ZARNOCH, J.
In this case, members of the family of Charles Williams, Jr. (Gineene Williams, Patricia Gaines, Michelle Crippen, and Charles Williams, Sr.) (collectively, "the family members") appeal a judgment from the Circuit Court for Wicomico County in favor of appellees, Dr. Michael P. Murphy, nursing assistant George Stroop, and Peninsula Regional Medical Center ("PRMC") (collectively, "the health care providers"). Williams was killed by police officers after breaking into a home, obtaining a knife, entering the front yard, and eventually charging at police. The health care providers' role in this story occurred earlier in the day, when Williams' mother brought him to PRMC because of a concern over his mental state. The health care providers evaluated Williams, he said he did not want to be admitted to the medical center, and the health care providers decided not to involuntarily admit him.
The family members brought a wrongful death/survival action in the Circuit Court for Wicomico County.
Although the parties disagree sharply on the legal issues in this case, there is no dispute about the facts. On April 20, 2009, Williams' mother brought him to PRMC because she was concerned about his mental state. She was troubled by Williams' suicidal thoughts, his auditory and visual hallucinations, his belief that he was under a curse, his obsessive behavior, headaches, trouble sleeping, and generally unusual behavior.
At PRMC, Williams was examined and evaluated by, at least, Dr. Murphy and Stroop.
After evaluating Williams, the health care providers decided not to involuntarily admit Williams. He was diagnosed with insomnia, fatigue, and bizarre behavior. He was prescribed Ambien and his mother was advised to remove the firearms from the residence, follow up with Lower Shore Clinic the next day, and return to the hospital if the symptoms became worse. Williams was also told to "return here immediately if you feel you are going to harm yourself or anyone else."
After leaving PRMC, Williams left his mother and went to a restaurant with his children and their mother, Michelle Crippen. Williams' mother filled his prescription and took it to the restaurant. Williams left the restaurant with Crippen but, at some point, he asked her to pull the vehicle to the side of the road. He jumped out. Members of the police department saw him in Salisbury later in the day and noted that he was acting strange. At the time, he was not engaging in any activity that would have caused the police to detain him. But shortly before midnight he broke into a house. The resident saw him and called 9-1-1. When the police arrived, Williams was in the front yard wielding a knife. He said to the officers: "shoot me, fucking shoot me, somebody's going to die tonight." He held the knife to his throat and said: "I want you to shoot me, I want to die." The officers told Williams to drop the knife and surrender himself. He refused and charged at the officers. The officers shot Williams, but he persisted in his attack. The officers shot Williams 15 times and he died from the gunshot wounds.
Williams' family members initially brought a claim in the Health Care Alternative Dispute Resolution Office. They filed a statement of claim, a certificate of merit of a qualified expert, and two medical reports from two separate physicians. When this did not resolve the claim, the family members filed a complaint in the circuit court against the health care providers alleging negligence. PRMC and Stroop filed a motion to dismiss, which Dr. Murphy joined. The health care providers contended that H-G § 10-618 in conjunction with Md.Code (1974, 2006 Repl. Vol.), Courts and Judicial Proceedings Article ("CJP"), § 5-623(c)-(d) gave them immunity, and in the alternative, Williams' death was so remote in time and place so as not to be reasonably foreseeable as a matter of law. The circuit court granted the motion to dismiss, finding that the immunity statute applied to the health care providers' actions and that the family members had not alleged any facts to overcome the immunity. The family members timely appealed.
The rationale behind the court's decision and the contents of the family members' complaint will be discussed below as they relate to each question presented.
The family members present two questions for review, which we have reworded to properly capture the issues:
For reasons more fully explained below, we answer these questions in the health care providers' favor and uphold the decision below.
This Court reviews the grant of a motion to dismiss for failure to state a claim for which relief can be granted under a de novo standard. Clark v. Prince George's Cnty., 211 Md.App. 548, 557, 65 A.3d 785 (2013). "In reviewing the grant of a motion to dismiss, we must determine whether the complaint, on its face, discloses a legally sufficient cause of action. An appellate court should presume the truth of all well-pleaded facts in the complaint, along with any reasonable inferences derived therefrom." Id. (Citations and internal quotation marks omitted). Dismissal of the action is only warranted "if the allegations and permissible inferences, if true, would not afford relief to the plaintiff." Gomez v. Jackson, 198 Md.App. 87, 93, 16 A.3d 261 (2011) (Citations omitted).
This appeal also requires us to construe a Maryland statute. We interpret Maryland statutes without giving any deference to the circuit court's interpretation. See Davis v. Slater, 383 Md. 599, 604, 861 A.2d 78 (2004).
At the outset, we are called upon to determine whether H-G § 10-618 controls the outcome of this case. The parties disagree on whether the statute applies to the health care providers' actions in deciding not to involuntarily admit Williams to PRMC. Thus, we embark on a journey of statutory construction. We have noted that many issues of statutory construction are resolvable on the basis of judicial consideration of three general factors: (1) text; (2) purpose; and (3) consequences. Town of Oxford v. Koste, 204 Md.App. 578, 585, 42 A.3d 637 (2012), aff'd, 431 Md. 14, 63 A.3d 582 (2013); Goss v. Estate of Jennings, 207 Md.App. 151, 169, 51 A.3d 761 (2012). In Goss, we said:
Id. at 169-70, 51 A.3d 761 (Citations and internal quotation marks omitted). This is a case where the text of the relevant provision is the predominant factor.
H-G §§ 10-101 et seq. is the State's Mental Hygiene Law. Subtitle 6 of Title 10 is divided into five "parts."
CJP § 5-623(b)-(d) further describes this immunity:
All parties in this case assert that the language of § 10-618 is unambiguous in favor of their respective interpretations. The family members argue that the statute provides immunity for liability for individuals who take certain steps only when those steps lead to the involuntary admission of a person. They contend that the statute only applies to involuntary admission because Part III is labeled "involuntary admission" and the words also appear in CJP § 5-623(a) and H-G § 10-618(a). Williams was never admitted, so his family members contend that the involuntary admission statute does not apply to his situation.
The circuit court's interpretation of this statute is sound. The title "involuntary admission" can include an evaluation for such admission. The statute provides that a facility or a veterans' administration hospital and their agents and employees are not civilly or criminally liable for any action taken in good faith and with reasonable grounds in compliance with the provisions of Title 10, Subtitle 6, Part III of the Health-General Article. See CJP § 5-623. The limitations on involuntary admission, H-G § 10-617, is one provision under Part III. Thus, as the court explained, admitting someone who meets the described criteria in H-G § 10-617 would be acting in compliance with Part III. In turn, deciding not to admit someone who did not meet the criteria would also be acting in compliance with Part III.
Additionally, the very same exception from liability appears in Part IV of Title 10, captioned, "Emergency Evaluations." This immunity provision, H-G § 10-629, was added to the law at the same time as H-G § 10-618. Chapter 459, Laws of 1982. The short title of the legislation reads: "Involuntary Admissions and Emergency Evaluations — Liability." In light of this fact and that "evaluation" provisions are included in Part III's "compliance" requirements, it seems extremely
The family members' emphasis on the label/caption of Part III fails for two reasons. First, this heading is not part of the law. See n.5, supra. Second, captions do not control the plain meaning of the text. See State v. Holton, 193 Md.App. 322, 365, 997 A.2d 828 (2010), aff'd, 420 Md. 530, 24 A.3d 678 (2011). Their contention that H-G § 10-618 itself limits the immunity to admitting misreads the provision. The "involuntary admission" language in § 10-618 applies only to applicants not institutions or providers covered by § 10-618(b)-(c). The latter immunity more broadly applies to all acts encompassed within Part III.
Reading the statute as a whole and viewing the immunity statute within the context of the statutory scheme to which it belongs, the medical professionals would be covered under the immunity provision if they acted in good faith and with reasonable grounds when they made the decision to admit or not to admit. Thus, we conclude that the statute's language is unambiguous and provides immunity to any health care provider who conducts an evaluation for involuntary admission, acting in good faith and with reasonable grounds, whether or not that evaluation leads to an admittance or some less restrictive care.
Even if we assumed that the immunity statute's language was ambiguous and we turned our attention to the purpose of the statute and consequences of the family members' interpretation, our conclusion would be the same. The legislative history of the 1982 enactment is not conclusive on whether the General Assembly envisioned the statute to apply to anyone who engaged in the process of evaluating an individual for involuntary admission or only someone who decided to involuntarily admit an individual.
Statutory provisions regulating involuntary admission to mental facilities are put in place to protect citizens from unnecessary commitment. "[C]ivil commitment for any purpose constitutes a significant deprivation of liberty that requires due process protection." Anderson v. Dep't of Health and Mental Hygiene, 310 Md. 217, 228, 528 A.2d 904 (1987) (Citation and internal
In the same year that these stringent involuntary admission procedures were passed, the General Assembly considered several bills aimed at protecting the rights of mentally ill individuals. See Senate Bill 676 (1982); House Bill 1429 (1982). In testifying for these bills, a representative of the Mental Health Association of Maryland, Inc. said:
Testimony on SB 676 and HB 1429, March 9-10, 1982. Although a bill of rights for mentally ill individuals in facilities was not passed that year, one was passed the following year. See H-G §§ 10-701 et seq.
Understanding the deep concern for patient rights and stringent requirements for involuntary admittance, it would lead to an absurd result if we were to interpret the immunity provision to only apply when someone is actually admitted. In one breath the statute would discourage admitting individuals before a careful evaluation, but in the next breath provide immunity only when the decision is to admit. Out of fear of liability, mental health professionals might err on the side of admittance, instead of properly exercising their discretion and following the stringent requirements before taking away someone's liberty.
Two Fourth Circuit Decisions, focusing on Maryland's involuntary commitment scheme, support this conclusion. In S.P. v. City of Takoma Park, 134 F.3d 260, 268-69 (4th Cir.1998), the United States Court of Appeals rejected the contention that a private physician and a private hospital were state actors for purposes of civil rights liability because they were compelled to involuntarily detain and admit an individual. The appellate court said:
Id. at 270. The Court concluded "that the legislature's intent was to protect the individual and potentially the general public,
In Farwell v. Un, 902 F.2d 282 (4th Cir.1990), the Fourth Circuit echoed these thoughts in describing the purpose of both Maryland's and Delaware's involuntary commitment statutes and their relationship to duty of care in a negligent failure to admit case:
Id. at 289.
Other states have reached conclusions similar to ours regarding the purpose of immunity provisions relating to involuntary admissions. In Taylor v. Herst, 537 A.2d 1163, 1166 (Me.1988), a Maine court reasoned: "Without protection from civil liability, physicians would be discouraged from examining persons for involuntary commitment, thereby making the process unworkable.... [I]f release decisions were exposed to the threat of liability those individuals charged with rendering those decisions would likely become unduly responsive to one consideration — the cost of liability." (Citation and internal quotation marks omitted). In Ziemba v. Riverview Med. Ctr., 275 N.J.Super. 293, 645 A.2d 1276, 1280 (Ct.App.Div.1994), a New Jersey court commented:
In our view, the purpose of the immunity statute at issue in this case is to protect the discretionary nature of the evaluation so that the medical professionals can be guided by their medical judgment and not the fear of liability. To do so, the statute must protect those who decide to involuntarily commit a patient as well as those who decide not to involuntarily commit a patient. As the circuit court pointed out in this case, "[i]t makes no sense for the legislature to grant immunity when someone is involuntarily committed but to deny it when he is not. The clear legislative intent is to allow health care providers to exercise sound medical judgment in making such decisions without being unduly influenced by the threat of litigation." We believe this adequately captures the purpose of the immunity statute. The statute protects health care providers from any and all claims related to their decision to admit or not to admit.
For these reasons, we conclude the court correctly interpreted the immunity statute to apply to the health care providers' decision not to admit Williams' involuntarily.
The family members argue that even if the immunity statute applies, the standard of acting in "good faith" and "with reasonable grounds" is functionally equivalent to the standard for negligence. Thus, they argue, because negligence is an issue for the trier of fact, so too is whether the health care providers acted with reasonable grounds. The family members contend that they submitted the opinions of two medical experts who opined that the health care providers violated the standard of care. They argue that the health care providers could not have acted with reasonable grounds if they violated the standard of care. Thus, they contend that their complaint sufficiently stated a claim against the health care providers.
In addressing this argument, the circuit court stated that the family members were improperly "equating `good faith/reasonable grounds' with ordinary negligence." The court determined that this could not have been the intent of the legislature in enacting the immunity statute because it would "vitiate the concept of `immunity' by adding another step in the litigation process." This is because, the court explained, if good faith/reasonable grounds was always a jury issue, then health care providers would need to "mount a full fledged defense involving costly expert witnesses just to adjudicate" that issue.
We agree with the circuit court. Under the family members' interpretation of the immunity statute, medical professionals would not be held liable unless they acted negligently. This interpretation would render the statute unnecessary and truly useless, because even without the statute, medical professionals cannot be liable absent negligence.
In 1982 — the same year that the involuntary admittance immunity statute was passed — Governor Harry Hughes vetoed a bill seemingly providing immunity if there was no negligence. See 1982 Md. Laws 5015 (vetoes). The bill read, in part, "[a]n operator of an emergency vehicle, who is authorized to operate the emergency vehicle by its owner or lessee, is not liable in his individual capacity, when exercising reasonable care, for any damages resulting from a tortious act or omission within the scope of performing emergency service." Id. at 5016. In explaining the reason for vetoing the bill, the governor wrote "[t]he bill as originally drafted and as amended has given rise to certain severe interpretive problems which the Attorney General believes will unnecessarily perplex both courts and litigants." Id. at 5017. In his letter to the governor, Attorney General Stephen Sachs wrote that the bill "seems to say that an operator is not liable in tort if he exercises reasonable care. But, under such circumstances, he would not be liable in tort in any event, be it for negligence or gross negligence." Id. at 5019.
The same rationale applies to the immunity statute. The statute must provide medical professionals with more protection from liability than they had before the statute. Although the amount of protection may be open to debate, it must be at least a protection from mere negligence.
The family members fell well short of the minimum required to overcome the immunity statute. Their complaint did not allege anything other than negligence. Count I states, in relevant part:
Count II states, in relevant part: "36. That as a result of the negligence and breach of the standard of care articulated above by the Defendants, jointly and severally, the Plaintiffs ... have suffered loss...."
The complaint does not even allege, let alone provide facts to support the failure of the health care providers to act in good faith and with reasonable grounds. The family members never discuss a failure in the statutory process of evaluation. Instead, their primary concern is that the
Williams' family members argue that the purpose described in the title of the bill that enacted H-G § 10-618 specifically limits the health care providers immunity to situations where an individual is involuntarily admitted. The purpose clause of the title reads: "For the purpose of protecting certain individuals and institutions from civil or criminal liability under certain conditions relating to involuntary admissions, emergency evaluations, and emergency involuntary admissions, and making structural changes." Md. House Bill 1709, 1982 Md. Laws 3021. This Court does not read a limitation from the purpose clause. In fact, "certain conditions relating to involuntary admissions" very likely includes any evaluation for involuntary admission even when admission is not recommended.
