The ability to involuntarily administer medications to individuals who have been committed against their will to an institution has varied significantly over time. In 2007, Mr. Anthony Kelly challenged Health General §10-708(g), the Maryland law that allowed for the use of a Clinical Review Panel (CRP) to authorize the involuntary administration of medication.  The CRP reasoned that “without the medication, Mr. Kelly was at risk of a longer period of hospitalization due to his remaining serious mental illness that caused him to be a danger to himself or others.” After a series of challenges, and based on the U.S. Supreme Court’s decision in Washington v. Harper (1990), the Court of Appeals of Maryland determined that Mr. Kelly should not be forced to take medications against his will unless he displayed signs of dangerousness as a result of his mental illness while in the hospital.

That decision presented a challenge to the treatment of mentally ill individuals who were involuntarily committed and refused pharmacological intervention because, although they were committed to restore their competency, they could not be treated appropriately unless dangerous while in the hospital.  Thus, in October 2014, Health General §10-708(g) was amended to allow for an individual to also be involuntarily medicated if the individual was at substantial risk of continued hospitalization because they would remain seriously mentally ill with no relief, or as a result of the symptoms that led to their hospitalization.

Most recently, this statute was challenged by Mr. Gary Allmond, a man with Schizophrenia who was charged with first-degree murder after allegedly strangling his girlfriend. He was adjudicated incompetent to stand trial and, like Mr. Kelly, was committed to Clifton T. Perkins Hospital Center. During his hospitalization, Mr. Allmond displayed signs of paranoia, hallucinations, delusional thoughts, and disorganization, but did not pose imminent dangerousness while in the hospital. When his treatment team recommended he start taking psychotropic medications, Mr. Allmond refused, became more agitated, and attempted to assault a staff member. A CRP authorized the involuntary administration of medications for a period of 90 days. Mr. Allmond did not contest that decision. A second CRP reauthorized the involuntary administration of medication on the grounds that he would remain seriously mentally ill for a significantly longer period of time with symptoms that would cause him to be dangerous if released.  Mr. Allmond appealed the decision to an Administrative Law Judge (ALJ), and ultimately to the Circuit Court of Howard County.   At that stage, Mr. Allmond argued that the statute violated his rights under the Due Process Clause of the U.S. Constitution and Article 24 of the Maryland Declaration of Rights. The Circuit Court reasoned that the State had a legitimate self-interest in medicating a hospitalized individual with a mental illness and thus held that the statute was not unconstitutional.

The case reached the Court of Appeals of Maryland, where Mr. Allmond raised a facial challenge to the statute’s constitutionality under Article 24 of the Maryland Declaration of Rights.  A facial challenge is a challenge to the statute as a whole or on its face, as opposed to an as applied challenge, which would focus on how the statute is applied to his particular circumstances. The Court noted that a law is unconstitutional on its face if it can be demonstrated that “no set of circumstances exist under which the Act would be valid.” As part of this analysis, the Court considered Article 24 of the Maryland Declaration to be coextensive with the substantive due process rights of the U.S. Constitution and, thus, considered past U.S. Supreme Court cases which had addressed this issue: specifically, Washington v. Harper (1990), Riggins v. Nevada (1992), and Sell v. United States (2003). These cases established that in order to involuntarily administer medications, there must be “medical appropriateness” and an “overriding justification.” The Court noted that some examples of “overriding justifications” include preventing danger to self or others within a facility and restoring competency to stand trial. Because a set of circumstances giving rise to these justifications was conceivable, the Court rejected Mr. Allmond’s facial challenge to the statute and affirmed the Circuit Court ruling.

Therefore, Maryland’s Health General §10-708(g) is facially consistent with Article 24 of the Maryland Declaration of Rights.  Although applied constitutional challenges to the statute may occur in the future, Health General §10-708(g) continues to allow for the involuntary use of medication if an individual is at substantial risk of prolonged hospitalization as a result of the symptoms that led to their commitment, even if they do not demonstrate dangerousness while in the hospital.

Viviana Alvarez-Toro, M.D.
PGY2 Resident
University of Maryland/Sheppard Pratt
Psychiatry Residency Program