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 also participated in the decision and adoption of this 2019-11-15 14:50-05:00 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/ (https://perma.cc/GFH3-Y7BD) (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 (https://perma.cc/ST98-VEUJ) (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 5 under her current placement in therapeutic foster care; and (v) if released, there was a 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 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 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. 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 7 disposition of that motion, the Circuit Court may also consider after argument [D.L.]’s Petition for Judicial Review.

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: 8 Because I think the only thing I’m authorized to do today is to conduct a hearing on the issue of mootness *** 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. 9 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. 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. 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 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: 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 11 “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 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. 6 The provision specifically notes that Veterans’ Administration Hospitals do not constitute “facilities.” HG § 10-101(g)(2). 12 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 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 13 against self-compelled incrimination. Id.

The Court held the defendant’s challenge was moot commenting: 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 7 At this point in time, the collateral consequences doctrine had yet to develop its current moniker. 14 deportation for committing a crime involving moral turpitude within five years after his entry into the United States.

Id. 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. 15 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. 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 16 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 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 17 exhausted all available state remedies. Id. at 629 . Primarily, the court determined that the 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