Williams v. Peninsula Regional Medical Center

ADKINS, J. In this tragic case, a young man, age 34, was brought to a hospital emergency room suffering from suicidal ideation and auditory and visual hallucinations. After evaluating him, health care providers decided not to admit him for psychiatric treatment and discharged him to the care of his mother. That same night, he was killed by law enforcement officers after inviting the officers to shoot him, and then aggressively rushing them. Our task is to decide whether hospital and health care providers enjoy statutory immunity against a wrongful death and survivorship action alleging negligence in the decision to release rather than involuntarily admit the young man to the hospital.

FACTS AND PROCEEDINGS On April 20, 2009, Gineene Williams brought her son, Charles Williams, Jr., to Peninsula Regional Medical Center (“PRMC”), where Dr. Michael P. Murphy and mental health ⁵⁷⁶ worker George Stroop (collectively with PRMC, “the Health Care Providers”) examined and evaluated him. 1 Williams had been suffering with suicidal ideation and auditory and visual hallucinations. Although alert and cooperative during his examination, Williams informed the Health Care Providers that he was “communicating with ‘the lord[,’] that he believed his ex-girlfriend had placed a curse on him[,] and that he had suffered blindness when he looked at a text message from her while in the emergency room.” During the examination, the Health Care Providers noted cuts on the inside of Williams’s arms and that he “minimiz[ed] any problems going on with him.” Upon completing the examination, the Health Care Providers elected not to admit Williams, discharging him to the care of his mother and advising her to remove any firearms from the home. Williams received a discharge diagnosis of “insomnia, fatigue, [and] bizarre behavior,” a prescription for the sedative Ambien, and instructions to return if he felt that he would harm himself or others. Immediately after discharge, Williams absconded from his mother’s care and went to a restaurant with his children and their mother, Michelle Crippen.

At some point upon leaving the restaurant, Williams demanded that Crippen pull her vehicle to the side of the road. He exited the vehicle and disappeared. Shortly before midnight, after spending several hours wandering the streets of Salisbury, Williams broke into a residence, at which time the homeowner notified police. Upon arrival, officers encountered Williams in the front yard of the residence wielding a knife and saying, “shoot me, f* * *ing shoot me, somebody’s going to die tonight.” He then held the knife to his throat and declared, “I want you to shoot me, I want to die.” When Williams rushed the officers, ⁵⁷⁷ they fired their weapons at him.

When he persisted, the officers fired again, killing him. Plaintiffs Gineene Williams, 2 Patricia Gaines, Michelle Crippen, and Charles A. Williams, Sr. (“the Family” or “Plaintiffs”) filed a wrongful death and survivorship action against the Health Care Providers in the Circuit Court for Wicomico County, alleging negligence, including (1) a “failure to appreciate the signs and symptoms” exhibited by Williams, (2) a failure to perform the appropriate diagnostic tests, (3) a “failure to appreciate the seriousness” of Williams’s condition, (4) a “failure to admit” Williams, and (5) a “general failure to properly care for” Williams. No bad faith was alleged. The Health Care Providers filed Motions to Dismiss, arguing that the Complaint failed to state a claim upon which relief could be granted, that they were entitled to statutory immunity, and that the Complaint failed to assert that the actions of the Health Care Providers were the proximate cause of Williams’s injuries.

After hearing arguments, the Circuit Court granted the Motions to Dismiss, concluding that the Health Care Providers were protected from liability by statutory immunity. The Family appealed to the Court of Special Appeals, which affirmed the decision of the Circuit Court. Williams v. Peninsula Reg’l Med. Ctr., 213 Md.App. 644 , 75 A.3d 359 (2013).

We granted the Family’s Petition for Writ of Certiorari to answer the following question: Does Maryland’s involuntary admission immunity statute, [Md.Code (1982, 2009 RepLVoL), § 10-618 of the Health-General Article], apply to health care providers who evaluate an individual and decide to discharge the patient from psychiatric care? 3 ⁵⁷⁸ Because we answer yes, we shall affirm the judgment of the Court of Special Appeals. STANDARD OF REVIEW The standard of appellate review of a lower court’s grant of a motion to dismiss is well-settled: “[i]n reviewing the underlying grant of a motion to dismiss, we must assume the truth of the well-pleaded factual allegations of the complaint, including the reasonable inferences that may be drawn from those allegations.” Debbas v. Nelson, 389 Md. 364, 372 , 885 A.2d 802, 807 (2005) (citations omitted). We review these issues as a matter of law. See Davis v. Slater, 383 Md. 599, 604 , 861 A.2d 78, 80-81 (2004) (citations omitted) (stating that interpreting the Maryland Code is a matter of law).

DISCUSSION The single question presented by the Petitioners unfolds in their brief as two distinct issues. First, they read the text of Md.Code (1982, 2009 RepLVol.), § 10-618 of the Health-General Article (“HG”) and Md.Code (1973, 2013 Repl.Vol.), § 5-623 of the Courts and Judicial Proceedings Article (“CJP”) narrowly. They would have us interpret the statutory scheme to limit immunity to those individuals who apply for the involuntary admission of another and exclude those who perform the involuntary admission evaluation. Second, Plaintiffs contend that the immunity provided by HG § 10-618 and CJP § 5-623 applies only if the patient is admitted to the ⁵⁷⁹ hospital, not in instances in which the individual is evaluated and released.

The Health Care Providers read this legislation more expansively. They contend that both the plain language and underlying purpose of HG § 10-618 and CJP § 5-623 dictate that statutory immunity extends to health care providers who perform an evaluation and decide not to involuntarily admit an individual. Counseling against our adoption of the Family’s view, they warn that such a narrow reading of statutory immunity would create a perverse incentive for health care providers to involuntarily admit individuals to avoid potential liability. Here, we are asked to address the statutory immunity conferred in HG § 10-618, which cross-references CJP § 5-623.

Section 10-618 provides: (a) A person who applies for involuntary admission of an individual shall have the immunity from liability described under § 5—623(b) of the Courts and Judicial Proceedings Article. (b) A facility or Veterans’ Administration hospital that acts in compliance with the provisions of Part III of this subtitle shall have the immunity from liability described under § 5-623(c) of the Courts and Judicial Proceedings Article. (c) An agent or employee of a facility or Veterans’ Administration hospital who acts in compliance with the provisions of Part III of this subtitle shall have the immunity from liability described under § 5-623(d) of the Courts and Judicial Proceedings Article. The subsections in HG § 10-618 correspond to relevant subsections in CJP § 5-623, which states in part 4 : ⁵⁸⁰ (b) A person who in good faith and with reasonable grounds applies for involuntary admission of an individual is not civilly or criminally liable for making the application under Title 10, Subtitle 6, Part III of the Health-General Article.

(c) A facility or veterans’ administration hospital that, in good faith and with reasonable grounds, acts in compliance with the provisions of Title 10, Subtitle 6, Part III of the Health-General Article is not civilly or criminally liable for that action. (d) An agent or employee of a facility or veterans’ administration hospital who, in good faith and with reasonable grounds, acts in compliance with the provisions of Title 10, Subtitle 6, Part III of the Health-General Article is not civilly or criminally liable for that action. “The cardinal rule of statutory interpretation is to ascertain and effectuate the intent of the Legislature.” Kushell v. Dep’t of Natural Res., 385 Md. 563, 576 , 870 A.2d 186, 193 (2005). Therefore, we must determine whether the General Assembly intended to provide the Health Care Providers immunity from liability. In ascertaining legislative intent, we return to our oft-repeated canons of statutory construction: [W]e begin with the normal, plain meaning of the language of the statute.

If the language of the statute is unambiguous and clearly consistent with the statute’s apparent purpose, our inquiry as to legislative intent ends ordinarily and we apply the statute as written, without resort to other rules of construction.... We, however, do not read statutory language in a vacuum, nor do we confine strictly our interpretation of a statute’s plain language to the isolated section alone. Rather, the plain language must be viewed ⁵⁸¹ within the context of the statutory scheme to which it belongs, considering the purpose, aim, or policy of the Legislature in enacting the statute. Lockskin v. Semsker, 412 Md. 257, 275-76 , 987 A.2d 18, 28-29 (2010) (internal citations omitted).

Also, “[i]n analyzing a statute, we must always be cognizant of the fundamental principle that statutory construction is approached from a ‘commonsensical’ perspective. Thus, we seek to avoid constructions that are illogical, unreasonable, or inconsistent with common sense.” Frost v. State, 336 Md. 125, 137 , 647 A.2d 106, 112 (1994) (citation omitted). Whether HG § 10-618 And CJP § 5-623 Apply To The Health Care Providers Generally To resolve the Family’s contention that HG 10-618 does not apply to those—like the Health Care Providers—who perform an involuntary admission evaluation, we look to the words of the statute. The Family members rely upon the language in § 10-618(a) that “[a] person who applies for involuntary admission of an individual shall have the immunity from liability,” arguing that because the Health Care Providers did not apply for Williams’s involuntary admission, they are not covered by the statutory immunity scheme.

Quite simply, this argument fails because Petitioners stop short in their reading of § 10-618. They read subpart (a) and ignore the rest of the section. Section 10-618 provides immunity to the three groups who participate in the involuntary admission process. Although the Health Care Providers would not qualify for immunity under subsection (a), the General Assembly clearly included them when drafting subsections (b) and (c).

PRMC qualifies as a “facility” under § 10-618(b), as it is a “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(e)(l). Stroop and Murphy qualify as agents or employees of a facility, pursuant to § 10-618(c). In light of this statutory scheme, Plaintiffs’ narrow reading is incomplete and incorrect. ⁵⁸² The plain, unambiguous language of HG § 10-618 and CJP § 5-623 extends immunity to health care institutions and their agents who evaluate an individual as part of the involuntary admission process. Whether HG § 10-618 And CJP § 5-623 Apply When Evaluation Does Not Lead To Involuntary Admission We next consider whether the General Assembly intended to provide immunity to the Health Care Providers when they evaluate patients but decide not to involuntarily admit them.

In support of their narrow reading of HG § 10-618, Plaintiffs point to the titling of Part III of Subtitle 6, captioned “Involuntary Admissions,” and to CJP § 5-623 because of its caption: “Admissions to mental health facilities.” Thus, Plaintiffs urge us to interpret these statutes as only applying when an individual is admitted. Here, Williams was evaluated but discharged. Again we turn to the text of HG § 10-618 and CJP § 5-623, which shield institutions and their agents who “act[ ] in compliance with the provisions of’ Subtitle 6, Part III of the Health-General Article. 5 In addition to exempting certain actors from liability, Part III also includes provisions regarding involuntary admission applications (§ 10-615), admission certificates (§ 10-616), and limitations on admission (§ 10-617). Specifically, § 10-617 states in part: (a) A facility or Veterans’ Administration hospital may not admit the individual under Part III of this subtitle unless: (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 ⁵⁸³ (5) There is no available, less restrictive form of intervention that is consistent with the welfare and safety of the individual.

That the General Assembly referred to all of Part III, including these