation demonstrate that
the applicant will not “be likely to act in a manner dangerous to public safety and that
granting of the relief would not be contrary to the public interest.” Id.
Sheppard Pratt argues that these statutory provisions that permit those who have
been involuntarily admitted to regain the ability to own or transfer firearms sufficiently
mitigate any collateral consequences stemming from D.L.’s involuntary admission.
Nonetheless, as reiterated throughout our discussion, our analysis of collateral
consequences focuses on the possibility of collateral consequences. Adkins, 324 Md. at
654. Although existing possible collateral consequences may be statutorily mitigated to
some degree, such an inquiry falls beyond the ambit of our analysis. Although these
mitigating provisions exist, they do not undercut the existence of possible collateral
consequences. Additionally, with respect to the limitations on firearm ownership at the
federal level, although applications may be filed with the Attorney General to reinstate an
10
We note that this provision is likely implicated by D.L.’s prior stay at Mann RTC based
on the language concerning voluntary admissions. In short, the record does not adequately
reflect the nature of D.L.’s prior stay at Mann RTC, i.e. whether voluntary or involuntary.
The interaction between D.L.’s prior stay at Mann RTC and the involuntary commitment
undergirding the instant appeal will be discussed in detail shortly hereafter. See infra at
39—43.
40
individual’s firearm rights, there is no guarantee that the application will be granted. Put
simply, any mitigating effect these statutory provisions provide is ad hoc and emerges after
judicial action has engendered any collateral consequences.
Next, we turn to the distinction between facilities and RTCs to ascertain the extent
to which D.L.’s prior stay at Mann RTC would affect our determination regarding the
existence of collateral consequences.
This case involves a subsidiary issue that concerns the difference between a
“facility” as used in HG § 10-613 and an RTC as defined within HG § 19-301(p). As noted
above, D.L. was admitted to Mann RTC prior to the involuntary admission at issue in the
present appeal. Sheppard Pratt argues that a majority of these collateral consequences from
D.L.’s involuntary admission are attributable to her prior stay at Mann RTC. Primarily,
they argue that an RTC meets the statutory definition of a facility and therefore, a majority
of the alleged collateral consequences that may limit D.L.’s rights, i.e., owning firearms,
employment, and social stigma,11 were implicated by her prior stay at Mann RTC rather
than her involuntary admission to Sheppard Pratt which this appeal centers upon.
11
As noted above, the State statutory provisions restricting a certain individual’s rights are
primarily based upon an individual’s prior admission to a facility. See PS § 5-118(b)(3)(xi)
(requiring disclosure of whether an individual has ever been “committed to a facility” for
the purpose of applications to own registered firearms); PS § 5-205(b) (prohibiting the
possession of firearms for those “involuntary committed to a facility[.]”).
Additionally, at the federal level, the relevant statutory provisions use the term “mental
institutions” rather than facility. 18 U.S.C. 922(d)(4) (prohibiting sale of firearms to
individuals that have “been committed to any mental institution[.]”). The regulations
concerning employment also utilize the term “mental institution” rather than facility. See
COMAR 29.04.01.02.E(6); COMAR 29.04.08.03.C(6).
41
Based on the scant record before us, we cannot confidently determine that sufficient
overlap exists between an RTC and a facility. The Court of Special Appeals held that any
collateral consequences D.L. may face already existed based on her prior stay at Mann
RTC. The court commented that her “stays at the Mann RTC . . . are involuntary
commitments because [D.L.] is a minor[,]” and “we hold that the instant involuntary
commitment does not generate potential collateral consequences that were not already
created by [D.L.]’s prior and subsequent commitments.” D.L. v. Sheppard Pratt Health
Sys., Inc., No. 2023, Sept. Term, 2016, 2018 WL 896905, at *8 (Md. Ct. Spec. App. Feb.
12, 2018). However, during the hearing before the circuit court, when discussing whether
an RTC constitutes a less restrictive form of intervention, counsel for Sheppard Pratt
testified that “a residential treatment center, which is yes, considered a less-restrictive
environment to the extent that there’s no involuntary admission process.”
After concluding that her stay at Mann RTC was an involuntary admission, which
stands in opposition to testimony adduced at the hearing in the courts below, the Court of
Special Appeals determined that a majority of the alleged collateral consequences may be
attributed to D.L.’s stay at Mann RTC and therefore cannot flow from D.L.’s involuntary
admission at Sheppard Pratt. In particular, based on its determination that D.L.’s prior stay
at Mann RTC was an involuntary commitment, the court concluded that the following
statutory restrictions had already been implicated: (i) FBI NCIS reporting; (ii) Maryland
restrictions to firearms ownership;12 (iii) State driving privileges; (iv) governmental
12
PS § 5-118(b)(3)(xi) (prohibiting those who have been involuntarily committed to a
facility from acquiring a firearm application); PS § 5-205(b)(10) (prohibiting possession
42
employment; and (v) the social stigmatization of mental illness. Before this Court,
Sheppard Pratt echoes the analysis of our intermediate appellate court, arguing that D.L.’s
prior stay in Mann RTC implicates the above mentioned collateral consequences.
The Health-General Article defines an RTC as “a psychiatric institution that
provides campus-based intensive and extensive evaluation and treatment of children and
adolescents with severe and chronic emotional disturbances who require a self-contained
therapeutic, educational, and recreational program in a residential setting.” HG § 19-
301(p). In contrast, HG § 10-101(g)(1) provides that the term ‘“facility’ means any public
or private clinic, hospital, or other institution that provides or purports to provide treatment
or other services for individuals who have mental disorders.” HG § 10-101(g)(1).
Despite Sheppard Pratt’s contentions that D.L.’s earlier stay at Mann RTC was an
admission—either voluntary or involuntary, juveniles are not always necessarily placed at
RTCs based on admissions and the record before us does not adequately reflect the
underlying situation which compelled D.L.’s stay at Mann RTC. Instead, a juvenile may
be placed at an RTC based on interaction with the criminal justice system. See generally
CJ § 3-8a-15. In fact, the Maryland Department of Juvenile Services explains the
or ownership of a rifle or shotgun where the owner has previously been involuntarily
admitted to a facility); PS § 5-133(b)(10) (prohibiting the possession of regulated firearms
where an individual has been involuntarily committed). All of these statutory provisions
reference HG § 10-101 for the definition of a facility.
The federal restrictions on an individual’s ability to transfer firearms is broader than those
at the State level and does not require an individual be involuntarily admitted. Instead, the
provision excludes those from transferring firearms if he or she “has been adjudicated as a
mental defective or has been committed to any mental institution[.]” 18 U.S.C. § 922(d)(4).
43
procedure through which a juvenile found involved, in what would otherwise constitute
criminal conduct, may end up at an RTC:
The juvenile court may commit a youth to the care of DJS. Legal custody of
the youth is thereby transferred to the Department. A range of out-of-home
program options (or placements) have been developed for committed youth.
Community-based program options include placement in a foster home,
group home, or independent living program. Placements in non-community
settings include Intermediate Care Facilities for Addictions (ICFA),
Residential Treatment Centers (RTC), DJS-operated Youth Centers, and
secure confinement facilities. DJS operates seven facilities in Maryland and
contracts with others both in-state and out-of-state.
2018 Data Resource Guide, Section IV: Committed Programs, Maryland Department of
Juvenile Services at 144, available at:
https://djs.maryland.gov/Documents/DRG/Data_Resource_Guide_FY2018_full_book.pd
f (last visited Aug. 12, 2019).
In addition, other sources confirm that a juvenile may be placed in an RTC based
on involvement with the juvenile criminal system:
Less than 1% of children in DHR out-of-homecare are placed in the State’s
most restrictive placements (hospitalizations), while an average of 4% are in
non-community-based placements (Residential Treatment Centers,
Correctional Institutions, or Secure Detention (Table 21)). Both of these
placement categories are necessitated by severe mental health and medical
needs, and/or involvement in the juvenile/adult criminal justice system;
these placements are primarily driven by the behavioral needs of the child
rather than the family’s inability to provide a safe environment, although past
abuse and trauma may contribute to individual children’s mental health
issues and/or criminal acting-out behaviors.
State of Maryland Out-Of-Home Placement and Family Preservation Resource Plan 2013,
the Governor’s Office for Children, available at:
http://dlslibrary.state.md.us/publications/JCR/2013/2013_14.pdf (last visited Aug. 12,
44
2019) (emphasis added). Prior Maryland cases confirm this interpretation. See Long v.
Maryland State Dep’t of Pub. Safety and Corr. Servs., 230 Md. App. 1, 18 (2016); In re
Nick H., 224 Md. App. 668, 672 (2015); In re William G., 52 Md. App. 131, 132 (1982);
In re Glenn H., 43 Md. App. 510, 513 (1979).
Put simply, although there may be a slight overlap between the definitions of an
RTC and a facility within the Health-General Article, based on the record before us, we
lack the requisite clarity to determine that D.L.’s prior stay at Mann RTC was actually an
admission. As we have demonstrated, juveniles are occasionally placed in RTCs as a result
of interaction with the criminal justice system. The record does not provide sufficient detail
from which we can conclude that D.L.’s prior stay at Mann RTC was an involuntary
admission as represented by Sheppard Pratt. Therefore, because there was no hearing on
the merits in the circuit court, we determine that the record is insufficient to prove that the
collateral consequences were implicated by D.L.’s earlier stay at Mann RTC.
Accordingly, we hold that D.L. faces possible collateral consequences stemming
from her involuntary admission. Although some of these possible collateral consequences
may be implicated by an individual’s earlier voluntary or involuntary admission, the record
before us is sparse and does not indicate whether D.L.’s prior stay at Mann RTC was an
involuntary admission. Because D.L. faces collateral consequences from her involuntary
admission, we need not analyze the several exceptions to the mootness doctrine or whether
D.L. preserved the capable of repetition yet evading review exceptions for our review. We
remand to the circuit court to analyze the substantive issues within D.L.’s petition for
judicial review, i.e. whether an available less restrictive form of intervention existed.
45
Overall, we must note that analysis of whether an individual faces collateral consequences
as a result of an involuntary admission is heavily fact dependent and the existence of such
collateral consequences may vary dependent upon the facts of a particular case.
CONCLUSION
D.L. faces collateral consequences as a result of her involuntary admission. As we
have determined that D.L. is subject to several collateral consequences stemming from her
involuntary admission, the instant appeal is not moot and the circuit court erred by
dismissing D.L.’s petition for judicial review as moot based simply on her release from
Sheppard Pratt.
JUDGMENT OF THE COURT OF
SPECIAL APPEALS REVERSED
AND CASE REMANDED TO THAT
COURT FOR REVERSAL OF THE
JUDGMENT BY THE CIRCUIT
COURT FOR HOWARD COUNTY
AND REMAND TO THAT COURT
FOR FURTHER PROCEEDIGNS
CONSISTENT WITH THIS OPINION.
COSTS TO BE PAID BY
RESPONDENT.
46