1. OFFICE OF ADMINSTRATIVE HEARINGS (OAH) HEARINGS INVOLVING COMMITTMENT TO PSYCHIATRIC FACILITIES

2. THREE TYPES OF HEARINGS
Involuntary admission of individuals to psychiatric units in private or state hospitals (“IVA”) or to Developmental Disability Administration (“DDA”) Facilities
Release or revocation of conditional release hearings for defendants the courts have found to be not criminally responsible and have committed to state hospitals (“NCRs”)
Hearings to compel psychiatric patients to take specified medication (“Forced Meds”)

3. OAH IS A INDEPENDENT AGENCY WITHIN THE EXECUTIVE BRANCH OF GOVERNMENT
OAH IS A INDEPENDENT AGENCY WITHIN THE EXECUTIVE BRANCH OF GOVERNMENT. OAH’S AUTHORITY TO CONDUCT HEARINGS COMES FROM EITHER AGENCY OR STATUTORY DELEGATION. THE DEPARTMENT OF HEALTH AND MENTAL HYGIENE (“DHMH”) IS THE DELEGATING AGENCY

4. INVOLUNTARY ADMISSION HEARINGS (“IVAs”)
Health-General Article §
COMAR

5. “IVAs” ARE INVOLUNTARY ADMISSIONS OF INDIVIDUALS WITH MENTAL DISORDERS TO INPATIENT:
State psychiatric hospitals
Freestanding private psychiatric hospitals
Psychiatric wards in general hospitals
Veteran’s Administration hospitals
COMAR

6. TIMELINE FOR IVA HEARING
OAH shall hold IVA hearings within 10 days of a patient’s initial confinement
ALJ may postpone hearings, for good cause, for no more than 7 days
ALJ shall state the reasons for the PP on the record
Health-General Article §§ (b) and (c)(1)

7. PATIENT AT HEARING
The patient has the right to attend or to waive his attendance
The patient has the right to testify and almost always does
The patient or the hospital sometimes calls the patient’s family member(s) as witnesses (who are required to receive notice of the hearing)
A public defender is automatically assigned to represent a patient
The public defender’s investigator will meet with the patient one or two days before the hearing
The patient may have a private attorney, at his/her own expense, or reject the public defender and proceed pro se

8. WAIVER OF PATIENT’S PRESENCE AT HEARING
Knowingly and intelligently made
Witnessed by the individual's counsel
and
Witnessed by the ALJ (ALJ must see the patient and inquire whether he/she wants to attend the hearing)
COMAR C(2)(b)

9. STANDARD and BURDEN OF PROOF
The hospital bears the burden of proof by clear and convincing evidence
COMAR F

10. MEDICAL TESTIMONY AT HEARING
ALJs shall require hospitals to present the testimony of one of the following,
who has examined the patient
within 48 hours of hearing:
A psychiatrist
A physician in an accredited psychiatric residency program, who is under the supervision of a psychiatrist
A psychologist
COMAR E(1)

11. CRITERIA FOR ALJ’S DECISION TO RETAIN PATIENT
Patient has a mental disorder
Patient needs inpatient care or treatment
Patient presents a danger to his/her/others’ life or safety
Patient is unable or unwilling to be voluntarily admitted to the facility
and
No less restrictive form of intervention is available that is consistent with the Patient’s welfare and safety
and if the Patient is 65 years old or older and is to be admitted to a State facility
he/she has been evaluated by a geriatric evaluation team finding that no less restrictive form of care or treatment was appropriate
Health General Article § (e)(2); COMAR F

12. PATIENT TO BE RELEASED
IF ANY OF THE REQUIRED CRITERIA FOR RETENTION HAVE NOT BEEN PROVEN BY CLEAR AND CONVINCING EVIDENCE OR
IF A SUBSTANTIAL PROCEDURAL VIOLATION HAS OCCURRED

13. Procedural release is made at the conclusion of the hearing if:
An error in the process has occurred;
The error is substantial;
No other remedy is available, which is consistent with due process and the protection of the patient’s rights
COMAR G(3)

14. The ALJ’S DECISION
Decision is made orally from the bench and written on multi-part decision form
Basis for decision is explained orally at hearing
Decision is final and appealable under the Administrative Procedure Act and both parties have the right to file an appeal.

15. BASIS FOR A PETITION FOR EMERGENCY EVALUATION (“EP”)
An individual who signs a petition for emergency evaluation may base the petition on:
Examination or observation or
Other information obtained that is pertinent to the factors giving rise to the petition.
A Peace Officer must base an EP on personal observation

16. Health-General Article § 10-622
CONTENTS OF AN EP
Description of the patient’s behavior and/or statements or any other information that led the petitioner to believe that the patient has a mental disorder and presents a danger to his/hers/others’ life or safety
and
Any other facts that support the need for an emergency evaluation
Health-General Article §

17. Health-General Article § 10-622
WHO MAY COMPLETE AN EP
A peace officer who personally has observed the individual or the individual's behavior; or
An examining:
Physician
Psychologist
Clinical social worker
Licensed clinical professional counselor
Clinical nurse specialist in psychiatric and mental health nursing
Psychiatric nurse practitioner
Health officer or designee of a health officer
Any other interested person, but a Court must approve the EP
Health-General Article §

18. Health-General Article § 10-623
COURT APPROVAL OF EP
District Court judges are available 24/7 to review emergency petitions
To approve an EP, the court must find probable cause to believe that the emergency evaluee has shown the symptoms of a mental disorder and that the individual presents a danger to the life or safety of the individual or of others
If the court does not find probable cause, it shall indicate that fact on the petition and no further action may be taken under the petition
Health-General Article §

19. COURT ORDERED EVALUATION OF ARRESTED INDIVIDUAL
A court may also order an emergency evaluation of an arrested individual upon a showing of probable cause that the individual has a mental disorder and that the individual presents a danger to the his/her/others life or safety
A court order under this section is a detainer against an individual until:
The charges against the individual are dismissed, nol prossed, or stetted or
The individual appears in court
Health-General Article §

20. PEACE OFFICER’S TRANSFER OF PATIENT TO EMERGENCY ROOM
A court-endorsed EP serves as a bench warrant that allows a peace officer to transport an evaluee to the nearest emergency facility
A peace officer cannot act on an endorsed EP that is more than 5 days old
5-day limitation only applies to a court- endorsed EP signed by a lay petitioner
Health-General Article §

21. WHAT HAPPENS AT THE EMERGENCY ROOM?
If the EP is executed properly, the emergency facility shall accept the patient
Within 6 hours of arriving at an emergency facility, a physician shall examine the patient to determine whether he/she meets the requirements for involuntary admission
An emergency evaluee may not be kept at an emergency facility for more than 30 hours
Health-General Article §

22. PROMPTLY AFTER THE PATIENT’S EXAMINATION, HE/SHE SHALL BE RELEASED UNLESS :
The Patient agrees to a voluntary admission (and is sufficiently competent to do so)
or Physician certificates have been signed and proper notice of status/rights has been provided to the patient

23. Health-General Article § 10-609
VOLUNTARY ADMISSION
Patient may sign voluntary admission agreement
Patient must be able to understand the nature of the request for voluntary admission
If the hospital refuses to accept the patient as a voluntary admission, ALJ may decide whether patient is willing and able
If ALJ finds patient is willing and able and hospital still refuses to accept voluntary, ALJ must release patient because hospital has not proven the involuntary admission requirement
Hospitals generally accept the voluntary agreement upon ALJ’s findings
ALJ cannot force hospital to accept voluntary
Health-General Article §

24. PHYSICIANS’ CERTIFICATES
Two physicians or one physician and one psychologist must certify the patient for involuntary admission
Certificates must be based on personal examination
The examination may not be done more than one week before the certificate is signed or more than 30 days before the inpatient facility receives the application for admission
Health-General Article § ; COMAR

25. CERTIFYING NOTE
One certificate must be accompanied by a note that details why the patient meets the requirements for involuntary admission
COMAR C(4)

26. NOTICE OF RIGHTS/STATUS
Within 12 hours after initial confinement, each patient must be given and read (in a language understood by the Patient) a notice, including the following information:
Notice of the confinement of the individual
The right to consult with a lawyer that the individual chooses
The availability of the legal aid bureaus, lawyer referral services, and lawyer referral agencies
The right of the individual to call or write a lawyer or a referral agency
The relevant law
Health-General Article § ; COMAR

27. Health-General Article § 10-631(b)(2)
IF THE PATIENT DOES NOT UNDERSTAND THE NOTICE OF RIGHTS/STATUS, THE FACILITY SHALL GIVE THE NOTICE TO:
the parent or guardian
the next of kin of the individual
the applicant for an involuntary admission of the individual
and
and any other individual who has a significant interest in the status of the individual
Health-General Article § (b)(2)

28. NOTICE OF HEARING
Staff at an inpatient facility shall give oral and written notice of the scheduled hearing to the patient and the patient’s parent, guardian, or next of kin, containing the following:
The date, time, and place that the hearing will be held
The legal authority for and purpose of the hearing
A short statement explaining why the individual's involuntary admission is being sought
The standards that govern whether the patient shall be involuntarily admitted
The patient’s right to consult with an attorney and the availability of representation at the hearing by a public defender
and
A list of the individual's rights at a hearing
COMAR

29. SEMIANNUAL HEARING
After a patient is involuntarily committed, he/she is entitled to a subsequent hearing within 150 to180 days, and
After that hearing, he/she is entitled to a semiannual hearing
COMAR C

30. SEMIANNUAL PROCEDURES
At least 7 days before a semiannual hearing:
Two physicians or one physician and one psychologist shall complete new certificates
The Patient shall be given notice of rights/hearing
If the patient is 65 years or older and is in a State or VA hospital, GES approval must be obtained if it has not been obtained during that hospitalization
COMAR C

31. NOT CRIMINALLY RESPONSIBLE (“NCR”) HEARINGS
Criminal Procedure Article § to No regulations

32. NCR HEARINGS ARE ONLY AT STATE HOSPITALS
Spring Grove Hospital Center, Catonsville
Springfield Hospital Center, Sykesville
Walter P. Carter Center, Baltimore City
Timothy B. Finan Center, Cumberland
Eastern Shore Hospital Center, Easton
Upper Shore Community Mental Health Center, Chestertown
Clifton T. Perkins Hospital Center, Jessup

33. A COMMITTED PERSON MAY REQUEST A JURY TRIAL RATHER THAN A RELEASE HEARING BEFORE OAH Criminal Procedure Article § 3-119(c)(3)

34. Criminal Procedure Article § 3-112
COMMITTMENT
After a verdict of not criminally responsible, the court immediately shall commit the defendant to DHMH for institutional inpatient care or treatment
If the court commits a defendant who was found not criminally responsible, primarily because of intellectual disability, DHMH shall designate a facility for individuals with intellectual disabilities for care and treatment of the committed person
Criminal Procedure Article § 3-112

35. UNDER CERTAIN CIRCUMSTANCES, A COURT MAY ORDER THAT A PERSON BE RELEASED AFTER A VERDICT OF NOT CRIMINALLY RESPONSIBLE, WITH OR WITHOUT CONDITIONS, INSTEAD OF BEING COMMITTED TO DHMH See Criminal Procedure Article § 3-312(c)

36. TIMING OF APPLICATION FOR RELEASE BY PATIENT
Not earlier than 1 year after the initial release hearing ends or was waived and not more than once a year thereafter OR
At any time if the application is accompanied by an affidavit of a physician or licensed psychologist that attests to an improvement in the mental condition of the committed person since the last hearing
Criminal Procedure Article § 3-119

37. Criminal Procedure Article § 3-114
STANDARD FOR RELEASE
A committed person is eligible for discharge from commitment only if that person would not be a danger, as a result of a mental disorder or intellectual disability, to self or to the person or property of others if discharged or if conditionally released from confinement
To be released, a committed person has the burden to establish, by a preponderance of the evidence, his/her eligibility for discharge or for conditional release.
Criminal Procedure Article § 3-114

38. TIMELINE FOR INITIAL NCR RELEASE HEARING
Within 50 days after commitment to DHMH
following an NCR finding:
ALJ shall hold a hearing to determine whether to recommend to the court that the patient is eligible for conditional release or discharge
ALJ may postpone the hearing for good cause
The committed person may waive the release hearing
Criminal Procedure Article § 3-115

39. Criminal Procedure Article § 3-115
NCR RELEASE HEARING
ALJ may admit and consider any relevant evidence, as
the formal rules of evidence do not apply
DHMH (through the hospital’s/State’s representative) shall present the evaluation report on the committed person and any other relevant evidence
The patient has a right to be present; to offer evidence and to cross-examine adverse witnesses
The Patient has a right to be represented by counsel, including, if the committed person is indigent, the Public Defender or a designee of the Public Defender
Criminal Procedure Article § 3-115

40. ALJ’S REPORT AND RECOMMENDATION
Within 10 days after the hearing ends, the ALJ shall prepare a report of recommendations to the court that contains:
a summary of the evidence presented at the hearing
recommendations as to whether the committed person proved, by a preponderance of the evidence, eligibility for conditional release or eligibility for discharge
and
if the ALJ determines that the committed person proved eligibility for conditional release, the recommended conditions of the release (giving consideration to any specific conditions recommended by the DHMH facility that has charge of the committed person, the committed person, or counsel for the committed person)
Criminal Procedure Article § 3-116

41. COURT’S DECISION Within 30 days after the court receives
the report and recommendation from OAH, the Court may
on its own initiative hold a hearing
if timely exceptions are filed or if the court requires more information, hold a hearing (unless the committed person and the State's Attorney waive the hearing)
The court’s hearing is on the record that was made before the ALJ
The court may continue its hearing and remand to OAH to take additional evidence
Criminal Procedure Article § 3-117
Note: While our decisions are usually timely, Courts frequently take much more than 30 days to rule, so do not promise Patients a final decision by a set date

42. ALLEGATIONS OF VIOLATION OF CONDITIONAL RELEASE
State's Attorney shall determine whether there is a factual basis for allegations
If the State's Attorney determines that there is a factual basis to believe that the committed person has violated any of the terms of a conditional release and believes further action by the court is necessary, the State's Attorney promptly shall:
notify DHMH
and
file with the court a petition for revocation or modification of conditional release
Criminal Procedure Article § 3-121