Source: http://jaapl.org/content/45/2/265
Timestamp: 2019-04-21 14:36:21+00:00

Document:
In Allmond v. Department of Health and Mental Hygiene, 141 A.3d 57 (Md. 2016), Mr. Allmond challenged Maryland Code Health-General Article (HG) § 10-708(g) (2010), which provides the criteria for authorizing involuntary medications for an individual committed to a mental health facility. A panel, pursuant to the statute, approved the involuntary administration of medication to Mr. Allmond, and he appealed by requesting an administrative hearing. An Administrative Law Judge (ALJ) of the Office of Administrative Hearings found that authorization for involuntary medication was satisfied under certain criteria; that decision was affirmed by the Circuit Court for Howard County. The Court of Appeals of Maryland granted a writ of certiorari to review the constitutionality of certain provisions of Maryland's procedures.
Mr. Allmond, diagnosed with schizophrenia since his mid-20s, was charged with first-degree murder after his girlfriend's strangled body was found on September 1, 2011. After an evaluation by the Department of Health and Mental Hygiene (DHMH), the Circuit Court of Baltimore City determined that Mr. Allmond was incompetent to stand trial, committing him to Clifton T. Perkins Hospital Center.
During his hospitalization, Mr. Allmond repeatedly refused psychotropic medications, despite exhibiting symptoms such as paranoia, delusions, hallucinations, and disorganized thinking. He preferred nondrug treatments, including psychotherapy and group therapy. Although he remained symptomatic, he maintained good behavior until a medical treatment meeting on September 3, 2014. During that meeting, after it was suggested that he receive psychotropic medications, Mr. Allmond became agitated and attempted to assault a staff member.
Following this incident, Mr. Allmond's psychiatrist requested that a clinical review panel be convened, pursuant to HG § 10-708, to assess the possibility of involuntary administration of medications to Mr. Allmond. The panel approved the request for involuntary administration of medications for 90 days; he did not appeal.
Mr. Allmond's psychiatrist requested a reconvening of the clinical panel shortly before the 90-day period expired. The panel again approved involuntary administration of medications to Mr. Allmond for 90 days. After this decision, Mr. Allmond requested an administrative hearing before an ALJ to appeal the panel's decision. The ALJ concluded that sufficient criteria for involuntary medication were met; this decision was affirmed by the Circuit Court for Howard County. Mr. Allmond appealed to the Court of Appeals of Maryland and a writ of certiorari was granted.
The statute at issue, HG § 10-708(g), provides criteria for the involuntary medication of persons in mental health facilities. The first two prongs of the statute are not at issue in this case: that “the medication is prescribed by a psychiatrist for the purpose of treating the individual's mental disorder” and “the administration of medication represents a reasonable exercise of professional judgment.” The language in question concerns the third part of the criteria, § 10-708(g)(3), which consists of seven alternative criteria that must be satisfied to authorize involuntary medication of an individual. Three of those criteria are not in question in this case. They involve a finding that, without the medication, the individual's mental disorder causes the individual to be (1) a danger to self or (2) danger to others in the facility, or without medication, the individual would (3) relapse into a condition in which the individual is unable to provide for his essential human needs.
The four criteria in question in this case are HG § 10-708(g)(3)(i)(2), (g)(3)(i)(3), (g)(3)(ii)(2), and (g)(3)(ii)(3). These four subsections discuss situations other than those in which the individual is a danger to self or others in the facility or unable to provide essential human needs. They concern involuntary medication in situations where an individual's mental illness results in commitment to a hospital or the mental illness presents a danger to self or others if the patient is released from the hospital.
Mr. Allmond challenged these provisions on the basis that they violate Article 24 of the Maryland Declaration of Rights, the counterpart to the Due Process Clauses found in the Fifth and Fourteenth Amendments to the United States Constitution. He asserted a facial challenge to the statute, arguing that the law was invalid. The court applied a “no set of circumstances” test, meaning “a facial challenge to the relevant provisions of the statute can succeed only if there is no set of circumstances under which these provisions authorize involuntary medications of an individual and doing so is constitutional” (Allmond, p 71). They found that there are potential scenarios in which the statute could be used to medicate an individual forcibly; accordingly, Mr. Allmond's facial challenge failed.
To illustrate this point, the court provided a hypothetical scenario in which the state desires to make a pretrial detainee competent to stand trial for a serious crime and meets the requirements enunciated in Sell v. United States, 539 U.S. 166 (2003), for involuntarily medicating this individual. In Sell, the Court stated that “the Constitution permits the government to administer antipsychotic drugs involuntarily to a defendant with mental illness facing serious criminal charges to render that defendant competent to stand trial, but only if the treatment is medically appropriate, is substantially unlikely to have side effects that may undermine the fairness of the trial, and, taking account of less intrusive alternatives, is necessary significantly to further important governmental trial-related interests” (Allmond, p 69, quoting Sell v. United States, 539 U.S.). In addition, suppose that this hypothetical detainee, while not dangerous within the facility without medication, was at significant risk of continued hospitalization because of his serious mental illness and committed to a hospital. Under this scenario, one of the challenged provisions of HG § 10-708(g) could be constitutionally used to medicate this prisoner forcibly.
The Allmond decision cited Washington v. Harper, 494 U.S. 210 (1990), for the principle that a substantive due process right allows refusal of psychotropic medications. They further provided that there must be “a finding of overriding justification and a determination of medical appropriateness” to provide involuntary psychotropic medications (Allmond, p 69, quoting Riggins v. Nevada, 504 U.S. 127 (1992), 135). None of the justifications provided by DHMH were found to satisfy the requirement of overriding justification. These unsatisfactory justifications included an interest in providing medical care to those committed to its custody, obligations under the Americans with Disabilities Act, and the principle of optimal resource allocation. To meet the standard of overriding justification, the State must meet the standards set forth in Harper, Riggins, and Sell before authorizing involuntarily medicating a pretrial detainee. The state interests that meet these standards include preventing harm to the individual or others or making the individual competent to stand trial. Thus, provided that the state interest meets the overriding justification requirement, the Maryland statute can provide the statutory authorization for involuntary medication.
In this case, the Court of Appeals of Maryland sought to reconcile an individual's due process right to refuse psychotropic medications with a state's interest in providing such medications for reasons it considers justified. Their reasoning underscored the importance of the due process right to refuse psychotropic medications while also acknowledging that there may be certain overriding justifications in which the state's interest may outweigh that right to refuse. They comprehensively reviewed the precedents established by significant cases such as Harper, Riggins, and Sell to analyze the Maryland statute at issue, HG § 10-708(g), and concluded that it is constitutional, provided that the State present appropriate justification. As the Court stated, “For a pretrial detainee like Mr. Allmond, Riggins and Sell approve the State interests in preventing harm to the individual or others and in making the individual competent to stand trial” (Allmond, p 73). We agree with the court that the State's proposed justifications, which include providing medical care for those in its custody, obligations under the Americans with Disabilities Act, and optimizing its use of resources, are not appropriate justifications to override an individual's right to refuse psychotropic medications. A rationale provided by the state must be examined with the framework of Riggins and Sell, and the state is not permitted to use any justification it may deem appropriate. In this context, the state's proposed justifications fail to establish the necessary overriding justification to provide involuntary psychotropic medication to an individual in a mental health facility.

References: v. 
 § 10
 § 10
 § 10
 § 10
 § 10
 v. 
 v. 
 § 10
 v. 
 v. 
 § 10