WATTS, J.
This case concerns whether the Court of Special Appeals erred in dismissing on its own initiative an appeal by the Department of Health and Mental Hygiene ("DHMH"), Respondent, and whether the Circuit Court for Anne Arundel County, sitting as a juvenile court ("the juvenile court"), had the authority to order DHMH to continue to provide services after age twenty-one to Dustin R. ("Dustin"), Petitioner, a medically fragile child who needed life-sustaining care.
We hold that: (I) the Court of Special Appeals erred in dismissing DHMH's appeal because the juvenile court's order was immediately appealable at a minimum as an interlocutory order granting injunctive relief; (II) the juvenile court had jurisdiction and the statutory authority to order DHMH to develop and approve a written plan of clinically appropriate services in the least restrictive setting that ensured that Dustin would continue to receive services, where Dustin was not yet twenty-one years old when the juvenile court issued its order and where such services were required to protect Dustin's health and welfare, and where the juvenile court's order served to bridge the gap in services as Dustin transitioned from his juvenile guardianship case to adult guardianship care and the final outcome (meaning judicial review, including the appellate process) may be of any Medicaid fair hearing proceedings; and (III) the juvenile court did not violate the separation of powers.
On December 16, 1992, Dustin was born. In February 1995, when he was two years old, Dustin entered foster care. In that year, the juvenile court terminated Dustin's biological parents' parental rights and granted guardianship to the Anne Arundel County Department of Social Services ("DSS") with the right to consent to adoption or long-term care short of adoption. On March 28, 1995, DSS placed Dustin in a treatment foster care home with Jacqueline and Darrell P. ("Mrs. P." and "Mr. P.," respectively).
There is no dispute that Dustin is medically fragile and has special needs. Dustin has, among other conditions, an intellectual disability, severe seizure disorder, cortical visual impairment, gastro-esophageal reflux, scoliosis, osteoporosis, ischemic encephalopathy, global orthopedic impairments, cerebral palsy, and an Unidentified Long Chain Fatty Acid Syndrome with a Mitochondrial
As Dustin grew older, his condition worsened. On February 18, 2005, when Dustin was twelve years old, after an emergency hearing, the juvenile court ordered DSS to secure round-the-clock (twenty-four hours per day, seven days per week) nursing services for Dustin.
As early as 2010, Dustin began to seek the provision of services for himself after age twenty-one. In March 2010, at age seventeen, Dustin filed a petition for co-commitment to DHMH and DSS. The juvenile court denied the petition without prejudice. In June 2011, Dustin filed an amended petition for co-commitment to DHMH and DSS, requesting that the juvenile court require DHMH and DSS to "present a written plan to provide for the care of Dustin [] in the [] home [of Mr. and Mrs. P.], including 24 hour skilled nursing care, upon turning" twenty-one years old. Dustin described his medical condition at that time in the amended petition as follows:
(Record references omitted). Eventually, in April 2013, DHMH consented to co-commitment, and the juvenile court ordered DHMH to "continue the planning process for the transition of [Dustin] from foster care under the guardianship of [DSS] to the guardianship of his current foster parents or other appropriate persons[.]" Significantly, between March 2010 — when Dustin first filed a petition for co-commitment to DHMH and DSS — and August 2013, on multiple occasions, Dustin requested that the juvenile court order DHMH to fund and provide to him after his twenty-first birthday the same services that he was then receiving. DHMH consistently opposed those requests on the grounds that such requests exceeded the juvenile court's authority.
In Fall 2012, DHMH and DSS began planning for Dustin's transition out of his juvenile guardianship and foster care. On December 6, 2012, representatives of DHMH participated in a quarterly Treatment Team Meeting that DSS organized. A DDA representative, who was at the meeting to help plan for Dustin's transition from foster care, stated that DDA was committed to working with Medicaid's Rare and Expensive Case Management Program ("REM") "to determine the recommended level of services." The DDA representative agreed to follow up with a DDA nurse to complete an assessment of Dustin in coordination with REM before the next scheduled Treatment Team Meeting. On February 7, 2013, a DDA nurse assessed Dustin and observed that Dustin "has an extensive medical history with treatment needs that are not deleg[]able
On March 7, 2013, DSS conducted a Treatment Team Meeting, which representatives of DHMH, Dustin's resource coordinator, Mrs. P, and Dustin's counsel attended. The notes from the meeting state that the group was "in the process of planning for Dustin's transition to DDA when he turns [twenty-one years old] in December." The notes from the meeting state that a request for service change had already been submitted to DDA, and that DDA was to respond by March 29, 2013. During the meeting, Mrs. P. expressed her concern "for Dustin to continue with the current quality of nursing services[,]" which she believed to be "essential ... for Dustin to remain in the [P. family] home after he turns" twenty-one years old. The notes from the meeting indicate that "[t]here continue[d] to be disagreement about the rate of nursing care[,]" and reported DDA's intent to distribute a plan for Dustin for care in the P. family home "[i]n the next 3 to 4 months," and the need for an "alternative plan" if Mrs. P. was not comfortable with the plan for nursing care in the P. family home.
In a letter dated June 5, 2013 — after DHMH consented to co-commitment — DDA proposed a transition plan for Dustin. DDA stated that Dustin would remain eligible to participate in REM; that Medicaid would pay for Dustin's medical care; and that Dustin would be eligible for a DDA waiver,
Mr. and Mrs. P. decided to seek guardianship of Dustin so that he could remain in their home; on July 26, 2013, Mr. and Mrs. P. submitted through Dustin's resource coordinator a proposed service funding plan, in which they, in coordination with MedSource, proposed to "[c]ontinu[e] Dustin's budget `as is[.]'" The budget for Dustin's care would continue to cover items such as training and orientation for Dustin's nursing team, case management, payment of non-covered medical supplies and prescriptions, partial payment of utilities within the home of Mr. and Mrs. P., and equipment maintenance. In a letter dated August 14, 2013, DHMH responded to the proposed service funding plan, stating that certain services provided to Dustin were "covered waiver services[,]" including Dustin's nursing, medical equipment and supplies, medications, and other medical care, but that other services requested in the proposed service
On August 26 and 27, 2013, and September 27, 2013, the juvenile court conducted an annual guardianship review hearing. At the hearing, counsel for DHMH and DSS readily acknowledged that the dispute was over funding for Dustin's services, which Mr. P. and Mrs. P. wanted to continue after Dustin's twenty-first birthday. The juvenile court heard testimony from witnesses on Dustin's behalf, including: Dr. Richard Kelley, a pediatrician specializing in metabolic diseases, accepted as an expert in biochemical genetics and the complex nature of metabolic disease and its impact on bodily systems of children and adults, who had been caring for Dustin for approximately fifteen years; Stefania Bockmiller, a registered nurse, who had been caring for Dustin for nearly ten years, accepted as an expert in registered nursing care of medically complex and fragile patients in hospital and community settings; Mona Yudkoff, a registered nurse, accepted as an expert in registered nursing with a focus on rehabilitation and life care planning; Jay Balint, the executive director, president, and chief executive officer of MedSource; Sherry Davis, Dustin's resource coordinator; Mrs. P.; Laura Kress, the assistant director of nursing for nursing practice at Johns Hopkins Hospital; and A'lise Williams, director of DHMH's Board of Nursing, whose deposition testimony was admitted into evidence.
The juvenile court also heard testimony from witnesses on DHMH's behalf and DSS's behalf, including: Rosslyn Hill, Dustin's DSS social worker; Vanessa Bullock, the deputy director of the central Maryland regional office of DDA; and Marie Adams, a DDA registered nurse.
At the hearing, counsel for DHMH argued that the juvenile court lacked the statutory authority to order the relief that Dustin requested — namely, that services continue after his twenty-first birthday. Counsel for DSS argued that ordering the relief would violate the separation of powers. By contrast, Dustin's counsel contended that the juvenile court had the statutory authority to order a plan of clinically appropriate services in the least restrictive setting.
At the conclusion of the hearing, the juvenile court orally ruled that DHMH's plan was clinically inadequate, stating:
The juvenile court identified two issues, namely, "what services are necessary[] to obtain the ongoing care needed after the guardianship terminates ... at age" twenty-one, and whether DHMH's plan offered "clinically appropriate services in the least restrictive setting." The juvenile court stated that the following factual findings had been found to be proven "no matter what standard of proof" applied:
After making the factual findings above, the juvenile court addressed a two-page document that Dustin submitted entitled "Proposed Findings and Order," and the following exchange occurred:
After the guardianship review hearing, the clerk of the juvenile court made the following docket entries:
Num/Seq Description Filed Jdg 00168000 Hearing Sheet 09/27/13 PFH 00169000 No Pro Se Party at time of Proceeding 09/30/13 TBA 00170000 Reasonable Efforts Made by DSS 09/30/13 TBA 00171000 Another Planned Permanent Living Arrangement 09/30/13 TBA 00172000 Proposed Finding and order 09/30/13 PFH
On October 24, 2013, DHMH noted an appeal to the Court of Special Appeals.
On December 2, 2013, the juvenile court conducted another guardianship review hearing.PROPOSED ORDER"; the order, as amended and signed by the juvenile court judge, provided, in pertinent part:
After the December guardianship review hearing, the clerk of the juvenile court made the following docket entries:
Num/Seq Description Filed Jdg
00180000 Hearing Sheet 12/02/13 PTC 00181000 No Pro Se Party at time of Proceeding 12/02/13 TBA 00182000 Order of Court 12/03/13 PTC
On December 11, 2013, DHMH entered into a contract with MedSource Community Services, Inc. for "MedSource to implement the [September 27, 2013] Order and the Plan, pending the outcome of [DHMH]'s appeal of the Order[.]"
On appeal, although neither DHMH nor Dustin raised any issue as to the appealability of the juvenile court's September 27, 2013 order, in an unreported opinion dated December 22, 2014, a three-judge panel of the Court of Special Appeals dismissed DHMH's appeal on its own initiative, a majority holding that the September 27, 2013 order was not a final, appealable order; accordingly, the Court of Special Appeals did not reach the merits. Specifically, the Court of Special Appeals determined that, although "[t]he hearing transcript le[ft] no doubt that the [juvenile] court subjectively intended to render an unqualified, final disposition of the claim[,]" "the document executed by the [juvenile court] did not adjudicate the claim, and, objectively speaking, it was not a final order"; and, "although the clerk made a record of the document that the [juvenile court] signed, the docket entry did nothing to indicate that anything had actually been determined." Notably, the Honorable Andrea M. Leahy dissented, stating that the juvenile court signed the proposed order, consistent with its oral rulings on the record, and that the juvenile court and the parties intended the signed proposed order to be a final, appealable order.
On January 21, 2015, Dustin filed in this Court a petition for a writ of certiorari, raising the following three issues:
On February 5, 2015, DHMH filed an answer and cross-petition for a writ of certiorari, raising the following three issues:
On April 17, 2015, this Court granted the petition and denied the cross-petition. See In re: Adoption/Guardianship of Dustin R., 442 Md. 515, 113 A.3d 624 (2015).
"An appellate court reviews without deference a [lower] court's interpretation of a statute[.]" Howard v. State, 440 Md. 427,
Both Dustin and DHMH contend that the juvenile court's order is appealable as an interlocutory order granting an injunction, and that the Court of Special Appeals erred in dismissing DHMH's appeal on its own initiative. We agree. The September 27, 2013 order was immediately appealable at a minimum as an interlocutory order granting injunctive relief.
Md.Code Ann., Cts. & Jud. Proc. (1973, 2013 Repl.Vol.) ("CJP") § 12-303(3)(i) provides that an order granting an injunction is an appealable interlocutory order, stating:
(Paragraph breaks omitted). Maryland Rule 15-501(a) defines an "injunction" as "an order mandating or prohibiting a specified act." In State Comm'n on Human Relations v. Talbot Cnty. Det. Ctr., 370 Md. 115, 139, 803 A.2d 527, 541 (2002), we explained: "An injunction is a writ framed according to the circumstances of the case commanding an act which the court regards as essential to justice, or restraining an act which it esteems contrary to equity and good conscience." (Citation and internal quotation marks omitted). "Injunctive relief is relief prohibiting someone from doing some specified act or commanding someone to undo some wrong or injury ... generally, it is a preventive and protective remedy, aimed at future acts, and it is not intended to redress past wrongs." Colandrea v. Wilde Lake Cmty. Ass'n, Inc., 361 Md. 371, 394-95, 761 A.2d 899, 911 (2000) (ellipsis in original) (citation, internal quotation marks, and emphasis omitted).
Although the Maryland Rules do not define "order," in Prince George's Cnty. v. Vieira, 340 Md. 651, 661, 667 A.2d 898, 903 (1995), we described an "order" as follows: "[A]n `order' emanates from a court and, in fact, constitutes a command or decree of the court." For purposes of contempt of a court order, the Court of Special Appeals has stated that "the order must be sufficiently definite, certain, and specific in its terms so that the party may understand precisely what conduct the order requires." Droney v. Droney, 102 Md.App. 672, 684, 651 A.2d 415, 421 (1995) (citations omitted). If the order is sufficiently definite, then parties must comply with the dictates of the order, and a party may be held in contempt for "willful" noncompliance. Royal Inv. Grp., LLC v. Wang, 183 Md.App. 406, 448, 961 A.2d 665, 689 (2008), cert. dismissed, 409 Md. 413, 975 A.2d 875 (2009).
Here, it is plainly evident that the juvenile court's September 27, 2013 order was an "order" as that term is understood, and that it was an order that at a minimum granted injunctive relief to Dustin. The record demonstrates that the juvenile court ordered DHMH to develop, approve, and implement a plan to provide ongoing services to Dustin. As such, the order granted injunctive relief because it was "a writ framed according to the circumstances of the case commanding an act which the court regard[ed] as essential to justice[.]" State Comm'n on Human Relations, 370 Md. at 139, 803 A.2d at 541. It is obvious that the order was, indeed, an order. The juvenile court orally ruled and signed the "Proposed Findings and Order" submitted by Dustin; in its oral ruling, the
The record demonstrates that the juvenile court at a minimum granted mandatory injunctive relief to Dustin, as confirmed by: (1) the positions taken by the parties in the Court of Special Appeals and this Court, i.e., the lack of any contest whatsoever as to the appealability of the order; and (2) more importantly, the juvenile court's subsequent order of December 2, 2013, requiring DHMH's compliance with the September 27, 2013 order by the close of business on December 9, 2013. Both parties had actual notice of the entry of the September 27, 2013 order and its terms, as both were present at the hearing. See Md. R. 15-502(d) ("An injunction is not binding on a person until that person has been personally served with it or has received actual notice of it by any means."). That the docket entry simply noted entry of the order under the title of the order — "Proposed Finding[s] and Order" — is of no consequence; it is clear that the courtroom clerk simply entered the title of the document as the docket entry.
In sum, we hold that the Court of Special Appeals erred in dismissing the appeal because the juvenile court's order was appealable at a minimum as an interlocutory order granting injunctive relief. See CJP § 12-303(3)(i). It is clear that, here, the juvenile court signed an order setting forth the relief requested by Dustin, and both parties understood the order to be the juvenile court's command or decree. Having held that the appeal was erroneously dismissed, we address the merits of the issues presented to this Court.
Dustin contends that the juvenile court was authorized to order DHMH to enter into a plan to obtain "life-sustaining services" for him to continue after he reached age twenty-one. Dustin argues that Md.Code Ann., Fam. Law (1984, 2012
DHMH responds that the juvenile court lacked the authority to order it to develop, approve, and implement a plan to provide services to Dustin after his twenty-first birthday because, under FL § 5-328(a)(2), the juvenile court had limited statutory jurisdiction extending only until Dustin attained the age of twenty-one, and, under FL § 5-324(b)(1)(ii), the juvenile court lacked the authority to order services after the conclusion of its jurisdiction. DHMH argues that the plain language and legislative history of the statutes confirm that the juvenile court lacked the authority to order it to provide services or funding after Dustin's twenty-first birthday.
For the following reasons, we agree with Dustin.
The statutes' plain language leads to the conclusion that the juvenile court had the authority to order DHMH to provide services for Dustin to continue after he reached age twenty-one. "As a court of limited jurisdiction, the juvenile court may exercise only those powers granted to it by statute." In re Ryan W., 434 Md. 577, 602, 76 A.3d 1049, 1064 (2013) (citations omitted); see also Smith v. State, 399 Md. 565, 574, 924 A.2d 1175, 1180 (2007) ("We have held that juvenile courts, as statutorily created courts of limited jurisdiction, may exercise only those powers expressly designated by statute."). Pursuant to FL § 5-328(a), if a local department is a child's guardian, as is the circumstance here, the juvenile court:
In other words, the juvenile court's jurisdiction extends only "until the child attains 21 years of age." FL § 5-328(a)(2).
FL § 5-324(b)(1), concerning the grant of guardianship and accompanying order, provides, in pertinent part:
We unequivocally hold that the juvenile court had jurisdiction and the statutory authority to order DHMH to develop and approve a plan that ensured that Dustin would continue to receive services, where Dustin was not yet twenty-one years old when the juvenile court issued its order and where such services were required to protect Dustin's health and welfare; in other words, the juvenile court had jurisdiction and statutory authority to issue the September 27, 2013 order to DHMH to provide services for Dustin after age twenty-one. By its plain language, FL § 5-328(a) provides that, in cases where the local department is a child's guardian, the juvenile court "retains jurisdiction[] until the child attains 18 years of age[,]" but that it "may continue jurisdiction until the child attains 21 years of age." (Paragraph break omitted). In other words, although the juvenile court's jurisdiction ordinarily ends once a child turns eighteen years old, the juvenile court's jurisdiction "may" extend until the child turns twenty-one years old. FL § 5-328(a)(2). Indeed, when read in its logical order, FL § 5-328(a)(2) states, in its entirety: "If a local department is a child's guardian under this subtitle, a juvenile court: [] may continue jurisdiction until the child attains 21 years of age." (Paragraph break omitted). By contrast, FL § 5-328(a)(1)(i) states, in its entirety: "If a local department is a child's guardian under this subtitle, a juvenile court: [] retains jurisdiction until[] the child attains 18 years of age[.]" (Paragraph breaks omitted).
FL § 5-328(a)(2)'s use of the word "may" is significant because it indicates a legislative intent to provide the juvenile court with the discretion to extend its jurisdiction over a guardianship matter past the ordinary cut-off date of a child's eighteenth birthday. See, e.g., Anne Arundel Cnty. Ethics Comm'n v. Dvorak, 189 Md.App. 46, 83, 983 A.2d 557, 579 (2009) ("[T]he word `may,' when used in a statute, usually implies some degree of discretion." (Citation and some internal quotation marks omitted)). In other words, under FL § 5-328(a)(2), if the juvenile court exercises its discretion to extend its jurisdiction in a guardianship proceeding past a child's eighteenth birthday, the juvenile court is not thereafter divested of jurisdiction in that guardianship proceeding until the child turns twenty-one years old. Thus, the juvenile court has the authority to act, even if a child is twenty years and three hundred and sixty-four days old. What this means is that the juvenile court in the instant case had jurisdiction to issue both the September 27, 2013 order and the December 2, 2013 order because Dustin was twenty years old at the time those orders were issued; indeed, Dustin did not turn twenty-one years old until December 16, 2013. FL § 5-328(a)(2)'s plain language leads to the conclusion that the juvenile
Accordingly, we turn to FL § 5-324(b)(1)(ii)(7)(B) and (8) to determine whether the juvenile court had the statutory authority to order DHMH to develop and approve a written plan of clinically appropriate services in the least restrictive setting that ensured that Dustin would continue to receive the services that he was then receiving. FL § 5-324(b)(1)(ii)(7)(B) states:
By its plain language, FL § 5-324(b)(1)(ii)(7)(B) provides that, prior to termination of the guardianship case (i.e., before the juvenile court is divested of jurisdiction), the juvenile court must order a party to provide any service or take any other action to obtain any ongoing care needed to protect the health of a child with disabilities after he or she turns twenty-one years old. In other words, FL § 5-324(b)(1)(ii)(7)(B)'s purpose is to ensure that services are provided for, if needed, i.e., that care is in place before a child turns twenty-one years old, so that there is no gap in care between the end of the juvenile guardianship case and transition into the adult guardianship system.
Indeed, such judicial action is mandated by FL § 5-324(b)(1)(ii)(7)(B), which provides that the juvenile court "shall direct" the provision of such services. See, e.g., Dove v. State, 415 Md. 727, 738, 4 A.3d 976, 982 (2010) ("[T]he word `shall' indicates the intent that a provision is mandatory." (Citations omitted)). Furthermore, FL § 5-324(b)(1)(ii)(7)(B)'s plain language — specifically, "any other service or taking of any other action" — encompasses a multitude and variety of services or actions. "Any" means, in relevant part, "one, some, or all indiscriminately of whatever quantity" and is "used to indicate a maximum or whole[.]" Any, Merriam-Webster (2015), http://www.merriam-webster.com/dictionary/any [http://perma.cc/W9FK-M476]. "Service" means "help, use, benefit" or a "contribution to the welfare of others[,]" and can include "a facility supplying some public demand[.]" Service, Merriam-Webster (2015), http://www.merriam-webster.com/dictionary/service [http://perma.cc/NA66-8PYS]. And, "action" means "[t]he process of doing something; conduct or behavior" or "[a] thing done[.]" Black's Law Dictionary (10th ed.2014). Thus, FL § 5-324(b)(1)(ii)(7)(B) authorizes — indeed, requires — the juvenile court to order any service or action, without limitation, consistent with the child's bests interests.
In the case of "a child with a disability," FL § 5-324(b)(1)(ii)(7)(B) requires the juvenile court to direct the provisions of "services to obtain ongoing care, if any, needed after the guardianship case ends[.]" "Obtain" means "to gain or get (something) usually by effort" or "to gain or attain usually by planned action or effort[.]" Obtain, Merriam-Webster (2015), http://www.merriam-webster.com/dictionary/obtain [http://perma.cc/UH42-KJLE]. "Ongoing" means "continuing to exist, happen, or progress" or "continuing without reaching an end[.]" Ongoing, Merriam-Webster (2015), http://www.merriam-webster.com/dictionary/ongoing [http://perma.cc/R2QK-J9LU]. And,
In short, FL § 5-324(b)(1)(ii)(7)(B) unambiguously provides that, while a juvenile court has jurisdiction in a guardianship case (i.e., before a child turns twenty-one years old, assuming the juvenile court has exercised its discretion to extend its jurisdiction pursuant to FL § 5-328(a)(2)), the juvenile court is required, consistent with the best interests of a child with a disability, to direct the provision of any service or the taking of any action necessary for the child's health and welfare, including services to obtain ongoing care that may be needed after the guardianship case ends. Here, the juvenile court acted in accordance with the express authority conferred on it by FL § 5-324(b)(1)(ii)(7)(B). In the September 27, 2013 order, the juvenile court directed DHMH to take action to ensure that Dustin continued receiving ongoing services necessary for his health and well-being. As discussed above, because Dustin was twenty years old at the time, the juvenile court had jurisdiction over the guardianship case. And, as Dustin is disabled, FL § 5-324(b)(1)(ii)(7)(B) directed the juvenile court to take action before Dustin turned twenty-one years old to obtain the ongoing care that Dustin would need after the guardianship case ended on his twenty-first birthday.
We perceive no merit in DHMH's contention that FL § 5-324(b)(1)(ii)(7)(B) limits the juvenile court's authority to order the guardian to apply for public benefits or entitlements that would take effect after a child turns twenty-one years old, and that the juvenile court could not order the guardian or another to provide a particular service after the guardianship case ends. As an initial matter, FL § 5-324(b)(1)(ii)(7)(B)'s plain language does not limit the services or actions that the juvenile court can and must order; indeed, FL § 5-324(b)(1)(ii)(7)(B) authorizes the juvenile court to order any and all services needed to obtain ongoing care for a child with a disability, not just services that assist the child in obtaining care once he or she turns twenty-one years old. And, lest there be any confusion, we reiterate that FL § 5-324(b)(1)(ii)(7)(B) authorizes the juvenile court to order services to obtain ongoing care needed after the guardianship case ends; FL § 5-324(b)(1)(ii)(7)(B) does not extend the juvenile court's jurisdiction or otherwise permit the juvenile court, after the guardianship case has ended, to direct the provision of services or the taking of actions. Stated otherwise, FL § 5-324(b)(1)(ii)(7)(B) authorizes the juvenile court, while it has jurisdiction and while the guardianship case is ongoing, to order the provision of services to obtain ongoing care to be provided after the guardianship case ends, but FL § 5-324(b)(1)(ii)(7)(B) does not authorize the juvenile court to order anything once the guardianship case has ended. Had the juvenile court issued its order after Dustin's twenty-first birthday, our analysis in this case would differ. Simply put, though, FL § 5-324(b)(1)(ii)(7)(B) does not run afoul of the jurisdiction granted to the juvenile court by FL § 5-328(a), but instead grants the juvenile court the authority to order services to obtain ongoing care in the case of a child
Moreover, FL § 5-324(b)(1)(ii)(7), unlike other subsubparagraphs in FL § 5-324(b)(1)(ii), does not limit the juvenile court to ordering DSS to take action or provide services, but rather authorizes the juvenile court to direct the provision of any services or the taking of any action as to the child's welfare. For example, FL § 5-324(b)(1)(ii)(2) states that the juvenile court "may direct provision of services by a local department [of social services] to: A. the child; or B. the child's caregiver[.]" (Paragraph breaks omitted). And, FL § 5-324(b)(1)(ii)(3) states that the juvenile court, "subject to a local department [of social services] retaining legal guardianship, may award to a caregiver limited authority to make an emergency or ordinary decision as to the child's care, education, mental or physical health, or welfare[.]" Because FL § 5-324(b)(1)(ii) includes language in subsubparagraphs (2) and (3) limiting the juvenile court's order to DSS, but does not contain such language in subsubparagraph (7), such an omission is presumed to be intentional. See, e.g., Miller v. Miller, 142 Md.App. 239, 251, 788 A.2d 717, 723, aff'd sub nom. Goldberg v. Miller, 371 Md. 591, 810 A.2d 947 (2002) (Using one of the rules of statutory construction, negative implication, in a particular Supreme Court case, "the Court reasoned that, when Congress included particular language in one section of a statute, but omitted it in another section of the same act, it could be presumed that Congress acted intentionally and purposely in the disparate inclusion or exclusion." (Citations omitted)).
FL § 5-324(b)(1)(ii)(8) provides that, consistent with a child's best interest, the juvenile court "may co-commit the child to the custody of [DHMH] and order [DHMH] to provide a plan for the child of clinically appropriate services in the least restrictive setting, in accordance with federal and State law[.]" By its plain language, FL § 5-324(b)(1)(ii)(8) authorizes the juvenile court to order DHMH to submit a plan of clinically appropriate services in the least restrictive setting for a child who is co-committed to DHMH. That is exactly what occurred here. Dustin was already co-committed to DHMH as of April 2013, and the juvenile court ordered DHMH to develop and approve a plan of clinically appropriate services — including "24/7, one-on-one skilled nursing care provided by registered nurses" — to serve Dustin in the P. home, which the juvenile court determined to be the least restrictive setting. Indeed, given the juvenile court's factual findings — which DHMH has not challenged in this Court — we have no difficulty in concluding that the juvenile court was correct in ordering DHMH to develop and provide a plan for the minimum level of clinically appropriate services necessary for Dustin in the P. home. FL § 5-324(b)(1)(ii)(8) is unambiguous, and the juvenile court adhered to it in this case.
We are unpersuaded by DHMH's contention that FL § 5-324(b)(1)(ii)(8) does not permit the juvenile court to order "specific services[.]" The September 27, 2013 order directed DHMH "to develop and approve a written plan that ensure[d] that Dustin w[ould] continue to receive all of the services and supports [that] he [was then] current[ly] receiving[.]" The order left the contours of the plan up to DHMH, which had the flexibility and discretion on how to fashion a plan that complied with the requirement of providing Dustin with the services and supports that he had been receiving for a number of years prior to the guardianship review hearing. For example, nothing in the juvenile court's order required DHMH to continue using MedSource as the provider of Dustin's nursing
In sum, we hold that, under the plain language of FL §§ 5-328(a)(2), 5-324(b)(1)(ii)(7)(B), and 5-324(b)(1)(ii)(8), the juvenile court had both the jurisdiction and statutory authority to order DHMH to develop and approve a written plan of clinically appropriate services in the least restrictive setting that ensured that Dustin would continue to receive the services that he was then receiving, where Dustin was not yet twenty-one years old when the juvenile court issued its order, where such services were required to protect Dustin's health and welfare, and where it was necessary for the juvenile court to order services to bridge the gap as Dustin transitioned from his juvenile guardianship case to the adult guardianship system.
Although the plain language of the relevant statutes is unambiguous and our analysis could end at this point, we nonetheless address the legislative history on which DHMH relies.
We are aware that, in 2013, the General Assembly considered and rejected a proposal to amend FL § 5-328 to extend the juvenile court's jurisdiction over cases involving children who are medically fragile until age twenty-three; the General Assembly also rejected an amendment that would have authorized the juvenile court to review the content and enforcement of certain plans with respect to medically fragile children. See S.B. 1010, Third Reading (Mar. 29, 2013), at 6, available at http://www.mgaleg.maryland.gov/2013RS/bills/sb/sb1010t.pdf [http://perma.cc/E6LY-WGC8]. Specifically, Senate Bill 1010 would have amended FL § 5-328(a)(2), such that the statute would have read as follows:
Id. (bolding and underlining in original). Senate Bill 1010 was passed by the Senate before failing in the House of Delegates. See S.B. 1010, History, http://mgaleg.maryland.gov/webmga/frmMain.aspx?pid=billpage&stab=03&id=sb1010&tab=subject3&ys=2013rs [http://perma.cc/W6QB-XYAN].
DHMH's reliance on this legislative history is a red herring. Whether the General Assembly rejected an amendment to extend the juvenile court's jurisdiction in guardianship cases to age twenty-three in the case of medically fragile children has no bearing whatsoever in this case, where the juvenile court acted while it had jurisdiction, i.e., before Dustin turned twenty-one years old. Thus, that the General Assembly rejected such an amendment extending the juvenile court's jurisdiction is simply not relevant and does not assist this Court with ascertaining the General Assembly's intent as to a juvenile court's authority when it has jurisdiction; indeed, what can be gleaned from the rejection of the proposed amendment is that the General Assembly "did not intend to achieve the results that the amendment would have achieved, if adopted." State v. Bell, 351 Md. 709, 721, 720 A.2d 311, 317 (1998) (citations omitted). Thus, that the General Assembly did not intend to extend the juvenile court's jurisdiction in guardianship cases to age twenty-three in the case of medically fragile children is of no consequence.
The General Assembly enacted FL § 5-324 as part of the Permanency for Families and Children Act of 2005. See 2005 Md. Laws 2581, 2628-29 (Ch. 464, S.B. 710). As originally proposed, FL § 5-324(b)(1)(ii) contained only seven subsubparagraphs, including FL § 5-324(b)(1)(ii)(7), but not FL § 5-324(b)(1)(ii)(8). See S.B. 710, First Reading (Feb. 4, 2005), at 50-52, available at http://www.mgaleg.maryland.gov/2005rs/bills/sb/sb0710f.pdf [http://perma.cc/BP27-VAAF]. However, the Public Justice Center, a non-profit legal organization, supported by the Foster Care Court Improvement Project, proposed adding an eighth subsubparagraph to what would become FL § 5-324(b)(1)(ii) to read as follows:
Letter from Kevin Slayton, Policy Director of the Public Justice Center, to Brian E. Frosh, Chairperson, and Members of the Judicial Proceedings Committee (Feb. 23, 2005). According to the Public Justice Center:
Id. (emphasis added). In its memorandum supporting amending FL § 5-324(b)(1)(ii) to add the eighth subsubparagraph proposed by the Public Justice Center, the Foster Care Court Improvement Project explained why it supported the amendment, stating:
Memorandum from Althea R. Stewart Jones, Director of the Foster Care Court Improvement Project, to Delegate Theodore J. Sophocleus (Apr. 6, 2005).
Ultimately, the Senate amended Senate Bill 710 to add subsubparagraph FL § 5-324(b)(1)(ii)(8) as proposed by the Public Justice Center, except for substituting "any services" for "such services." Amendments to Senate Bill No. 710 (First Reading File Bill), Judicial Proceedings Committee (Mar. 22, 2005), at 1, available at http://www.mgaleg.maryland.gov/2005rs/ amds/bil_0000/sb0710_07897801.pdf [http:// perma.cc/KY89-BJVL]. DHMH objected to the breadth of the proposed language and opposed Senate Bill 710 as amended, urging the Judicial Proceedings Committee to issue "an unfavorable report." As a result, the House of Delegates revised FL § 5-324(b)(1)(ii)(8) to eliminate the phrase "any services that the court finds to be in the child's best interests" and replace it with the phrase "a plan for the child of clinically appropriate services in the least restrictive setting, in accordance with federal and State law." Amendment to Senate Bill No. 710 (Third Reading File Bill), Delegate Hubbard (Apr. 8, 2005), available at http://www.mgaleg.maryland.gov/2005rs/ amds/bil_0000/sb0710_89362402.pdf [http:// perma.cc/6W5C-W5SQ]; see also 2005 Md. Laws at 2629. Notably, the House of Delegates did not oppose Senate Bill 710 in its entirety as DHMH urged, but instead amended and passed Senate Bill 710. Accordingly, the General Assembly enacted FL § 5-324(b)(1)(ii)(8) as amended by the House of Delegates. See 2005 Md. Laws at 2629. Amending the language in Senate Bill 710 from "any services that the court finds to be in the child's best interests" to the language currently in FL § 5-324(b)(1)(ii)(8) — "a plan for the child of clinically appropriate services in the least restrictive setting, in accordance with federal and State law" — demonstrates only the General Assembly's intent to narrow the scope of the juvenile court's order under FL § 5-324(b)(1)(ii)(8). Indeed, the amended language still authorizes the juvenile court to order DHMH to provide such a plan where a child is co-committed to DHMH. Moreover, we note that amendment to FL § 5-324(b)(1)(ii)(8) before its enactment has no effect whatsoever on FL § 5-324(b)(1)(ii)(7)(B)'s plain language, and does not demonstrate any legislative intent to limit the juvenile court to particular boundaries when ordering the provision of services or actions to obtain needed ongoing care for a child with a disability.
Additionally, Senate Bill 710's Fiscal and Policy Note addressed the impact of Senate Bill 710 on DHMH, noting at the outset that there was a "[p]otential significant general fund expenditure increase for ... DHMH[ ] to provide plans for clinically appropriate treatment services that may be ordered by a juvenile court." S.B. 710 Fiscal and Policy Note Revised, at 1, available at http://www.mgaleg.maryland. gov/2005rs/fnotes/bil_0000/sb0710.pdf [http://perma.cc/6WVN-7YW8]. Senate Bill 710's Fiscal and Policy Note later explained in greater detail:
Id. at 6-7 (emphasis in original). In other words, Senate Bill 710's Fiscal and Policy Note expressly recognized that, although Senate Bill 710 — specifically, what is now FL § 5-324(b)(1)(ii)(8) — "does not specifically require that DHMH implement the plan" that a juvenile court may order it to provide, the juvenile court could order DHMH to "implement each plan[,]" in which circumstance, there "could be a potentially significant increase in general fund expenditures for DHMH to provide the services that may be required[.]" Id. at 6-7. Thus, Senate Bill 710's Fiscal and Policy Note bolsters our reading of FL §§ 5-324(b)(1)(ii)(7)(B) and (8) — that FL § 5-324(b)(1)(ii)(8) authorizes the juvenile court to order DHMH to provide a written plan of clinically appropriate services in the least restrictive setting, and FL § 5-324(b)(1)(ii)(7)(B) authorizes the juvenile court to order DHMH to implement that plan and, indeed, provide any other service or take any other action to obtain ongoing care for a child with a disability that is needed after the guardianship case ends. In short, the legislative history on which DHMH relies does not alter the plain meaning of FL §§ 5-324(b)(1)(ii)(7)(B) and (8), but rather supports affirmance of the juvenile court's orders.
In addition to having both jurisdiction and statutory authority to issue the September 27, 2013 order and the December 2, 2013 order, the juvenile court had authority to act in accord with Dustin's best interests pursuant to its common law parens patriae authority. In Wentzel v. Montgomery Gen. Hosp., Inc., 293 Md. 685, 702, 447 A.2d 1244, 1253 (1982), we
(Citations omitted). And, more recently, in In re Najasha B., 409 Md. 20, 33-34, 972 A.2d 845, 852-53 (2009), in the context of a child in need of assistance case, we elaborated:
(Citations, ellipsis, and internal quotation marks omitted). To that end, in Montgomery Cnty. Dep't of Soc. Servs. v. Sanders, 38 Md.App. 406, 418, 381 A.2d 1154, 1162 (1977), the Court of Special Appeals stated that the juvenile court "stands as a guardian of all children, and may interfere at any time and in any way to protect and advance [a child's] welfare and interests." (Citation and internal quotation marks omitted).
Here, the juvenile court had broad authority under its common law parens patriae authority to act in Dustin's best interests to provide for Dustin's ongoing care as he aged out of the juvenile guardianship system and transitioned into the adult guardianship system, particularly where Dustin is a child with extraordinary disabilities who cannot care for himself. The State has the ultimate responsibility for the health and welfare of those children with disabilities who are under guardianship. Thus, even if FL §§ 5-324(b)(1)(ii)(7)(B) and (8) were ambiguous as to the juvenile court's authority — which they are not — we would nevertheless hold that, under the circumstances of this case, involving a child indisputably in need of life-sustaining services, common law parens patriae authority empowered the juvenile court to act as it did to issue an order requiring DHMH to have ongoing care in place for Dustin after he turns twenty-one years old and ages out of the child welfare system. Stated otherwise, absent clear statutory language prohibiting the juvenile court from acting as it did, the juvenile court had inherent authority and discretion pursuant to its common law parens patriae authority to act to provide life-sustaining services.
Additionally, practical concerns support our holding. As Amici curiae
According to Amici curiae, adopting "DHMH's position would strip the juvenile court of its ability to enter numerous orders for which its authority had previously been unquestioned." To the extent that Amici curiae are correct, for this Court to essentially pull the rug out from under the juvenile court and read FL §§ 5-324(b)(1)(ii)(7)(B) and (8) contrary to their plain language would render uncertainty throughout the juvenile courts of this State, and would render juvenile courts unable to enter orders consistent with the best interests of the child. We decline to do so.
As a final matter, although we hold that the juvenile court had statutory authority under FL §§ 5-324(b)(1)(ii)(7)(B) and (8) to act as it did, that statute serves to provide a bridge in services as a child transitions from the juvenile guardianship system and into the adult guardianship system. In other words, FL §§ 5-324(b)(1)(ii)(7)(B) and (8) do not serve as the basis for creating an entitlement to particular services for all time.
In conclusion, we reiterate that we hold that the juvenile court had jurisdiction and statutory authority to order DHMH to develop and approve a written plan of clinically appropriate services in the least restrictive setting that ensured that Dustin would continue to receive the services that he was then receiving, where Dustin was not yet twenty-one years old when the juvenile court issued its order and where such services were required to protect Dustin's health and welfare, and where the juvenile court's order served to bridge the gap in services as Dustin transitioned from his juvenile guardianship case to adult guardianship care.
DHMH contends that the juvenile court's order violates the separation of powers because it interferes with DHMH's "administration of its programs and budget by ordering services without regard to the funds appropriated to pay for such services or [DHMH]'s regulations governing the provision of such services[.]" On the other hand, Dustin contends that the juvenile court's order does not violate the separation of powers because it acted pursuant to express statutory authority. We agree with Dustin and explain.
Article 8 of the Maryland Declaration of Rights provides: "That the Legislative, Executive and Judicial powers of Government ought to be forever separate and distinct from each other; and no person exercising the functions of one of said Departments shall assume or discharge the duties of any other." Article 8 of the Maryland Declaration of Rights "explicitly prohibit[s] one branch of government from assuming or usurping the power of any other branch." Getty v. Carroll Cnty. Bd. of Elections, 399 Md. 710, 730, 926 A.2d 216, 229 (2007). In O'Hara v. Kovens, 92 Md.App. 9, 20, 606 A.2d 286, 291, cert. denied, 328 Md. 93, 612 A.2d 1316 (1992), cert. denied, 507 U.S. 920, 113 S.Ct. 1282, 122 L.Ed.2d 675 (1993), the Court of Special Appeals remarked that "[t]here is no concept more fundamental to our system of government than the doctrine of separation of powers among the legislative, executive, and judicial branches." Nevertheless, "[d]espite its language, the [separation of powers] doctrine has never been so rigidly applied," as Article "8 of the Maryland Declaration of Rights does not impose a complete separation [among] the branches of government." McCulloch v. Glendening, 347 Md. 272, 283, 701 A.2d 99, 104 (1997) (citation and internal quotation marks omitted).
Here, the juvenile court did not violate the separation of powers. As discussed above, FL §§ 5-328(a)(2), 5-324(b)(1)(ii)(7)(B), and 5-324(b)(1)(ii)(8) expressly authorized and empowered the juvenile court to act as it did. As Dustin's counsel pointed out in his brief and at oral argument, the issue is not whether the juvenile court improperly exercised judicial power to the detriment of the executive branch, but instead the issue is one of statutory interpretation, i.e., whether the General Assembly delegated the authority to the juvenile court to act as it did in this case. Perhaps tellingly, DHMH does not contend that the General Assembly lacked the authority to enact the statutes at issue in this case or that the statutes themselves are unconstitutional. We note that "enactments of the [General Assembly] are presumed to be constitutionally valid and [ ] this presumption prevails until it appears that the [statute] is invalid or obnoxious to the expressed terms of the Constitution or to the necessary implication afforded by, or flowing from, such expressed provisions." Dep't of Nat. Res. v. Linchester Sand & Gravel Corp., 274 Md. 211, 218, 334 A.2d 514, 520 (1975) (citations omitted).